Monday, April 21
Grant Miller: Managerial Incentives in Public Service Delivery
Levine, D., Mary Haan, Kenneth M. Langa, L. Morgenstern, J. Neuhaus, Amy K. Lee Boonstra, and L. Lisabeth. 2012. "Impact of Gender and Blood Pressure on Poststroke Cognitive Decline among Older Latinos." Journal of Stroke and Cerebrovascular Diseases, Available online 27 June 2012.
BACKGROUND: Poststroke cognitive decline (PSCD) is an important consequence of stroke that may be more severe in women than in men. The existence of any gender differences in PSCD among Mexican Americans, and their potential mechanisms, such as blood pressure (BP), remain unknown. We assessed PSCD stratified on gender in older Mexican Americans and explored the influence of pre- and poststroke systolic BP on PSCD. METHODS: Among 1576 nondemented, stroke-free adults 60 years of age or older when recruited between 1998 and 1999 in the Sacramento Area Latino Study on Aging (SALSA) cohort, we examined pre- and poststroke longitudinal changes in Spanish English Verbal Learning test scores (WL), a verbal memory test, and errors on the Modified Mini Mental State Examination (3MSE) scores, a global cognition test, stratified by gender, adjusting for baseline and time-varying covariates with linear mixed effects models. RESULTS: We identified 151 adults (mean age 72 +/- 8 years) with incident first-ever stroke during 10 years of follow-up. After adjustment for age, education, and time-varying depressive symptoms, 3MSE errors increased by 22% per year (95% confidence interval [CI] 6.8-36.7%) in men and 13.2% per year (95% CI 3.5-22.9%) in women over the poststroke period. Poststroke WL scores improved by 0.05 words per year (95% CI -0.24 to 0.33) in men and by 0.09 words per year (95% CI -0.16 to 0.34) in women. Results persisted after adjustment for time-varying systolic BP. CONCLUSIONS: Among this population of older Mexican Americans, PSCD did not differ by gender. We found no evidence that systolic BP influenced PSCD in women or men.
NIHMSID: NIHMS379083. (Pub Med Central)