Prestroke Dementia: Characteristics and Clinical Features in Consecutive Series of Patients

Abstract

Background/Aim: The prestroke level of cognitive function should be taken into account in order to predict the impact of stroke on the subsequent risk of dementia. The aim of the present study was to investigate the presence and correlates of prestroke dementia (PSD) as well as to identify its clinical features. Methods: Premorbid clinical and cognitive features of 158 consecutively recruited patients with a diagnosis of acute cerebrovascular pathology were assessed by interviewing the caregivers using multidimensional assessment. Patients were divided into two groups (PSD group and prestroke nondemented group). Baseline cognitive, functional and behavioral variables and neuroradiological hallmarks (medial temporal lobe atrophy, MTLA) were compared between these two groups. Results: In a logistic regression model, older age (OR 1.05), female gender (OR 2.3), Neuropsychiatric Inventory total score (OR 1.1) and MTLA (OR 1.2) were the variables independently associated with PSD. Conclusions: These findings support the hypothesis that cognitive impairment in patients with stroke may not only be a direct consequence of the acute cerebrovascular event but also a consequence of underlying neurodegenerative pathology.

The role of pre-stroke cognitive disorders in the formation of post-stroke cognitive impairment

“…Стоит отметить, что наличие предшествующего когнитивного снижения становится предиктором тяжести постинсультного когнитивного дефекта [23], а нейропсихологический дефицит, выявленный по результатам IQCODE, может быть неоднороден по своей структуре. Так, предшествующие когнитивные нарушения могут иметь не только сосудистую, но и нейродегенеративную этиологию [24]. Поэтому постинсультные когнитивные нарушения часто бывают представлены смешанным когнитивным дефицитом (сосудистое поражение головного мозга в сочетании с болезнью Альцгеймера).…”

Prestroke Cognitive Impairment: Frequency and Association With Premorbid Neuropsychiatric, Functional, and Neuroimaging Features

“…Previous studies have indicated lower prevalence estimates of pre-SCI, but some of these have used 4.0 as the IQCODE cutoff for the definition of pre-SCI, 21 – 23 thus restricting the investigation to the most severe forms of pre-SCI. When comparing our study with others that used the same IQCODE cutoff, 2 , 3 our study still has a higher prevalence of pre-SCI, which could be explained by the higher age of our cohort, but also by some differences in the inclusion criteria. Mok et al 2 have studied a small number of patients with an ischemic stroke associated with small vessel disease, excluding patients with other stroke etiologies.…”

“… 1 When including the milder forms of cognitive impairment, prevalence estimates are higher, reaching 24% in some studies. 2 , 3 Part of the variability in the epidemiology of pre-SCI depends on the lack of a standardized diagnosis. Some studies have relied on the medical history or clinical interview for the definition of pre-SCI, 4 , 5 while others have used informant-based questionnaires, 2 , 3 which allow a more reproducible assessment.…”

“… 2 , 3 Part of the variability in the epidemiology of pre-SCI depends on the lack of a standardized diagnosis. Some studies have relied on the medical history or clinical interview for the definition of pre-SCI, 4 , 5 while others have used informant-based questionnaires, 2 , 3 which allow a more reproducible assessment. Among them, the most commonly used tool is the IQCODE (Informant Questionnaire on Cognitive Decline in the Elderly).…”

Transoral robotic surgery (TORS) for laryngeal and hypopharyngeal cancers

“…Suction drains are typically used to improve tissue adhesion, minimize seroma formation and to monitor for fistula. Patients are typically placed on antibiotics and a proton pump inhibitor .Patients are initially fed via a nasogastric tube or previously established G‐Tube. The time to oral feeding is surgeon dependent and may be contingent upon a barium swallow.…”