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Memory and thinking ability keep getting worse for years after a stroke

By smallory, 11/04/2017

ANN ARBOR, Mich. -- A stroke happens in an instant. And many who survive one report that their brain never works like it once did. But new research shows that these problems with memory and thinking ability keep getting worse for years afterward – and happen faster than normal brain aging.  After a stroke, memory and thinking ability continue to decline - faster than for non-stroke survivors. Stroke survivors also had a faster rate of developing cognitive impairment over the years after stroke compared to their pre-stroke rate.


The study results are published in the Journal of the American Medical Association this week.  Lead author Deborah A. Levine, M.D., M.P.H., of the University of Michigan Medical School and VA Ann Arbor Healthcare System and her U-M colleagues used data from 23,572 Americans aged 45 years or older from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study led by the University of Alabama at Birmingham and funded by the National Institutes of Health.  “We found that stroke is associated with cognitive decline over the long-term,” says Levine. “That is, survivors had accelerated and persistent declines in memory and thinking ability during the years after stroke -- even after accounting for their cognitive changes before and early after the event.”  



Participants had no history of cognitive impairment when they entered the large population-based study in the mid-2000s. They had tests of their memory and thinking ability at the beginning of the study and at regular intervals during follow-up. They were monitored twice per year for acute stroke events; suspected strokes were confirmed by study physicians using medical records.

Over the next six to 10 years, 515 of them had a stroke, and researchers compared their test results with those from the 23,057 who remained stroke-free.  Because they had information on how stroke survivors’ memory and thinking ability changed over time before the stroke, Levine and her colleagues could separate the declines in brain function associated with aging from declines in brain function associated with stroke.  In their study, stroke was associated with declines in global cognition, new learning, and verbal memory early after stroke as well as accelerated and persistent declines in global cognition and thinking ability over the years after the event.


“Stroke is common, costly, and disabling, and cognitive decline is a major cause of disability in stroke survivors,” says Levine, who holds faculty appointments in internal medicine and neurology at U-M. “Yet cognitive decline after stroke has not received enough attention. We hope these findings will shine a spotlight on stroke survivors’ long-term cognitive needs.”




The findings suggest a need for better long-term follow-up care for the nation’s 7 million stroke survivors, including therapy to retain or even regain cognitive ability.  “Our results suggest that stroke survivors warrant monitoring for mounting cognitive impairment over the years after the event,” says Levine. “Health systems and payers will need to develop cost-effective systems of care that will best manage the long-term needs and cognitive problems of this growing and vulnerable stroke survivor population.


In addition to Levine, the study’s authors are U-M’s Andrzej T. Galecki, M.D., Ph.D., Kenneth M. Langa, M.D., Ph.D., Mohammed U. Kabeto, M.S., and Bruno Giordani, Ph.D.; Indiana University’s Frederick W. Unverzagt, Ph.D.; and UAB School of Medicine’s Virginia G. Wadley, Ph.D.  Levine, Langa and Kabeto are members of the Division of General Medicine; Langa also holds a position in the U-M Institute for Social Research and Galecki and Langa both have a dual faculty appointment in the U-M School of Public Health. Giordani is a neuropsychologist in the U-M Department of Psychiatry.



Levine is a member of the U-M Comprehensive Stroke Program, which includes treatment for stroke from emergency care to long-term follow-up and is certified as a Comprehensive Stroke Center. Langa and Levine are members of the U-M Institute for Healthcare Policy and Innovation. Levine, Langa and Kabeto are members of the VA Center for Clinical Management Research.  Patients interested in learning more about stroke care at the U-M Health System should call 1-888-287-1082 or visit www.uofmehealth.org/stroke.




    Deborah Levine, M.D., MPH

                                                                                                           Deborah Levine, M.D., MPH

Levine and her colleagues also suggest that their results mean long-term cognitive ability could be a new marker for measuring the effects of therapies to treat the initial effects of stroke. Levine and her colleagues note that research is needed to determine whether the acute and also accelerated long-term cognitive declines after stroke are the result of incomplete rehabilitation from the initial stroke, subsequent brain injury due to uncontrolled risk factors, behavioral changes, or other mechanisms.   The research was funded by the National Institute for Neurological Disorders and Stroke and by the National Institute on Aging (NS041588 and AG040278). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the U.S. Department of Veterans Affairs.






I'm glad I read this!  I'm just a little past the two-year mark, and I've been noticing more and more "little things" that aren't my usual sharp mind.  I've been to a speech therapist twice, once right after the stroke and the other time about a year later, and they both laughed at how perfectly I performed on their tests.  But I know something's not right.  Maybe I did really well for an average person, but I have a pretty quick mind and it's not as quick as it was before the stroke.  Also, I'm noticing more and more that I can only think about one thing at a time.  If a second idea pops into my awareness, the first one is completely lost.  I walk off and leave things half finished because I thought of something else and just turned around and started doing it instead.  I don't realize I did that until later when I walk by the first thing that isn't finished.  I stop to finish it, and whatever I was on my way to do doesn't get done because I've already forgotten it.  This is not the same "me" who kept her entire client-based schedule in her head for months at a time and could direct choirs, ensembles, and plays (try to do THAT without thinking about 20 things at once!).  Or trying to do math - my friends used to call me a human calculator, but now when I have a simple math problem (like, $7.99 is 20% off), my brain just gives a big sigh and goes blank, like it's just too exhausting to think through this problem.  I can force my way through it, but three other people will have come up with the answer before I can - not my norm!


Sorry, I'm going on and on, but I'm just starting to realize this lately, and I haven't really had a chance to talk about it.  This article is very exciting to me, because it says I'm not crazy - I can go back to the speech therapist again without feeling stupid!  Thanks for posting this!

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I'm living this truth on a daily basis; my stroke was in 1996.  My short term memory has gotten really bad, and there are times when I'm talking or thinking, and I just go blank.  :confused:  (Word retrieval can be interesting!) 


I try and do something every day to 'exercise' my brain; lately that's been jigsaw puzzles.  Sites like 'lumosity.com' can help a lot.

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thank you for this article. Makes sense .....:yikes:...... I'm not going crazy ( ier) lol

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