Low ankle-brachial index and cognitive function after stroke—the PROSpective with Incident Stroke Berlin (PROSCIS-B)

Frontiers in Neurology, vol. 13, pp. 963262

Abstract

Introduction: Low ankle-brachial index (ABI) ≤0. 9 is a marker for generalized atherosclerosis and a risk factor for cognitive decline in the general population. Objective: To evaluate the impact of ABI ≤0.9 on cognitive function up to 3 years after first-ever ischemic stroke. Methods: Data was used from the "PROspective Cohort with Incident Stroke-Berlin" (PROSCIS-B; NCT01363856). ABI was measured at baseline and categorized into normal (1.4-0.9) vs. low (≤0.9). Cognitive function was assessed with the Montreal Cognitive Assessment (MoCA) and the Mini-Mental-State-Examination (MMSE) at baseline and with the Telephone Interview for Cognitive Status-modified (TICS-m) at 1-3 years of follow-up. We performed confounder adjusted generalized linear models (GLM) to calculate relative risks (RR) for cognitive impairment at baseline (MMSE≤26; MoCA≤25) and linear mixed models (LMM) to estimate the impact of low ABI on TICS-m over time. Results: We included 325 patients [mean age: 66 (SD = 13); 38% female, median NIHSS = 2 (IQR = 1-4), ABI≤0.9: 59 (18%)]. Patients with low ABI were at increased risk of cognitive impairment at baseline (adjusted RR for MoCA≤25 = 1.98; 95%-CI:1.24 to 3.16). TICS-m scores were consistently lower over time in patients with low ABI (adjusted ß = -1.96; 95%-CI:-3.55 to -0.37). Independent of ABI, cognitive function did not decline over time (adjusted ß:0.29; 95%-CI:-0.06 to 0.64). Conclusion: In patients with mild to moderate first-ever ischemic stroke, low ABI is associated with reduced cognitive function over a 3-year follow-up. Study Registration: https://clinicaltrials.gov; Unique identifier: NCT01363856.

Authors 9

1. Maria R. V. Stillfried

   Center for Stroke Research Berlin · Charité - Universitätsmedizin Berlin

   Affiliation as printed

   Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany

   Center for Stroke Research Berlin, Charité – Universitätsmedizin Berlin, Berlin, Germany

2. Pia S. Sperber

   German Centre for Cardiovascular Research · Center for Stroke Research Berlin · Charité - Universitätsmedizin Berlin

   Affiliation as printed

   Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany

   German Centre for Cardiovascular Research DZHK, Charité -Universitätsmedizin Berlin, Berlin, Germany

   Center for Stroke Research Berlin, Charité – Universitätsmedizin Berlin, Berlin, Germany

   German Centre for Cardiovascular Research DZHK, Charité –Universitätsmedizin Berlin, Berlin, Germany

3. Leonie H. A. Broersen

   Center for Stroke Research Berlin · Charité - Universitätsmedizin Berlin

   Affiliation as printed

   Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany

   Center for Stroke Research Berlin, Charité – Universitätsmedizin Berlin, Berlin, Germany

4. Shufan Huo

   Center for Stroke Research Berlin · Charité - Universitätsmedizin Berlin

   Affiliation as printed

   Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany

   Klinik und Hochschulambulanz für Neurologie, Charité- Universitätsmedizin Berlin, Berlin, Germany

   Center for Stroke Research Berlin, Charité – Universitätsmedizin Berlin, Berlin, Germany

5. Sophie K. Piper

   German Center for Neurodegenerative Diseases · Charité - Universitätsmedizin Berlin

   Affiliation as printed

   German Center for Neurodegenerative Disease DZNE, Berlin Charité-Universitätsmedizin Berlin, Berlin, Germany

6. Peter Ulrich Heuschmann

   University of Würzburg

   Affiliation as printed

   Institute of Biometry and Clinical Epidemiology, University of Würzburg, Würzburg, Germany

7. Matthias Endres

   German Center for Neurodegenerative Diseases · German Centre for Cardiovascular Research · Center for Stroke Research Berlin · Charité - Universitätsmedizin Berlin

   Affiliation as printed

   Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany

   German Center for Neurodegenerative Disease DZNE, partner site Berlin Charité-Universitätsmedizin Berlin, Berlin, Germany

   German Centre for Cardiovascular Research DZHK, Charité -Universitätsmedizin Berlin, Berlin, Germany

   Klinik und Hochschulambulanz für Neurologie, Charité- Universitätsmedizin Berlin, Berlin, Germany

   NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Berlin, Germany

   Center for Stroke Research Berlin, Charité – Universitätsmedizin Berlin, Berlin, Germany

   German Centre for Cardiovascular Research DZHK, Charité –Universitätsmedizin Berlin, Berlin, Germany

   NeuroCure Clinical Research Center, Charité – Universitätsmedizin Berlin, Berlin, Germany

8. Bob Siegerink Aachen Department of Clinical Epidemiology

   Leiden University Medical Center · Center for Stroke Research Berlin · Charité - Universitätsmedizin Berlin

   Affiliation as printed

   Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany

   Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, Netherlands

   Center for Stroke Research Berlin, Charité – Universitätsmedizin Berlin, Berlin, Germany

9. Thomas Liman corresponding

   Carl von Ossietzky Universität Oldenburg · German Center for Neurodegenerative Diseases · German Centre for Cardiovascular Research · Center for Stroke Research Berlin · Charité - Universitätsmedizin Berlin

   Affiliation as printed

   Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany

   Department of Neurology, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany

   German Center for Neurodegenerative Disease DZNE, partner site Berlin Charité-Universitätsmedizin Berlin, Berlin, Germany

   German Centre for Cardiovascular Research DZHK, Charité -Universitätsmedizin Berlin, Berlin, Germany

   Center for Stroke Research Berlin, Charité – Universitätsmedizin Berlin, Berlin, Germany

   German Centre for Cardiovascular Research DZHK, Charité –Universitätsmedizin Berlin, Berlin, Germany