Cognitive Decline in Patients with Leukoaraiosis Within 5 Years after Initial Stroke
Background Leukoaraiosis (LA) is closely associated with cognitive deficits. The association between LA and cognitive disorders, such as mild cognitive impairment (MCI) and dementia, after initial stroke has not been systematically studied. In this study, we sought to identify whether LA contributes...
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| creator | Kumral, Emre, MD Güllüoğlu, Halil, MD Alakbarova, Naila, MD Deveci, Emrah E., MD Çolak, Ayşe Y., MD Çağında, Ayşe D., MD Evyapan, Dilek, MD Orman, Mehmet, PhD |
| description | Background Leukoaraiosis (LA) is closely associated with cognitive deficits. The association between LA and cognitive disorders, such as mild cognitive impairment (MCI) and dementia, after initial stroke has not been systematically studied. In this study, we sought to identify whether LA contributes to the occurrence of certain type of cognitive disorders after initial stroke. Methods Data from our Stroke Registry were examined, and 5-year follow-up data for LA and cognitive disorders were analyzed. We performed Kaplan–Meier analysis and log-rank test to assess the predictive value of LA for risk of cognitive decline and the Cox proportional hazards model to test the risk factors studied as independent determinants of cognitive impairment. Results The frequency of patients with normal cognitive function decreased significantly at 5 years compared with initial stroke (78% vs 70%; odds ratio, 1.51; 95% confidence interval, 1.41-1.62). Of 8784 patients, 1659 (19%) had dementia and 964 (11%) had MCI at the final analysis. After 5 years of follow-up, survival analysis showed that all patients with LA had an increased probability of MCI compared with those without LA ( P |
| doi_str_mv | 10.1016/j.jstrokecerebrovasdis.2015.06.012 |
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| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1718906559</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>1_s2_0_S1052305715003377</els_id><sourcerecordid>1718906559</sourcerecordid><originalsourceid>FETCH-LOGICAL-c529t-27e1846c6c27a9746f82d5cc3b08eeb6a49206eadd6f7eedccff7ba861c014b13</originalsourceid><addsrcrecordid>eNqVkc1u1DAUhS0Eoj_wCshLhJTg64ztZIMEA5RKI4HUItSV5Tg34Ewmbm1nUN--TqewQGy68o-Ovmt_h5A3wEpgIN8O5RBT8Fu0GLANfm9i52LJGYiSyZIBf0KOQVS8qAXA07xnghcVE-qInMQ4MAYgavGcHHHJK5mPx-Ry7X9OLrk90o9oRzchdRP9ZpLDKUX626VfdIPz1ptgnI8u0h_5KkcEvUITIjV9wkDPF4YZ6cX9-16QZ70ZI758WE_J98-fLtdfis3Xs_P1-01hBW9SwRVCvZJWWq5Mo1ayr3knrK1aViO20qwaziSarpO9Quys7XvVmlqCZbBqoTolrw_c6-BvZoxJ71y0OI5mQj9HDQrqhkkhmhz9cIja4GMM2Ovr4HYm3GpgerGrB_0_u3qxq5nU2W6GvHqYN7c77P4i_ujMgc0hgPnXe4dBR5tFWuxcQJt0593j5r37B7c05KwZt3iLcfBzmLJfDTpyzfTF0vdSNwjGqkqp6g75Eq-c</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1718906559</pqid></control><display><type>article</type><title>Cognitive Decline in Patients with Leukoaraiosis Within 5 Years after Initial Stroke</title><source>MEDLINE</source><source>Access via ScienceDirect (Elsevier)</source><creator>Kumral, Emre, MD ; Güllüoğlu, Halil, MD ; Alakbarova, Naila, MD ; Deveci, Emrah E., MD ; Çolak, Ayşe Y., MD ; Çağında, Ayşe D., MD ; Evyapan, Dilek, MD ; Orman, Mehmet, PhD</creator><creatorcontrib>Kumral, Emre, MD ; Güllüoğlu, Halil, MD ; Alakbarova, Naila, MD ; Deveci, Emrah E., MD ; Çolak, Ayşe Y., MD ; Çağında, Ayşe D., MD ; Evyapan, Dilek, MD ; Orman, Mehmet, PhD</creatorcontrib><description>Background Leukoaraiosis (LA) is closely associated with cognitive deficits. The association between LA and cognitive disorders, such as mild cognitive impairment (MCI) and dementia, after initial stroke has not been systematically studied. In this study, we sought to identify whether LA contributes to the occurrence of certain type of cognitive disorders after initial stroke. Methods Data from our Stroke Registry were examined, and 5-year follow-up data for LA and cognitive disorders were analyzed. We performed Kaplan–Meier analysis and log-rank test to assess the predictive value of LA for risk of cognitive decline and the Cox proportional hazards model to test the risk factors studied as independent determinants of cognitive impairment. Results The frequency of patients with normal cognitive function decreased significantly at 5 years compared with initial stroke (78% vs 70%; odds ratio, 1.51; 95% confidence interval, 1.41-1.62). Of 8784 patients, 1659 (19%) had dementia and 964 (11%) had MCI at the final analysis. After 5 years of follow-up, survival analysis showed that all patients with LA had an increased probability of MCI compared with those without LA ( P < .0001). Patients with LA had an increased chance of dementia compared with those without LA ( P < .0001) at the end of follow-up. Cognitive decline probability was significantly higher in patients with severe LA compared with those with mild/moderate LA ( P < .0001). Cox regression analyses showed that recurrence of stroke (hazard ratio [HR], 3.92 [95% CI, 3.26-4.72]), hypertension (HR, 1.11 [95% CI, 1.0-1.22]), LA (HR, 1.15 [95% CI, 1.05-1.25]), age (HR, 1.05 [95% CI, 1.04-1.06]), hypercholesterolemia (HR, .86 [95% CI, .77-.95]), higher LDL cholesterol (HR, 1.21 [95% CI, 1.11-1.32]), lower HDL cholesterol (HR, .90 [95% CI, .83-.98]), coronary heart disease (HR, .85 [95% CI, .77-.94]), and National Institutes of Health Stroke Scale score at admission (HR, .77 [95% CI, .72-.82]) were also significantly associated with cognitive impairments. Conclusions Our findings suggest that patients with LA may be at risk of developing new cognitive impairments at long-term period after initial stroke. The evaluation of the concomitant risk factors, besides providing insights about the possible mechanisms behind the cognitive dysfunction present in LA, may be of help for the prevention of cognitive impairments.</description><identifier>ISSN: 1052-3057</identifier><identifier>EISSN: 1532-8511</identifier><identifier>DOI: 10.1016/j.jstrokecerebrovasdis.2015.06.012</identifier><identifier>PMID: 26236001</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Cardiovascular ; Chi-Square Distribution ; Cognition Disorders - classification ; Cognition Disorders - diagnosis ; Cognition Disorders - epidemiology ; Cognition Disorders - etiology ; Cognition Disorders - mortality ; cognitive disorders ; Dementia - diagnosis ; Dementia - epidemiology ; Dementia - etiology ; Dementia - metabolism ; Disease Progression ; Female ; Humans ; Kaplan-Meier Estimate ; Leukoaraiosis ; Leukoaraiosis - complications ; Leukoaraiosis - epidemiology ; Leukoaraiosis - mortality ; Longitudinal Studies ; Male ; Middle Aged ; mild cognitive impairment ; Neurology ; Neuropsychological Tests ; Registries ; Severity of Illness Index ; Stroke - classification ; Stroke - epidemiology ; Stroke - mortality ; Turkey - epidemiology ; vascular dementia</subject><ispartof>Journal of stroke and cerebrovascular diseases, 2015-10, Vol.24 (10), p.2338-2347</ispartof><rights>National Stroke Association</rights><rights>2015 National Stroke Association</rights><rights>Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c529t-27e1846c6c27a9746f82d5cc3b08eeb6a49206eadd6f7eedccff7ba861c014b13</citedby><cites>FETCH-LOGICAL-c529t-27e1846c6c27a9746f82d5cc3b08eeb6a49206eadd6f7eedccff7ba861c014b13</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2015.06.012$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>315,782,786,3552,27931,27932,46002</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26236001$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kumral, Emre, MD</creatorcontrib><creatorcontrib>Güllüoğlu, Halil, MD</creatorcontrib><creatorcontrib>Alakbarova, Naila, MD</creatorcontrib><creatorcontrib>Deveci, Emrah E., MD</creatorcontrib><creatorcontrib>Çolak, Ayşe Y., MD</creatorcontrib><creatorcontrib>Çağında, Ayşe D., MD</creatorcontrib><creatorcontrib>Evyapan, Dilek, MD</creatorcontrib><creatorcontrib>Orman, Mehmet, PhD</creatorcontrib><title>Cognitive Decline in Patients with Leukoaraiosis Within 5 Years after Initial Stroke</title><title>Journal of stroke and cerebrovascular diseases</title><addtitle>J Stroke Cerebrovasc Dis</addtitle><description>Background Leukoaraiosis (LA) is closely associated with cognitive deficits. The association between LA and cognitive disorders, such as mild cognitive impairment (MCI) and dementia, after initial stroke has not been systematically studied. In this study, we sought to identify whether LA contributes to the occurrence of certain type of cognitive disorders after initial stroke. Methods Data from our Stroke Registry were examined, and 5-year follow-up data for LA and cognitive disorders were analyzed. We performed Kaplan–Meier analysis and log-rank test to assess the predictive value of LA for risk of cognitive decline and the Cox proportional hazards model to test the risk factors studied as independent determinants of cognitive impairment. Results The frequency of patients with normal cognitive function decreased significantly at 5 years compared with initial stroke (78% vs 70%; odds ratio, 1.51; 95% confidence interval, 1.41-1.62). Of 8784 patients, 1659 (19%) had dementia and 964 (11%) had MCI at the final analysis. After 5 years of follow-up, survival analysis showed that all patients with LA had an increased probability of MCI compared with those without LA ( P < .0001). Patients with LA had an increased chance of dementia compared with those without LA ( P < .0001) at the end of follow-up. Cognitive decline probability was significantly higher in patients with severe LA compared with those with mild/moderate LA ( P < .0001). Cox regression analyses showed that recurrence of stroke (hazard ratio [HR], 3.92 [95% CI, 3.26-4.72]), hypertension (HR, 1.11 [95% CI, 1.0-1.22]), LA (HR, 1.15 [95% CI, 1.05-1.25]), age (HR, 1.05 [95% CI, 1.04-1.06]), hypercholesterolemia (HR, .86 [95% CI, .77-.95]), higher LDL cholesterol (HR, 1.21 [95% CI, 1.11-1.32]), lower HDL cholesterol (HR, .90 [95% CI, .83-.98]), coronary heart disease (HR, .85 [95% CI, .77-.94]), and National Institutes of Health Stroke Scale score at admission (HR, .77 [95% CI, .72-.82]) were also significantly associated with cognitive impairments. Conclusions Our findings suggest that patients with LA may be at risk of developing new cognitive impairments at long-term period after initial stroke. The evaluation of the concomitant risk factors, besides providing insights about the possible mechanisms behind the cognitive dysfunction present in LA, may be of help for the prevention of cognitive impairments.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Cardiovascular</subject><subject>Chi-Square Distribution</subject><subject>Cognition Disorders - classification</subject><subject>Cognition Disorders - diagnosis</subject><subject>Cognition Disorders - epidemiology</subject><subject>Cognition Disorders - etiology</subject><subject>Cognition Disorders - mortality</subject><subject>cognitive disorders</subject><subject>Dementia - diagnosis</subject><subject>Dementia - epidemiology</subject><subject>Dementia - etiology</subject><subject>Dementia - metabolism</subject><subject>Disease Progression</subject><subject>Female</subject><subject>Humans</subject><subject>Kaplan-Meier Estimate</subject><subject>Leukoaraiosis</subject><subject>Leukoaraiosis - complications</subject><subject>Leukoaraiosis - epidemiology</subject><subject>Leukoaraiosis - mortality</subject><subject>Longitudinal Studies</subject><subject>Male</subject><subject>Middle Aged</subject><subject>mild cognitive impairment</subject><subject>Neurology</subject><subject>Neuropsychological Tests</subject><subject>Registries</subject><subject>Severity of Illness Index</subject><subject>Stroke - classification</subject><subject>Stroke - epidemiology</subject><subject>Stroke - mortality</subject><subject>Turkey - epidemiology</subject><subject>vascular dementia</subject><issn>1052-3057</issn><issn>1532-8511</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqVkc1u1DAUhS0Eoj_wCshLhJTg64ztZIMEA5RKI4HUItSV5Tg34Ewmbm1nUN--TqewQGy68o-Ovmt_h5A3wEpgIN8O5RBT8Fu0GLANfm9i52LJGYiSyZIBf0KOQVS8qAXA07xnghcVE-qInMQ4MAYgavGcHHHJK5mPx-Ry7X9OLrk90o9oRzchdRP9ZpLDKUX626VfdIPz1ptgnI8u0h_5KkcEvUITIjV9wkDPF4YZ6cX9-16QZ70ZI758WE_J98-fLtdfis3Xs_P1-01hBW9SwRVCvZJWWq5Mo1ayr3knrK1aViO20qwaziSarpO9Quys7XvVmlqCZbBqoTolrw_c6-BvZoxJ71y0OI5mQj9HDQrqhkkhmhz9cIja4GMM2Ovr4HYm3GpgerGrB_0_u3qxq5nU2W6GvHqYN7c77P4i_ujMgc0hgPnXe4dBR5tFWuxcQJt0593j5r37B7c05KwZt3iLcfBzmLJfDTpyzfTF0vdSNwjGqkqp6g75Eq-c</recordid><startdate>20151001</startdate><enddate>20151001</enddate><creator>Kumral, Emre, MD</creator><creator>Güllüoğlu, Halil, MD</creator><creator>Alakbarova, Naila, MD</creator><creator>Deveci, Emrah E., MD</creator><creator>Çolak, Ayşe Y., MD</creator><creator>Çağında, Ayşe D., MD</creator><creator>Evyapan, Dilek, MD</creator><creator>Orman, Mehmet, PhD</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20151001</creationdate><title>Cognitive Decline in Patients with Leukoaraiosis Within 5 Years after Initial Stroke</title><author>Kumral, Emre, MD ; Güllüoğlu, Halil, MD ; Alakbarova, Naila, MD ; Deveci, Emrah E., MD ; Çolak, Ayşe Y., MD ; Çağında, Ayşe D., MD ; Evyapan, Dilek, MD ; Orman, Mehmet, PhD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c529t-27e1846c6c27a9746f82d5cc3b08eeb6a49206eadd6f7eedccff7ba861c014b13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Cardiovascular</topic><topic>Chi-Square Distribution</topic><topic>Cognition Disorders - classification</topic><topic>Cognition Disorders - diagnosis</topic><topic>Cognition Disorders - epidemiology</topic><topic>Cognition Disorders - etiology</topic><topic>Cognition Disorders - mortality</topic><topic>cognitive disorders</topic><topic>Dementia - diagnosis</topic><topic>Dementia - epidemiology</topic><topic>Dementia - etiology</topic><topic>Dementia - metabolism</topic><topic>Disease Progression</topic><topic>Female</topic><topic>Humans</topic><topic>Kaplan-Meier Estimate</topic><topic>Leukoaraiosis</topic><topic>Leukoaraiosis - complications</topic><topic>Leukoaraiosis - epidemiology</topic><topic>Leukoaraiosis - mortality</topic><topic>Longitudinal Studies</topic><topic>Male</topic><topic>Middle Aged</topic><topic>mild cognitive impairment</topic><topic>Neurology</topic><topic>Neuropsychological Tests</topic><topic>Registries</topic><topic>Severity of Illness Index</topic><topic>Stroke - classification</topic><topic>Stroke - epidemiology</topic><topic>Stroke - mortality</topic><topic>Turkey - epidemiology</topic><topic>vascular dementia</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kumral, Emre, MD</creatorcontrib><creatorcontrib>Güllüoğlu, Halil, MD</creatorcontrib><creatorcontrib>Alakbarova, Naila, MD</creatorcontrib><creatorcontrib>Deveci, Emrah E., MD</creatorcontrib><creatorcontrib>Çolak, Ayşe Y., MD</creatorcontrib><creatorcontrib>Çağında, Ayşe D., MD</creatorcontrib><creatorcontrib>Evyapan, Dilek, MD</creatorcontrib><creatorcontrib>Orman, Mehmet, PhD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of stroke and cerebrovascular diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kumral, Emre, MD</au><au>Güllüoğlu, Halil, MD</au><au>Alakbarova, Naila, MD</au><au>Deveci, Emrah E., MD</au><au>Çolak, Ayşe Y., MD</au><au>Çağında, Ayşe D., MD</au><au>Evyapan, Dilek, MD</au><au>Orman, Mehmet, PhD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Cognitive Decline in Patients with Leukoaraiosis Within 5 Years after Initial Stroke</atitle><jtitle>Journal of stroke and cerebrovascular diseases</jtitle><addtitle>J Stroke Cerebrovasc Dis</addtitle><date>2015-10-01</date><risdate>2015</risdate><volume>24</volume><issue>10</issue><spage>2338</spage><epage>2347</epage><pages>2338-2347</pages><issn>1052-3057</issn><eissn>1532-8511</eissn><abstract>Background Leukoaraiosis (LA) is closely associated with cognitive deficits. The association between LA and cognitive disorders, such as mild cognitive impairment (MCI) and dementia, after initial stroke has not been systematically studied. In this study, we sought to identify whether LA contributes to the occurrence of certain type of cognitive disorders after initial stroke. Methods Data from our Stroke Registry were examined, and 5-year follow-up data for LA and cognitive disorders were analyzed. We performed Kaplan–Meier analysis and log-rank test to assess the predictive value of LA for risk of cognitive decline and the Cox proportional hazards model to test the risk factors studied as independent determinants of cognitive impairment. Results The frequency of patients with normal cognitive function decreased significantly at 5 years compared with initial stroke (78% vs 70%; odds ratio, 1.51; 95% confidence interval, 1.41-1.62). Of 8784 patients, 1659 (19%) had dementia and 964 (11%) had MCI at the final analysis. After 5 years of follow-up, survival analysis showed that all patients with LA had an increased probability of MCI compared with those without LA ( P < .0001). Patients with LA had an increased chance of dementia compared with those without LA ( P < .0001) at the end of follow-up. Cognitive decline probability was significantly higher in patients with severe LA compared with those with mild/moderate LA ( P < .0001). Cox regression analyses showed that recurrence of stroke (hazard ratio [HR], 3.92 [95% CI, 3.26-4.72]), hypertension (HR, 1.11 [95% CI, 1.0-1.22]), LA (HR, 1.15 [95% CI, 1.05-1.25]), age (HR, 1.05 [95% CI, 1.04-1.06]), hypercholesterolemia (HR, .86 [95% CI, .77-.95]), higher LDL cholesterol (HR, 1.21 [95% CI, 1.11-1.32]), lower HDL cholesterol (HR, .90 [95% CI, .83-.98]), coronary heart disease (HR, .85 [95% CI, .77-.94]), and National Institutes of Health Stroke Scale score at admission (HR, .77 [95% CI, .72-.82]) were also significantly associated with cognitive impairments. Conclusions Our findings suggest that patients with LA may be at risk of developing new cognitive impairments at long-term period after initial stroke. The evaluation of the concomitant risk factors, besides providing insights about the possible mechanisms behind the cognitive dysfunction present in LA, may be of help for the prevention of cognitive impairments.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>26236001</pmid><doi>10.1016/j.jstrokecerebrovasdis.2015.06.012</doi><tpages>10</tpages></addata></record> |
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| subjects | Adult Aged Aged, 80 and over Cardiovascular Chi-Square Distribution Cognition Disorders - classification Cognition Disorders - diagnosis Cognition Disorders - epidemiology Cognition Disorders - etiology Cognition Disorders - mortality cognitive disorders Dementia - diagnosis Dementia - epidemiology Dementia - etiology Dementia - metabolism Disease Progression Female Humans Kaplan-Meier Estimate Leukoaraiosis Leukoaraiosis - complications Leukoaraiosis - epidemiology Leukoaraiosis - mortality Longitudinal Studies Male Middle Aged mild cognitive impairment Neurology Neuropsychological Tests Registries Severity of Illness Index Stroke - classification Stroke - epidemiology Stroke - mortality Turkey - epidemiology vascular dementia |
| title | Cognitive Decline in Patients with Leukoaraiosis Within 5 Years after Initial Stroke |
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