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Cerebrovascular disease
Original research
Long-term trajectories of decline in cognition and daily functioning before and after stroke
  1. Alis Heshmatollah1,2,
  2. Lisanne J. Dommershuijsen1,
  3. Lana Fani1,
  4. Peter J. Koudstaal2,
  5. M. Arfan Ikram1,
  6. M. Kamran Ikram1,2
  1. 1 Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
  2. 2 Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
  1. Correspondence to Dr M. Kamran Ikram, Epidemiology and Neurology, Erasmus MC, Rotterdam, Zuid-Holland, Netherlands; m.ikram{at}erasmusmc.nl

Abstract

Objective Although knowledge on poststroke cognitive and functional decline is increasing, little is known about the possible decline of these functions before stroke. We determined the long-term trajectories of cognition and daily functioning before and after stroke.

Methods Between 1990 and 2016, we repeatedly assessed cognition (Mini-Mental State Examination (MMSE), 15-Word Learning, Letter–Digit Substitution, Stroop, Verbal Fluency, Purdue Pegboard) and basic and instrumental activities of daily living (BADL and IADL) in 14 712 participants within the population-based Rotterdam Study. Incident stroke was assessed through continuous monitoring of medical records until 2018. We matched participants with incident stroke to stroke-free participants (1:3) based on sex and birth year. Trajectories of cognition and daily functioning of patients who had a stroke 10 years before and 10 years after stroke and the corresponding trajectories of stroke-free individuals were constructed using adjusted linear mixed effects models.

Results During a mean follow-up of 12.5±6.8 years, a total of 1662 participants suffered a first-ever stroke. Patients who had a stroke deviated from stroke-free controls up to 10 years before stroke diagnosis in cognition and daily functioning. Significant deviations before stroke were seen in scores of MMSE (6.4 years), Stroop (5.7 years), Purdue Pegboard (3.8 years) and BADL and IADL (2.2 and 3.0 years, respectively).

Conclusion Patients who had a stroke have steeper declines in cognition and daily functioning up to 10 years before their first-ever stroke compared with stroke-free individuals. Our findings suggest that accumulating intracerebral pathology already has a clinical impact before stroke.

Data availability statement

Rotterdam Study data can be made available to interested researchers upon request. Requests can be directed to secretariat.epi@erasmusmc.nl. Because of restrictions based on privacy regulations and informed consent of the participants, data cannot be made freely available in a public repository.

https://doi.org/10.1136/jnnp-2021-326043

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    Data availability statement

    Rotterdam Study data can be made available to interested researchers upon request. Requests can be directed to secretariat.epi@erasmusmc.nl. Because of restrictions based on privacy regulations and informed consent of the participants, data cannot be made freely available in a public repository.

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    Footnotes

    • Contributors AH, LD, MAI and MKI designed and conceptualised the study and interpreted the data. AH and LD analysed the data. AH, LF, PK and MKI had a major role in the acquisition of data. AH drafted the manuscript. LD, LF, PK, MAI and MKI revised the manuscript for intellectual content.

    • Funding The Rotterdam Study was supported by the Erasmus MC University Medical Center and Erasmus University Rotterdam; The Netherlands Organization for Scientific Research (NWO); The Netherlands Organization for Health Research and Development (ZonMw); the Research Institute for Diseases in the Elderly; The Netherlands Genomics Initiative; the Ministry of Education, Culture and Science; the Ministry of Health, Welfare and Sports; the European Commission (DG XII) and the Municipality of Rotterdam. The abovementioned funding is not based on a grant/award number.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.