Cognitive impairment predicts poststroke death in long-term follow-up

Oksala, Niku; Jokinen, Hanna; Melkas, Susanna; Oksala, Anni; Pohjasvaara, Tarja; Hietanen, Maria; Vataja, Risto; Kaste, Markku; Karhunen, Pekka J.; Erkinjuntti, Timo

doi:10.1136/jnnp.2009.174573

Cited by 114 publications

(112 citation statements)

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“…2 One study found that poststroke CIND is a negative predictor of survival. 3 Studies have also shown that poststroke dementia (PSD) increases the risk of recurrent vascular events. 4,5 However, no studies to date have examined the effect of CIND on poststroke recurrent vascular events or dependency.…”

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confidence: 99%

“…Previous studies that have examined the prognostic abilities of domain-specific impairments have found that visual memory impairments predict for disturbances in activities of daily living, 8 whereas executive functioning and visuospatial impairments 3,9 predict for poor survival after stroke. Therefore, in this study, we aimed to determine domain-specific predictors of dependency, recurrent vascular events, and death.…”

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confidence: 99%

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The Prognostic Effects of Poststroke Cognitive Impairment No Dementia and Domain-Specific Cognitive Impairments in Nondisabled Ischemic Stroke Patients

Narasimhalu

Ang

Silva

et al. 2011

Stroke

105

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Background and Purpose-There is some evidence that poststroke dementia, cognitive impairment no dementia (CIND), and mild cognitive impairment predict for poor outcomes such as dementia, death, and institutionalization. However, few studies have examined the prognostic value of CIND, CIND severity, and domain impairments in a poststroke cohort. Methods-A cohort of ischemic stroke patients with baseline cognitive assessments 3 months poststroke were followed up annually for outcomes of dependency, vascular events, and death for up to 5 years. Univariate and multivariate Cox proportional regression was performed to determine the ability CIND, CIND severity, and domain impairments to predict dependency, vascular outcomes, and death. Results-Four-hundred nineteen patients without dementia (mean age 60Ϯ11 years, 32% female) were followed for a mean of 3.2 years. Older age, diabetes, more severe strokes, CIND-mild, and CIND-moderate were independently predictive of dependency. There were no independent predictors of recurrent vascular events. Older age, diabetes, and CIND-moderate were independently predictive of death. In analyses of individual cognitive domains, impairments in visuomotor speed were independently predictive of dependency. Conclusions-In poststroke patients, CIND predicts dependency and death, while CIND severity discriminates patients with poor survival. Impairments in visuomotor speed independently predict dependency. Clinical Trial Registration-URL: http://clinicaltrials.gov. Unique Identifier: NCT00161070.(Stroke. 2011;42:883-888.)Key Words: dementia Ⅲ stroke Ⅲ mild cognitive impairment Ⅲ cognitive impairment no dementia D ementia, cognitive impairment no dementia (CIND), and mild cognitive impairment (MCI) have become increasingly prevalent in aging populations. CIND is a broad concept that has been used to define impairments in any objective cognitive domain in neuropsychological testing in the absence of dementia. 1 In community-based studies, CIND has been shown to predict for dementia, death, and institutionalization. 2 One study found that poststroke CIND is a negative predictor of survival. 3 Studies have also shown that poststroke dementia (PSD) increases the risk of recurrent vascular events. 4,5 However, no studies to date have examined the effect of CIND on poststroke recurrent vascular events or dependency. We hypothesize that CIND is associated with dependency, recurrent vascular events, and death following ischemic stroke.In a previous study from this cohort, 6 we have shown that CIND severity predicts incident dementia; CIND-mild patients shared a similar risk profile with patients with no cognitive impairment (NCI), and CIND-moderate patients experienced a 6-fold increase in the risk of incident dementia. Because PSD has been associated with recurrent vascular events 4 and death, 7 we hypothesize that a similar association may exist with CIND severity and outcomes after stroke.Previous studies that have examined the prognostic abilities of domain-specific impairments have found tha...

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confidence: 99%

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confidence: 99%

The Prognostic Effects of Poststroke Cognitive Impairment No Dementia and Domain-Specific Cognitive Impairments in Nondisabled Ischemic Stroke Patients

Narasimhalu

Ang

Silva

et al. 2011

Stroke

105

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“…1,2,12 Beyond, animals in our model exhibit deficits in memory, visuospatial abilities, and executive function, thus resembling the clinical features of multi-infarct dementia. 13 Another advantage of our model is the use of adult mice without comorbidities, which excludes confounding risk factors for vascular dementia and nonstroke-related cognitive impairment. A limitation of the presented model is that large sample sizes are needed to detect behavioral improvement.…”

Section: Discussionmentioning

confidence: 99%

Progressive Cognitive Deficits in a Mouse Model of Recurrent Photothrombotic Stroke

Schmidt

Diederich

Strecker³

et al. 2015

Stroke

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Focal cerebral ischemia was induced in the right parietal cortex of 25 adult male C57BL/6 mice by photothrombosis of cortical microvessels (detailed Methods are available in the online-only Data Supplement).6 At an interval of 10 days, a second photothromboticBackground and Purpose-In spite of its high disease burden, there is no specific treatment for multi-infarct dementia. The preclinical evaluation of candidate drugs is limited because an appropriate animal model is lacking. Therefore, we aimed to evaluate whether a mouse model of recurrent photothrombotic stroke is suitable for the preclinical investigation of multi-infarct dementia. Methods-Recurrent photothrombotic cortical infarcts were induced in 25 adult C57BL/6 mice. Twenty-five sham-operated animals served as controls. The object recognition test and the Morris water maze test were performed >6 weeks to assess cognitive deficits. Afterward, histological analyses were performed to characterize histopathologic changes associated with recurrent photothrombotic infarcts. Results-After the first infarct, the object recognition test showed a trend toward an impaired formation of recognition memories (P=0.08), and the Morris Water Maze test revealed significantly impaired spatial learning and memory functions (P<0.05). After recurrent infarcts, the object recognition test showed significant recognition memory deficits (P<0.001) and the Morris water maze test demonstrated persisting spatial learning and memory deficits (P<0.05). Histological analyses revealed remote astrogliosis in the hippocampus. Conclusions-Our results show progressive cognitive deficits in a mouse model of recurrent photothrombotic stroke. The presented model resembles the clinical features of human multi-infarct dementia and enables the investigation of its pathophysiological mechanisms and the evaluation of treatment strategies.

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“…Prejuízo da FE após AVC tem sido descrito em 30% a 76% dos casos Gutierrez Perez, Savborg et al ;Sundar and Adwani ;Hoffmann, Schmitt et al 2009;Oksala, Jokinen et al 2009), e está associado a recuperação funcional (Barker-Collo, Feigin et al ;Paolucci, Antonucci et al 1996;Patel, Coshall et al 2002) e AVD. (Pohjasvaara, Erkinjuntti et al 1998;Zinn, Bosworth et al 2007 …”

Section: Função Executiva E Avcunclassified

“…Apenas estudos mais recentes focaram a associação da depressão pós AVC mais especificamente com a FE. Esses estudos demonstraram maior morbidade em pacientes com essa associação (Pohjasvaara, Leskela et al 2002;Oksala, Jokinen et al 2009;Melkas, Vataja et al 2010 HL= hiperlipidemia; EP= estatina prévia; EC= estatina corrente; T= tabagismo atual; HT= história de tabagismo; HDA= história de dependência ao álcool; AIT= ataque isquêmico transitório; E= enxaqueca; ACO= anticoncepcional; * = Prontuário do paciente não localizado. HL= hiperlipidemia; EP= estatina prévia; EC= estatina corrente; T= tabagismo atual; HT= história de tabagismo; HDA= história de dependência ao álcool; AIT= ataque isquêmico transitório; E= enxaqueca; ACO= anticoncepcional; * = Prontuário do paciente não localizado.…”

Section: Análise De Colinearidadeunclassified

Associação entre função executiva e sintomas depressivos em pacientes com acidente vascular cerebral isquêmico

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Cognitive impairment predicts poststroke death in long-term follow-up

Abstract: Background: Poststroke global cognitive decline and dementia have been related to poor

Cited by 114 publications

References 59 publications

The Prognostic Effects of Poststroke Cognitive Impairment No Dementia and Domain-Specific Cognitive Impairments in Nondisabled Ischemic Stroke Patients

The Prognostic Effects of Poststroke Cognitive Impairment No Dementia and Domain-Specific Cognitive Impairments in Nondisabled Ischemic Stroke Patients

Progressive Cognitive Deficits in a Mouse Model of Recurrent Photothrombotic Stroke

Associação entre função executiva e sintomas depressivos em pacientes com acidente vascular cerebral isquêmico

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