Change in cognition following ischaemic stroke

Yan, Wenci, Quinn, Terence, McConnachie, Alex, Broomfield, Niall, Wong, Yun, Dickie, David, Forbes, Kirsten, Walters, Matthew and Dawson, Jesse (2025) Change in cognition following ischaemic stroke. Annals of Clinical and Translational Neurology. ISSN 2328-9503

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Abstract

Objective: Cognitive decline can occur following ischaemic stroke. How cognition changes over time and associations with cognitive change are poorly understood. This study aimed to explore these issues over 2 years following ischaemic stroke. Methods: This analysis used data from the XILO-FIST study, a clinical trial of allopurinol versus placebo in people with ischaemic stroke according to Tissue-Based Definition. Participants underwent clinical assessment, brain MRI at baseline, and Montreal Cognitive Assessment (MoCA) at baseline, year 1 and year 2. We defined cognitive impairment as a MoCA score < 26 and cognitive change as a difference in MoCA score of 2 points or more at year 1 or year 2 after randomisation. Associations with cognitive impairment and cognitive change were assessed by univariable analysis and multiple logistic regression. Results: Three hundred and sixty participants with complete MoCA data were included. Mean age was 65.4 (SD 8.36) years, and mean baseline MoCA score was 26.4 (SD 2.7). Seventy-seven participants had second-year cognitive improvement. Eighty-four had second-year cognitive decline. After adjustment for age and education year, second-year cognitive improvement was associated with smaller brain volume, lower albumin level, smoking and greater white-matter hyperintensity, and second-year cognitive decline was associated with peripheral arterial disease, higher cholesterol level, small-vessel stroke and greater white-matter hyperintensity. Interpretation: Cognition is dynamic following stroke, with different patterns of change. Brain reserve and vascular risk factors relate to later post-stroke cognitive change. This complex nature of cognitive trajectory has implications for cognitive rehabilitation provision and cognitive impairment detection after stroke.

Item Type: Article
Additional Information: Data Availability Statement: Study data will be shared with academic investigators or health care professionals following review and approval of a proposal and subject to a data sharing agreement (contact: jesse.dawson@glasgow.ac.uk). This work was supported by the UK Stroke Association and British Heart Foundation [grant number TSA BHF 2013/01]. The work of Dr. David Dickie and Prof. Terence Quinn was funded by the Stroke Association.
Uncontrolled Keywords: cognitive impairment,cognitive trajectory,post-stroke cognition,risk factor,stroke,clinical neurology,neuroscience(all) ,/dk/atira/pure/subjectarea/asjc/2700/2728
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
UEA Research Groups: Faculty of Medicine and Health Sciences > Research Centres > Mental Health and Social Care (fka Lifespan Health)
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Depositing User: LivePure Connector
Date Deposited: 22 Sep 2025 11:30
Last Modified: 30 Sep 2025 11:30
URI: https://ueaeprints.uea.ac.uk/id/eprint/100444
DOI: 10.1002/acn3.70192

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