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Mediation of Post-Stroke Function by Cognition in the Canadian Longitudinal Study on Aging

Published online by Cambridge University Press:  11 January 2023

Raed A. Joundi Open the ORCID record for Raed A. Joundi [Opens in a new window] ,
Megan E. O’Connell ,
Scott Patten  and
Eric E. Smith Open the ORCID record for Eric E. Smith [Opens in a new window]
Raed A. Joundi*
Affiliation:
Division of Neurology, Hamilton Health Sciences, McMaster University & Population Health Research Institute, Hamilton, Ontario, Canada
Megan E. O’Connell
Affiliation:
Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
Scott Patten
Affiliation:
Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
Eric E. Smith
Affiliation:
Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
*
Corresponding author: Raed A. Joundi, MD, DPhil, FRCPC, Division of Neurology, Hamilton Health Sciences, McMaster University & Population Health Research Institute, 237 Barton Street East, Hamilton, ON, L8L 2X2, Canada. Email: raed.joundi@phri.ca
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Abstract:

Introduction:

Cognitive and functional impairment after stroke are common, but the relation between cognitive and functional decline after stroke is not well studied.

Methods:

We used the comprehensive cohort in the Canadian Longitudinal Study on Aging to identify those with prior stroke, and we calculated reliable cognitive change scores from baseline to follow-up for the memory and executive domains. Functional decline was defined as an increase in the number of dependent daily activities. Using formal mediation analysis, we tested the presence and degree of mediation of the association between stroke and functional decline by cognitive decline.

Results:

There were 22,648 individuals with memory change scores (325 with stroke) and 17,613 individuals with executive change scores (241 with stroke). History of stroke was significantly associated with memory decline (−0.26 standard deviations, 95% CI −0.33 to −0.19), executive decline (−0.22, 95% CI −0.36 to −0.09), and new functional impairment (adjusted odds ratio 2.31, 95% CI 1.80–2.97) over a median of 3-year follow-up. Cognitive decline was a significant mediator of functional decline. Memory decline mediated only 5% of the relationship, whereas executive and overall cognitive decline mediated 13% and 22%, respectively.

Conclusion:

Cognitive decline is a mediator of the association between prior stroke and functional decline; consequently, strategies to delay, attenuate, or prevent cognitive decline after stroke may be important to preserving long-term functional status.

Résumé :

RÉSUMÉ :

Médiation de l’état fonctionnel après un accident vasculaire cérébral par l’intermédiaire de l’état cognitif dans l’étude Canadian Longitudinal Study on Aging.

Introduction :

Les troubles cognitifs et fonctionnels sont fréquents après un accident vasculaire cérébral (AVC), mais la relation entre ces deux types de déclin après une attaque n’est pas clairement établie.

Méthode :

Tout d’abord, nous avons procédé au repérage des personnes qui avaient des antécédents d’AVC dans l’ensemble de la cohorte de l’étude Canadian Longitudinal Study on Aging, puis avons calculé des scores fiables de changement cognitif, entre le début et le suivi, dans les domaines de la mémoire et de l’exécution de tâches. Le déclin fonctionnel a été défini comme l’augmentation du nombre d’activités quotidiennes nécessitant de l’aide. La présence et le degré de médiation de l’association entre les AVC et le déclin fonctionnel par l’intermédiaire du déclin cognitif ont été évalués à l’aide d’une analyse structurée de médiation.

Résultats :

Dans l’ensemble, 22 648 personnes ont enregistré des scores de changement relatifs à la mémoire (325 ayant déjà subi un AVC) et 17 613 personnes, des scores de changement relatifs à l’exécution de tâches (236 ayant déjà subi un AVC). Les antécédents d’AVC étaient significativement associés aux pertes de mémoire (écart type [σ] : -0,26; IC à 95 % : -0,33 à -0,19), à la diminution de la capacité d’exécution de tâches (σ : -0,22; IC à 95 % : -0,36 à -0,09) et à l’apparition de nouveaux troubles fonctionnels (risque relatif approché rajusté : 2,31; IC à 95 % : 1,80 à 2,97) sur un suivi médian de 3 ans. Le déclin cognitif s’est révélé un médiateur significatif du déclin fonctionnel. Ainsi, les pertes de mémoire ont joué un rôle dans 5 % seulement de la relation, tandis que la diminution de la capacité d’exécution de tâches et le déclin cognitif global représentaient 13 % et 22 % de la relation, respectivement.

Conclusion :

Le déclin cognitif est un médiateur de l’association entre les antécédents d’AVC et le déclin fonctionnel; il se pourrait donc que des stratégies visant à retarder, à atténuer ou à prévenir le déclin cognitif après un AVC jouent un rôle important dans le maintien à long terme de l’état fonctionnel des personnes concernées.

Keywords

StrokeCognitionFunctionMediationCanadian Longitudinal Study on Aging
Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 51 , Issue 1 , January 2024 , pp. 64 - 72
Copyright
© The Author(s), 2023. Published by Cambridge University Press on behalf of Canadian Neurological Sciences Federation

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