Multifactorial Vascular Risk Factor Intervention to Prevent Cognitive Impairment after Stroke and TIA: A 12-month Randomized Controlled Trial

Ihle‐Hansen, Hege; Thommessen, Bente; Fagerland, Morten Wang; Øksengård, Anne Rita; Wyller, Torgeir Bruun; Engedal, Knut; Fure, Brynjar

doi:10.1111/j.1747-4949.2012.00928.x

Cited by 56 publications

(69 citation statements)

References 36 publications

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“…A similar neutral finding was shown in a previous trial, where interventions to control vascular risk factors did not lead to better cognitive performance in neuropsychological tests in comparison with the control group. 17 But compared with our trial, fewer interventions were used and follow-up was restricted to 12 months. To date, no other trial was designed to test the effect of lifestyle interventions on poststroke cognition.…”

Section: Discussionmentioning

confidence: 99%

Multidomain Lifestyle Interventions for the Prevention of Cognitive Decline After Ischemic Stroke

Matz¹,

Teuschl²,

Firlinger³

et al. 2015

Stroke

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4-6Modifiable risk factors for stroke such as hypertension, dyslipidaemia, diabetes mellitus, smoking, physical inactivity, and poor diet have been associated with an increased risk of cognitive impairment.7-10 Thus, it is plausible that effective secondary prevention strategies in combination with lifestyleoriented interventions adjusted to individual risk factors can Background and Purpose-Cognitive impairment occurs in ≤30% of all stroke survivors. However, effective therapies aimed at preventing poststroke cognitive decline are lacking. We assessed the efficacy of a multidomain intervention on preventing cognitive decline after stroke. Methods-In this randomized, observer-blind trial patients were recruited within 3 months after an acute stroke in 5Austrian neurological centers. Patients were assigned to a 24-month lifestyle-based multidomain intervention or standard stroke care. Primary outcomes were the cognitive subscale of the Alzheimer Disease Assessment Scale (ADAS-cog) and occurrence of cognitive decline in the composite scores of at least 2 of 5 cognitive domains at 24 months.

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Section: Discussionmentioning

confidence: 99%

Multidomain Lifestyle Interventions for the Prevention of Cognitive Decline After Ischemic Stroke

Matz¹,

Teuschl²,

Firlinger³

et al. 2015

Stroke

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“…Two randomized trials have been performed with multifactorial interventions including optimal medical treatment for secondary prevention in addition to physical activity, diet, weight control, smoking cessation, healthy diet with better glycemic control, and cognitive stimulation. One tested the effect of the multimodal risk factor intervention over 1 year on cognition, but no change in cognitive outcome was found [105]. However, significant beneficial effects were found on depression as the secondary outcome [106].…”

Section: Lifestyle Interventionsmentioning

confidence: 99%

Post-stroke dementia – a comprehensive review

Mijajlović

Pavlović

Brainin

et al. 2017

BMC Med

517

411

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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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“…6 Also, depression and anxiety are highly comorbid conditions in stroke survivors, 7,8 both being the most responsive complications of stroke to pharmacological and psychosocial interventions, 9 including multifaceted risk factors optimization strategies. 10 …”

Section: | Introductionmentioning

confidence: 99%

Prevalence and predictors of anxiety in an African sample of recent stroke survivors

et al. 2017

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Objectives Studies considering emotional disturbances in the setting of stroke have primarily focused on depression and been conducted in high-income countries. Anxiety in stroke survivors, which may be associated with its own unique sets of risk factors and clinical parameters, has been rarely investigated in sub-Saharan Africa (SSA). We assess the characteristics of anxiety and anxiety-depression comorbidity in a SSA sample of recent stroke survivors. Materials and methods We assessed baseline data being collected as part of an intervention to improve one-year blood pressure control among recent (≤1 month) stroke survivors in SSA. Anxiety in this patient population was measured using the Hospital Anxiety and Depression Scale (HADS), while the community screening instrument for dementia was used to evaluate cognitive functioning. Independent associations were assessed using logistic regression analysis. Results Among 391 participants, clinically significant anxiety (HADS anxiety score≥11) was found in 77 (19.7%). Anxiety was comorbid with depression in 55 (14.1%). Female stroke survivors were more likely than males to have anxiety (OR=2.4, 95% CI=1.5–4.0). Anxiety was significantly associated with the presence of cognitive impairment after adjusting for age, gender and education (OR=6.8, 95% CI=2.6–18.0). Conclusions One in five recent stroke survivors in SSA has clinically significant anxiety, and well over 70% of those with anxiety also have depression. Future studies will need to determine what specific impact post-stroke anxiety may have on post-stroke clinical processes and outcomes.

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Multifactorial Vascular Risk Factor Intervention to Prevent Cognitive Impairment after Stroke and TIA: A 12-month Randomized Controlled Trial

Cited by 56 publications

References 36 publications

Multidomain Lifestyle Interventions for the Prevention of Cognitive Decline After Ischemic Stroke

Multidomain Lifestyle Interventions for the Prevention of Cognitive Decline After Ischemic Stroke

Post-stroke dementia – a comprehensive review

Prevalence and predictors of anxiety in an African sample of recent stroke survivors

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