on behalf of the PROGRESS Collaborators
People with stroke and transient ischemic attack (TIA) have greater risk of cognitive decline (CD) and dementia. This study determined the effect of randomized blood pressure (BP) lowering and major predictors for CD/dementia in stroke/TIA in the Perindopril Protection Against Recurrent Stroke Study (PROGRESS) randomized controlled trial.
PROGRESS included 6,105 patients with prior stroke/TIA. Multinomial logistic regressions were used to estimate odds ratios (OR) for predictors of CD/dementia, with death considered as a competing risk, and evaluated the effect modification of sex.
Over a median 4-year follow-up, 779 CD/dementia (31% women) were recorded. Active treatment was associated with lower odds of CD/dementia (OR:0.85, 95% confidence interval:0.73–0.99), with no evidence of a sex difference. Higher baseline cognitive function (0.84, 0.82–0.86 (per point in Mini-Mental State Examination) and longer years of education (0.96,0.94–0.98 (per year)) were associated with lower odds of CD/dementia. Higher diastolic BP (1.11, 1.03–1.20 (per 10 mmHg)), low estimated glomerular filtration rate (eGFR, <60 ml/min/1.73m2) (1.55,1.20–2.01), and peripheral arterial disease (1.86,1.32–2.61) were associated with greater odds of CD/dementia. Greater dependency and disability, and residual neurological signs were all associated with greater odds of CD/dementia than their comparators. Women had lower odds of CD/dementia than men (0.77,0.63–0.95), low eGFR was more strongly associated with CD/dementia in women than men, and diabetes was more strongly associated in men than women.
Several factors were associated with CD/dementia in people with stroke/TIA. The long-term cognitive sequelae of stroke should be taken into consideration to strengthen the joint prevention strategies for stroke and dementia.
This trial was not registered because patients were enrolled before July 1, 2005.