The Effect of the APOE-&amp;#949;4 Allele and ACE-I/D Polymorphism on Cognition during a Two-Year Follow-Up in First-Ever Stroke Patients

Bour, A.; Rasquin, S.M.C.; Baars, L. G. M.; Boxtel, M.P.J. van; Visser, Pieter Jelle; Limburg, M.; Verhey, Frans R.J.

doi:10.1159/000314678

Cited by 14 publications

(9 citation statements)

References 139 publications

(87 reference statements)

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“…Another reported SNP is in the gene encoding the angiotensin-converting enzyme, one of the enzymes in the renin-angiotensin system. Studies investigating the angiotensin-converting enzyme SNP as a predictor for post-stroke cognitive decline have yielded controversial data [48–52]. A genome-wide association study in the Rotterdam cohort revealed a genetic locus associated with VaD, located on the X chromosome close to the androgen receptor gene [53].…”

Section: Biomarkers and Predictors Of Psdmentioning

confidence: 99%

Post-stroke dementia – a comprehensive review

Mijajlović

Pavlović

Brainin

et al. 2017

BMC Med

514

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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Section: Biomarkers and Predictors Of Psdmentioning

confidence: 99%

Post-stroke dementia – a comprehensive review

Mijajlović

Pavlović

Brainin

et al. 2017

BMC Med

514

411

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“…This effect may be stronger in the presence of APOE4 [46,50,51]. However, studies investigating ACE DD as a predictor for post-stroke cognitive decline ended with conflicting data [52][53][54][55].…”

Section: Biomarkersmentioning

confidence: 99%

Post‐stroke cognitive decline: an update and perspectives for clinical research

Brainin

Tuomilehto

Heiss

et al. 2014

Euro J of Neurology

204

160

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The close relationship between stroke and dementia is an important health issue. Ischaemic stroke can facilitate the onset of vascular dementia as well as aggravate pre-existing cognitive decline. The onset of cognitive decline may become manifest immediately following the onset of ischaemic stroke, but often there is a delay in the development of cognitive decline after a stroke. This delay can be seen as a therapeutic time window allowing interventions to be applied to preserve cognition following stroke. Both neurodegenerative and vascular mechanisms are activated and probably result in overlapping processes within the neurovascular unit. This review focuses on the incidence and prevalence of cognitive decline following stroke, predisposing stroke aetiologies, pre-stroke decline, imaging factors and biomarkers. Outcomes are discussed in relation to timing of assessment and neuropsychological tests used for evaluation of cognitive decline in ischaemic stroke patients. Including such tests in routine evaluations of stroke patients after some weeks or months is recommended. Finally, an outlook on ongoing and planned intervention trials is added and some recommendations for future research are proposed.

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“…That decline may result from the cumulative effects of additional (including otherwise clinically “silent”) cerebrovascular disease,33–37 the induction of Alzheimer’s-type neuropathology by cerebrovascular disease,38–41 or both of these and/or other factors 42–46. This interpretation is concordant with findings from other similar studies,24,37,47–49 and suggests that a single known stroke is probably understood most usefully as an overt manifestation of an underlying cerebrovascular process that in a substantial minority of individuals will result in gradual cognitive decline.…”

Section: Discussionmentioning

confidence: 99%

Screening for cognitive decline following single known stroke using the Mini-Mental State Examination

Arciniegas

Kellermeyer²,

Bonifer³

et al. 2011

NDT

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Background:Progressive cognitive decline develops in a nontrivial minority of stroke survivors. Although commonly used to identify cognitive decline in older stroke survivors, the usefulness of the Mini-Mental State Examination (MMSE) as a screening tool for post-stroke cognitive decline across a wider range of ages is not well established. This study therefore investigated the usefulness of the MMSE for this purpose.Methods:Twenty-seven subjects, aged 18–82 years, with a single known remote stroke were assessed using the MMSE. The frequency of cognitive impairment was determined by comparison of MMSE scores with population-based norms. Relationships between cognitive performance, motor impairments, age, gender, handedness, stroke laterality, and time since stroke also were explored.Results:Age-adjusted MMSE scores identified mild cognitive impairment in 22.2% and moderate-to-severe cognitive impairment in 7.4% of subjects. Raw and age-adjusted MMSE scores were inversely correlated with time since stroke, but not with other patient or stroke characteristics.Conclusion:A relationship between time since single known stroke and MMSE performance was observed in this study. The proportion of subjects identified as cognitively impaired in this group by Z-transformation of MMSE scores using previously published normative data for this measure comports well with the rates of late post-stroke cognitive impairment reported by other investigators. These findings suggest that the MMSE, when normatively interpreted, may identify cognitive decline in the late period following single known stroke. Additionally, the lack of a relationship between MMSE and Fugl-Meyer scores suggests that the severity of post-stroke motor impairments is unlikely to serve as a clinically useful indicator of the need for cognitive assessment. A larger study of stroke survivors is needed to inform more fully on the usefulness of normatively interpreted MMSE scores as a method of screening for post-stroke cognitive decline.

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The Effect of the APOE-ε4 Allele and ACE-I/D Polymorphism on Cognition during a Two-Year Follow-Up in First-Ever Stroke Patients

Cited by 14 publications

References 139 publications

Post-stroke dementia – a comprehensive review

Post-stroke dementia – a comprehensive review

Post‐stroke cognitive decline: an update and perspectives for clinical research

Screening for cognitive decline following single known stroke using the Mini-Mental State Examination

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