Cognitive performance following stroke, transient ischaemic attack, myocardial infarction, and hospitalisation: an individual participant data meta-analysis of six randomised controlled trials.

Humans Ischemic Attack, Transient / epidemiology Stroke / epidemiology Brain Ischemia / complications Myocardial Infarction / complications Hospitalization Randomized Controlled Trials as Topic

Journal

The lancet. Healthy longevity
ISSN: 2666-7568
Titre abrégé: Lancet Healthy Longev
Pays: England
ID NLM: 101773309

Informations de publication

Date de publication:
Dec 2023
Historique:
received: 27 03 2023
revised: 26 09 2023
accepted: 27 09 2023
medline: 4 12 2023
pubmed: 3 12 2023
entrez: 2 12 2023
Statut: ppublish

Résumé

Survivors of stroke are often concerned about cognitive problems, and information on the risk of cognitive problems often comes from small studies. We aimed to estimate years of cognitive ageing associated with stroke compared with transient ischaemic attack, myocardial infarction, and other hospitalisations in a large population. Using data from six randomised controlled trials (ORIGIN, ONTARGET, TRANSCEND, COMPASS, HOPE-3, and NAVIGATE ESUS), we completed an individual participant data meta-analysis using data requested from the Public Health Research Institute to estimate the association of stroke (by type and severity), transient ischaemic attack, myocardial infarction, and other hospitalisations with cognitive performance measured at the end of each trial. We included participants in any of these randomised controlled trials with a cognitive assessment at baseline and at least one other timepoint. Cognitive performance was measured with the Mini-Mental State Examination or the Montreal Cognitive Assessment, transformed into Z scores. We estimated Z score differences in end of trial cognitive performance between people with and without events and calculated corresponding years of cognitive ageing in these trials, and additionally calculated using a population representative cohort-the Cognitive Function and Ageing Study. In 64 106 participants from 55 countries, compared with no event, stroke was associated with 18 years of cognitive ageing (1487 strokes included in the model, 95% CI 10 to 28; p<0·0001) and transient ischaemic attack with 3 years (660 transient ischaemic attacks included in the model, 0 to 6; p=0·021). Myocardial infarction (p=0·60) and other hospitalisations (p=0·26) were not associated with cognitive ageing. The mean difference in SD compared with people without an event was -0·84 (95% CI -0·91 to -0·76; p<0·0001) for disabling stroke, and -0·12 (-0·19 to -0·05; p=0·0012) for non-disabling stroke. Haemorrhagic stroke was associated with worse cognition (-0·75, -0·95 to -0·55; p<0·0001) than ischaemic stroke (-0·42, -0·48 to -0·36; p <0·0001). Stroke has a substantial effect on cognition. The effects of transient ischaemic attack were small, whereas myocardial infarction and hospitalisation had a neutral effect. Prevention of stroke could lead to a reduction in cognitive ageing in those at greatest risk. Population Health Research Institute and Chief Scientist Office of Scotland.

Sections du résumé

BACKGROUND BACKGROUND
Survivors of stroke are often concerned about cognitive problems, and information on the risk of cognitive problems often comes from small studies. We aimed to estimate years of cognitive ageing associated with stroke compared with transient ischaemic attack, myocardial infarction, and other hospitalisations in a large population.
METHODS METHODS
Using data from six randomised controlled trials (ORIGIN, ONTARGET, TRANSCEND, COMPASS, HOPE-3, and NAVIGATE ESUS), we completed an individual participant data meta-analysis using data requested from the Public Health Research Institute to estimate the association of stroke (by type and severity), transient ischaemic attack, myocardial infarction, and other hospitalisations with cognitive performance measured at the end of each trial. We included participants in any of these randomised controlled trials with a cognitive assessment at baseline and at least one other timepoint. Cognitive performance was measured with the Mini-Mental State Examination or the Montreal Cognitive Assessment, transformed into Z scores. We estimated Z score differences in end of trial cognitive performance between people with and without events and calculated corresponding years of cognitive ageing in these trials, and additionally calculated using a population representative cohort-the Cognitive Function and Ageing Study.
FINDINGS RESULTS
In 64 106 participants from 55 countries, compared with no event, stroke was associated with 18 years of cognitive ageing (1487 strokes included in the model, 95% CI 10 to 28; p<0·0001) and transient ischaemic attack with 3 years (660 transient ischaemic attacks included in the model, 0 to 6; p=0·021). Myocardial infarction (p=0·60) and other hospitalisations (p=0·26) were not associated with cognitive ageing. The mean difference in SD compared with people without an event was -0·84 (95% CI -0·91 to -0·76; p<0·0001) for disabling stroke, and -0·12 (-0·19 to -0·05; p=0·0012) for non-disabling stroke. Haemorrhagic stroke was associated with worse cognition (-0·75, -0·95 to -0·55; p<0·0001) than ischaemic stroke (-0·42, -0·48 to -0·36; p <0·0001).
INTERPRETATION CONCLUSIONS
Stroke has a substantial effect on cognition. The effects of transient ischaemic attack were small, whereas myocardial infarction and hospitalisation had a neutral effect. Prevention of stroke could lead to a reduction in cognitive ageing in those at greatest risk.
FUNDING BACKGROUND
Population Health Research Institute and Chief Scientist Office of Scotland.

Identifiants

DOI: 10.1016/S2666-7568(23)00207-6 PMID: 38042159
pubmed: 38042159
pii: S2666-7568(23)00207-6
doi: 10.1016/S2666-7568(23)00207-6
pii:
doi:

Types de publication

Meta-Analysis Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

e665-e674

Informations de copyright

Copyright © 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.

Déclaration de conflit d'intérêts

Declaration of interests TC-Y has received payment or honoraria for lectures, presentations, speaker's bureaus, manuscript writing, and educational events from Eli Lilly, Sanofi, Merck Sharp & Dohme, Novo Nordisk, Medtronic, Geffen Medical, AstraZeneca, and Boehringer Ingelheim. MS has done consultancy work for Bayer and Jassen, and is a member of the Board of Canadian Stroke Consortium. AS has done consultancy work for AstraZeneca, Takeda Pharmaceutical Company, Bioxodes, Bayer, Servier Canada, and Daiichi Sankyo; has done data safety monitoring for Bayer; and has received payment or honoraria for lectures, presentations, speaker's bureaus, manuscript writing, or educational events from AstraZeneca, Bayer, Daiichi Sankyo, and Servier Canada. HCG has done consultancy work for Abbott, AstraZeneca, Eli Lilly and Company, Novo Nordisk, Sanofi, Kowa, Pfizer, and Hanmi, and has received payment or honoraria for lectures, presentations, speaker's bureaus, manuscript writing, or educational events from AstraZeneca, Eli Lilly and Company, Jiangsu-Hanen, Carbon Brand, Novo Nordisk, Sanofi, and Boehringer Ingelheim. WNW has done consultancy work for Bayer; data safety monitoring for the Universities of Calgary, Manchester, Oxford, and Utrecht; has received compensation from UK Courts for expert witness services; and has received compensation from American Heart Association for other services. All other authors declare no competing interests.

Auteurs

Laura Sherlock (L)

Population Health Research Institute, Hamilton, ON, Canada; Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.

Shun Fu Lee (SF)

Population Health Research Institute, Hamilton, ON, Canada.

Aristeidis H Katsanos (AH)

Population Health Research Institute, Hamilton, ON, Canada; Department of Medicine-Neurology, McMaster University, Hamilton, ON, Canada.

Tali Cukierman-Yaffe (T)

Department of Epidemiology and Preventive Medicine, Sackler Faculty of Medicine, School of Public Health, Tel Aviv University, Tel-Aviv, Israel; Division of Endocrinology and Metabolism, Sheba Medical Center, Ramat Gan, Israel.

Michelle Canavan (M)

HRB-Clinical Research Facility, National University of Ireland, Galway, Ireland; Department of Geriatric and Stroke Medicine, Galway University Hospital, Galway, Ireland.

Raed Joundi (R)

Population Health Research Institute, Hamilton, ON, Canada; Department of Medicine-Neurology, McMaster University, Hamilton, ON, Canada.

Mukul Sharma (M)

Population Health Research Institute, Hamilton, ON, Canada; Department of Medicine-Neurology, McMaster University, Hamilton, ON, Canada.

Ashkan Shoamanesh (A)

Population Health Research Institute, Hamilton, ON, Canada; Department of Medicine-Neurology, McMaster University, Hamilton, ON, Canada.

Carol Brayne (C)

Cambridge Public Health, University of Cambridge, Cambridge, UK.

Hertzel C Gerstein (HC)

Population Health Research Institute, Hamilton, ON, Canada; Department of Medicine-Neurology, McMaster University, Hamilton, ON, Canada; Hamilton Health Sciences, Hamilton, ON, Canada.

Martin J O'Donnell (MJ)

Population Health Research Institute, Hamilton, ON, Canada; HRB-Clinical Research Facility, National University of Ireland, Galway, Ireland; Department of Geriatric and Stroke Medicine, Galway University Hospital, Galway, Ireland.

Graciela Muniz-Terrera (G)

Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; Department of Social Medicine, Ohio University, OH, USA.

Salim Yusuf (S)

Population Health Research Institute, Hamilton, ON, Canada; Department of Medicine-Cardiology, McMaster University, Hamilton, ON, Canada.

Jackie Bosch (J)

Population Health Research Institute, Hamilton, ON, Canada; School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada.

William N Whiteley (WN)

Population Health Research Institute, Hamilton, ON, Canada; Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; Nuffield Department of Population Health, University of Oxford, Oxford, UK. Electronic address: william.whiteley@phri.ca.

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Classifications MeSH

questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Cognitive performance following stroke,...
questionsmedicales.fr › Maladies cardiovasculaires › Maladies vasculaires › Angiopathies intracrâniennes › Encéphalopathie ischémique › Accident ischémique transitoire › Cognitive performance following stroke,...
questionsmedicales.fr › Maladies cardiovasculaires › Maladies vasculaires › Angiopathies intracrâniennes › Accident vasculaire cérébral › Cognitive performance following stroke,...
questionsmedicales.fr › Maladies cardiovasculaires › Maladies vasculaires › Angiopathies intracrâniennes › Encéphalopathie ischémique › Cognitive performance following stroke,...
questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Nécrose › Infarctus › Infarctus du myocarde › Cognitive performance following stroke,...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Services de santé › Soins aux patients › Hospitalisation › Cognitive performance following stroke,...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études cliniques comme sujet › Essais cliniques comme sujet › Essais cliniques contrôlés comme sujet › Essais contrôlés randomisés comme sujet › Cognitive performance following stroke,...