Evolution of Cognitive Impairment After Stroke and Risk Factors for Delayed Progression

Ser, Teodoro del; Barba, Raquel; Morin, Maria M.; Domingo, J; Cemillán, Carlos; Pondal, Margarita; Vivancos, José

doi:10.1161/01.str.0000189626.71033.35

Cited by 141 publications

(99 citation statements)

References 44 publications

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“…The significant association between the APOE- ε 4 genotype and mixed VaD/AD and an increase in Aβ pathology in VaD cases is consistent with the well-established association between APOE- ε 4 and AD [13,38]. The association between the APOE- ε 4 genotype and stroke/infarct dementia or SIVD could also be explained by concurrent Aβ deposition.…”

Section: Discussionsupporting

confidence: 84%

Genetic Associations of Autopsy-Confirmed Vascular Dementia Subtypes

Jones

Kalaria

Sharp³

et al. 2011

Dement Geriatr Cogn Disord

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Background/Aims: Genetic risk factors have not been clearly established for vascular dementias (VaD) related to stroke and cerebrovascular disease. Methods: Samples were genotyped for APOE, MTHFR and ICAM. Aβ levels and choline acetyltransferase (ChAT) activities were assayed in controls and individuals with VaD. Results: Associations were found between the APOE-Ε4 allele and mixed dementia, infarct/stroke dementia and subcortical ischemic vascular dementia (SIVD), and higher Aβ1-42 levels and decreased ChAT activity. MTHFR was more associated with SIVD, mixed dementia, and lower ChAT activity. Conclusions: The study demonstrates important differences in the genetic associations of VaD and begins to clarify the genetic basis of key pathological substrates.

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Section: Discussionsupporting

confidence: 84%

Genetic Associations of Autopsy-Confirmed Vascular Dementia Subtypes

Jones

Kalaria

Sharp³

et al. 2011

Dement Geriatr Cogn Disord

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“…High rates of improvement from CIND (44%) and dementia (19%) were also found at 2 years after stroke in a Spanish study. 3 In contrast, cognitive improvement was not frequently observed in our stroke sample. Definitional differences may partly explain the varying results between these studies and ours.…”

Section: Discussioncontrasting

confidence: 54%

“…1,3 In a Singapore sample, 1 31% of patients with CIND at 6 months were cognitively intact at 1 year. High rates of improvement from CIND (44%) and dementia (19%) were also found at 2 years after stroke in a Spanish study.…”

Section: Discussionmentioning

confidence: 99%

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Long-Term Cognitive Transitions, Rates of Cognitive Change, and Predictors of Incident Dementia in a Population-Based First-Ever Stroke Cohort

Srikanth

Quinn

Donnan

et al. 2006

Stroke

104

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Background and Purpose-There are few data on long-term cognitive outcomes after first-ever stroke. We aimed to study long-term cognitive transitions, rates of cognitive change, and factors associated with incident dementia and cognitive impairment-no dementia (CIND) 2 years after first-ever stroke. Methods-A population-based cohort of incident first-ever stroke cases (nϭ99; mean age, 69.9 years) and an age-and sex-matched comparison group (nonstrokes, nϭ99) were followed up for 2 years by 3 serial examinations. Rates of cognitive change were compared by repeated-measures analyses. Factors associated with incident dementia and CIND at 2 years were determined by multinomial logistic regression. Results-Significant strokeϫtime interactions were present for all cognitive domains, with stroke cases showing a greater rate of decline compared with nonstrokes. Stroke recurrence during follow-up was responsible for significantly greater global decline. Strokes with recurrence (Pϭ0.02), age (Pϭ0.004), and baseline cognitive impairment (PϽ0.001) were independently associated with incident dementia at 2 years. Strokes without recurrence (Pϭ0.008), age (Pϭ0.001), and baseline cognitive impairment (PϽ0.001) were independently associated with CIND at 2 years. Conclusions-Recurrent stroke contributes importantly to global cognitive decline after a first-ever stroke. Secondary stroke prevention will be important in ameliorating dementia related to stroke. Mechanisms underlying the progression of early cognitive impairment to dementia in stroke patients need further investigation. (Stroke. 2006;37:2479-2483.)

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“…However, it is clear from these studies that not all patients who show early cognitive impairment after stroke will decline: many patients improve [79,80,81]. There is a suggestion that diabetic patients are less likely to improve than other patients and that initial attentional and executive deficits are less likely to get better than memory deficits.…”

Section: Risk Of Dementia After Strokementioning

confidence: 99%

Risk of Recurrent Stroke, Other Vascular Events and Dementia after Transient Ischaemic Attack and Stroke

Pendlebury

Rothwell²

2009

Cerebrovasc Dis

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The early risk of recurrence after transient ischaemic attack (TIA) or minor stroke is high, ranging from 11% at 7 days in population-based studies, where patients are seen non-urgently, to 3% at 7 days in studies where patients are seen urgently in specialist services. In long-term (up to 10 years) studies of vascular risks after TIA and stroke, the risk of stroke is highest early after the event, and then falls, whereas the risk of coronary events is constant over the follow-up period at around 2% per year. In contrast to the early risk after TIA and stroke, the long-term risks are more dependent on the underlying vascular risk factors than the characteristics of the event itself. Stroke is also associated with an increased risk of dementia. Prevalence of post-stroke dementia varies between studies but is around 28% at 3 months in hospital-based studies where pre-stroke dementia was not excluded and 18% in hospital-based studies excluding pre-stroke dementia. Risk factors for post-stroke dementia include low education, prior or recurrent stroke, and older age. In conclusion, available data suggest that the risk of recurrent vascular events is considerable after TIA and stroke, even in the longer term, and that there is also a high risk of dementia after stroke. However, more studies are required to determine medium- and long-term outcomes in the current era of aggressive secondary preventive therapy.

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Evolution of Cognitive Impairment After Stroke and Risk Factors for Delayed Progression

Cited by 141 publications

References 44 publications

Genetic Associations of Autopsy-Confirmed Vascular Dementia Subtypes

Genetic Associations of Autopsy-Confirmed Vascular Dementia Subtypes

Long-Term Cognitive Transitions, Rates of Cognitive Change, and Predictors of Incident Dementia in a Population-Based First-Ever Stroke Cohort

Risk of Recurrent Stroke, Other Vascular Events and Dementia after Transient Ischaemic Attack and Stroke

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