Dementia in stroke survivors in the Stroke Data Bank cohort. Prevalence, incidence, risk factors, and computed tomographic findings.

Abstract

We determined the prevalence of dementia in 927 patients with acute ischemic stroke aged years in the Stroke Data Bank cohort based on the examining neurologist's best judgment Diagnostic agreement among examiners was 68% (K=034). Of 726 testable patients, 116 (16%) were demented. Prevalence of dementia was related to age but not to sex, race, handedness, educational level, or employment status before the stroke. Previous stroke and previous myocardial infarction were related to prevalence of dementia although hypertension, diabetes mellitus, atrial fibrillation, and previous use of antithrombotic drugs were not Prevalence of dementia was most frequent in patients with infarcts due to large-artery atherosclerosis and in those with infarcts of unknown cause. Computed tomographic findings related to prevalence of dementia included infarct number, infarct site, and cortical atrophy. Among 610 patients who were not demented at stroke onset, we used methods of survival analysis to determine the incidence of dementia occurring during the 2-year follow-up. Incidence of dementia was related to age but not sex. Based on logistic regression analysis, the probability of new-onset dementia at 1 year was 5.4% for a patient aged 60 years and 10.4% for a patient aged 90 years. With a multivariate proportional hazards model, the most important predictors of incidence of dementia were a previous stroke and the presence of cortical atrophy at stroke onset (Stroke 1990-^1:858-866) C erebrovascular disease is considered to be the second most common cause of dementia; 20%-25% of cases of dementia are due to stroke, and another 10%-15% are attributed to a combination of vascular and Alzheimer's disease.

Cerebral complications of hypertension

“…138,142,[144][145][146][147] Risk factors for post-stroke dementia At least three different groups of factors, each acting independently, rather than a single pathophysiological mechanism probably contribute to the development of post-stroke dementia: 111,148 (1) stroke-related factors such as the location and the severity of the brain lesions; 149,150 (2) the overall cardiovascular risk profile as determined by the presence of atrial fibrillation 140 or diabetes mellitus; 149 (3) non-strokerelated factors similar to those found in Alzheimer's disease including increasing age, 149,151 low education, 149 cortical atrophy. 145,152 Hypertension has been identified as a risk factor by Pohjasvaara et al (1998), 111 but not by Skoog et al (1996). 101 In addition to those risk factors, coexisting Alzheimer's disease pathology may also play a role, as indicated 146 9.6 Andersen et al, 1996 147 5.5 Kokmen et al, 1996 138 8.4 Hénon et al, 1997 144 16.3 Pohjaasvara et al, 1997 142 12.2…”

Predictive Value of Platelet Activation for the Rate of Cognitive Decline in Alzheimer's Disease Patients

“…Taken together, as platelet activation predicts recurrent stroke and previous stroke is the most important predictor of incidence of dementia in stroke survivors in a large stroke cohort (Tatemichi et al, 1990), we investigated the expression of activated fibrinogen receptor and P-selectin on circulating platelets in patients with AD and evaluated their association with cognitive decline in patients with AD after a 1-year follow-up period.…”

The Time Onset of Post Stroke Dementia

“…One study found no relation between silent infarcts and PSD (Bornstein et al 1996), but the assessment of the pre-existing cognitive status was not standardized, and the study was underpowered. Other studies clearly identified silent infarcts as independent predictors of PSD (Tatemichi et al, 1990;Desmond et al, 2000;Henon et al, 2001;Pohjasvaara et al, 2000).…”

“…In other words, what is the "correct" timing to define "demented" a stroke patient? Tatemichi 21 years ago was the first to put VaD in a temporal context, by observing that 3 months after stroke about one fourth of the patients developed PSD (Tatemichi et al, 1990). Several subsequent studies confirmed this finding, so the time relationship between stroke and cognitive decline was included in the diagnostic criteria for VaD.…”

“…In addition, the few data on the influence of PSD on functional outcome suggest that patients with PSD are more impaired and more dependent in daily living activities than patients with stroke who do not develop PSD (Tatemichi et al, 1990;Tatemichi et al, 1992;Barba et al, 2000;Lin et al, 2003;Prencipe et al, 1997).…”