Association of Stroke With Dementia, Cognitive Impairment, and Functional Disability in the Very Old

Abstract

Background and Purpose-Stroke is a major cause of disability in the elderly and is also related to the development of dementia, which is another important source of disability in old age. The aim of the present study was to examine the potential impact of stroke on cognitive and functional status in a community-based cohort of individuals aged 75 years and older. Methods-The data were derived from a cross-sectional survey on aging and dementia that included all inhabitants of the Kungsholmen district in central Stockholm who were aged Ն75 years. Cases of stroke were identified through the computerized inpatient register system that has been widely used to study stroke in Sweden. Dementia was defined according to the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised. Dementia onset was considered the appearance, according to an informant, of the first symptom. Cognitive impairment without dementia was defined as the presence of a Mini-Mental State Examination score of Ͻ24 and the absence of dementia. Functional disability was assessed according to Katz Index of independence in activities of daily living. Results-The prevalence of stroke was 10.0% in men and 8.0% in women. One third of stroke survivors were diagnosed as demented, which was 3 times higher than those without stroke: adjusted odds ratio (OR) was 3.6 (95% confidence interval, 2.5 to 5.8). Stroke was also significantly related to cognitive impairment without dementia (adjusted OR, 2.4 [95% confidence interval, 1.3 to 4.6]). The population-attributable risks of dementia and cognitive impairment in relation to stroke were 18.4% and 8.5%, respectively. Among the 49 stroke patients with dementia, 15 cases (30.6%) had missing information on dementia onset, 22 (44.9%) had been reported by the informant to have dementia-related symptoms after or close to the occurrence of stroke, and 12 (24.5%) had symptoms before stroke occurrence. The prevalence rates of disability in activities of daily living were much higher among stroke patients than among stroke-free subjects, even after adjustment for age, sex, heart disease, hip fracture, and dementia: the corresponding adjusted ORs for bathing, dressing, toileting, transfer, and continence were 3.5 (2.4 to 5.3), 2.2 (1.4 to 3.3), 3.0 (2.0 to 4.5), 3.3 (1.9 to 5.7), and 2.1 (1.3 to 3.3), respectively. After dementia and hip fracture, stroke was the third largest contributor to disability in bathing, dressing, and transfer. Stroke was the second contributor to disability in toileting. Conclusions-Stroke is strongly associated with dementia, although it may relate to dementia in different ways: it can be the main cause or a precipitating factor of dementia, or they may share common etiological bases. Together with dementia and hip fracture, stroke is a major contributor to disability in most aspects of activities of daily living in very old people.

A quantitative systematic review of domain-specific cognitive impairment in lacunar stroke

“…Although age and prior stroke did not significantly account for heterogeneity across studies in the present systematic review, these factors are well-recognized predictors of cognitive impairment. Specifically, both increasing age and increased lacunar burden are associated with greater cognitive decline 53,54 and their potential impact on cognitive impairment merits further study. Thus, future work would benefit from the use of sample sizes sufficient to allow for both adjusted and subgroup analyses; study designs that account and report on factors shown to moderate potential factors of heterogeneity, including type of neuropsychological protocol (single vs composite measure), age, time since stroke, study design (cross-sectional vs longitudinal), and history of prior stroke; and the explicit exploration of the impact of these factors on measures of poststroke cognitive decline.…”

Reducing Attention Deficits After Stroke Using Attention Process Training

“…[2][3][4][5][6][7][8] Impaired attention is the "most prominent" stroke-related neuropsychological change, 1 with rates of up to 46% to 92% reported in acute stroke survivors. 9,10 Impaired attention can reduce cognitive productivity when other cognitive functions are intact 11 and is key to learning motor skills.…”

Cognitive Impairment in Lacunar Strokes

“…In cohort studies, the relative risk for dementia after stroke is between two and four compared to age-matched healthy persons. [30][31][32] Regarding LACS, the severity of cognitive impairment seems to be related to the severity of leukoaraiosis. 13,33 Even if LACS often are mild, they may be associated with cognitive impairment on longer term, more so than other types of strokes.…”