Poststroke cognitive impairment and dementia: prevalence, diagnosis, and treatment

Melkas, Susanna; Jokinen, Hanna; Hietanen, Marja; Erkinjuntti, Timo

doi:10.2147/dnnd.s37353

Cited by 31 publications

(30 citation statements)

References 67 publications

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“…Our results support previous findings suggesting that EFs are highly susceptible to stroke-related impairments [23,24]. An extensive battery was used to examine which of the EF tests are able to detect stroke-related deficits in the elderly.…”

Section: Discussionsupporting

confidence: 90%

Executive function subdomains are associated with post‐stroke functional outcome and permanent institutionalization

Laakso

Hietanen

Melkas

et al. 2018

Euro J of Neurology

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Background and purpose Impairment of executive functions (EFs) is a common cognitive symptom post‐stroke and affects independence in daily activities. Previous studies have often relied on brief cognitive tests not fully considering the wide spectrum of EF subdomains. A detailed assessment of EFs was used to examine which of the subdomains and tests have the strongest predictive value on post‐stroke functional outcome and institutionalization in long‐term follow‐up. Methods A subsample of 62 patients from the Helsinki Stroke Aging Memory Study was evaluated with a battery of seven neuropsychological EF tests 3 months post‐stroke and compared to 39 healthy control subjects. Functional impairment was evaluated with the modified Rankin Scale (mRS) and Instrumental Activities of Daily Living (IADL) scale at 3 months, and with the mRS at 15 months post‐stroke. Institutionalization was reviewed from the national registers of permanent hospital admissions in up to 21‐year follow‐up. Results The stroke group performed more poorly than the control group in multiple EF tests. Tests of inhibition, set shifting, initiation, strategy formation and processing speed were associated with the mRS and IADL scale in stroke patients. EF subdomain scores of inhibition, set shifting and processing speed were associated with functional outcome. In addition, inhibition was associated with the risk for earlier institutionalization. Conclusions Executive function was strongly associated with post‐stroke functional impairment. In follow‐up, poor inhibition was related to earlier permanent institutionalization. The results suggest the prognostic value of EF subdomains after stroke.

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Section: Discussionsupporting

confidence: 90%

Executive function subdomains are associated with post‐stroke functional outcome and permanent institutionalization

Laakso

Hietanen

Melkas

et al. 2018

Euro J of Neurology

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“…Acute post-stroke cognitive impairment (PSCI) is reported in up to 70% of patients [1]. While these deficits may improve within weeks/months after onset, over half of stroke survivors experience persisting long-term deficits, which can affect the daily functioning and quality of life [2].…”

Section: Introductionmentioning

confidence: 99%

Determinants, Prevalence, and Trajectory of Long-Term Post-Stroke Cognitive Impairment: Results from a 4-Year Follow-Up of the ARCOS-IV Study

et al. 2017

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Background: The long-term (>12 months) prevalence, predictors, and trajectory of post-stroke cognitive deficits are not well established, especially at a community level. This study investigated the longitudinal course and prevalence of cognitive impairment in an incidence cohort, identifying factors associated with declining cognition. Methods: Two hundred fifty-seven participants (mean age = 67.93 ± 13.59) of first-ever stroke survivors, completed cognitive assessments within 2 weeks post stroke, and/or 1, 6, 12, and 48-month. Multivariate linear and logistic models were used to identify baseline predictors (reported as OR with 95% CI) and trajectory of cognitive impairment. Results: Cognitive functioning significantly declined by 2.8 points by 4 years post stroke. Eighty-four percent of stroke survivors had cognitive impairment indicative of post-stroke dementia (mean Montreal cognitive assessment = 20 ± 4.7) at 4-year. There were significant associations between progressive cognitive decline and the following factors: male gender (OR 2.9, 95% CI 1.6–5.9, p = 0.0171), coronary artery disease (OR 2.96, 95% CI 1.35–6.49, p = 0.0070), arrhythmia (OR 2.21, 95% CI 1.07–4.57, p = 0.0317), not in a relationship (OR 2.8, 95% CI 1.4–5.50, p < 0.0001), and not employed (OR 4.9, 95% CI 1.9–12.1, p < 0.0001). Conclusions: Cognitive deficits remain highly prevalent at 4-year post stroke. Early identification of those at higher risk of declining cognition is vital to target rehabilitation interventions at the acute stage and improve overall outcomes.

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“… 32 This study found a prior history of stroke to be more correlated with cognitive dysfunction, which is consistent with previous findings. 36 , 37 High cholesterol in particular has been found to be significant among females, and has been examined previously. 16 , 38 A recent study has found higher apolipoprotein e4-related risk of developing Alzheimer’s dementia in females, and this also partly accounts for the female preponderance with MCI.…”

Section: Discussionmentioning

confidence: 84%

Voluntary cognitive screening: characteristics of participants in an Asian setting

Ho¹,

Zainal²,

Lim³

et al. 2015

CIA

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BackgroundMild cognitive impairment (MCI) and dementia are reaching epidemic proportions in Asia. Lack of awareness and late presentation are major obstacles to early diagnosis and timely intervention. Cognitive screening may be an effective method for early detection of dementia in Asia. The purpose of this work was to study the characteristics of subjects volunteering for cognitive screening in an Asian setting and to determine the prevalence of MCI.MethodsRetrospective and cross-sectional data from community subjects attending a screening program from 2008 to 2013 were analyzed. Information on demographics, vascular risk factors, subjective symptoms, and cognitive measures were analyzed over the 6-year period.ResultsOver the 6 years from 2008 to 2013, 1,243 community subjects voluntarily turned up for cognitive screening (91.2% were Chinese, 5.23% were Indian, 1.37% were Malay, and 2.25% were Eurasian). The mean age of the participants was 61.3 years and the mean number of years of education was 11.0 years. A total of 71.1% of participants were living in public housing, 59.8% had at least one cardiovascular risk factor, and 56.2% reported subjective cognitive symptoms. Over a period of 6 years, no significant change in demographic or clinical variables was noted. High cholesterol and hypertension were consistently the top two risk factors found in the population screened. In total, 17.2% of the total cohort had MCI. Across the 6 years, the proportion with MCI and depression was relatively constant.ConclusionA significant proportion of participants attending voluntary cognitive screening have MCI. Low level of education and presence of vascular risk factors are general predisposing characteristics for MCI, and there are more specific factors pertaining to sex and employment status.

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Poststroke cognitive impairment and dementia: prevalence, diagnosis, and treatment

Cited by 31 publications

References 67 publications

Executive function subdomains are associated with post‐stroke functional outcome and permanent institutionalization

Executive function subdomains are associated with post‐stroke functional outcome and permanent institutionalization

Determinants, Prevalence, and Trajectory of Long-Term Post-Stroke Cognitive Impairment: Results from a 4-Year Follow-Up of the ARCOS-IV Study

Voluntary cognitive screening: characteristics of participants in an Asian setting

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