Citation
Wang, Qianyi; Mejia-Guevara, Ivan; Rist, Pamela M.; Walter, Stefan; Capistrant, Benjamin D.; & Glymour, M. Maria (2014). Changes in Memory before and after Stroke Differ by Age and Sex, but Not by Race. Cerebrovascular Diseases, 37(4), 235-243. PMCID: PMC4347666Abstract
Background: Post-stroke memory impairment is more common among older adults, women and blacks. It is unclear whether post-stroke differences reflect differential effects of stroke per se or differences in prestroke functioning. We compare memory trajectories before and after stroke by age, sex and race.Methods: Health and Retirement Study participants aged >/=50 years (n = 17,341), with no stroke history at baseline, were interviewed biennially up to 10 years for first self- or proxy-reported stroke (n = 1,574). Segmented linear regression models were used to compare annual rates of memory change before and after stroke among 1,169 stroke survivors, 405 stroke decedents and 15,767 stroke-free participants. Effect modification was evaluated with analyses stratified by baseline age (=70 vs. >70), sex and race (white vs. nonwhite), and using interaction terms between age/sex/race indicators and annual memory change.
Results: Older (>70 years) adults experienced a faster memory decline before stroke (-0.19 vs. -0.10 points/year for survivors, -0.24 vs. -0.13 points/year for decedents, p < 0.001 for both interactions), and among stroke survivors, larger memory decrements (-0.64 vs. -0.26 points, p < 0.001) at stroke and faster memory decline (-0.15 vs. -0.07 points/year, p = 0.003) after stroke onset, compared to younger adults. Female stroke survivors experienced a faster prestroke memory decline than male stroke survivors (-0.14 vs. -0.10 points/year, p < 0.001). However, no sex differences were seen for other contrasts. Although whites had higher post-stroke memory scores than nonwhites, race was not associated with rate of memory decline during any period of time; i.e. race did not significantly modify the rate of decline before or after stroke or the immediate effect of stroke on memory.
Conclusions: Older age predicted worse memory change before, at and after stroke onset. Sex and race differences in post-stroke memory outcomes might be attributable to prestroke disparities, which may be unrelated to cerebrovascular disease.
URL
http://dx.doi.org/10.1159/000357557Reference Type
Journal ArticleYear Published
2014Journal Title
Cerebrovascular DiseasesAuthor(s)
Wang, QianyiMejia-Guevara, Ivan
Rist, Pamela M.
Walter, Stefan
Capistrant, Benjamin D.
Glymour, M. Maria