How Stroke Affects Cognition Over Time

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Posted by Lisa O’Neill Hill

A new study has found that people who have survived a stroke may continue to have challenges with their thinking years after the brain attack, and that those challenges may get worse. The study is one of the first to follow cognitive decline in stroke survivors over a long period of time.

The study, published in JAMA, was conducted over the course of six years, and suggests that stroke survivors may need to be monitored for cognitive impairment long after their strokes.

Unlike previous studies, which have suggested that cognitive decline doesn’t speed up after a stroke unless another one occurs, the recent findings suggest the opposite.

New Long-term Expectations

“The information is useful as education for patients and their caregivers to understand what might be expected in the long term after a stroke,” said Richard D. Zorowitz, MD, Attending Physician, Outpatient Services, MedStar National Rehabilitation Network in Washington, D.C.  “This may allow patients, their caregivers, and their physicians, to anticipate potential issues that may arise in the future and plan appropriately for them. In addition, there may be medications, such as stimulants like Ritalin, or dementia drugs, that may slow cognitive decline over time.”

The study included 23,572 people from the United States who were 45 or older. They did not have cognitive challenges when they entered the study. Out of the group, 515 people had strokes—470 ischemic, 43 hemorrhagic and two of unknown type. Researchers said the people who’d had strokes were more likely to have health problems such as higher blood pressure and diabetes, be older, and be male.

The stroke survivors had a “significantly faster” rate of cognitive impairment compared to the people who hadn’t had strokes.

Specific Areas of Cognitive Decline

Stroke was associated with a decline in verbal memory, new learning, and global cognition. Compared to the non-stroke group, stroke survivors had more challenges with global cognition and things like reasoning and problem solving, but not with new learning and verbal memory.

The findings may affect the future of patient care, research, and health care policy.

Survivors, now monitored before they’re discharged from the hospital and in rehab settings, should be checked for growing cognitive impairment years after their strokes. Cognitive decline greatly increases the risk of death, depression, dementia, and functional decline, the study said.

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