Poststroke dementia predicts poor survival in long-term follow-up: influence of prestroke cognitive decline and previous stroke

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

doi:10.1136/jnnp.2008.166603

Cited by 54 publications

(48 citation statements)

References 32 publications

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“…30 Tobacco was associated with post-stroke dementia. 10,19,24 Cohort study found that smoker associated with potential covariates and diagnosis of post-stroke dementia (OR 1.51, 95%CI; 0.89-2.58) 10 and alcohol consumption risk factors were more frequent in demented patients than no demented patients (OR 1.87, 95%CI; 1.02-3.44). 26 Third, stroke factors such as the previous stroke has been indicated as a risk factor for poststroke dementia.…”

Section: Resultsmentioning

confidence: 99%

“…30 Atrial fibrillation was associated with an increased prevalence of post-stroke dementia. 16,19,23 Multivariate analysis of predictors of post-stroke dementia demonstrated that atrial fibrillation was associated with dementia in stroke patients which is statistically significant (OR 1.29, 95%CI; 1.02 to 1.63). 30 Myocardial infarction was independent predictors of dementia in stroke patients.…”

Section: Resultsmentioning

confidence: 99%

“…First, demographics and clinical characteristics of patients which showed increasing age associated with an increased risk of poststroke dementia in most studies. 16,[18][19][20][21]23,25,32 Adding demographics factors showed that the risk of incident dementia elevated in relation to older age especially > 80 years (RR 4.66, 95%CI; 2.36 to 9.22) and age 70 to 79 years (RR 2.68, 95%CI; 1.52 to 4.74) versus age 60 to 69 years. 28 33 Previous mental decline was the correlation of dementia in logistic regression analysis (OR 1.20, 95%CI; 1.10 to 1.40).…”

Section: Resultsmentioning

confidence: 99%

“…3 This may result from stroke and Alzheimer's disease or from other factors 16,17 such as aging, low education level, diabetes mellitus, atrial fibrillation, myocardial infarction, hypertension, medial temporal lope atrophy and white matter changes. 10,11,16,[18][19][20][21][22][23][24][25] Currently, dementia is considered untreatable, and there are many factors that cause dementia. The previous study was unable to identify the factors that affect directly.…”

Section: Introductionmentioning

confidence: 99%

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Risk factors associated with post-stroke dementia: a systematic review and meta-analysis

et al. 2017

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This study aimed to evaluate the risk factors for prognostic of post-stroke dementia (PSD). A systematic review included case-control and/or cohort studies, we searched both published and unpublished literatures between 2000 to July 31, 2016. Two authors independently screened and selected research articles. If another one disagreed, the third author would be just along with his/her professionally. Moreover, Critical appraisal was measured by the quality (GRADE). Data collection was in the data extraction form. The Rev-Man 5.3 was used to estimate pooled data. The fixed-effect model will be used when the heterogeneity I² <50%, whereas the random-effects model will be used when the heterogeneity I²>50%. Result eight publications were pooled for measuring an association between risk factors and PSD by meta-analysis. There were 6 strongly PSD risk factors. The pooled relative ratio (RR) of atrial fibrillation was 1.68, previous stroke 1.59, myocardial infarction 1.40, hypertension 1.36, diabetes mellitus 1.25 and previous transient ischemic attack 1.25 respectively. Un-pooled data from 13 publications reported that the risk factors for dementia in stroke patients were i) demographic factors, ii) vascular risk factors, iii) stroke factors, iv) stroke complications, and v) abnormalities on brain imaging. Strongly risk factors associated with increasing PSD risk were atrial fibrillation, previous stroke, myocardial infarction, hypertension, diabetes mellitus, and previous transient ischemic attack. Further studies, strongly risk factors need to investigate and develop the risk score for the prediction of dementia in stroke patients.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Risk factors associated with post-stroke dementia: a systematic review and meta-analysis

et al. 2017

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“…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.…”

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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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Cerebral small vessel disease burden and cognitive and functional outcomes after stroke: A multicenter prospective cohort study

Georgakis

Fang

Düring

et al. 2022

Alzheimer's & Dementia

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Introduction: It remains unknown whether the global small vessel disease (SVD) burden predicts post-stroke outcomes. Methods:In a prospective multicenter study of 666 ischemic and hemorrhagic stroke patients, we quantified magnetic resonance imaging (MRI)-based SVD markers (lacunes, white matter hyperintensities, microbleeds, perivascular spaces) and explored associations with 6-and 12-month cognitive (battery of 15 neuropsychological tests) and functional (modified Rankin scale) outcomes. Results:A global SVD score (range 0-4) was associated with cognitive impairment; worse performance in executive function, attention, language, and visuospatial ability; and worse functional outcome across a 12-month follow-up. Although the global SVD score did not improve prediction, individual SVD markers, assessed across their severity range, improved the calibration, discrimination, and reclassification of predictive models including demographic, clinical, and other imaging factors. Discussion: SVD presence and severity are associated with worse cognitive and functional outcomes 12 months after stroke. Assessing SVD severity may aid prognostication for stroke patients. Marios K. Georgakis and Rong Fang contributed equally to this work. *Names and affiliations of DEMDAS investigators are listed in the supplement (Table S23).

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Poststroke dementia predicts poor survival in long-term follow-up: influence of prestroke cognitive decline and previous stroke

Cited by 54 publications

References 32 publications

Risk factors associated with post-stroke dementia: a systematic review and meta-analysis

Risk factors associated with post-stroke dementia: a systematic review and meta-analysis

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

Cerebral small vessel disease burden and cognitive and functional outcomes after stroke: A multicenter prospective cohort study

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