Introduction: Stroke is closely related to cognitive function, and many patients experience cognitive impairment after stroke; however, whether cognitive impairment is associated with an increased risk of stroke remains inconclusive. This study aims to investigate whether cognitive impairment is associated with new-onset stroke (first ever nonfatal stroke) using a national prospective study. Methods: Data from the China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2018 were used. A total of 11,961 Chinese participants aged ≥45 years without a history of stroke were included in the present study and divided into a cognitive impairment group and a normal group according to the baseline cognitive score. Logistic regression analysis was used to analyse the association between baseline cognitive function and new-onset stroke. Results: During the 6.96-year follow-up period, 875 participants experienced new-onset stroke. Compared with the cognitively normal group, the odds ratio (95% confidence intervals) for new-onset stroke in the cognitively impaired group was 1.21 (1.04, 1.40) when not adjusted for confounders and 1.22 (1.01, 1.48) after adjusting for established confounding factors, including demographic data, medical history, physical examination, and laboratory indicators. Conclusion: Cognitive impairment was associated with new-onset stroke among middle-aged and elderly Chinese individuals. Further studies should be carried out to confirm the causal relationship between cognitive impairment and stroke.

1.
GBD 2019 Stroke Collaborators. Global, regional, and nationa burden of stroke and its risk factors, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol. 2021 Oct;10(20):795–820.
2.
Wang W, Jiang B, Sun H, Ru X, Sun D, Wang L, et al. Prevalence, incidence, and mortality of stroke in China: results from a nationwide population-based survey of 480 687 adults. Circulation. 2017;135(8):759–71.
3.
Kim AS, Cahill E, Cheng NT. Global stroke belt: geographic variation in stroke burden worldwide. Stroke. 2015 Dec;46(12):3564–70.
4.
Jia L, Du Y, Chu L, Zhang Z, Li F, Lyu D, et al. Prevalence, risk factors, and management of dementia and mild cognitive impairment in adults aged 60 years or older in China: a cross-sectional study. Lancet Public Health. 2020 Dec;5(12):e661–71.
5.
Zhu L, Fratiglioni L, Guo Z, Winblad B, Viitanen M. Incidence of stroke in relation to cognitive function and dementia in the Kungsholmen Project. Neurology. 2000 Jun 13;54(11):2103–7.
6.
Chi NF, Chien LN, Ku HL, Hu CJ, Chiou HY. Alzheimer disease and risk of stroke: a population-based cohort study. Neurology. 2013 Feb 19;80(8):705–11.
7.
Rajan KB, Aggarwal NT, Wilson RS, Everson-Rose SA, Evans DA. Association of cognitive functioning, incident stroke, and mortality in older adults. Stroke. 2014 Sep;45(9):2563–7.
8.
Heshmatollah A, Dommershuijsen LJ, Fani L, Koudstaal PJ, Ikram MA, Ikram MK. Long-term trajectories of decline in cognition and daily functioning before and after stroke. J Neurol Neurosurg Psychiatry. 2021 Nov;92(11):1158–63.
9.
Wu X, Fan L, Ke S, He Y, Zhang K, Yang S. Longitudinal associations of stroke with cognitive impairment among older adults in the United States: a population-based study. Front Public Health. 2021;9(9):637042.
10.
de Moraes SA, Szklo M, Tilling K, Sato R, Knopman D. Cognitive functioning as a predictor of ischemic stroke incidence. Epidemiology. 2003 Nov;14(6):673–9.
11.
Zhao Y, Hu Y, Smith JP, Strauss J, Yang G. Cohort profile: the China Health and retirement longitudinal study (CHARLS). Int J Epidemiol. 2014 Feb;43(1):61–8.
12.
Xiong S, Liu S, Qiao Y, He D, Ke C, Shen Y. Estimation of losses of quality-adjusted life expectancy attributed to the combination of cognitive impairment and multimorbidity among Chinese adults aged 45 years and older. BMC Public Health. 2021 Jan 5;21(1):24.
13.
Lo JW, Crawford JD, Desmond DW, Bae HJ, Lim JS, Godefroy O, et al. Long-Term cognitive decline after stroke: an individual participant data meta-analysis. Stroke. 2022 Apr;53(4):1318–27.
14.
Stephan BCM, Richardson K, Savva GM, Matthews FE, Brayne C, Hachinski V. Potential value of impaired cognition in stroke prediction: a U.K. Population-based study. J Am Geriatr Soc. 2017 Aug;65(8):1756–62.
15.
Heshmatollah A, Mutlu U, Koudstaal PJ, Ikram MA, Ikram MK. Cognitive and physical impairment and the risk of stroke: a prospective cohort study. Sci Rep. 2020 Apr 14;10(1):6274.
16.
Sabayan B, Gussekloo J, de Ruijter W, Westendorp RG, de Craen AJ. Framingham stroke risk score and cognitive impairment for predicting first-time stroke in the oldest old. Stroke. 2013 Jul;44(7):1866–71.
17.
Lee M, Saver JL, Hong KS, Wu YL, Liu HC, Rao NM, et al. Cognitive impairment and risk of future stroke: a systematic review and meta-analysis. CMAJ. 2014 Oct 7;186(14):E536–46.
18.
Rabin JS, Schultz AP, Hedden T, Viswanathan A, Marshall GA, Kilpatrick E, et al. Interactive associations of vascular risk and β-amyloid burden with cognitive decline in clinically normal elderly individuals: findings from the harvard aging brain study. JAMA Neurol. 2018 Sep 1;75(9):1124–31.
19.
Heshmatollah A, Fani L, Koudstaal PJ, Ghanbari M, Ikram MA, Ikram MK. Plasma beta-amyloid, total-tau, and neurofilament light chain levels and the risk of stroke: a prospective population-based study. Neurology. 2022 Apr 26;98(17):e1729–37.
20.
Jin X, He W, Zhang Y, Gong E, Niu Z, Ji J, et al. Association of APOE ε4 genotype and lifestyle with cognitive function among Chinese adults aged 80 years and older: a cross-sectional study. PLoS Med. 2021 Jun;18(6):e1003597.
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