Systematic review and meta-analysis of the prevalence of cognitive impairment no dementia in the first year post-stroke

Abstract

Introduction: Increasing attention is being paid to interventions for cognitive impairment (CI) post-stroke, including for CI that does not meet dementia criteria. The aim of this paper was to conduct a systematic review and meta-analysis of the prevalence of cognitive impairment no dementia (CIND) within one year post-stroke. Patients and methods: Pubmed, EMBASE and PsychInfo were searched for papers published in English in 1995-2017. Included studies were population or hospital-based cohort studies for first-ever/recurrent stroke, assessing CIND using standardised criteria at 1-12 months post-stroke. Abstracts were screened, followed by full text review of potentially relevant articles. Data were extracted using a standard form, and study quality was appraised using the Crowe Critical Appraisal Tool. A pooled prevalence of CIND with 95% confidence intervals (CI) was estimated using random-effects meta-analysis. Heterogeneity was measured using the I 2 statistic. Results: A total of 7000 abstracts were screened, followed by 1028 full text articles. Twenty-three articles were included in the systematic review, and 21 in the meta-analysis. The pooled CIND prevalence was 38% [95% CI ¼ 32-43%] (I 2 ¼92.5%, p < 0.01). Study quality emerged as one source of heterogeneity. The five studies with the highest quality scores had no heterogeneity (I 2 ¼0%, p ¼ 0.99), with a similar pooled prevalence (39%, 95%CI ¼ 35-42%). Other sources of heterogeneity were stroke type, inclusion of pre-stroke CI, and age at assessment time. Discussion and conclusion: Meta-analysis of available studies indicates that in the first year post-stroke, 4 in 10 patients display a level of cognitive impairment that does not meet the criteria for dementia.

Effect of bridging with intravenous thrombolysis on cognitive function in stroke thrombectomy – An analysis of the German Stroke Registry

“…In our study, we found a high rate of CI after 90 days in general (80%), which is well above the expected prevalence in other studies (3,4,7). A selection-bias could occur due to the limited group size in this study: Only 10% of the patients treated in the GSR were finally given cognitive testing.…”

“…Even after good clinical recovery, about 30-50% of patients complain of cognitive impairment or dementia within the first year after an ischemic stroke (3)(4)(5)(6)(7). In the course, the prevalence of dementia even increases (8) with a broad spectrum of cognitive disturbances, ranging from mild cognitive impairment into a manifest dementia (9-12).…”

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“…Stroke has been found to be a strong, independent and potentially modifiable risk factor for cognitive impairment and dementia [ 4 ]. It is estimated that, in the first year following stroke, 26.5% of stroke survivors have dementia, and 38% of survivors experience cognitive impairment that does not meet the criteria for dementia (cognitive impairment no dementia (CIND)) [ 5 , 6 ]. Yet post–stroke cognitive impairment (PSCI) is an often overlooked consequence of stroke [ 5 , 6 , 7 , 8 ].…”