Post-stroke cognitive impairment and the risk of stroke recurrence and death in patients with insulin resistance

  • Kat Schmidt
    Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, George Washington University, Washington, DC, United States
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  • Melinda C. Power
    Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, United States
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  • Author Footnotes
    1 These authors contributed equally to these work.
    Adam Ciarleglio
    1 These authors contributed equally to these work.
    Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, George Washington University, Washington, DC, United States
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  • Author Footnotes
    1 These authors contributed equally to these work.
    Zurab Nadareishvili
    Corresponding author.
    1 These authors contributed equally to these work.
    Department of Neurology, School of Medicine and Health Sciences, The George Washington University, Washington, DC and Stroke Center, Virginia Hospital Center, 1625 North George Mason Drive, Suite #344, Arlington, VA 22205, United States
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  • on behalf of theIRIS Study Group
  • Author Footnotes
    1 These authors contributed equally to these work.



      Post-stroke cognitive impairment (PSCI) is associated with etiology, severity, and functional outcome of stroke. The risks of recurrent stroke and death in patients with PSCI and insulin resistance (IR) is unknown. The goal of this study was to determine whether global and domain-specific cognitive impairment after stroke in patients with IR was associated with recurrent stroke and death.

      Materials and Methods

      We studied patients with recent stroke or transient ischemic attack (TIA) and IR with a baseline Modified Mini-Mental State Examination (3MS) cognitive exam at median of 79 days after stroke. We considered a baseline score of ≤ 88 on the 3MS to indicate global cognitive impairment, and domain-specific summary scores in the lowest quartile to indicate language, attention, orientation, memory and visuospatial impairments. The primary endpoint was fatal or non-fatal recurrent stroke, and the secondary endpoints were all-cause mortality, and fatal or non-fatal myocardial infarction (MI).


      Among studied n = 3,338 patients 13.6% had global cognitive impairment. During the median 4.96 years of follow-up, 7.4% patients experienced recurrent stroke, 3.5% MI, and 7.3% died. In the fully adjusted model, impairment in language (HR 1.35; 95% CI 1.01—1.81) and orientation (HR 1.41; 95% CI: 1.06—1.87) were associated with a higher risk of recurrent stroke, while attention impairment was associated with all-cause mortality (HR 1.34; 95% CI: 1.01—1.78).


      In patients with recent stroke/TIA and IR, post-stroke language and orientation impairments independently predicted recurrent stroke, while attention deficit was associated with increased risk of all-cause mortality.


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