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Subjective memory complaints and the risk of stroke.

Abstract

BACKGROUND AND PURPOSE

Persons with cognitive impairment, as assessed by cognitive tests, are at a higher risk of stroke. Subjective memory complaints might be an earlier marker for stroke, especially in persons with higher education. Their cognitive reserve might mask their cognitive impairment during cognitive testing. In a population-based setting, we investigated the association between subjective memory complaints and stroke. We simultaneously investigated the association between Mini-Mental State Examination and stroke. We also assessed whether these associations varied with educational level.

METHODS

9152 participants from the Rotterdam Study (baseline 1990-1993 or 2000-2001) completed the subjective memory complaints questionnaire and underwent Mini-Mental State Examination assessment. Subsequently, the entire cohort was followed for incident stroke until 2012. We used Cox proportional hazard models to estimate the associations between subjective memory complaints and Mini-Mental State Examination, with stroke.

RESULTS

During a follow-up of 111 593 person years, 1134 strokes were identified, of which 663 were ischemic and 99 hemorrhagic. In the fully adjusted model, presence of subjective memory complaints was independently associated with a higher risk of stroke (hazard ratio, 1.20; 95% confidence interval, 1.04-1.39), but a higher Mini-Mental State Examination was not (hazard ratio per point increase, 0.99; 95% confidence interval, 0.95-1.02). The association between subjective memory complaints and risk of stroke was modified by educational level, with a higher risk of stroke in persons with a higher level of education (hazard ratio, 1.39; 95% confidence interval, 1.07-1.81).

CONCLUSIONS

Subjective memory complaints might be an early indicator of stroke risk, especially in highly educated individuals.

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  • Authors+Show Affiliations

    ,

    From the Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands (A.S., S.S.M., M.L.P.P., M.J.B., A.H., H.T., M.A.I.); Department of Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands (H.T.); Department of Radiology, Erasmus University Medical Center, Rotterdam, The Netherlands (M.A.I.); and Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands (M.L.P.P., P.J.K., M.A.I.).

    ,

    From the Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands (A.S., S.S.M., M.L.P.P., M.J.B., A.H., H.T., M.A.I.); Department of Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands (H.T.); Department of Radiology, Erasmus University Medical Center, Rotterdam, The Netherlands (M.A.I.); and Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands (M.L.P.P., P.J.K., M.A.I.).

    ,

    From the Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands (A.S., S.S.M., M.L.P.P., M.J.B., A.H., H.T., M.A.I.); Department of Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands (H.T.); Department of Radiology, Erasmus University Medical Center, Rotterdam, The Netherlands (M.A.I.); and Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands (M.L.P.P., P.J.K., M.A.I.).

    ,

    From the Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands (A.S., S.S.M., M.L.P.P., M.J.B., A.H., H.T., M.A.I.); Department of Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands (H.T.); Department of Radiology, Erasmus University Medical Center, Rotterdam, The Netherlands (M.A.I.); and Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands (M.L.P.P., P.J.K., M.A.I.).

    ,

    From the Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands (A.S., S.S.M., M.L.P.P., M.J.B., A.H., H.T., M.A.I.); Department of Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands (H.T.); Department of Radiology, Erasmus University Medical Center, Rotterdam, The Netherlands (M.A.I.); and Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands (M.L.P.P., P.J.K., M.A.I.).

    ,

    From the Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands (A.S., S.S.M., M.L.P.P., M.J.B., A.H., H.T., M.A.I.); Department of Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands (H.T.); Department of Radiology, Erasmus University Medical Center, Rotterdam, The Netherlands (M.A.I.); and Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands (M.L.P.P., P.J.K., M.A.I.).

    ,

    From the Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands (A.S., S.S.M., M.L.P.P., M.J.B., A.H., H.T., M.A.I.); Department of Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands (H.T.); Department of Radiology, Erasmus University Medical Center, Rotterdam, The Netherlands (M.A.I.); and Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands (M.L.P.P., P.J.K., M.A.I.).

    From the Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands (A.S., S.S.M., M.L.P.P., M.J.B., A.H., H.T., M.A.I.); Department of Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands (H.T.); Department of Radiology, Erasmus University Medical Center, Rotterdam, The Netherlands (M.A.I.); and Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands (M.L.P.P., P.J.K., M.A.I.). m.a.ikram@erasmusmc.nl.

    Source

    MeSH

    Aged
    Aged, 80 and over
    Brain Ischemia
    Cognitive Reserve
    Cohort Studies
    Female
    Humans
    Intracranial Hemorrhages
    Male
    Memory Disorders
    Mental Status Schedule
    Middle Aged
    Neuropsychological Tests
    Proportional Hazards Models
    Prospective Studies
    Self Report
    Stroke

    Pub Type(s)

    Journal Article
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    25503545

    Citation

    TY - JOUR T1 - Subjective memory complaints and the risk of stroke. AU - Sajjad,Ayesha, AU - Mirza,Saira Saeed, AU - Portegies,Marileen L P, AU - Bos,Michiel J, AU - Hofman,Albert, AU - Koudstaal,Peter J, AU - Tiemeier,Henning, AU - Ikram,M Arfan, Y1 - 2014/12/11/ PY - 2014/12/11/aheadofprint PY - 2014/12/16/entrez PY - 2014/12/17/pubmed PY - 2015/4/22/medline KW - cognitive impairment KW - education KW - stroke SP - 170 EP - 5 JF - Stroke; a journal of cerebral circulation JO - Stroke VL - 46 IS - 1 N2 - BACKGROUND AND PURPOSE: Persons with cognitive impairment, as assessed by cognitive tests, are at a higher risk of stroke. Subjective memory complaints might be an earlier marker for stroke, especially in persons with higher education. Their cognitive reserve might mask their cognitive impairment during cognitive testing. In a population-based setting, we investigated the association between subjective memory complaints and stroke. We simultaneously investigated the association between Mini-Mental State Examination and stroke. We also assessed whether these associations varied with educational level. METHODS: 9152 participants from the Rotterdam Study (baseline 1990-1993 or 2000-2001) completed the subjective memory complaints questionnaire and underwent Mini-Mental State Examination assessment. Subsequently, the entire cohort was followed for incident stroke until 2012. We used Cox proportional hazard models to estimate the associations between subjective memory complaints and Mini-Mental State Examination, with stroke. RESULTS: During a follow-up of 111 593 person years, 1134 strokes were identified, of which 663 were ischemic and 99 hemorrhagic. In the fully adjusted model, presence of subjective memory complaints was independently associated with a higher risk of stroke (hazard ratio, 1.20; 95% confidence interval, 1.04-1.39), but a higher Mini-Mental State Examination was not (hazard ratio per point increase, 0.99; 95% confidence interval, 0.95-1.02). The association between subjective memory complaints and risk of stroke was modified by educational level, with a higher risk of stroke in persons with a higher level of education (hazard ratio, 1.39; 95% confidence interval, 1.07-1.81). CONCLUSIONS: Subjective memory complaints might be an early indicator of stroke risk, especially in highly educated individuals. SN - 1524-4628 UR - https://www.unboundmedicine.com/medline/citation/25503545/Subjective_memory_complaints_and_the_risk_of_stroke_ L2 - http://stroke.ahajournals.org/cgi/pmidlookup?view=long&pmid=25503545 ER -