Cognitive impairment after cerebrovascular stroke: Relationship to vascular risk factors

Abstract

Background: Cognitive decline after cerebrovascular stroke has adverse outcome consequences. Since some vascular causes can be prevented and treated, the identifi cation of stroke-related cognitive impairment is a challenge. Patients with cognitive impairment and vascular diseases exhibit higher homocysteine (Hcy) concentrations. Whether Hcy is an independent risk factor for cognitive impairment after stoke is still in question. The objectives of this study were to determine: 1) the relative frequency of fi rst-ever post-stroke dementia (PSD) (three months after onset) in a consecutive sample of our population, 2) the risk factors associated with PSD, and 3) the relationship between Hcy levels and PSD. Methods: Eighty-one inpatients with fi rst-ever stroke were prospectively evaluated with a neuropsychological battery and event-related evoked potentials (P300) at onset and then after three months. A wide range of demographic, clinical, radiological and laboratory variables were examined. PSD was diagnosed if the clinical presentation fulfi lled DSM-IV criteria of vascular dementia, the patient scored Յ21 on Mini Mental State Examination (MMSE) and Յ67 points on Cognitive Abilities Screening Instruments (CASI). Results: PSD was diagnosed in 21%. PSD was signifi cantly associated with increasing age, low levels of education, large sized and lacunar infarctions, severity of stroke, prolonged P300 latency, smoking, hypertension, and elevated Hcy levels. High Hcy levels increased the odds ratio of PSD after adjustment of signifi cantly relevant variables including age, smoking, size of infarction, and carotid stenosis. Conclusions: Cognitive decline is common after stroke. The results of this study indicate that PSD may result from stroke and its related risk factors including possible direct association with high Hcy levels. Better knowledge of the risk factors for PSD should increase the effectiveness of preventive strategies in patients with this condition.

Epidemiological Study and Risk Factors of Stroke in Assiut Governorate, Egypt: Community-Based Study

“…The frequency of dementia after cerebrovascular stroke (CVS) varies between studies, ranging between 21 and 37% [35,36]. In the present study only 15.6% of cases had dementia.…”

The relationship between indoleamine 2,3-dioxygenase activity and post-stroke cognitive impairment

“…Additionally, the type of cognitive impairment observed post-stroke varies; often including deficits in measures of global cognition, as well as domain-specific impairments involving executive function, language, visuospatial ability, and memory[ 56 ]. Some previously identified risk factors for the development of PSCI, including family history of dementia and individual cardiovascular risk factors[ 8 ], could not be controlled for given the sample size. Although all efforts were made to control for potentially confounding variables, pre-stroke cognitive capacity and white matter disease burden were not assessed.…”

“…The prevalence of post-stroke MMSE scores less than 24, indicative of significant cognitive impairment, was much higher than the prevalence of dementia diagnosed by standard criteria, which included the DSM-IV or ICD-10[ 7 ]. The majority of these and other known risk factors for PSCI including older age, lower level of education, family history of dementia [ 8 ] are not readily amenable to treatment. Therefore, there is considerable need to identify pathophysiological mechanisms that may contribute to PSCI.…”

Evaluation and follow-up of cognitive functions in patients with minor stroke and transient ischemic attack

“…In a study by Khedr et al, 14 AF was more common among patients with PSD, although no significant association with PSD could be established. On the other hand, in 2000, Barba et al 1 found correlations between cognitive decline and AF.…”