Stroke preventive strategies and long-term cognitive function: A population-based study

OBJECTIVES: Limited data exist on the impact of secondary stroke prevention and on cognitive function after stroke. This study aims to investigate whether post-stroke care strategies protect cognitive function up to ten-year. MATERIALS AND METHODS: Data were collected between 1995 and 2018 from the population-based South London Stroke Register (SLSR, n = 6504). Multivariable Poisson regression models with robust standard errors and confounders were constructed to evaluate adjusted relative risks (aRRs) between cognitive impairment and different treatment strategies; before, at acute care or after stroke. Use multiple imputation to manage the missing data. RESULTS: The prevalence of cognitive impairment was 29% (confidence interval (CI) 26-32). 5-years after stroke, in ischemic stroke patients with a history of atrial fibrillation (AF), there was a reduced risk of cognitive impairment of 50% associated with antihypertensive (aRR:0.5, 0.27-0.91), 77% with statin (aRR:0.23, 0.06-0.91) and 82% with anticoagulant (aRR:0.18, CI 0.05-0.64). In ischemic stroke patients with no history of AF, the reduced risk was 26% (aRR:0.74, 0.57-0.95) with antihypertensive and 19% (aRR:0.81, 0.64-1.03) with statin. All these protective associations tend to diminish over time up to ten years after stroke. When clinically indicated, a combined treatment of these were strongly associated with a reduced risk of cognitive impairment. Small risk reduction was observed between cognitive impairment and acute stroke unit admission (aRR:0.96, 0.93-0.98). CONCLUSIONS: Consistent use of combined treatments is associated with better cognitive function up to 10 years post-stroke. These findings suggest that optimizing medication management could help reduce the risk of long-term cognitive decline.