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Int J Geriatr Psychiatry. 2019 Dec;34(12):1792-1798. doi: 10.1002/gps.5194. Epub 2019 Aug 27.

Physical activities attenuate the negative cognitive impact from white matter hyperintensities in stroke and TIA patients with low education.

Wong A1,2, Yiu S1, Lam BYK1,2, Leung KT1, Shi L3, Lo E1, Abrigo J3, Au LW1,4,2, Lau A1, Mok V1,4,2.

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Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.
Therese Pei Fong Chow Research Centre for Prevention of Dementia, The Chinese University of Hong Kong, Hong Kong, China.
Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
Gerald Choa Neuroscience Centre, Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong, China.



The objective of this study is to examine the effects of recent regular participation leisure activities upon cognitive functions between 3 and 6 months after stroke or transient ischemic attack (TIA). We also explored whether the cognitive effects interacted with the severity of white matter hyperintensities (WMH), a marker of cerebral white matter disease, in patients with low or high education.


Two-hundred and ninety-two subjects with mean age of 66.1 (11.0) years were recruited at median 161(131-180) days post index event. WMH volume was evaluated using a semi-automated method on MRI brain. Cognitive functions were measured using the Montreal Cognitive Assessment (MoCA). Multivariable linear regression analysis was conducted to explore the associations between leisure activity participation with WMH and the moderating effects of leisure activities upon relationship between WMH and MoCA. Analyses were further stratified by low (<6 years) or high education (≥6 years). All models were adjusted with age, sex, and years of education.


Physical activity (PA), but not intellectual activity (IA), was negatively related to WMH volume (P < .05). IA exerted a main effect on MoCA performance (b = 3.21, P < .001). PA, but not IA, significantly interacted with WMH volume (b = -0.18, P < .01) on MoCA performance, but the interaction was only significant in the lower education group (b = 0.28, P < .01) but not in the higher education group.


In patients with stroke/TIA, IA confers general cognitive benefits. Regular participation in PA negatively correlated with WMH volume. In patients with low education, PA increases resilience against vascular cognitive impairment.


cognitive impairment; leisure activity; prevention; stroke; transient ischemic attack


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