Prevalence, incidence, and factors associated with pre-stroke and post-stroke dementia: a systematic review and meta-analysis

Pendlebury, Sarah T.; Rothwell, Peter M.

doi:10.1016/s1474-4422(09)70236-4

Cited by 1,531 publications

(1,375 citation statements)

References 95 publications

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“…Mixed findings may be related to differences in the cognitive tests used and test timing, history of previous stroke, stroke location, large‐ and small‐vessel disease, population sample (clinical versus population based), ethnicity, and the presence of neurodegenerative pathology 9. Nevertheless, it is also possible that the initial poststroke cognitive state may reflect prestroke cognitive decline10 or delirium 11. There is a drive toward detecting long‐term cognitive outcomes after stroke to explore prevention; however, a preferred testing strategy is lacking, making cross‐study comparison difficult 12…”

Section: Introductionmentioning

confidence: 99%

Longitudinal Effect of Stroke on Cognition: A Systematic Review

Tang

Amiesimaka

Harrison

et al. 2018

JAHA

144

114

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BackgroundStroke is associated with an increased risk of dementia; however, the impact of stroke on cognition has been found to be variable, such that stroke survivors can show decline, remain stable, or revert to baseline cognitive functioning. Knowing the natural history of cognitive impairment after stroke is important for intervention. The aim of this systematic review is to investigate the longitudinal course of cognitive function in stroke survivors.Methods and ResultsThree electronic databases (Medline, Embase, PsycINFO) were searched using OvidSP from inception to July 15, 2016. Longitudinal studies with ≥2 time points of cognitive assessment after stroke were included. In total, 5952 articles were retrieved and 14 were included. There was a trend toward significant deterioration in cognitive test scores in stroke survivors (8 studies). Cognitive stability (3 studies) and improvement (3 studies) were also demonstrated, although follow‐up time tended to be shorter in these studies. Variables associated with impairment included age, ethnicity, premorbid cognitive performance, depression, stroke location, and history of previous stroke. Associations with APOE*E4 (apolipoprotein E with the E4 allele) allele status and sex were mixed.ConclusionsStroke is associated with an increased risk of cognitive decline, but cognitive decline is not a consequence. Factors associated with decline, such as sociodemographic status, health‐related comorbidity, stroke history, and clinical features could be used in models to predict future risk of dementia after stroke. A risk model approach could identify patients at greatest risk for timely intervention to reduce the frequency or delay the onset of poststroke cognitive impairment and dementia.

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Section: Introductionmentioning

confidence: 99%

Longitudinal Effect of Stroke on Cognition: A Systematic Review

Tang

Amiesimaka

Harrison

et al. 2018

JAHA

144

114

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“…New ischemic lesions, even without corresponding focal deficit, might lead to long-term clinical consequences, including cognitive decline and dementia [24]. Thus, reducing ischemic lesions as much as possible is essential in CAS.…”

Section: Discussionmentioning

confidence: 99%

Effect of Pitavastatin on Preventing Ischemic Complications with Carotid Artery Stenting: A Multicenter Prospective Study—EPOCH-CAS Study

Takayama

Taki

Toma

et al. 2013

Cardiovasc Intervent Radiol

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Purpose Periprocedural ischemic stroke is one problem associated with carotid artery stenting (CAS). This study was designed to assess whether preoperative statin therapy reduces the risk of periprocedural ischemic complications with CAS. Methods In this prospective study at 11 centers, patients with carotid artery stenosis (symptomatic C50 %, asymptomatic C80 %) and a high risk of carotid endarterectomy but without previous statin treatments were divided into two groups by low-density lipoprotein cholesterol (LDL-C) levels. With LDL-C C120 mg/dl, the pitavastatin-treated (PS) group received pitavastatin at 4 mg/day. With LDL-C \120 mg/dl, the non-PS group received no statin therapy. After 4 weeks, both groups underwent CAS. Frequencies of new ipsilateral ischemic lesions on diffusion-weighted imaging within 72 h after CAS and cerebrovascular events (transient ischemic attack, stroke, or death) within 30 days were assessed. Results Among the 80 patients enrolled, 61 patients (PS group, n = 31; non-PS group, n = 30) fulfilled the inclusion criteria. New ipsilateral ischemic lesions were identified in 8 of 31 patients (25.8 %) in the PS group and 16 of 30 patients (53.3 %) in the non-PS group (P = 0.028). Cerebrovascular events occurred in 0 patients in the PS group and in 3 of 30 patients (10.0 %) in the non-PS group (P = 0.071). Multivariate analyses demonstrated the pitavastatin treatment (b = 0.74, 95 % confidence interval 0.070-1.48, P = 0.042) to be an independent factor for decreasing post-CAS ischemic lesions.This study was conducted on behalf of the EPOCH-CAS Investigators. The members of EPOCH-CAS Investigators are given in Appendix. 123Cardiovasc Intervent Radiol (2014) 37:1436-1443 DOI 10.1007 Conclusion Pretreatment with pitavastatin significantly reduced the frequency of periprocedural ischemic complications with CAS.

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“…Diabetes also increases the risk of post‐stroke dementia (OR 1.4, 95% CI 1.2–1.7)100. Furthermore, hyperglycemia in the acute phase of stroke is associated with poor outcome, also in people without diabetes.…”

Section: Type 2 Diabetes Mellitus Stroke and Incretin‐based Therapiesmentioning

confidence: 99%

Potentials of incretin‐based therapies in dementia and stroke in type 2 diabetes mellitus

Groeneveld

Kappelle

Biessels

2015

J of Diabetes Invest

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Patients with type 2 diabetes mellitus are at risk for accelerated cognitive decline and dementia. Furthermore, their risk of stroke is increased and their outcome after stroke is worse than in those without diabetes. Incretin‐based therapies are a class of antidiabetic agents that are of interest in relation to these cerebral complications of diabetes. Two classes of incretin‐based therapies are currently available: the glucagon‐like‐peptide‐1 agonists and the dipeptidyl peptidase‐4 ‐inhibitors. Independent of their glucose‐lowering effects, incretin‐based therapies might also have direct or indirect beneficial effects on the brain. In the present review, we discuss the potential of incretin‐based therapies in relation to dementia, in particular Alzheimer's disease, and stroke in patients with type 2 diabetes. Experimental studies on Alzheimer's disease have found beneficial effects of incretin‐based therapies on cognition, synaptic plasticity and metabolism of amyloid‐β and microtubule‐associated protein tau. Preclinical studies on incretin‐based therapies in stroke have shown an improved functional outcome, a reduction of infarct volume as well as neuroprotective and neurotrophic properties. Both with regard to the treatment of Alzheimer's disease, and with regard to prevention and treatment of stroke, randomized controlled trials in patients with or without diabetes are underway. In conclusion, experimental studies show promising results of incretin‐based therapies at improving the outcome of Alzheimer's disease and stroke through glucose‐independent pleiotropic effects on the brain. If these findings would indeed be confirmed in large clinical randomized controlled trials, this would have substantial impact.

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Prevalence, incidence, and factors associated with pre-stroke and post-stroke dementia: a systematic review and meta-analysis

Cited by 1,531 publications

References 95 publications

Longitudinal Effect of Stroke on Cognition: A Systematic Review

Longitudinal Effect of Stroke on Cognition: A Systematic Review

Effect of Pitavastatin on Preventing Ischemic Complications with Carotid Artery Stenting: A Multicenter Prospective Study—EPOCH-CAS Study

Potentials of incretin‐based therapies in dementia and stroke in type 2 diabetes mellitus

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