Incident cognitive impairment is elevated in the stroke belt

The REGARDS Study

Virginia G. Wadley, Frederick Unverzagt, Lisa C. McGuire, Claudia S. Moy, Rodney Go, Brett Kissela, Leslie A. McClure, Michael Crowe, Virginia J. Howard, George Howard

Research output: Contribution to journalArticle

37 Citations (Scopus)

Abstract

Objective: To determine whether incidence of impaired cognitive screening status is higher in the southern Stroke Belt region of the United States than in the remaining United States. Methods: A national cohort of adults age ≥45 years was recruited by the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study from 2003 to 2007. Participants' global cognitive status was assessed annually by telephone with the Six-Item Screener (SIS) and every 2 years with fluency and recall tasks. Participants who reported no stroke history and who were cognitively intact at enrollment (SIS >4 of 6) were included (N = 23,913, including 56% women; 38% African Americans and 62% European Americans; 56% Stroke Belt residents and 44% from the remaining contiguous United States and the District of Columbia). Regional differences in incident cognitive impairment (SIS score ≤4) were adjusted for age, sex, race, education, and time between first and last assessments. Results: A total of 1,937 participants (8.1%) declined to an SIS score a;circ4 at their most recent assessment, over a mean of 4.1 (±1.6) years. Residents of the Stroke Belt had greater adjusted odds of incident cognitive impairment than non-Belt residents (odds ratio, 1.18; 95% confidence interval, 1.07-1.30). All demographic factors and time independently predicted impairment. Interpretation: Regional disparities in cognitive decline mirror regional disparities in stroke mortality, suggesting shared risk factors for these adverse outcomes. Efforts to promote cerebrovascular and cognitive health should be directed to the Stroke Belt.

Original languageEnglish
Pages (from-to)229-236
Number of pages8
JournalAnnals of Neurology
Volume70
Issue number2
DOIs
StatePublished - Aug 2011

Fingerprint

Stroke
Sex Education
Cognitive Dysfunction
Telephone
African Americans
Odds Ratio
Demography
Confidence Intervals
Mortality
Incidence
Health

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

Cite this

Wadley, V. G., Unverzagt, F., McGuire, L. C., Moy, C. S., Go, R., Kissela, B., ... Howard, G. (2011). Incident cognitive impairment is elevated in the stroke belt: The REGARDS Study. Annals of Neurology, 70(2), 229-236. https://doi.org/10.1002/ana.22432

Incident cognitive impairment is elevated in the stroke belt : The REGARDS Study. / Wadley, Virginia G.; Unverzagt, Frederick; McGuire, Lisa C.; Moy, Claudia S.; Go, Rodney; Kissela, Brett; McClure, Leslie A.; Crowe, Michael; Howard, Virginia J.; Howard, George.

In: Annals of Neurology, Vol. 70, No. 2, 08.2011, p. 229-236.

Research output: Contribution to journalArticle

Wadley, VG, Unverzagt, F, McGuire, LC, Moy, CS, Go, R, Kissela, B, McClure, LA, Crowe, M, Howard, VJ & Howard, G 2011, 'Incident cognitive impairment is elevated in the stroke belt: The REGARDS Study', Annals of Neurology, vol. 70, no. 2, pp. 229-236. https://doi.org/10.1002/ana.22432
Wadley, Virginia G. ; Unverzagt, Frederick ; McGuire, Lisa C. ; Moy, Claudia S. ; Go, Rodney ; Kissela, Brett ; McClure, Leslie A. ; Crowe, Michael ; Howard, Virginia J. ; Howard, George. / Incident cognitive impairment is elevated in the stroke belt : The REGARDS Study. In: Annals of Neurology. 2011 ; Vol. 70, No. 2. pp. 229-236.
@article{b2cb0f906db04b8d88344f5bbba7aba5,
title = "Incident cognitive impairment is elevated in the stroke belt: The REGARDS Study",
abstract = "Objective: To determine whether incidence of impaired cognitive screening status is higher in the southern Stroke Belt region of the United States than in the remaining United States. Methods: A national cohort of adults age ≥45 years was recruited by the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study from 2003 to 2007. Participants' global cognitive status was assessed annually by telephone with the Six-Item Screener (SIS) and every 2 years with fluency and recall tasks. Participants who reported no stroke history and who were cognitively intact at enrollment (SIS >4 of 6) were included (N = 23,913, including 56{\%} women; 38{\%} African Americans and 62{\%} European Americans; 56{\%} Stroke Belt residents and 44{\%} from the remaining contiguous United States and the District of Columbia). Regional differences in incident cognitive impairment (SIS score ≤4) were adjusted for age, sex, race, education, and time between first and last assessments. Results: A total of 1,937 participants (8.1{\%}) declined to an SIS score a;circ4 at their most recent assessment, over a mean of 4.1 (±1.6) years. Residents of the Stroke Belt had greater adjusted odds of incident cognitive impairment than non-Belt residents (odds ratio, 1.18; 95{\%} confidence interval, 1.07-1.30). All demographic factors and time independently predicted impairment. Interpretation: Regional disparities in cognitive decline mirror regional disparities in stroke mortality, suggesting shared risk factors for these adverse outcomes. Efforts to promote cerebrovascular and cognitive health should be directed to the Stroke Belt.",
author = "Wadley, {Virginia G.} and Frederick Unverzagt and McGuire, {Lisa C.} and Moy, {Claudia S.} and Rodney Go and Brett Kissela and McClure, {Leslie A.} and Michael Crowe and Howard, {Virginia J.} and George Howard",
year = "2011",
month = "8",
doi = "10.1002/ana.22432",
language = "English",
volume = "70",
pages = "229--236",
journal = "Annals of Neurology",
issn = "0364-5134",
publisher = "John Wiley and Sons Inc.",
number = "2",

}

TY - JOUR

T1 - Incident cognitive impairment is elevated in the stroke belt

T2 - The REGARDS Study

AU - Wadley, Virginia G.

AU - Unverzagt, Frederick

AU - McGuire, Lisa C.

AU - Moy, Claudia S.

AU - Go, Rodney

AU - Kissela, Brett

AU - McClure, Leslie A.

AU - Crowe, Michael

AU - Howard, Virginia J.

AU - Howard, George

PY - 2011/8

Y1 - 2011/8

N2 - Objective: To determine whether incidence of impaired cognitive screening status is higher in the southern Stroke Belt region of the United States than in the remaining United States. Methods: A national cohort of adults age ≥45 years was recruited by the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study from 2003 to 2007. Participants' global cognitive status was assessed annually by telephone with the Six-Item Screener (SIS) and every 2 years with fluency and recall tasks. Participants who reported no stroke history and who were cognitively intact at enrollment (SIS >4 of 6) were included (N = 23,913, including 56% women; 38% African Americans and 62% European Americans; 56% Stroke Belt residents and 44% from the remaining contiguous United States and the District of Columbia). Regional differences in incident cognitive impairment (SIS score ≤4) were adjusted for age, sex, race, education, and time between first and last assessments. Results: A total of 1,937 participants (8.1%) declined to an SIS score a;circ4 at their most recent assessment, over a mean of 4.1 (±1.6) years. Residents of the Stroke Belt had greater adjusted odds of incident cognitive impairment than non-Belt residents (odds ratio, 1.18; 95% confidence interval, 1.07-1.30). All demographic factors and time independently predicted impairment. Interpretation: Regional disparities in cognitive decline mirror regional disparities in stroke mortality, suggesting shared risk factors for these adverse outcomes. Efforts to promote cerebrovascular and cognitive health should be directed to the Stroke Belt.

AB - Objective: To determine whether incidence of impaired cognitive screening status is higher in the southern Stroke Belt region of the United States than in the remaining United States. Methods: A national cohort of adults age ≥45 years was recruited by the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study from 2003 to 2007. Participants' global cognitive status was assessed annually by telephone with the Six-Item Screener (SIS) and every 2 years with fluency and recall tasks. Participants who reported no stroke history and who were cognitively intact at enrollment (SIS >4 of 6) were included (N = 23,913, including 56% women; 38% African Americans and 62% European Americans; 56% Stroke Belt residents and 44% from the remaining contiguous United States and the District of Columbia). Regional differences in incident cognitive impairment (SIS score ≤4) were adjusted for age, sex, race, education, and time between first and last assessments. Results: A total of 1,937 participants (8.1%) declined to an SIS score a;circ4 at their most recent assessment, over a mean of 4.1 (±1.6) years. Residents of the Stroke Belt had greater adjusted odds of incident cognitive impairment than non-Belt residents (odds ratio, 1.18; 95% confidence interval, 1.07-1.30). All demographic factors and time independently predicted impairment. Interpretation: Regional disparities in cognitive decline mirror regional disparities in stroke mortality, suggesting shared risk factors for these adverse outcomes. Efforts to promote cerebrovascular and cognitive health should be directed to the Stroke Belt.

UR - http://www.scopus.com/inward/record.url?scp=80051546619&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=80051546619&partnerID=8YFLogxK

U2 - 10.1002/ana.22432

DO - 10.1002/ana.22432

M3 - Article

VL - 70

SP - 229

EP - 236

JO - Annals of Neurology

JF - Annals of Neurology

SN - 0364-5134

IS - 2

ER -