Does Stroke Contribute to Racial Differences in Cognitive Decline?

TitleDoes Stroke Contribute to Racial Differences in Cognitive Decline?
Publication TypeJournal Article
Year of Publication2015
AuthorsLevine, DA, Kabeto, M, Langa, KM, Lisabeth, LD, Rogers, MAM, Galecki, AT
JournalStroke
Volume46
Issue7
Pagination1897-902
Date Published2015 Jul
ISSN Number1524-4628
KeywordsAfrican Continental Ancestry Group, Aged, Aged, 80 and over, Cognition Disorders, European Continental Ancestry Group, Female, Humans, Longitudinal Studies, Male, Risk Factors, Stroke
Abstract

BACKGROUND AND PURPOSE: It is unknown whether blacks' elevated risk of dementia is because of racial differences in acute stroke, the impact of stroke on cognitive health, or other factors. We investigated whether racial differences in cognitive decline are explained by differences in the frequency or impact of incident stroke between blacks and whites, controlling for baseline cognition.

METHODS: Among 4908 black and white participants aged ≥65 years free of stroke and cognitive impairment in the nationally representative Health and Retirement Study with linked Medicare data (1998-2010), we examined longitudinal changes in global cognition (modified version of the Telephone Interview for Cognitive Status) by race, before and after adjusting for time-dependent incident stroke followed by a race-by-incident stroke interaction term, using linear mixed-effects models that included fixed effects of participant demographics, clinical factors, and cognition, and random effects for intercept and slope for time.

RESULTS: We identified 34 of 453 (7.5%) blacks and 300 of 4455 (6.7%) whites with incident stroke over a mean (SD) of 4.1 (1.9) years of follow-up (P=0.53). Blacks had greater cognitive decline than whites (adjusted difference in modified version of the Telephone Interview for Cognitive Status score, 1.47 points; 95% confidence interval, 1.21 to 1.73 points). With further adjustment for cumulative incidence of stroke, the black-white difference in cognitive decline persisted. Incident stroke was associated with a decrease in global cognition (1.21 points; P<0.001) corresponding to ≈7.9 years of cognitive aging. The effect of incident stroke on cognition did not statistically differ by race (P=0.52).

CONCLUSIONS: In this population-based cohort of older adults, incident stroke did not explain black-white differences in cognitive decline or impact cognition differently by race.

URLhttp://stroke.ahajournals.org/content/early/2015/05/20/STROKEAHA.114.008156.abstract
DOI10.1161/STROKEAHA.114.008156
User Guide Notes

http://www.ncbi.nlm.nih.gov/pubmed/25999389?dopt=Abstract

Endnote Keywords

dementia/Medicare/stroke/African American/cognitive status/decline

Endnote ID

999999

Alternate JournalStroke
Citation Key8289
PubMed ID25999389
PubMed Central IDPMC4480064
Grant ListUL1 TR000433 / TR / NCATS NIH HHS / United States
U01 AG009740 / AG / NIA NIH HHS / United States
UL1TR000433 / TR / NCATS NIH HHS / United States
P30 AG024824 / AG / NIA NIH HHS / United States
U01AG09740 / AG / NIA NIH HHS / United States
P30 AG024824-07 / AG / NIA NIH HHS / United States
K23 AG040278 / AG / NIA NIH HHS / United States