Trajectories of cognitive change following stroke: stepwise decline towards dementia in the elderly
Open accessAbstract
Stroke events increase the risk of developing dementia, 10% for a first-ever stroke and 30% for recurrent strokes. However, the effects of stroke on global cognition, leading up to dementia, remain poorly understood. We investigated: (i) post-stroke trajectories of cognitive change, (ii) trajectories of cognitive decline in those who develop dementia over periods of follow-up length and (iii) risk factors precipitating the onset of dementia. Prospective cohort of hospital-based stroke survivors in North-East England was followed for up to 12 years. In this study, we included 355 stroke survivors of ≥75 years of age, not demented 3 months post-stroke, who had had annual assessments during follow-up. Global cognition was measured annually and characterized using standardized tests: Cambridge Cognition Examination—Revised and Mini-Mental State Examination. Demographic data and risk factors were recorded at baseline. Mixed-effects models were used to study trajectories in global cognition, and logistic models to test associations between the onset of dementia and key risk factors, adjusted for age and sex. Of the 355 participants, 91 (25.6%) developed dementia during follow-up. The dementia group had a sharper decline in Cambridge Cognition Examination—Revised (coeff. = −1.91, 95% confidence interval = −2.23 to −1.59, P < 0.01) and Mini-Mental State Examination (coeff. = −0.46, 95% confidence interval = −0.58 to −0.34, P < 0.01) scores during follow-up. Stroke survivors who developed dementia within 3 years after stroke showed a steep decline in global cognition. However, a period of cognitive stability after stroke lasting 3 years was identified for individuals diagnosed with dementia in 4–6 years (coeff. = 0.28, 95% confidence interval = −3.28 to 3.8, P = 0.88) of 4 years when diagnosed at 7–9 years (coeff. = −3.00, 95% confidence interval = −6.45 to 0.45, P = 0.09); and of 6 years when diagnosed at 10–12 years (coeff. = −6.50, 95% confidence interval = −13.27 to 0.27, P = 0.06). These groups then showed a steep decline in Cambridge Cognition Examination—Revised in the 3 years prior to diagnosis of dementia. Risk factors for dementia within 3 years include recurrent stroke (odds ratio = 3.99, 95% confidence interval = 1.30–12.25, P = 0.016) and previous disabling stroke, total number of risk factors for dementia (odds ratio = 2.02, 95% confidence interval = 1.26–3.25, P = 0.004) and a Cambridge Cognition Examination—Revised score below 80 at baseline (odds ratio = 3.50, 95% confidence interval = 1.29–9.49, P = 0.014). Our unique longitudinal study showed cognitive decline following stroke occurs in two stages, a period of cognitive stability followed by rapid decline before a diagnosis of dementia. This pattern suggests stroke may predispose survivors for dementia by diminishing cognitive reserve but with a smaller impact on cognitive function, where cognitive decline may be precipitated by subsequent events, e.g. another cerebrovascular event. This supports the assertion that the development of vascular dementia can be stepwise even when patients have small stroke lesions.
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Stroke events may bring forward dementia diagnosis by approximately 10 years.
“Stroke events may further bring forward dementia diagnosis by ≈ 10 years, which can effectively diminish cognitive reserve and lead to a stepwise decline to dementia.”
From High vulnerability of medial prefrontal pyramidal neurons in post-stroke, vascular, Alzheimer's disease, and aging-related dementias (2026) · cites this paper as [9]
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- Authors
- Delgado, J., Masoli, J., Hase, Y., Akinyemi, R., Ballard, C., Kalaria, R. N., & Allan, L. M.
- Affiliations
- University of Exeter (GB)
- Newcastle University (GB)
- University of Ibadan (NG)
- Corresponding author
- Delgado, João
- ORCID
- Venue
- Brain Communications
- Publisher
- Oxford University Press (OUP)
- Published
- 2022-05-02
- Volume
- 4
- Issue
- 3
- Pages
- fcac129-fcac129
- ISSN
- 2632-1297 (ISSN-L)
- PMC
- PMC9161377
- OpenAlex
- W4285743793
- Cited by
- 28
- References
- 30
- Citations by year
- 2026: 8 · 2025: 4 · 2024: 11 · 2023: 4 · 2022: 1
- FWCI
- 3.26
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Brain Communications (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Royal Devon and Exeter Research Repository (Royal Devon and Exeter) (submittedVersion, public-domain)
- Newcastle University ePrints (Newcastle Univesity) (cc-by)
- Funders
- UK Medical Research Council (G0500247, G0700718)
- Vascular Factors in Neurodegeneration and Dementia study
- the Newcastle Centre for Brain Ageing and Vitality (G0700718)
- National Institute for Health Research Applied Research Collaboration South West Peninsula
- the National Institute for Health Research
- Department of Health and Social Care
- National Institute for Health Research
- NHS
- NIHR
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Life Sciences › Neuroscience › Neurology › Neurological Disease Mechanisms and Treatments
- Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
- Keywords
- stroke, dementia, cognitive decline, cognitive trajectories, global cognition, stroke survivors, dementia risk factors, dementia onset, Mini-Mental State Examination, older adults, stroke recurrence, stroke rehabilitation, stroke risk factors, stroke mortality
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