Current view on post‐stroke dementia

Droś, Jakub; Klimkowicz‐Mrowiec, Aleksandra

doi:10.1111/psyg.12666

Cited by 17 publications

(19 citation statements)

References 113 publications

(213 reference statements)

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“…Interactions between cognitive and motor impairment attract more attention during the last years. Prevalence of post-stroke CI is high and varies from 19 to 92 %, depending on severity and the method used for its detection [2,3,24]. Upper extremity motor impairment is a leading factor that impacts long-term disability due to a major role of manual dexterity in patients' self-care and functional independence.…”

Section: Discussionmentioning

confidence: 99%

Effect of the complex physical therapy on the upper extremity function, functional independence and cognition in post-stroke patients

et al. 2021

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Motor dysfunction and cognitive impairment (CI) are the most prevalent and disabling among the stroke consequences. CI decreases the effectivity of motor rehabilitation, but motor dysfunction itself may also influence the manifestations and progression of CI. So development and study of novel physical therapy tactics, which are aiming to target both of these syndromes, becomes a subject of great interest nowadays. The aim of study was to evaluate the impact of different physical therapy approaches on the upper extremity function, cognition and functional independence in patients in 1 year after ischemic stroke. Materials and methods. Totally there were 72 patients examined in the 1-year period after first-ever anterior circulation ischemic stroke. Neurological status, upper extremity function and functional independence were assessed with the National Institutes of Health Stroke Scale (NIHSS), Fugl-Meyer assessment (FMA), modified Rankin Scale (mRS) and the Functional Independence Measurement (FIM). Cognitive function was assessed with the Montreal Cognitive Assessment (MoCA), Frontal Assessment Battery (FAB), Trail-making Test A and B tests (TMT). Patients in Group 1 received secondary stroke prevention therapy and performed the exercises complex for general muscle function improvement for 2 months; patients in Group 2 also performed the exercise complex for paretic hand function improvement for 2 months. Results. After 2 months of physical therapy a significant increase of the FIM “Self-care”, “Transfer” and therefore subtotal motor and total scores was observed in patients in Group 2; in Group 1 significant improvement was observed only in “Transfer” and subtotal motor scores. Adding of the hand exercise to the physical therapy complex (Group 2) appeared to be more beneficial for the upper extremity motor function. Patients in Group 2 after 2 months showed increase of the FMA “Wrist” score by 40 % (p<0.05), “Hand” score by 42.8 % (p<0.01) and “Total motor function” by 30.1 % (p<0.05), and the “Total motor function” score in Group 2 was 10.9 % higher in comparison with the Group 1 (p<0.05). In cognitive status significant differences compared to baseline level were observed only in Group 2; MoCA score increased by 14.3 % (p<0.05) and TMT-B performance time decreased by 14.8 % (p<0.05). Baseline MoCA score correlated with FMA “Wrist” (r=0.32; p=0.028), “Hand” (r=0.49; p=0.001) and “Total motor function” (r=0.46; p=0.004) scores. TMT-B score showed significant correlation with the FMA “Wrist” (r=-0.032; p=0.025), “Hand” (-0.45; p=0.009), “Speed/coordination” (r=-0.023; p=0.036) and “Total motor function” (r=-0.42; p=0.023). Conclusion. Adding of exercise for hand function improvement into the physical therapy complex for post-stroke patients contributes to better upper extremity motor performance and therefore is more favourable for patients’ functional independence. Upper extremity motor impairment, especially hand and wrist dysfunction, are associated with worse cognitive performance. Hand function and fine motor skills improvement could be beneficial for the patients’ cognition. Further research is needed in regard to the prognostic significance of these findings and their impact on the treatment and rehabilitation strategies.

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Section: Discussionmentioning

confidence: 99%

Effect of the complex physical therapy on the upper extremity function, functional independence and cognition in post-stroke patients

et al. 2021

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“…The general characteristics of various treatments for post-stroke complications are shown in Table 1. Thus far, there are no specific FDA approved pharmacological treatments for PSCID [16]. Several agents have been proved to be effective for vascular dementia, such as cholinesterase inhibitors (galantamine, donepezil, or rivastigmine), memantine and gingko biloba [135].…”

Section: Pharmacological Treatmentmentioning

confidence: 99%

Post-Stroke Neuropsychiatric Complications: Types, Pathogenesis, and Therapeutic Intervention

et al. 2023

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Almost all stroke survivors suffer physical disabilities and neuropsychiatric disturbances, which can be briefly divided into post-stroke neurological diseases and post-stroke psychiatric disorders. The former type mainly includes post-stroke pain, post-stroke epilepsy, and post-stroke dementia while the latter one includes post-stroke depression, post-stroke anxiety, post-stroke apathy and post-stroke fatigue. Multiple risk factors are related to these post-stroke neuropsychiatric complications, such as age, gender, lifestyle, stroke type, medication, lesion location, and comorbidities. Recent studies have revealed several critical mechanisms underlying these complications, namely inflammatory response, dysregulation of the hypothalamic pituitary adrenal axis, cholinergic dysfunction, reduced level of 5-hydroxytryptamine, glutamate-mediated excitotoxicity and mitochondrial dysfunction. Moreover, clinical efforts have successfully given birth to many practical pharmaceutic strategies, such as anti-inflammatory medications, acetylcholinesterase inhibitors, and selective serotonin reuptake inhibitors, as well as diverse rehabilitative modalities to help patients physically and mentally. However, the efficacy of these interventions is still under debate. Further investigations into these post-stroke neuropsychiatric complications, from both basic and clinical perspectives, are urgent for the development of effective treatment strategies.

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“…By definition, PSCI refers to all severities of cognitive impairment after stroke [6,7]. According to the results of previous studies, PSCI is common in patients with AIS, with the reported incidence of 30-50 % [8,9]. Clinically, patients with PSCI have poor quality of life [10].…”

Section: Introductionmentioning

confidence: 99%

Uric Acid and Cognitive Impairment in Patients with Acute Ischemic Stroke: A Meta-Analysis

et al. 2022

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Serum uric acid (UA) has been suggested to be correlated with outcomes after stroke. We performed a meta-analysis to evaluate the association between serum UA and post-stroke cognitive impairment (PSCI) in patients with acute ischemic stroke (AIS). Relevant observational studies were identified by search of electronic databases including PubMed, Embase, and Web of Science. A randomized-effect model incorporating the possible between-study heterogeneity was used to pool the results. Overall, eleven studies with 4246 patients of AIS were included, 2073 (48.8%) of them had PSCI. Pooled results showed that patients with PSCI had significantly higher level of serum UA as compared to those without PSCI (mean difference: 35.70 μmol/l, 95% confidence interval (CI): 8.36 to 63.01, p=0.01; I2=95%). Subgroup analysis showed significant higher level of serum UA in patients with PSCI evaluated during follow-up of 3 months to 3 years, but not for those evaluated during hospitalization (p for subgroup difference=0.01). In addition, results of meta-analysis also showed that compared to patients with lower serum UA, AIS patients with higher serum UA had increased risk of PSCI (odds ratio: 1.33, 95% CI: 1.02 to 1.73, p=0.04; I2=72%). Higher level of serum UA after disease onset may be a marker of increased risk of PSCI in patients with AIS. Although these findings need to be validated in large-scale prospective studies, the possible mechanisms underlying the association between UA and PSCI should be also investigated.

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Current view on post‐stroke dementia

Cited by 17 publications

References 113 publications

Effect of the complex physical therapy on the upper extremity function, functional independence and cognition in post-stroke patients

Effect of the complex physical therapy on the upper extremity function, functional independence and cognition in post-stroke patients

Post-Stroke Neuropsychiatric Complications: Types, Pathogenesis, and Therapeutic Intervention

Uric Acid and Cognitive Impairment in Patients with Acute Ischemic Stroke: A Meta-Analysis

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