Risk Prediction Models for Post-Stroke Dementia

Abstract

A strong association exists between stroke and dementia with both diseases linked to ageing. Survival rates from stroke are improving which would equate to an ever-expanding population of patients at risk of future dementia. Early or timelier identification of dementia has become a priority in many countries, including the UK. Although screening for dementia is not advocated, targeting at risk populations could be used to reduce an individual's risk via intervention (i.e., personalised medicine), where available. One approach to improving identification of high-risk dementia individuals is using risk prediction models. Such models could be applied to stroke survivors. Dementia risk prediction models specific to stroke survivors have recently been developed and will be discussed here.

Risk Prediction of Cognitive Decline after Stroke

“…In this analysis we used data collected between 1995 and 2018. The methods of the SLSR have been described in detail by Wolfe et al [6][7][8][9][10][11][12][13][14][15][16][17] and are summarised here. All patients with a first ever stroke after 1 st January 1995 and residing in a defined inner-city area of South London were eligible for inclusion.…”

“…Whilst these models could be a useful assistive tool to predict cognitive decline, atrophy are not systematically measured in the practice. Tang et al [11] reported that several models have been developed for people with stroke to predict dementia [12] [13] or cognitive impairment [14] [15] and their predictive accuracy was found to be acceptable. Different variables including demographic, cognitive test scores and neuroimaging markers have been incorporated into different models, with predictive accuracy found to be moderate to high.…”

“…Cognitive impairment was measured using the Mini Mental State Examination (cut off 24/30) and the Abbreviated Mental Test (cut off 8/10) at 3-months and yearly thereafter. A penalised mixed-effects linear model was developed and temporal-validated in a new cohort consisted of 1,718 stroke register participants recruited from (2011)(2012)(2013)(2014)(2015)(2016)(2017)(2018). Prediction errors on discrimination and calibration were assessed.…”

The Prevalence of Cognitive Impairment on Admission to Nursing Home among Residents with and without Stroke: A Cross–Sectional Survey of Nursing Homes in Ireland

“…In our study sample, 62.5% of residents were female and over 80% of residents were 75 years of age or older, with those aged 85 years and older forming the biggest age group of residents. The prevalence of cognitive impairment post-stroke upon admission to nursing homes is an area in which there is a dearth of research, yet it may have considerable implications for health service planners, as the demand for nursing home placement for those with PSCI is likely to increase in the coming decades in line with population ageing [22][23][24].…”

“…The extent of the utilisation of nursing home care both for those with cognitive impairment and for those with dementia post-stroke has yet to be determined. These data are important for health service planners and policy makers, as epidemiological evidence suggests that, as the risks of stroke and cognitive impairment increase exponentially with age, PSCI is likely to become more prevalent in the coming decades, in line with an ageing population [22][23][24]. This is likely to have considerable implications for the demand for nursing home care places to meet this growing demand.…”