{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,11]],"date-time":"2026-11-11T20:22:29Z","timestamp":1794428549945,"version":"4.9.1"},"reference-count":57,"publisher":"American Medical Association (AMA)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"<jats:sec id=\"ab-zoi230426-4\">\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>Incident stroke is associated with accelerated cognitive decline. Whether poststroke vascular risk factor levels are associated with faster cognitive decline is uncertain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-zoi230426-5\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate associations of poststroke systolic blood pressure (SBP), glucose, and low-density lipoprotein (LDL) cholesterol levels with cognitive decline.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-zoi230426-6\">\n                    <jats:title>Design, Setting, and Participants<\/jats:title>\n                    <jats:p>Individual participant data meta-analysis of 4 US cohort studies (conducted 1971-2019). Linear mixed-effects models estimated changes in cognition after incident stroke. Median (IQR) follow-up was 4.7 (2.6-7.9) years. Analysis began August 2021 and was completed March 2023.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-zoi230426-7\">\n                    <jats:title>Exposures<\/jats:title>\n                    <jats:p>Time-dependent cumulative mean poststroke SBP, glucose, and LDL cholesterol levels.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-zoi230426-8\">\n                    <jats:title>Main Outcomes and Measures<\/jats:title>\n                    <jats:p>\n                      The primary outcome was change in global cognition. Secondary outcomes were change in executive function and memory. Outcomes were standardized as\n                      <jats:italic>t<\/jats:italic>\n                      scores (mean [SD], 50 [10]); a 1-point difference represents a 0.1-SD difference in cognition.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-zoi230426-9\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 1120 eligible dementia-free individuals with incident stroke were identified; 982 (87.7%) had available covariate data and 138 (12.3%) were excluded for missing covariate data. Of the 982, 480 (48.9%) were female individuals, and 289 (29.4%) were Black individuals. The median age at incident stroke was 74.6 (IQR, 69.1-79.8; range, 44.1-96.4) years. Cumulative mean poststroke SBP and LDL cholesterol levels were not associated with any cognitive outcome. However, after accounting for cumulative mean poststroke SBP and LDL cholesterol levels, higher cumulative mean poststroke glucose level was associated with faster decline in global cognition (\u22120.04 points\/y faster per each 10\u2013mg\/dL increase [95% CI, \u22120.08 to \u22120.001 points\/y];\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.046) but not executive function or memory. After restricting to 798 participants with apolipoprotein E4 (APOE4) data and controlling for APOE4 and APOE4\u2009\u00d7\u2009time, higher cumulative mean poststroke glucose level was associated with a faster decline in global cognition in models without and with adjustment for cumulative mean poststroke SBP and LDL cholesterol levels (\u22120.05 points\/y faster per 10\u2013mg\/dL increase [95% CI, \u22120.09 to \u22120.01 points\/y];\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.01; \u22120.07 points\/y faster per 10\u2013mg\/dL increase [95% CI, \u22120.11 to \u22120.03 points\/y];\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.002) but not executive function or memory declines.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-zoi230426-10\">\n                    <jats:title>Conclusions and Relevance<\/jats:title>\n                    <jats:p>In this cohort study, higher poststroke glucose levels were associated with faster global cognitive decline. We found no evidence that poststroke LDL cholesterol and SBP levels were associated with cognitive decline.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2023.13879","type":"journal-article","created":{"date-parts":[[2023,5,17]],"date-time":"2023-05-17T11:04:20Z","timestamp":1684321460000},"page":"e2313879","source":"Crossref","is-referenced-by-count":37,"title":["Associations Between Vascular Risk Factor Levels and Cognitive Decline Among Stroke Survivors"],"prefix":"10.1001","volume":"6","author":[{"given":"Deborah A.","family":"Levine","sequence":"first","affiliation":[{"name":"Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan, Ann Arbor"},{"name":"Department of Neurology and Stroke Program, University of Michigan, Ann Arbor"},{"name":"Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bingxin","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Nursing, University of Michigan, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrzej T.","family":"Galecki","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan, Ann Arbor"},{"name":"Department of Biostatistics, University of Michigan, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alden L.","family":"Gross","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Johns Hopkins Bloomberg School Public Health, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily M.","family":"Brice\u00f1o","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan, Ann Arbor"},{"name":"Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachael T.","family":"Whitney","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert J.","family":"Ploutz-Snyder","sequence":"additional","affiliation":[{"name":"Department of Nursing, University of Michigan, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruno J.","family":"Giordani","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Michigan Alzheimer\u2019s Disease Center, University of Michigan, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremy B.","family":"Sussman","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan, Ann Arbor"},{"name":"Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor"},{"name":"VA Ann Arbor Healthcare System, Ann Arbor, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James F.","family":"Burke","sequence":"additional","affiliation":[{"name":"Department of Neurology, Ohio State University College of Medicine, Columbus"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronald M.","family":"Lazar","sequence":"additional","affiliation":[{"name":"Department of Neurology and Evelyn F. 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V.","family":"Elkind","sequence":"additional","affiliation":[{"name":"Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York"},{"name":"Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca F.","family":"Gottesman","sequence":"additional","affiliation":[{"name":"Stroke Branch, National Institute of Neurological Disorders and Stroke, Bethesda, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Koton","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Johns Hopkins Bloomberg School Public Health, Baltimore, Maryland"},{"name":"Department of Nursing, The Stanley Steyer School of Health Professions, Tel Aviv University, Tel Aviv, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah T.","family":"Pendlebury","sequence":"additional","affiliation":[{"name":"Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom"},{"name":"NIHR Biomedical Research Centre, Departments of Medicine and Geratology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anu","family":"Sharma","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mellanie V.","family":"Springer","sequence":"additional","affiliation":[{"name":"Department of Neurology and Stroke Program, University of Michigan, Ann Arbor"},{"name":"Institute for Healthcare Policy and Innovation, University of Michigan, Ann 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