{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T13:16:00Z","timestamp":1783430160170,"version":"3.54.6"},"reference-count":60,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T00:00:00Z","timestamp":1783382400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Stroke"],"abstract":"<jats:p>\n                    Post-stroke cognitive decline (PSCD) poses a significant challenge to long-term recovery and quality of life following stroke, influenced by both fixed biological factors and modifiable health behaviors such as oral and dental care. In this data-driven exploratory analysis of the PREMIERS Phase II randomized trial (\n                    <jats:ext-link>ClinicalTrials.gov<\/jats:ext-link>\n                    NCT#02541032), we examined the moderating effects of clinical, biological, and demographic characteristics on the relationship between dental care and PSCD over a 12-month period. The study included 280 stroke\/transient ischemic attack (TIA) survivors who received either intensive or standard dental care. Cognitive outcomes were assessed using the Montreal Cognitive Assessment (MoCA) at baseline and follow-up, with change in MoCA score as the primary outcome. Lasso regression was applied for empirically based feature selection of moderators, and bootstrapped multiple linear regression demonstrated that increased dental visits predicted relatively better cognitive outcomes in older adults (age interaction-term\n                    <jats:italic>b<\/jats:italic>\n                    = \u22120.664,\n                    <jats:italic>p<\/jats:italic>\n                    &amp;lt; 0.001), Black participants (race interaction-term\n                    <jats:italic>b<\/jats:italic>\n                    = \u22120.475,\n                    <jats:italic>p<\/jats:italic>\n                    &amp;lt; 0.05), and those with low-intermediate education levels (education interaction-term\n                    <jats:italic>b<\/jats:italic>\n                    = 0.413,\n                    <jats:italic>p<\/jats:italic>\n                    &amp;lt; 0.05). Exploratory graphs revealed that older adults, Black adults, and adults with low-intermediate education showed greater cognitive improvement with higher dental visit frequency, with the final model (including selected moderators) significantly predicting PSCD [\n                    <jats:italic>F<\/jats:italic>\n                    <jats:sub>(11, 268)<\/jats:sub>\n                    = 10.51,\n                    <jats:italic>p<\/jats:italic>\n                    &amp;lt; 0.001]. These findings highlight the potential of equity-focused, precision-medicine interventions that incorporate dental care to mitigate PSCD in vulnerable stroke populations.\n                  <\/jats:p>","DOI":"10.3389\/fstro.2026.1807730","type":"journal-article","created":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T12:37:25Z","timestamp":1783427845000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Age, race, and education as moderators of post-stroke cognitive decline following dental care"],"prefix":"10.3389","volume":"5","author":[{"given":"Michael H.","family":"Parrish","sequence":"first","affiliation":[{"name":"Department of Neurology, University of South Carolina School of Medicine","place":["Columbia, SC, United States"]},{"name":"Division of Neurology, Prisma Health Richland Hospital","place":["Columbia, SC, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonardo","family":"Bonilha","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of South Carolina School of Medicine","place":["Columbia, SC, United States"]},{"name":"Division of Neurology, Prisma Health Richland Hospital","place":["Columbia, SC, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karly","family":"Pikel","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of South Carolina School of Medicine","place":["Columbia, SC, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caitlin","family":"Scott","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of South Carolina School of Medicine","place":["Columbia, SC, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefanie","family":"Wood","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of South Carolina School of Medicine","place":["Columbia, SC, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haley N.","family":"VerKuilen","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of South Carolina School of Medicine","place":["Columbia, SC, United States"]},{"name":"Division of Neurology, Prisma Health Richland Hospital","place":["Columbia, SC, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Souvik","family":"Sen","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of South Carolina School of Medicine","place":["Columbia, SC, United States"]},{"name":"Division of Neurology, Prisma Health Richland Hospital","place":["Columbia, SC, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,7]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"699","DOI":"10.3389\/fneur.2020.00699","article-title":"Post-stroke cognitive impairment\u2014impact of follow-up time and stroke subtype on severity and cognitive profile: the Nor-COAST study","volume":"11","author":"Aam","year":"2020","journal-title":"Front. Neurol."},{"key":"B2","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1016\/j.neurobiolaging.2022.10.007","article-title":"Longitudinal brain age prediction and cognitive function after stroke","volume":"122","author":"Aamodt","year":"2023","journal-title":"Neurobiol. Aging"},{"key":"B3","doi-asserted-by":"publisher","first-page":"856919","DOI":"10.3389\/fneur.2022.856919","article-title":"Longitudinal brain changes after stroke and the association with cognitive decline","volume":"13","author":"Aamodt","year":"2022","journal-title":"Front. Neurol."},{"key":"B4","doi-asserted-by":"publisher","first-page":"533","DOI":"10.5664\/jcsm.5684","article-title":"Effects of continuous positive airway pressure on cognitive and functional outcome of stroke patients with obstructive sleep apnea: a randomized controlled trial","volume":"12","author":"Aaronson","year":"2016","journal-title":"J. Clin. Sleep Med."},{"key":"B5","first-page":"35","article-title":"Classification of subtype of acute ischemic stroke","volume":"24","author":"Adams","year":"1993","journal-title":"Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in acute stroke treatment. Stroke"},{"key":"B6","doi-asserted-by":"publisher","first-page":"e0309158","DOI":"10.1371\/journal.pone.0309158","article-title":"Association between post-stroke depression and functional outcomes: a systematic review","volume":"19","author":"Butsing","year":"2024","journal-title":"PLoS ONE"},{"key":"B7","doi-asserted-by":"publisher","first-page":"701","DOI":"10.1038\/s41583-018-0068-2","article-title":"Maintenance, reserve and compensation: the cognitive neuroscience of healthy ageing","volume":"19","author":"Cabeza","year":"2018","journal-title":"Nat. Rev. Neurosci."},{"key":"B8","doi-asserted-by":"publisher","first-page":"293","DOI":"10.1016\/j.pmr.2023.06.030","article-title":"Health care disparities in stroke rehabilitation","volume":"35","author":"Chavez","year":"2024","journal-title":"Phys. Med. Rehabil. Clin."},{"key":"B9","doi-asserted-by":"publisher","first-page":"5635","DOI":"10.1007\/s11357-025-01529-5","article-title":"Intrinsic brain functional connectivity mediates the relationship between psychological resilience and cognitive decline in ageing","volume":"47","author":"Chen","year":"2025","journal-title":"GeroScience"},{"key":"B10","doi-asserted-by":"publisher","first-page":"229","DOI":"10.1007\/s40496-018-0202-2","article-title":"Age and periodontal health\u2014immunological view","volume":"5","author":"Ebersole","year":"2018","journal-title":"Curr. Oral Health Rep."},{"key":"B11","doi-asserted-by":"publisher","first-page":"e272","DOI":"10.1161\/STR.0000000000000430","article-title":"Cognitive impairment after ischemic and hemorrhagic stroke: a scientific statement from the American Heart Association\/American Stroke Association","volume":"54","author":"El Husseini","year":"2023","journal-title":"Stroke"},{"key":"B12","doi-asserted-by":"publisher","first-page":"1","DOI":"10.31579\/2578-8868\/260","article-title":"Premorbid employment and education predicts improvement in general cognition ten years after stroke onset: a longitudinal cohort study","volume":"13","author":"Elgh","year":"2023","journal-title":"J. Neurosci. Neurol. Surg."},{"key":"B13","doi-asserted-by":"publisher","first-page":"3406","DOI":"10.1161\/STROKEAHA.120.030424","article-title":"Approaches to studying determinants of racial-ethnic disparities in stroke and its sequelae","volume":"51","author":"Elkind","year":"2020","journal-title":"Stroke"},{"key":"B14","doi-asserted-by":"publisher","first-page":"2296","DOI":"10.1161\/STROKEAHA.123.042507","article-title":"Sex differences in poststroke cognitive impairment: a multicenter study in 2343 patients with acute ischemic stroke","volume":"54","author":"Exalto","year":"2023","journal-title":"Stroke"},{"key":"B15","doi-asserted-by":"publisher","first-page":"803","DOI":"10.1038\/s41380-021-01361-1","article-title":"Age-related immune alterations and cerebrovascular inflammation","volume":"27","author":"Finger","year":"2022","journal-title":"Mol. Psychiatry"},{"key":"B16","doi-asserted-by":"publisher","first-page":"576","DOI":"10.1038\/s41574-018-0059-4","article-title":"Inflammaging: a new immune\u2013metabolic viewpoint for age-related diseases","volume":"14","author":"Franceschi","year":"2018","journal-title":"Nat. Rev. Endocrinol."},{"key":"B17","doi-asserted-by":"publisher","first-page":"364","DOI":"10.1002\/JPER.22-0137","article-title":"Racial and ethnic disparities in periodontal health among adults seeking dental care in rural North Carolina communities: a retrospective study","volume":"94","author":"Gillone","year":"2023","journal-title":"J. Periodontol."},{"key":"B18","doi-asserted-by":"publisher","first-page":"983","DOI":"10.3233\/JAD-215644","article-title":"Post-stroke cognitive impairment: epidemiology, risk factors, and management","volume":"86","author":"Huang","year":"2022","journal-title":"J. Alzheimers Dis."},{"key":"B19","volume-title":"IBM SPSS Statistics for Windows, Version 29.0","year":"2022"},{"key":"B20","doi-asserted-by":"publisher","first-page":"229","DOI":"10.1007\/978-3-031-38747-0_6","article-title":"\u201cLinear model selection and regularization,\u201d","author":"James","year":"2023","journal-title":"An Introduction to Statistical Learning: with Applications in Python"},{"key":"B21","doi-asserted-by":"publisher","first-page":"810","DOI":"10.1001\/jamaneurol.2020.0568","article-title":"Association between blood pressure and later-life cognition among black and white individuals","volume":"77","author":"Levine","year":"2020","journal-title":"JAMA Neurol."},{"key":"B22","doi-asserted-by":"publisher","first-page":"987","DOI":"10.1161\/STROKEAHA.117.018529","article-title":"Risk factors for poststroke cognitive decline: the REGARDS study (reasons for geographic and racial differences in stroke)","volume":"49","author":"Levine","year":"2018","journal-title":"Stroke"},{"key":"B23","doi-asserted-by":"publisher","first-page":"898","DOI":"10.1161\/STROKEAHA.124.047640","article-title":"Associations between stroke type, ischemic stroke subtypes, and poststroke cognitive trajectories","volume":"56","author":"Levine","year":"2025","journal-title":"Stroke"},{"key":"B24","doi-asserted-by":"publisher","first-page":"1011510","DOI":"10.3389\/fnagi.2022.1011510","article-title":"The moderating effect of cognitive reserve on cognitive function in patients with Acute Ischemic Stroke","volume":"14","author":"Li","year":"2022","journal-title":"Front. Aging Neurosci."},{"key":"B25","doi-asserted-by":"publisher","first-page":"111486","DOI":"10.1016\/j.jpsychores.2023.111486","article-title":"Longitudinal relationships between depressive symptoms and cognitive function after stroke: a cross-lagged panel design","volume":"174","author":"Liang","year":"2023","journal-title":"J. Psychosom. Res."},{"key":"B26","doi-asserted-by":"publisher","first-page":"1318","DOI":"10.1161\/STROKEAHA.121.035796","article-title":"Long-term cognitive decline after stroke: an individual participant data meta-analysis","volume":"53","author":"Lo","year":"2022","journal-title":"Stroke"},{"key":"B27","doi-asserted-by":"publisher","first-page":"865","DOI":"10.1136\/jnnp.2008.166603","article-title":"Poststroke dementia predicts poor survival in long-term follow-up: influence of prestroke cognitive decline and previous stroke","volume":"80","author":"Melkas","year":"2009","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"B28","doi-asserted-by":"publisher","first-page":"623","DOI":"10.1177\/1545968314562116","article-title":"Effects of community exercise therapy on metabolic, brain, physical, and cognitive function following stroke: a randomized controlled pilot trial","volume":"29","author":"Moore","year":"2015","journal-title":"Neurorehabil. Neural Repair"},{"key":"B29","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1902\/jop.2016.160379","article-title":"Derivation and validation of the periodontal and tooth profile classification system for patient stratification","volume":"88","author":"Morelli","year":"2017","journal-title":"J. Periodontol."},{"key":"B30","doi-asserted-by":"publisher","first-page":"255","DOI":"10.1016\/j.jclinepi.2010.09.002","article-title":"Improving the measurement of self-reported medication nonadherence: response to authors","volume":"64","author":"Morisky","year":"2011","journal-title":"J. Clin. Epidemiol."},{"key":"B31","doi-asserted-by":"publisher","first-page":"1317","DOI":"10.1212\/WNL.48.5.1317","article-title":"Dementia after stroke increases the risk of long-term stroke recurrence","volume":"48","author":"Moroney","year":"1997","journal-title":"Neurology"},{"key":"B32","doi-asserted-by":"publisher","first-page":"149","DOI":"10.14283\/jpad.2023.80","article-title":"Computerized cognitive training in mild cognitive impairment: findings in African Americans and Caucasians","volume":"11","author":"Nwosu","year":"2024","journal-title":"J. Prev. Alzheimers Dis."},{"key":"B33","doi-asserted-by":"publisher","first-page":"e037982","DOI":"10.1136\/bmjopen-2020-037982","article-title":"Can we prevent poststroke cognitive impairment? An umbrella review of risk factors and treatments","volume":"10","author":"Obaid","year":"2020","journal-title":"BMJ Open"},{"key":"B34","doi-asserted-by":"publisher","first-page":"3093","DOI":"10.1161\/STROKEAHA.117.017319","article-title":"Effects of physical activity on poststroke cognitive function: a meta-analysis of randomized controlled trials","volume":"48","author":"Oberlin","year":"2017","journal-title":"Stroke"},{"key":"B35","doi-asserted-by":"publisher","first-page":"1230","DOI":"10.1136\/jnnp.2009.174573","article-title":"Cognitive impairment predicts poststroke death in long-term follow-up","volume":"80","author":"Oksala","year":"2009","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"B36","doi-asserted-by":"publisher","first-page":"1006","DOI":"10.1016\/S1474-4422(09)70236-4","article-title":"Prevalence, incidence, and factors associated with pre-stroke and post-stroke dementia: a systematic review and meta-analysis","volume":"8","author":"Pendlebury","year":"2009","journal-title":"Lancet Neurol."},{"key":"B37","doi-asserted-by":"publisher","first-page":"327327","DOI":"10.1016\/j.jstrokecerebrovasdis.2025.108327","article-title":"Determinants of post-stroke cognitive impairment in patients with periodontal disease","volume":"108","author":"Pikel","year":"2025","journal-title":"J. Stroke Cerebrovasc. Dis."},{"key":"B38","doi-asserted-by":"publisher","first-page":"483","DOI":"10.1161\/STROKEAHA.117.016994","article-title":"Cognitive and mood assessment tools for use in stroke","volume":"49","author":"Quinn","year":"2018","journal-title":"Stroke"},{"key":"B39","unstructured":"R: A Language and Environment for Statistical Computing\n          \n          2023"},{"key":"B40","doi-asserted-by":"publisher","first-page":"1252","DOI":"10.1161\/CIRCRESAHA.122.319951","article-title":"Post-stroke cognitive impairment and dementia","volume":"130","author":"Rost","year":"2022","journal-title":"Circ. Res."},{"key":"B41","doi-asserted-by":"publisher","first-page":"e2437145","DOI":"10.1001\/jamanetworkopen.2024.37145","article-title":"Understanding cognitive decline after stroke in the acute setting","volume":"7","author":"Sadigh","year":"2024","journal-title":"JAMA Netw. Open"},{"key":"B42","doi-asserted-by":"publisher","first-page":"116754","DOI":"10.1016\/j.jns.2020.116754","article-title":"Vascular-brain Injury Progression after Stroke (VIPS) study: concept for understanding racial and geographic determinants of cognitive decline after stroke","volume":"412","author":"Sarfo","year":"2020","journal-title":"J. Neurol. Sci."},{"key":"B43","doi-asserted-by":"publisher","first-page":"308","DOI":"10.1136\/jnnp.2005.072306","article-title":"Education and rates of cognitive decline in incident Alzheimer's disease","volume":"77","author":"Scarmeas","year":"2006","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"B44","doi-asserted-by":"publisher","first-page":"2214","DOI":"10.1161\/STROKEAHA.122.042047","article-title":"Periodontal disease treatment after stroke or transient ischemic attack: the Premiers study, a randomized clinical trial","volume":"54","author":"Sen","year":"2023","journal-title":"Stroke"},{"key":"B45","doi-asserted-by":"publisher","first-page":"705","DOI":"10.1007\/s10072-018-3254-0","article-title":"Diagnostic test accuracy of the Montreal Cognitive Assessment in the detection of post-stroke cognitive impairment under different stages and cutoffs: a systematic review and meta-analysis","volume":"39","author":"Shi","year":"2018","journal-title":"Neurol. Sci."},{"key":"B46","doi-asserted-by":"publisher","first-page":"99","DOI":"10.1161\/STROKEAHA.119.026829","article-title":"Effect of cognitive reserve on risk of cognitive impairment and recovery after stroke: the KOSCO study","volume":"51","author":"Shin","year":"2020","journal-title":"Stroke"},{"key":"B47","doi-asserted-by":"publisher","first-page":"389","DOI":"10.3390\/jpm12030389","article-title":"Post-stroke depression and cognitive aging: a multicenter, prospective cohort study","volume":"12","author":"Shin","year":"2022","journal-title":"J. Pers. Med."},{"key":"B48","doi-asserted-by":"publisher","first-page":"107966","DOI":"10.1016\/j.jstrokecerebrovasdis.2024.107966","article-title":"Impaired oral health associations with cognitive and motor decline in activities of daily living independence during hospitalization: insights from a post-stroke cohort","volume":"33","author":"Shiraishi","year":"2024","journal-title":"J. Stroke Cerebrovasc. Dis."},{"key":"B49","doi-asserted-by":"publisher","first-page":"107718","DOI":"10.1016\/j.jstrokecerebrovasdis.2024.107718","article-title":"Predictors of post stroke cognitive impairment: VITATOPS cognition substudy","volume":"33","author":"Siow","year":"2024","journal-title":"J. Stroke Cerebrovasc. Dis."},{"key":"B50","doi-asserted-by":"publisher","first-page":"e743","DOI":"10.1093\/geront\/gny126","article-title":"Can MoCA and MMSE be interchangeable cognitive screening tools? A systematic review","volume":"59","author":"Siqueira","year":"2019","journal-title":"Gerontologist"},{"key":"B51","doi-asserted-by":"publisher","first-page":"e252002","DOI":"10.1001\/jamanetworkopen.2025.2002","article-title":"Education levels and poststroke cognitive trajectories","volume":"8","author":"Springer","year":"2025","journal-title":"JAMA Netw. Open"},{"key":"B52","doi-asserted-by":"publisher","first-page":"4558279","DOI":"10.1155\/2021\/4558279","article-title":"Effects of combined cognitive and exercise interventions on poststroke cognitive function: a systematic review and meta-analysis","volume":"2021","author":"Sun","year":"2021","journal-title":"Biomed Res. Int."},{"key":"B53","doi-asserted-by":"publisher","first-page":"e0173291","DOI":"10.1371\/journal.pone.0173291","article-title":"Decline in changing Montreal Cognitive Assessment (MoCA) scores is associated with post-stroke cognitive decline determined by a formal neuropsychological evaluation","volume":"12","author":"Tan","year":"2017","journal-title":"PLoS ONE"},{"key":"B54","doi-asserted-by":"publisher","first-page":"1100469","DOI":"10.3389\/fneur.2023.1100469","article-title":"Role of cognitive reserve in ischemic stroke prognosis: a systematic review","volume":"14","author":"Tao","year":"2023","journal-title":"Front. Neurol."},{"key":"B55","doi-asserted-by":"publisher","first-page":"144","DOI":"10.1016\/j.jalz.2015.08.001","article-title":"Trajectories of decline in cognition and daily functioning in preclinical dementia","volume":"12","author":"Verlinden","year":"2016","journal-title":"Alzheimers Dement."},{"key":"B56","doi-asserted-by":"publisher","first-page":"1212728","DOI":"10.3389\/froh.2023.1212728","article-title":"Influences of race\/ethnicity in periodontal treatment response and bacterial distribution, a cohort pilot study","volume":"4","author":"Wang","year":"2023","journal-title":"Front. Oral Health"},{"key":"B57","doi-asserted-by":"publisher","first-page":"1147026","DOI":"10.3389\/fpubh.2023.1147026","article-title":"Association between adverse oral conditions and cognitive impairment: a literature review","volume":"11","author":"Wei","year":"2023","journal-title":"Front. Public Health"},{"key":"B58","doi-asserted-by":"publisher","first-page":"e0234659","DOI":"10.1371\/journal.pone.0234659","article-title":"Poor oral health conditions and cognitive decline: studies in humans and rats","volume":"15","author":"Zhang","year":"2020","journal-title":"PLoS ONE"},{"key":"B59","doi-asserted-by":"publisher","first-page":"1036994","DOI":"10.3389\/fnagi.2023.1036994","article-title":"Relation between sleep disorders and post-stroke cognitive impairment","volume":"15","author":"Zhang","year":"2023","journal-title":"Front. Aging Neurosci."},{"key":"B60","doi-asserted-by":"publisher","first-page":"89","DOI":"10.3233\/JAD-230021","article-title":"Men are at higher risk of screening positive for vascular cognitive impairment compared to women after stroke and transient ischemic attack","volume":"94","author":"Zinman","year":"2023","journal-title":"J. Alzheimers Dis."}],"container-title":["Frontiers in Stroke"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fstro.2026.1807730\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T12:37:35Z","timestamp":1783427855000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fstro.2026.1807730\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,7]]},"references-count":60,"alternative-id":["10.3389\/fstro.2026.1807730"],"URL":"https:\/\/doi.org\/10.3389\/fstro.2026.1807730","relation":{},"ISSN":["2813-3056"],"issn-type":[{"value":"2813-3056","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,7]]},"article-number":"1807730"}}