Intellectual Impairment in the First Year following Stroke, Compared to an Age-Matched Population Sample

Abstract

General intellectual impairment during the first year following stroke in 188 unselected, previously not demented patients aged 60–80 years was assessed with a comprehensive screening test, the Mattis Dementia Rating Scale, and compared to an age-matched population sample. Significant impairment occurred in 32, 26 and 26% of the stroke patients at 1, 6 and 12 months, which correlated to subjective complaints and a dependent life after discharge. Most patients scored stable or improved (84%), while 16% deteriorated significantly. Intellectual impairment correlated to CT lesion size and central atrophy, age and pre-stroke lower functional and social activity, as well as to stroke-induced handicap including aphasia, neglect, and increased mood symptoms. Thus, stroke-induced brain damage influences general intellectual function but may not be the sole reason for intellectual impairment.

Poststroke Dementia

“…9,31,32 Some studies involving PSD have been performed on nonprospective 16,33 or nonconsecutive samples 16,[33][34][35] ; some others have excluded hemorrhagic 6 -8,10,13,16,33,36,37 or recurrent 6,8,16,16 strokes; usually, the cognitive status before the stroke has not been considered. 16,34,38 We recruited a series of consecutive, unselected, incident stroke cases who reported to a general secondary hospital in an urban area without other alternative specialized health care facilities. The short distance to this single hospital in all the catchment area and the absence of financial restrictions for health care in Spain preclude referral bias in this sample, which can be considered rather representative of our population of stroke cases.…”

Cerebral complications of hypertension

“…145,152 Hypertension has been identified as a risk factor by Pohjasvaara et al (1998), 111 but not by Skoog et al (1996). 101 In addition to those risk factors, coexisting Alzheimer's disease pathology may also play a role, as indicated 146 9.6 Andersen et al, 1996 147 5.5 Kokmen et al, 1996 138 8.4 Hénon et al, 1997 144 16.3 Pohjaasvara et al, 1997 142 12.2…”

“…144 As shown in Table 6, 5.5 to 16.3% of patients admitted for stroke seem to have had undetected pre-existing progressive cognitive decline. 138,142,[144][145][146][147] Risk factors for post-stroke dementia At least three different groups of factors, each acting independently, rather than a single pathophysiological mechanism probably contribute to the development of post-stroke dementia: 111,148 (1) stroke-related factors such as the location and the severity of the brain lesions; 149,150 (2) the overall cardiovascular risk profile as determined by the presence of atrial fibrillation 140 or diabetes mellitus; 149 (3) non-strokerelated factors similar to those found in Alzheimer's disease including increasing age, 149,151 low education, 149 cortical atrophy. 145,152 Hypertension has been identified as a risk factor by Pohjasvaara et al (1998), 111 but not by Skoog et al (1996).…”

Post-Stroke Depression: A Review

“…26 However, Kimura et al 27 examined this issue in a study of patients with major (n = 33) or minor (n = 14) PSD, comparing nortriptyline-and placebo-treated patients using doubleblind methodology. When patients were divided into those who responded to treatment (that is, greater than 50% decline in HDRS score) and those who did not respond, there is a significantly greater improvement in MMSEs among patients who responded to treatment (n = 24), compared with patients who did not respond to treatment (n = 23).…”