Problems with memory and thinking continue to get worse years after a stroke occurs, and happen faster than normal brain aging, suggests a study published recently in the Journal of the American Medical Association.
Stroke survivors also develop cognitive impairment over the years after stroke at a faster rate than prior to the stroke, according to a news release from the University of Michigan Health System.
In their study, lead author Deborah A. Levine, MD, MPH, of the University of Michigan Medical School and VA Ann Arbor Healthcare System and her U-M colleagues used data from 23,572 Americans aged 45 years or older from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study led by the University of Alabama at Birmingham and funded by the National Institutes of Health, per the release.
“We found that stroke is associated with cognitive decline over the long term,” Levine says in the release. “That is, survivors had accelerated and persistent declines in memory and thinking ability during the years after stroke—even after accounting for their cognitive changes before and early after the event.”
Participants had no prior history of cognitive impairment when the study began in the mid-2000s. They had tests of their memory and thinking ability at the beginning of the study and at regular intervals during follow-up, and were monitored twice per year for acute stroke events. If a stroke was suspected, study physicians confirmed it using medical records, the release explains.
Over the next 6 to 10 years, 515 of the participants had a stroke, and researchers compared their test results with the other participants who remained stroke-free, per the release.
Because Levine and her colleagues had information on how stroke survivors’ memory and thinking ability changed over time before the stroke, they were able to separate the declines in brain function associated with aging from declines in brain function associated with stroke.
After analyzing their results, Levine and her team found that stroke was associated with declines in global cognition, new learning, and verbal memory early after stroke, as well as accelerated and persistent declines in global cognition and thinking ability over the years afterward, the release states.
“Stroke is common, costly, and disabling, and cognitive decline is a major cause of disability in stroke survivors,” Levine notes in the release.
“Yet cognitive decline after stroke has not received enough attention. We hope these findings will shine a spotlight on stroke survivors’ long-term cognitive needs,” she continues.
The release notes that these findings suggest a need for better long-term follow-up care for stroke survivors, including therapy to retain or even regain cognitive ability.
Levine suggests in the release that health systems and payors should develop cost-effective systems of care that will best manage the long-term needs and cognitive problems of the stroke survivor population.
Levine and her colleagues also suggest, per the release, that their results mean long-term cognitive ability could be a new marker for measuring the effects of therapies to treat the initial effects of stroke.
However, they note in the release that research is needed to determine whether the acute and also accelerated long-term cognitive declines after stroke are the result of incomplete rehabilitation from the initial stroke, subsequent brain injury due to uncontrolled risk factors, behavioral changes, or other mechanisms.
[Source: University of Michigan Health System]