Clinical factors associated with dementia in ischaemic stroke.

Abstract

SUMMARY 71 patients with an ischaemic stroke were studied. The patients were separated into two groups on the basis of the results of clinical investigation, computed tomography and psychological testing (WAIS). 40 patients showed an early dementia and 31 were without mental impairment. The mean age was 57 years in the demented group and 54 years in the non-demented group. The mean duration of the history of cerebrovascular disease was also not statistically different in both groups. The frequency of strokes was identical since 50 % of the patients in both groups had more than one stroke. The history of neurological symptoms together with the neurological deficits seen on admission were distributed evenly. The dominant hemisphere was more often diseased in the demented group. Bilateral symptoms were also more common in the demented stroke patients. The WAIS showed a similar IQ in both groups but the deterioration index was significantly altered in the demented group. Hypertension was the only risk factor which differed between both groups. Cardiac disease, diabetes, viscosity and fibrinogen did not differ in both groups. The CT showed more normal scans in the non-demented group, the distribution of atrophy on its own and infarction in the left or right hemisphere were both inconclusive, whilst patients with bilateral infarcts were more common in the dementia group. Also, generalised atrophy in combination with an infarct was found more often in the demented patients.Epidemiological studies have shown that dementia is present in between 4-4-8% of the population over the age of 65 years.'-3 The occurrence of dementia increases with age, from 2-3% in people of 65-69 years to 22 % in those aged 80 years or older.' Pathological studies have shown that dementia is caused by primary degenerative disease in 50 % of the cases in contrast to 20-22% being caused by cerebrovascular disease.4 5 Clinical investigations, however, have shown cerebrovascular disease to be the cause of dementia more often than primary degenerative disease.2 6 Because only some patients with cerebrovascular disease eventually develop dementia, it would seem important to study the processes leading to, or associated with, dementia. This type of dementia was called "multi-infarct" dementia because it is Address for reprint requests: G Ladurner,

Clinical Determinants of Poststroke Dementia

“…Major dominant stroke syndrome was also a predictor of dementia independent of the effect of dysphasia in the present study, which agrees with the findings of Tatemichi et al 6 and Ladurner et al 8 Left hemispheric stroke localization was also more common in demented patients, as shown previously. 6,9 In the series of Censori et al, 7 dominant hemisphere stroke was more frequent among the demented than nondemented patients (80.0% versus 50.6%), but the independent correlates were total anterior circulation stroke and frontal lesions.…”

“…In both series the frequency of dysphasia was close (8.9% versus 9.7%), but in our study the percentage of demented patients with dysphasia was higher (20.6% versus 12.6%). In the series of Ladurner et al 8 (nϭ71, demented nϭ41), dysphasia was also more frequent in the demented subjects. Furthermore, in a smaller series (nϭ110, demented nϭ15) focused on dementia after first-ever stroke, dysphasia was also independently associated with dementia.…”

Cranial computed tomographic observations in multi-infarct dementia. A controlled study.

“…32 - 34 Ladurner and colleagues 32 studied 71 patients with ischemic stroke; 40 patients showed early dementia and 31 were without mental impairment. The mean age, mean duration of cerebrovascular disease, frequency of strokes, and history of neurological symptoms and neurological deficits were comparable in the two groups.…”

Frequency and Determinants of Poststroke Dementia in Chinese

“…Vascular risk factors for PSDE include myocardial infarction, 17 hypertension, 18 diabetes mellitus, 13,15 nephropathy, atrial fibrillation, 11 and previous stroke. 9,13 A host of strokerelated factors has also been identified such as stroke severity 11,16 ; infarcts caused by arteriosclerosis of large arteries 17 ; cerebral atrophy; the number, volume, laterality, and location of lesion(s) with particular reference to the extent of white matter damage; vascular territory involvement 9,14 ; and hemispheric 13 and cortical involvement.…”