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

Abstract

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.)

Amyloid Burden, Neuroinflammation, and Links to Cognitive Decline After Ischemic Stroke

“…32 Whether ischemic infarcts only accelerate a pre-existing cognitive impairment or whether infarcts pose a risk for developing cognitive decline also in cognitively normal subjects remains unclear. Although 2 population-based cohort studies seem to support the view that prestroke cognitive status is an independent risk factor for poststroke dementia, 28,33 other studies found no such association 34 or only for nonamnestic mild cognitive impairment but not for amnestic mild cognitive impairment, 35 which usually is considered a prodromal state of AD. A recent longitudinal cohort study re-examining this question 36 indicates that although higher levels of prestroke executive function are associated with lower risk for poststroke dementia (relative risk, 0.24; 95% confidence interval, 0.13-0.45), stroke was a disproportionate risk factor (relative risk, 4.4; 95% confidence interval, 1.35-14.63) for dementia in patients with high cognitive function.…”

“…7 (2) The combination of AD-like pathology induced by intracerebroventricular injections of the toxic 25 to 35 fragment of Aβ peptide (Aβ [25][26][27][28][29][30][31][32][33][34][35] ) and stroke (unilateral endothelin-1 injections in the striatum) in the rat also resulted in enhanced neuroinflammatory responses and AD-like pathology in the neocortex and hippocampus and were correlated with memory deficits detected using the Barnes circular platform test.…”

“…[27][28][29] It was, however, not until the religious order study that an association between stroke, AD, or mild cognitive impairment and AD-specific pathology (parenchymal Aβ deposition) was described. 30,31 Interestingly, subjects with subcortical infarcts had the highest risk of developing dementia and exhibited fewer AD pathologies than those without infarcts, 30 whereas subjects with AD alone and subjects with AD with infarcts show otherwise similar clinical and risk factor characteristics.…”

Vascular Dementia and Alzheimer's Disease: Is There a Difference?

“…Barba et al (2000) commented that the frequency of post stroke dementia depends on various factors such as the exclusion of hemorrhage or recurrent stroke, age range, length of follow-up, and diagnostic criteria. Srikanth et al (2006) in the first prospective data on long-term cognitive transitions in a population-based first-ever stroke cohort, found that stroke recurrence was associated with an increased rate of long-term global cognitive decline after a first-ever stroke; stroke recurrence, early poststroke cognitive impairment, and increasing age were independently associated with diagnosis of new clinical dementia two years after a first-ever stroke.…”

Outpatient management after severe stroke with dementia

“…Другие авторы приводят похо-жие данные и отмечают, что те или иные КН имеются у 35-83% пациентов, перенесших инсульт [12,13], а у 6-32% из них они достигают степени деменции [13,14]. Повтор-ный инсульт существенно усугубляет когнитивный дефицит [15]. В популяционных исследованиях доля пациентов с де-менцией среди общего числа лиц, перенесших инсульт, соста-вляла 7%, через 3 года после инсульта -10%, через 25 лет -48% [5,16,17].…”