The convergence of stroke and dementia

Abstract

Neurological disorders account for the most Disability Adjusted Life Years (DALY's) -of the Global Burden of Disease (10%). More than half of neurological DALY's result from the combination of stroke (42%) and dementia (10%). The two pose risk for each other and share the same predisposing factors. A stroke doubles the risk of dementia. The close interactions call for convergent approaches. Stroke and dementia also converge at the microscopic level. The neurovascular unit has emerged as a key organizational structure of the brain. Involvement of any of its elements affects all the others. Thus, neurodegeneration impairs the microcirculation and disturbances of the microcirculation accelerate neurodegeneration. Evolving technologies allow “in vivo” imaging of the usual mixture of vascular and neurodegenerative pathology of the elderly that makes them prone to stroke and dementia. Since they occur together, they should be prevented together with a multimodal approach of lifestyle changes and mechanistic therapeutic targets. The two fields are also converging at the policy level. The World Stroke Organization has updated its Proclamation to include potentially preventable dementias that has been endorsed by Alzheimer Disease International, The World Federation of Neurology, the American Academy of Neurology and 20 international, regional and national organizations. Those interested in stroke and those dealing with dementia should work together where they can, differ where they must, with the common aim of preventing jointly, both stroke and dementia.

Explore the correlation between cerebral vessel characteristics with cognitive impairment among elder individuals: a community study from China

“…The risk factors for dementia overlap with those for stroke, indicating shared pathological mechanisms [ 43 ]. The risk factors for both vascular and Alzheimer’s dementia include increasing age, female sex as well as hypertension and diabetes [ 1 ].…”

Blood Neutrophil-to-Lymphocyte Ratio as a Predictor of Cerebral Small-Vessel Disease

“…Cohort studies in community-living older people have shown that the prevalence of visible WMHs is 50–98% [ 3 ]. It also causes serious and lasting damage to cognitive, emotional, sleep, and motor function [ 4 , 5 ]. The pathogenesis of CSVD has not yet been fully elucidated.…”

Absence of an Association between Macular Degeneration and Young-Onset Dementia

“…The estimated prevalence rates of YOD in various studies are much lower, about 42-77 per 100,000 population in the 30-65 age-group, and 98-163.1 per 100,000 in the 45-64 group [4][5][6][7]. Senile dementia and YOD share many risk factors, such as age [8,9], sex [10,11], smoking [12][13][14], alcohol use [15][16][17], stroke [18,19], traumatic brain injury [14,20,21], cardiovascular diseases [22,23], diabetes mellitus [24,25], obesity [26,27], dyslipidemia [28,29], and hereditary factors [30,31].…”