Post-stroke cognitive impairment and the risk of stroke recurrence and death in patients with insulin resistance

Authors

Kat Schmidt, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, George Washington University, Washington, DC, United States.
Melinda C. Power, Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, United States.
Adam Ciarleglio, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, George Washington University, Washington, DC, United States.
Zurab Nadareishvili, Department of Neurology, School of Medicine and Health Sciences, The George Washington University, Washington, DC and Stroke Center, Virginia Hospital Center, 1625 North George Mason Drive, Suite #344, Arlington, VA 22205, United States. Electronic address: znadareishvili@mfa.gwu.edu.

Document Type

Journal Article

Publication Date

8-26-2022

Journal

Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association

Volume

31

Issue

10

DOI

10.1016/j.jstrokecerebrovasdis.2022.106744

Keywords

Cognitive impairment; Cognitive testing; Insulin resistance; Stroke

Abstract

OBJECTIVE: Post-stroke cognitive impairment (PSCI) is associated with etiology, severity, and functional outcome of stroke. The risks of recurrent stroke and death in patients with PSCI and insulin resistance (IR) is unknown. The goal of this study was to determine whether global and domain-specific cognitive impairment after stroke in patients with IR was associated with recurrent stroke and death. MATERIALS AND METHODS: We studied patients with recent stroke or transient ischemic attack (TIA) and IR with a baseline Modified Mini-Mental State Examination (3MS) cognitive exam at median of 79 days after stroke. We considered a baseline score of ≤ 88 on the 3MS to indicate global cognitive impairment, and domain-specific summary scores in the lowest quartile to indicate language, attention, orientation, memory and visuospatial impairments. The primary endpoint was fatal or non-fatal recurrent stroke, and the secondary endpoints were all-cause mortality, and fatal or non-fatal myocardial infarction (MI). RESULTS: Among studied n = 3,338 patients 13.6% had global cognitive impairment. During the median 4.96 years of follow-up, 7.4% patients experienced recurrent stroke, 3.5% MI, and 7.3% died. In the fully adjusted model, impairment in language (HR 1.35; 95% CI 1.01-1.81) and orientation (HR 1.41; 95% CI: 1.06-1.87) were associated with a higher risk of recurrent stroke, while attention impairment was associated with all-cause mortality (HR 1.34; 95% CI: 1.01-1.78). DISCUSSION/CONCLUSION: In patients with recent stroke/TIA and IR, post-stroke language and orientation impairments independently predicted recurrent stroke, while attention deficit was associated with increased risk of all-cause mortality.

APA Citation

Schmidt, Kat; Power, Melinda C.; Ciarleglio, Adam; and Nadareishvili, Zurab, "Post-stroke cognitive impairment and the risk of stroke recurrence and death in patients with insulin resistance" (2022). GW Authored Works. Paper 1430.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/1430

Department

Epidemiology