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From Menzies Research Institute (Dr. Srikanth), Tasmania; Department of Psychology (J.F.I. Anderson, Dr. Saling, E. Didus, and R. Alpitsis), University of Melbourne, Parkville, Victoria; and National Stroke Research Institute (Drs. Donnan, Dewey, Macdonell, and Thrift), Repatriation Hospital, Austin Health, Victoria, Australia.
Address correspondence and reprint requests to Prof. Geoffrey A. Donnan, Director, National Stroke Research Institute, Neurosciences Building, Repatriation Hospital, Austin Health, 300 Waterdale Rd., Heidelberg Heights, Victoria 3081, Australia; e-mail: gdonnan{at}unimelb.edu.au
Objectives: To examine the risk and determinants of a progressive dementia syndrome and cognitive impairment not dementia (CIND) in community-based nonaphasic first-ever stroke cases 1 year after stroke, relative to a matched community-based stroke-free group.
Methods: Matched cohort design, with cognitive tests given on two occasions 9 months apart to 99 mild-to-moderate first-ever stroke patients and 99 age- and sex-matched people without stroke. At follow-up, progressive dementia or CIND were diagnosed, with judges blinded to stroke/nonstroke status.
Results: Progressive dementia was diagnosed in 12.5% of stroke patients and 15.4% of those without strokes (RR 1.1, 95% CI 0.5 to 2.2, p = 0.85). CIND was diagnosed in 37.5% of stroke patients and 17.6% of participants without strokes (RR 2.1, 95% CI 1.2 to 3.4, p = 0.003). In multivariable regression, age (p = 0.04) and baseline cognition (p < 0.001) were independently associated with dementia whereas stroke (p = 0.002), age (p = 0.05), baseline cognition (p = 0.001), and baseline mood (p = 0.03) were independently associated with CIND at follow-up.
Conclusions: In this community-based nonaphasic sample, mild-to moderate first-ever stroke was not associated with the presence of progressive dementia 1 year later, but was clearly associated with a greater risk of cognitive impairment not dementia (CIND). Baseline mood impairment remained independently associated with CIND at 1 year after taking into account stroke, age, and baseline cognitive ability.
Received December 24, 2003. Accepted in final form May 11, 2004.
Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the September 14 issue to find the title link for this article.
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