Prospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Neurol. Mar 28, 2016; 6(1): 14-22
Published online Mar 28, 2016. doi: 10.5316/wjn.v6.i1.14
Predictors of future stroke in adults 60-64 years living in the community
Nicolas Cherbuin, Leeanne Carey, Moyra Mortby, Kaarin J Anstey
Nicolas Cherbuin, Moyra Mortby, Kaarin J Anstey, Centre for Research on Ageing, Health and Wellbeing, Australian National University, Canberra, ACT 2601, Australia
Leeanne Carey, Neurorehabilitation and Recovery, Stroke Division, the Florey Institute of Neuroscience and Mental Health, Melbourne, VIC 3083, Australia
Leeanne Carey, Department of Occupational Therapy, La Trobe University, Bundoora, VIC 3083, Australia
Author contributions: Cherbuin N contributed to the design of the study, conducted all statistical analyses, managed all aspects of manuscript preparation and submission and approved the final version; Carey L and Anstey KJ contributed to the design of the study and interpretation of the findings, provided methodological input, contributed to the drafting and editing of the manuscript and approved the final version; Mortby M contributed to the interpretation of the findings, the drafting and editing of the manuscript and approved the final version.
Supported by The Dementia Collaborative Research Centre; the Centre for Excellence in Ageing Research; National Health and Medical Research Council of Australia, Nos. 973302, 179805, 157125; Australian Research Council, No. 130101705; Cherbuin N is funded by Australian Research Council Future Fellowship, No. 120100227; Mortby M by an Alzheimer Australia Foundation Fellowship; Anstey KJ by National Health and Medical Research Council Fellowship, No.1002560; Carey L by Australian Research Council Future Fellowship, No. 0992299; the James S. McDonnell Foundation 21st Century Science Initiative in Cognitive Rehabilitation -Collaborative Award, No. 220020413; and the Victorian Government’s Operational Infrastructure Support Program.
Institutional review board statement: The study was reviewed and approved by the Australian National University Ethics Committee.
Clinical trial registration statement: Not applicable.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to the study enrollment.
Conflict-of-interest statement: The authors have reported no conflict of interest.
Data sharing statement: While the study’s ethical agreements do not cover unconditional data sharing, relevant de-identified data can be obtained from the authors for review purposes.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Nicolas Cherbuin, PhD, Centre for Research on Ageing, Health and Wellbeing, Australian National University, 54 Mills Road, Canberra, ACT 2601, Australia. nicolas.cherbuin@anu.edu.au
Telephone: +61-2-61253858 Fax: +61-2-61251558
Received: May 15, 2015
Peer-review started: May 24, 2015
First decision: September 28, 2015
Revised: November 27, 2015
Accepted: January 5, 2016
Article in press: January 7, 2016
Published online: March 28, 2016
Processing time: 315 Days and 1.4 Hours
Abstract

AIM: To investigate predictors of incident stroke in a large epidemiological sample of cognitively healthy individuals in their early 60’s.

METHODS: Cardiovascular (systolic and diastolic blood pressure, hypertension status and medication, body mass index, lung forced vital capacity), lifestyle (alcohol intake, smoking, physical activity), mental health (anxiety and depression status, medication and symptomatology), cognition (executive function, processing speed, working memory, sensorimotor skills), and personality measures (behavioural inhibition and activation, positive and negative affect, neuroticism, psychoticism, extraversion) were investigated as predictors of incident stroke in 1774 participants from the Personality and Total Health Through Life Project over an 8-year follow-up. Logistic regression analyses controlled for age, gender, and education were conducted in the whole cohort as well as in case-control sub-analyses including precisely matched controls to identify factors associated with stroke incidence.

RESULTS: The cohort selected had a mean age of 62.5 years (SD = 1.5) and was 48.6% female with an average of 14.1 years of education (SD = 2.6). When 28 individuals with incident stroke were compared to 1746 cognitively healthy individuals in multivariate logistic regression analyses the only significant predictors of stroke across the five domains considered (cardiovascular, lifestyle, mental health, cognition, personality) and after controlling for gender, age, and education were systolic blood pressure (per unit above 140 mmHg: OR = 1.04, 95%CI: 1.01-1.07, P = 0.002), smoking (trend OR = 2.28, 95%CI: 0.99-5.24, P = 0.052), and sensorimotor skills (purdue pegboard: OR = 0.80, 95%CI: 0.62-0.96, P = 0.037). Similarly, in matched-control analyses significant group differences were found for systolic blood pressure (P = 0.001), smoking (P = 0.036), and sensorimotor skills (P = 0.028).

CONCLUSION: Identified predictors of incident stroke in community-living individuals included high systolic blood pressure and smoking - but also, sensorimotor performance, a measure which has not yet been reported in the literature.

Keywords: Smoking; Fine motor skills; Longitudinal; Epidemiology; Hypertension; Cognition; Personality; Stroke

Core tip: An investigation of incident stroke predictors in community-living individuals in their 60’s revealed that systolic blood pressure, smoking, and impaired sensorimotor skills were most predictive of future stoke. Every 10 mmHg above 140 was associated with a 40% increased risk and smoking was associated with a more than two-fold increased risk. While both blood pressure and smoking are known risk factors for stroke, impaired sensorimotor skills is a promising novel bio-marker which needs further investigation and may be useful in identifying those at risk.