Incidence and Subtypes of MCI and Dementia 1 Year after First-Ever Stroke in Patients without Pre-Existing Cognitive Impairment

Ihle‐Hansen, Hege; Thommessen, Bente; Wyller, Torgeir Bruun; Engedal, Knut; Øksengård, Anne Rita; Stenset, Vidar; Löken, Kirsti; Aaberg, Morten; Fure, Brynjar

doi:10.1159/000335361

Cited by 81 publications

(65 citation statements)

References 91 publications

(53 reference statements)

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“…For example, the differentiation of dementia from PSD and PSCI not fulfilling criteria for dementia is usually based on limitations in activities of daily living. In stroke survivors with substantial physical impairments it may be difficult to assess changes in activities of daily living related to specifically cognitive problems [8]. Usual definitions of dementia emphasize the presence of multidomain cognitive impairments, and in particular memory deficits.…”

Section: Definitionsmentioning

confidence: 99%

Post-stroke dementia – a comprehensive review

Mijajlović

Pavlović

Brainin

et al. 2017

BMC Med

486

397

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Post-stroke dementia (PSD) or post-stroke cognitive impairment (PSCI) may affect up to one third of stroke survivors. Various definitions of PSCI and PSD have been described. We propose PSD as a label for any dementia following stroke in temporal relation. Various tools are available to screen and assess cognition, with few PSD-specific instruments. Choice will depend on purpose of assessment, with differing instruments needed for brief screening (e.g., Montreal Cognitive Assessment) or diagnostic formulation (e.g., NINDS VCI battery). A comprehensive evaluation should include assessment of pre-stroke cognition (e.g., using Informant Questionnaire for Cognitive Decline in the Elderly), mood (e.g., using Hospital Anxiety and Depression Scale), and functional consequences of cognitive impairments (e.g., using modified Rankin Scale). A large number of biomarkers for PSD, including indicators for genetic polymorphisms, biomarkers in the cerebrospinal fluid and in the serum, inflammatory mediators, and peripheral microRNA profiles have been proposed. Currently, no specific biomarkers have been proven to robustly discriminate vulnerable patients (‘at risk brains’) from those with better prognosis or to discriminate Alzheimer’s disease dementia from PSD. Further, neuroimaging is an important diagnostic tool in PSD. The role of computerized tomography is limited to demonstrating type and location of the underlying primary lesion and indicating atrophy and severe white matter changes. Magnetic resonance imaging is the key neuroimaging modality and has high sensitivity and specificity for detecting pathological changes, including small vessel disease. Advanced multi-modal imaging includes diffusion tensor imaging for fiber tracking, by which changes in networks can be detected. Quantitative imaging of cerebral blood flow and metabolism by positron emission tomography can differentiate between vascular dementia and degenerative dementia and show the interaction between vascular and metabolic changes. Additionally, inflammatory changes after ischemia in the brain can be detected, which may play a role together with amyloid deposition in the development of PSD. Prevention of PSD can be achieved by prevention of stroke. As treatment strategies to inhibit the development and mitigate the course of PSD, lowering of blood pressure, statins, neuroprotective drugs, and anti-inflammatory agents have all been studied without convincing evidence of efficacy. Lifestyle interventions, physical activity, and cognitive training have been recently tested, but large controlled trials are still missing.

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Section: Definitionsmentioning

confidence: 99%

Post-stroke dementia – a comprehensive review

Mijajlović

Pavlović

Brainin

et al. 2017

BMC Med

486

397

View full text Add to dashboard Cite

show abstract

“…WM injury contributes to cognitive decline in stroke and cerebral SVD, and its severity is correlated with the degree of cognitive impairment (Pantoni, 2010; Sun et al, 2014). Although the pathophysiological mechanisms underlying WM lesions after stroke remain elusive, recent studies indicate that the presence and severity of WM hyperintensities on T2-weighted or FLAIR magnetic resonance images are predictive of post-stroke dementia (Burton et al, 2004; Ihle-Hansen et al, 2011; Kalaria et al, 2016; Leys et al, 2005; Sachdev et al, 2007). …”

Section: Age-related Vcidmentioning

confidence: 99%

The impact of cerebrovascular aging on vascular cognitive impairment and dementia

Yang

Sun

et al. 2017

Ageing Research Reviews

146

125

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As human life expectancy rises, the aged population will increase. Aging is accompanied by changes in tissue structure, often resulting in functional decline. For example, aging within blood vessels contributes to a decrease in blood flow to important organs, potentially leading to organ atrophy and loss of function. In the central nervous system, cerebral vascular aging can lead to loss of the integrity of the blood-brain barrier, eventually resulting in cognitive and sensorimotor decline. One of the major of types of cognitive dysfunction due to chronic cerebral hypoperfusion is vascular cognitive impairment and dementia (VCID). In spite of recent progress in clinical and experimental VCID research, our understanding of vascular contributions to the pathogenesis of VCID is still very limited. In this review, we summarize recent findings on VCID, with a focus on vascular age-related pathologies and their contribution to the development of this condition.

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“…Although the relationship between the severity of coronary artery disease (CAD) and cognitive deficit has been established [3, 4], the clinical and neurophysiological characteristics of cardiac patients with cognitive disorders have been insufficiently investigated. It has been reported that many patients with cerebrovascular diseases have mixed dementia (coexistence of vascular and degenerative changes) [5]. However, the cognitive deficit in CAD patients may have specific features developing independently of the other effects, and it is accompanied by a decrease in cerebral blood flow when at rest [2].…”

Section: Introductionmentioning

confidence: 99%

EEG and Clinical Factors Associated with Mild Cognitive Impairment in Coronary Artery Disease Patients

Тарасова

Трубникова

Barbarash

2018

Dement Geriatr Cogn Disord

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Background: Although an impaired cognitive status in patients with coronary artery disease (CAD) is not rare, the neurophysiological and clinical indicators of mild cognitive impairment (MCI) have been insufficiently investigated so far. Methods: EEG and neuropsychological testing as well as clinical examination were performed on 122 patients with CAD, who were divided into two groups, those with MCI (n = 60; mean age 57.4 ± 5.81 years) and those without MCI (n = 62; mean age 57.0 ± 5.04 years). Binary logistic regression was used to identify the relationship between EEG and clinical variables and the probability of MCI. Results: Higher theta/alpha ratios, theta1 rhythm power with closed eyes in the frontal and occipital areas of the left hemisphere, and alpha2 rhythm power with eyes open in the frontal areas of the right hemisphere were associated with an increased risk for MCI in CAD patients. A low educational level, type 2 diabetes mellitus, and severe coronary lesions according to the SYNTAX Score (≥23 points) increased the risk for MCI as well. Conclusions: The findings of our study show that a theta activity increase in frontal and occipital sites, as well as high theta/alpha ratios, may be considered as the earliest EEG markers of vascular cognitive disorders.

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Incidence and Subtypes of MCI and Dementia 1 Year after First-Ever Stroke in Patients without Pre-Existing Cognitive Impairment

Cited by 81 publications

References 91 publications

Post-stroke dementia – a comprehensive review

Post-stroke dementia – a comprehensive review

The impact of cerebrovascular aging on vascular cognitive impairment and dementia

EEG and Clinical Factors Associated with Mild Cognitive Impairment in Coronary Artery Disease Patients

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