The longitudinal STRATEGIC study set out to define the key factors that influence prognosis for memory and general cognitive function following first symptomatic ischemic stroke.

Cognitive impairment is an important determinant of quality of life after stroke and an area of unmet need, with few effective therapies. Cognitive performance can both improve and deteriorate after stroke. The factors that influence early trajectory and prognosis are not well understood.

Participants with first symptomatic ischemic stroke were recruited from a single stroke center. Subtyping, risk factor ascertainment and initial cognitive testing were performed within 30 days of stroke (n=179) and a follow-up evaluation performed at 1 year (n=141). Cognitive evaluation included the Montreal Cognitive Assessment (MoCA) and specific tests of memory and executive function.

MoCA scores at 1 year remained within 2 points of baseline scores in the majority of patients. Improvement occurred in 21 (15%) individuals and decline in 16 (11%). Age, education, hypertension, diabetes mellitus and grade of white matter disease were associated with MoCA at both timepoints but were not associated with change in score over 1 year. A history of ischemic heart disease, in contrast, was associated with decline in MoCA score over 1 year (F=8.4, p=0.004). In a combined ANCOVA, ischemic heart disease remained a significant associated factor, independent of other risk variables (F=8.18, p=0.005).

A history of ischemic heart disease is associated with a poor cognitive prognosis and a decline in cognitive performance in the year after first symptomatic ischemic stroke. Other risk factors including hypertension and diabetes mellitus are associated with cognitive function at both time points but not with change in performance over time.