Post-stroke cognitive impairment and the risk of stroke recurrence and death in patients with insulin resistance |
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| Institution: | 1. Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, George Washington University, Washington, DC, United States;2. Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, United States;3. Department of Neurology, School of Medicine and Health Sciences, The George Washington University, Washington, DC and Stroke Center, Virginia Hospital Center, 1625 North George Mason Drive, Suite #344, Arlington, VA 22205, United States;1. Division of Neurocritical Care, Massachusetts General Hospital, 55 Fruit Street, Lunder 644, Boston, MA 02114, USA;2. Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA;3. Department of Pathology, Massachusetts General Hospital, Boston, MA, USA;4. Divisions of Stroke, Cerebrovascular and Critical Care Neurology, Brigham and Women''s Hospital, Boston, MA, USA;5. Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA;1. Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China;2. Department of Neurosurgery, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China;1. Department of Interventional Radiology, Affiliated Hospital 2 of Nantong University, Nantong, China;2. Department of Radiology, Affiliated Hospital 2 of Nantong University, Nantong, China;1. Department of Radiology, University of Washington, 850 Republican St, Seattle, WA 98109, United States;2. Department of Bioengineering, University of Washington, United States;3. Department of Surgery, University of Washington, United States;4. Clinical Research Division, Fred Hutchinson Cancer Research Center, United States;1. Department of Neurology, Erasmus MC University Medical Center, Rotterdam, the Netherlands;2. Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands;3. Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, location AMC, Amsterdam, the Netherlands;4. Department of Biomedical Engineering and Physics, Amsterdam University Medical Centers, location AMC, Amsterdam, the Netherlands;5. Department of Neurology, Isala, Zwolle, the Netherlands;6. Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands;7. Department of Neurology, Maastricht University Medical Centre, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands;8. Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands;9. Department of Public Health, Erasmus MC University Medical Center, Rotterdam, the Netherlands |
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| Abstract: | ObjectivePost-stroke cognitive impairment (PSCI) is associated with etiology, severity, and functional outcome of stroke. The risks of recurrent stroke and death in patients with PSCI and insulin resistance (IR) is unknown. The goal of this study was to determine whether global and domain-specific cognitive impairment after stroke in patients with IR was associated with recurrent stroke and death.Materials and MethodsWe studied patients with recent stroke or transient ischemic attack (TIA) and IR with a baseline Modified Mini-Mental State Examination (3MS) cognitive exam at median of 79 days after stroke. We considered a baseline score of ≤ 88 on the 3MS to indicate global cognitive impairment, and domain-specific summary scores in the lowest quartile to indicate language, attention, orientation, memory and visuospatial impairments. The primary endpoint was fatal or non-fatal recurrent stroke, and the secondary endpoints were all-cause mortality, and fatal or non-fatal myocardial infarction (MI).ResultsAmong studied n = 3,338 patients 13.6% had global cognitive impairment. During the median 4.96 years of follow-up, 7.4% patients experienced recurrent stroke, 3.5% MI, and 7.3% died. In the fully adjusted model, impairment in language (HR 1.35; 95% CI 1.01—1.81) and orientation (HR 1.41; 95% CI: 1.06—1.87) were associated with a higher risk of recurrent stroke, while attention impairment was associated with all-cause mortality (HR 1.34; 95% CI: 1.01—1.78).Discussion/ConclusionIn patients with recent stroke/TIA and IR, post-stroke language and orientation impairments independently predicted recurrent stroke, while attention deficit was associated with increased risk of all-cause mortality. |
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