Article Text

The relationship between executive dysfunction and post-stroke mortality: a population-based cohort study
  1. Bernice Wiberg1,
  2. Lena Kilander1,
  3. Johan Sundström2,
  4. Liisa Byberg3,4,
  5. Lars Lind2
  1. 1Department of Public Health and Caring Sciences/Geriatrics, Uppsala University, Uppsala, Sweden
  2. 2Department of Medical Sciences, Uppsala University, Uppsala, Sweden
  3. 3Department of Surgical Sciences/Orthopedics, Uppsala University, Uppsala, Sweden
  4. 4UCR-Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
  1. Correspondence to Dr Bernice Wiberg; bernice.wiberg{at}


Objectives To study the associations of pre-stroke cognitive performance with mortality after first-ever stroke or transient ischaemic attack (TIA).

Design A prospective cohort study.

Setting and participants In participants having first-ever stroke or TIA during up to 14 years of post-test follow-up (n=155), we investigated the associations of pre-stroke variables and cognitive test results with post-stroke survival. The study is based on those participants of the Uppsala Longitudinal Study of Adult Men who performed cognitive function tests at approximately age 70 (n=919).

Primary outcome measures Mortality after first-ever stroke or TIA related to pre-stroke executive performance.

Results Eighty-four (54%) of the first-ever stroke/TIA patients died under a median follow-up of 2.5 years after the event. In Cox proportional hazard analyses adjusting for age, education, social group and traditional stroke risk factors, poor performance in Trail Making Test (TMT)-A was related to mortality (HR 1.88 per SD, 95% CI 1.31 to 2.71, p=0.001). The risk of mortality was approximately threefold higher in the highest tertile compared with the lowest tertile (HR TMT-A= 2.90 per SD, 95% CI 1.24 to 6.77, p=0.014). A similar pattern was seen for TMT-B, but Mini-Mental State Examination results were not related to risk of post-stroke mortality.

Conclusion Executive performance measured by TMT-A and -B before stroke was independently associated with long-term risk of mortality, after first-ever stroke or TIA in a population-based study of older men.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: and

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  • To cite: Wiberg B, Kilander L, Sundström J, et al. The relationship between executive dysfunction and post-stroke mortality: a population-based cohort study. BMJ Open 2012;2:e000458. doi:10.1136/bmjopen-2011-000458

  • Contributors BW gave substantial contributions to conception and design, was responsible for the statistical analyses, the interpretation of data and the writing of the manuscript. LK was deeply involved in acquisition of data, especially the cognitive testing and has given important comments to the manuscript. JS has given important support concerning the statistical analyses and revising of the article critically for important intellectual content. LB has been deeply involved in the statistical analyses and given important comments to the article. LL has given structure to the work in general and in choosing statistical analyses. All authors read and approved the final manuscript.

  • Funding This study was kindly supported by grants from the Medical Faculty at Uppsala University and STROKE-Riksförbundet.

  • Competing interests BW, LK and LB report no disclosures. JS serves on a scientific advisory board for Itrim. LL receives research support from AstraZeneca.

  • Ethics approval Ethics approval was provided by the ethics committee of Uppsala University.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement There are no additional unpublished data.