Determining modifiable factors for post-stroke Vascular Cognitive Impairment and Dementia - Vascular cognitive impairment and dementia (VCID) after stroke increases risk for death and is highly disabling. New-onset VCID after stroke is common, affecting as many as one-third of stroke survivors. There are currently no treatments recommended to reduce VCID risk. Interventions to reduce risk of incident VCID after stroke are critically needed. One simple, inexpensive, accessible intervention that holds promise for VCID prevention among stroke patients is cognitively stimulating activities (such as reading, doing crossword puzzles, and word games). The performance of cognitively stimulating activities has been associated with lower risk of dementia in stroke-free adults. Whether the performance of cognitively stimulating activities after stroke reduces risk for VCID after stroke has not been elucidated. Other opportunities for practical interventions to prevent VCID may be available in the treatment of sleep disorders. Obstructive sleep apnea (OSA) is prevalent after stroke (~70% of stroke survivors) and disrupted sleep (more time spent in wakefulness during periods of attempted sleep) is more common after stroke than in stroke-free adults. Both OSA and disrupted sleep have been associated with cognitive decline in stroke-free adults, but their contribution to post- stroke VCID remains unclear. If these sleep disorders are similarly associated with VCID among stroke patients, other novel targets for VCID may become available. Currently, performance of cognitively stimulating activities and screening and treatment for sleep disorders are not standard of care. In this project, we will: 1) pool and harmonize longitudinal cohorts with repeated measures of cognition over time to quantify the association between the performance of cognitively stimulating activities after stroke and post-stroke cognitive decline and incident VCID. We will also leverage an established cohort of stroke participants with baseline post-stroke polysomnography measures to: 2) evaluate the association between post-stroke OSA, assessed by the apnea-hypopnea index and a threshold of hypoxemia, and post-stroke cognitive decline and incident VCID over 2 years post-stroke, and 3) evaluate the association between measures of disrupted sleep, assessed by wake after sleep onset and sleep efficiency, and post-stroke cognitive decline and incident VCID over 2 years post-stroke. This project is innovative because it will leverage and pool longitudinal cohorts with repeated measurements of cognition and cognitively stimulating activities. This project is significant because it is a step towards identifying a possible simple intervention (cognitively stimulating activities) and novel intervention targets (OSA and disrupted sleep) for post-stroke VCID.
