Frequency and Determinants of Poststroke Dementia in Chinese

Abstract

Background and Purpose-Both dementia and stroke are major health problems in Chinese societies. Stroke is a frequent cause of dementia. Only a few studies have been published on poststroke dementia (PSDE), none of which has investigated a consecutive stroke cohort in Asian patient populations. The objective of this study was to examine the prevalence and clinical correlates of PSDE in Chinese stroke patients in Hong Kong. Methods-Two hundred eighty stroke patients consecutively admitted to the medical wards of a university-affiliated regional hospital were interviewed by a psychiatrist 3 months after stroke. The presence of dementia and vascular dementia was diagnosed according to the Diagnostic and Statistical Manual, 4th edition. In addition, a wide range of demographic and clinical variables were examined. Results-Fifty-five participants (20%) had PSDE. Univariate analysis found that PSDE was associated with age; level of education; prestroke Rankin Scale score; prestroke Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) score; National Institutes of Health Stroke Scale (NIHSS) best language score, dysarthria score, and total score; urinary incontinence; cortical infarct; leukoaraiosis; bilateral lesions; number of lesions; involvement of middle cerebral artery circulation; and cerebral atrophy index. Multivariate logistic regression suggested that prestroke IQCODE score, NIHSS total score, leukoaraiosis, involvement of middle cerebral artery territory, and cerebral atrophy index were independent risk factors of PSDE. After removal of 22 patients with prestroke dementia, which was defined as a prestroke IQCODE score Ն4.0, the frequency of PSDE dropped to 15.5%. Furthermore, involvement of the middle cerebral artery territory and cerebral atrophy index were replaced by level of education and bilateral lesions as independent predictors in the final logistic model. Conclusions-PSDE is common among Chinese stroke patients in Hong Kong. Its frequency is comparable to that in white populations. The clinical determinants of PSDE, after the exclusion of patients with prestroke dementia, include premorbid level of cognitive function, severity of stroke, leukoaraiosis, level of education, and bilateral lesions.

Cerebral Atrophy is an Independent Risk Factor for Unfavorable Outcome After Spontaneous Supratentorial Intracerebral Hemorrhage

“…In 2 studies, Tang et al, using the same volumetric approach as we did, have shown that cerebral atrophy in ischemic stroke patients is associated with prestroke 14 as well as with poststroke dementia. 15 Accordingly, cerebral volume was correlated with the extent of LA in the present study. We, therefore, hypothesize that in ICH, unfavorable outcome in the presence of cerebral atrophy is at least in part attributable to preexisting cerebral damage.…”

Five-Year Outcome of a Stroke Cohort in Martinique, French West Indies

“…21 Indeed, low-level education is a known risk factor for dementia. 22 In agreement with other studies, 23,24 we also found a strong association between the risk of developing poststroke dementia and the presence of silent infarcts (mainly lacunes or leukoaraiosis) on the first computed tomography scans 1 of our Martinican patients, who were frequently hypertensive and diabetic. Notably, the frequencies of the main prestroke risk factors for the Martinican patients were similar to those reported in Barbados, another Caribbean island, with high rates of hypertensive and diabetic patients (but lower than those of Caribbean migrants in London) and a culturally low rate of smokers.…”

Poststroke Dementia

“…In hospitalized stroke patients ≥70 years the prevalence of dementia was 28% 1.5 years after stroke, with a relative risk of 4.7 compared to the controls, the relative risk being 4.8 in patients ≥80 years and 6.7 in patients <80 years [3]. In cohorts of hospitalized stroke patients [4,5,6,7,8,9,10,11,12,13,14,15,16,17,18], the prevalence of PSD ranged from 6.2 to 32% (table 1). These discrepancies may be related to methodological differences [19]: the exclusion of aphasic patients or patients unable to undergo neuropsychological testing leads to a risk of underestimation of the prevalence of dementia [7, 20], while the lack of systematic research into cognitive disturbances existing prior to the stroke entails a risk of overestimation of the incidence of PSD, as prestroke dementia is frequent [21,22,23,24,25]and often undiagnosed [21].…”