Trajectory of Cognitive Decline After Incident Stroke
Trajectory of Cognitive Decline After Incident Stroke
From: JAMA. 2015;314(1):41-51. Read the article at: http://ja.ma/1dyQRZT.
Content
0.506 -> [ Music ]
3.156 -> >> The JAMA Network.
4.516 -> [ Silence ]
15.106 -> >> I am Dr. Deborah Levine.
16.676 -> I am a physician scientist, and an Assistant
Professor of Medicine in the departments
22.006 -> of Internal Medicine and Neurology at the
University of Michigan Medical School.
27.076 -> And the VA Ann Arbor Healthcare System.
29.936 -> The background of this research is that
stroke is common, costly, and disabling.
35.206 -> Cognitive decline is a major cause
of disability in stroke survivors.
39.736 -> Yet cognitive problems after stroke
have not received enough attention.
44.056 -> We decided to study this particular topic,
because there was a key knowledge gap.
48.836 -> Although it is known that stroke is
associated with acute cognitive decline,
53.696 -> it was unclear whether stroke
is also associated with decline
58.056 -> in cognitive function over the long-term.
60.586 -> That is, do stroke survivors experience
accelerated and persistent cognitive decline
66.086 -> over the years after the event,
67.456 -> after controlling for their cognitive
changes before, and acutely after the stroke.
73.986 -> We conducted a prospected cohort study of
23,572 participants, aged 45 years or older.
81.606 -> Free of baseline cognitive impairment.
84.156 -> Participating in the RGARD Study.
87.036 -> Which stands for the Reasons for Geographic
And Racial Differences in Stroke study.
91.206 -> Participants enrolled between 2003 and 2007,
and were followed up through March 31, 2013.
99.136 -> Over a median of 6.1 years, 515 participants had
expert physician adjudicated incident stroke.
107.376 -> And 23,057 participants remain stroke-free.
111.006 -> Our primary outcome was global cognition
as measured by the six item screener.
115.786 -> Secondary outcomes were new learning, as
measured by the word list learning test.
121.926 -> Verbal memory, as measured by the
word list delayed recall test.
125.666 -> And executive function, as
measured by the animal fluency test.
129.216 -> We found that stroke is associated
with acute cognitive decline.
133.466 -> And also accelerated, and persistent
cognitive decline over six years.
138.396 -> We found that stroke is associated
with significant,
142.516 -> long-term cognitive decline
over the years after the event.
146.656 -> Even after controlling for survivor's
pre-stroke cognitive trajectories
152.246 -> and their changes acutely after the event.
154.826 -> Our study has potential implications
for clinical practice.
158.156 -> Research. And healthcare policy.
160.406 -> Our results suggest that stroke
survivors weren't monitoring
164.266 -> for mounting cognitive impairment
over the years after the event.
167.716 -> Our results also suggest that long-term
cognitive dysfunction is a potential domain
173.256 -> for evaluating acute stroke therapies.
176.006 -> Finally, healthcare systems and payers will
need to develop cost effective systems of care
182.146 -> that will best manage the long-term needs
and cognitive problems of this growing
186.466 -> and vulnerable stroke survivor population.
188.896 -> We need to determine whether the acute, and also
the long-term accelerated, cognitive declines
195.286 -> after stroke are the result of incomplete
rehabilitation from the initial stroke, ongoing,
201.856 -> or new brain injury from
uncontrolled vascular risk factors,
206.436 -> behavior changes, or other mechanisms.
213.516 -> [ Music ]
220.016 -> [ Silence ]
Source: https://www.youtube.com/watch?v=tn6Nwpuf2TI