Background and Purpose Memory impairment is both a predictor and a consequence of stroke, but memory decline is common even in healthy elderly. We compared the long-term trajectory of memory functioning before and after stroke to memory change in stroke-free elderly. Methods Health and Retirement Study participants age 50+ (n=17,340) with no stroke history at baseline were interviewed biennially up to 10 years for first self- or proxy-reported stroke (n=1,574). Age-, sex-, and race- adjusted segmented linear regression models were used to compare annual rates of change in a composite memory score before and after stroke among three groups: 1,189 stroke survivors; 385 stroke decedents; and 15,766 cohort members who remained stroke-free. Results Before stroke onset, individuals who later survived stroke had significantly (p<0.001) faster average annual rate of memory decline (-0.143 points/year) than those who remained stroke-free throughout follow-up (-0.101 points/year). Stroke decedents had even faster pre-stroke memory decline (-0.212 points/year). At stroke onset, memory declined an average of -0.369 points among stroke survivors, comparable to 3.7 years of age-related decline in stroke-free cohort members. Following stroke, memory in stroke survivors continued to decline at -0.142 points/year, similar to their pre-stroke rate (p=0.93). Approximately 50% of the memory difference between stroke survivors shortly after stroke and age-matched stroke-free individuals was attributable to pre-stroke memory. Conclusions Although stroke onset induced large decrements in memory, memory differences were apparent years before stroke. Memory declines before stroke, especially among those who did not survive the stroke, were faster than declines among stroke-free adults.

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Background Post-stroke mortality is higher among residents of disadvantaged neighborhoods, but it is not known whether neighborhood inequalities are specific to stroke survival or similar to mortality patterns in the general population. We hypothesized that neighborhood disadvantage would predict higher post-stroke mortality and neighborhood effects would be relatively larger for stroke patients than for individuals with no history of stroke. Methods and Results Health and Retirement Study participants aged 50+ without stroke at baseline (n=15,560) were followed up to 12 years for incident stroke (1,715 events over 159,286 person-years) and mortality (5,325 deaths). Baseline neighborhood characteristics included objective measures based on census tracts (family income, poverty, deprivation, residential stability, and percent white, black or foreign-born) and self-reported neighborhood social ties. Using Cox proportional hazard models, we compared neighborhood mortality effects for people with versus without a history of stroke. Most neighborhood variables predicted mortality for both stroke patients and the general population in demographic-adjusted models. Neighborhood percent white predicted lower mortality for stroke survivors (HR=0.75 for neighborhoods in highest 25th percentile vs. below, 95 % CI: 0.62, 0.91) more strongly than for stroke-free adults (HR=0.92 (0.83, 1.02); p=0.04 for stroke-by-neighborhood interaction). No other neighborhood characteristic had different effects for people with versus without stroke. Neighborhood-mortality associations emerged within three months after stroke, when associations were often stronger than among stroke-free individuals. Conclusions Neighborhood characteristics predict post-stroke mortality, but most effects are similar for individuals without stroke. Eliminating disparities in stroke survival may require addressing pathways that are not specific to traditional post-stroke care.