%0 Journal Article %J Psychosom Med %D 2015 %T The association of depression, cognitive impairment without dementia, and dementia with risk of ischemic stroke: a cohort study. %A Dimitry S Davydow %A Deborah A Levine %A Zivin, Kara %A Wayne J Katon %A Kenneth M. Langa %K Aged %K Aged, 80 and over %K Cognitive Dysfunction %K Cohort Studies %K Dementia %K depression %K Female %K Humans %K Male %K Middle Aged %K Psychiatric Status Rating Scales %K Retrospective Studies %K Risk Factors %K Stroke %K United States %X

OBJECTIVE: To determine if depression, cognitive impairment without dementia (CIND), and/or dementia are each independently associated with risk of ischemic stroke and to identify characteristics that could modify these associations.

METHODS: This retrospective-cohort study examined a population-based sample of 7031 Americans older than 50 years participating in the Health and Retirement Study (1998-2008) who consented to have their interviews linked to their Medicare claims. The eight-item Center for Epidemiologic Studies Depression Scale and/or International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) depression diagnoses were used to identify baseline depression. The Modified Telephone Interview for Cognitive Status and/or ICD-9-CM dementia diagnoses were used to identify baseline CIND or dementia. Hospitalizations for ischemic stroke were identified via ICD-9-CM diagnoses.

RESULTS: After adjusting for demographics, medical comorbidities, and health-risk behaviors, CIND alone (odds ratio [OR] = 1.37, 95% confidence interval [CI] = 1.11-1.69) and co-occurring depression and CIND (OR = 1.65, 95% CI = 1.24-2.18) were independently associated with increased odds of ischemic stroke. Depression alone was not associated with odds of ischemic stroke (OR = 1.11, 95% CI = 0.88-1.40) in unadjusted analyses. Neither dementia alone (OR = 1.09, 95% CI = 0.82-1.45) nor co-occurring depression and dementia (OR = 1.25, 95% CI = 0.89-1.76) were associated with odds of ischemic stroke after adjusting for demographics.

CONCLUSIONS: CIND and co-occurring depression and CIND are independently associated with increased risk of ischemic stroke. Individuals with co-occurring depression and CIND represent a high-risk group that may benefit from targeted interventions to prevent stroke.

%B Psychosom Med %I 77 %V 77 %P 200-8 %8 2015 Feb-Mar %G eng %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/25647752?dopt=Abstract %R 10.1097/PSY.0000000000000136 %0 Journal Article %J Circ Cardiovasc Qual Outcomes %D 2014 %T Functional disability and cognitive impairment after hospitalization for myocardial infarction and stroke. %A Deborah A Levine %A Dimitry S Davydow %A Catherine L Hough %A Kenneth M. Langa %A Mary A M Rogers %A Theodore J Iwashyna %K Activities of Daily Living %K Cognition %K Cognition Disorders %K Disability Evaluation %K Disabled Persons %K Female %K Follow-Up Studies %K Hospitalization %K Humans %K Incidence %K Male %K Middle Aged %K Myocardial Infarction %K Odds Ratio %K Retrospective Studies %K Stroke %K Time Factors %K United States %X

BACKGROUND: We assessed the acute and long-term effect of myocardial infarction (MI) and stroke on postevent functional disability and cognition while controlling for survivors' changes in functioning over the years before the event.

METHODS AND RESULTS: Among participants in the nationally representative Health and Retirement Study with linked Medicare data (1998-2010), we determined within-person changes in functional limitations (basic and instrumental activities of daily living) and cognitive impairment after hospitalization for stroke (n=432) and MI (n=450), controlling for premorbid functioning using fixed-effects regression. In persons without baseline impairments, an acute MI yielded a mean acute increase of 0.41 functional limitations (95% confidence interval [CI], 0.18-0.63) with a linear increase of 0.14 limitations/year in the following decade. These increases were 0.65 limitations (95% CI, 0.07-1.23) and 0.27 limitations/year afterward for those with mild-to-moderate impairment at baseline. Stroke resulted in an acute increase of 2.07 (95% CI, 1.51-2.63) limitations because of the acute event and an increase of 0.15 limitations/year afterward for those unimpaired at baseline. There were 2.65 new limitations (95% CI, 1.86-3.44) and 0.19/year afterward for those with baseline mild-to-moderate impairment. Stroke hospitalization was associated with greater odds of moderate-to-severe cognitive impairment (odds ratio, 3.86; 95% CI, 2.10-7.11) at the time of the event, after adjustment for premorbid cognition but MI hospitalization was not.

CONCLUSIONS: In this population-based cohort, most MI and stroke hospitalizations were associated with significant increases in functional disability at the time of the event and in the decade afterward. Survivors of MI and stroke warrant screening for functional disability over the long-term.

%B Circ Cardiovasc Qual Outcomes %I 7 %V 7 %P 863-71 %8 2014 Nov %G eng %N 6 %1 http://www.ncbi.nlm.nih.gov/pubmed/25387772?dopt=Abstract %4 activities of daily living/cognitive impairment/myocardial infarction/stroke/functional decline/functional decline/Transient Ischemic Attack/Coronary Artery Disease/quality of life/medicare %$ 999999 %R 10.1161/HCQ.0000000000000008