Clinical Determinants of Poststroke Dementia

Abstract

Background and Purpose-Frequency of poststroke dementia is high, and stroke considerably increases the risk of dementia.The risk factors for dementia related to stroke are still incompletely understood. We sought to examine clinical determinants of poststroke dementia in a large well-defined stroke cohort. Methods-The study group comprised 337 of 486 consecutive patients aged 55 to 85 years who 3 months after ischemic stroke completed a comprehensive neuropsychological test battery and MRI, including structured medical, neurological, and laboratory evaluations; clinical mental status examination; interview of a knowledgeable informant; detailed history of risk factors; and evaluation of stroke type, localization, and syndrome. The DSM-III definition for dementia was used. Results-Frequency of any poststroke dementia was 31.8% (107/337), that of stroke-related dementia (mixed Alzheimer's disease plus vascular dementia excluded) was 28.4% (87/306), and that of dementia after first-ever stroke was 28.9% (79/273). The patients with poststroke dementia were older and more often had a low level of education, history of prior cerebrovascular disease and stroke, left hemispheric stroke (reflecting laterality), major dominant stroke syndrome (reflecting laterality and size), dysphasia, gait impairment, and urinary incontinence. The demented patients were also more frequently current smokers, had lower arterial blood pressure values, and more frequently had an orthostatic reaction compared with the nondemented stroke patients. The correlates of dementia in logistic regression analysis were dysphasia (odds ratio [OR], 5.6), major dominant stroke syndrome (OR, 5.0), history of prior cerebrovascular disease (OR, 2.0), and low educational level (OR, 1.1). When we excluded those with cerebrovascular disease plus Alzheimer's disease or those with recurrent stroke, the order of correlates remained the same. When the patients with dysphasia (nϭ30) were excluded, the correlates were major dominant syndrome (OR, 4.6) and low educational level (OR, 1.1). Conclusions-Our data suggest that a single explanation for poststroke dementia is not adequate; rather, multiple factors including stroke features (dysphasia, major dominant stroke syndrome), host characteristics (educational level), and prior cerebrovascular disease each independently contribute to the risk. (Stroke. 1998;29:75-81.)

Cerebral complications of hypertension

“…107 The main risk factors for white matter lesions are hypertension, particularly high systolic blood pressure, 101,108,109 although some authors have reported either no or an inverse association with blood pressure. 94,110,111 White matter lesions have also been associated with vascular risk factors including history of stroke, 105,110 heart disease, 105,110 atrial fibrillation 110 and diabetes mellitus. 112 The main hypothesis regarding the cause of white matter lesions is that long-standing hypertension may cause lipohyalinosis and thickening of the vessel walls with narrowing of the lumen of the small perforating arteries which could lead to ischaemia in the terminal distribution territories of these vessels, ie, deep white matter.…”

“…138,142,[144][145][146][147] Risk factors for post-stroke dementia At least three different groups of factors, each acting independently, rather than a single pathophysiological mechanism probably contribute to the development of post-stroke dementia: 111,148 (1) stroke-related factors such as the location and the severity of the brain lesions; 149,150 (2) the overall cardiovascular risk profile as determined by the presence of atrial fibrillation 140 or diabetes mellitus; 149 (3) non-strokerelated factors similar to those found in Alzheimer's disease including increasing age, 149,151 low education, 149 cortical atrophy. 145,152 Hypertension has been identified as a risk factor by Pohjasvaara et al (1998), 111 but not by Skoog et al (1996). 101 In addition to those risk factors, coexisting Alzheimer's disease pathology may also play a role, as indicated 146 9.6 Andersen et al, 1996 147 5.5 Kokmen et al, 1996 138 8.4 Hénon et al, 1997 144 16.3 Pohjaasvara et al, 1997 142 12.2…”

Short Telomeres in Patients with Vascular Dementia: An Indicator of Low Antioxidative Capacity and a Possible Risk Factor?

“…Controversy exists regarding the association of the ApoE⑀4 allele with VaD (Chapman et al, 1998;Marin et al, 1998), leading to the conclusion that ApoE is not a robust prognostic factor for this disease. In fact, despite its high incidence, no specific risk factors for VaD are known (Pohjasvaara et al, 1998). The distribution of ApoE polymorphisms was tested in a random subgroup of 75 patients (Table 1).…”

Severe carotid artery stenosis evaluated by ultrasound is associated with post stroke vascular cognitive impairment

“…The age and large artery stroke were observed to be significantly different in those patients. Our findings are in accordance with the results of previous works (Desmond et al., 2000; Patel, Coshall, Rudd, & Wolfe, 2002; Pohjasvaara et al., 1998; Rockwood, 2002). In contrast, Auperin et al.…”