Poststroke Cognitive Impairment and Dementia: Prevalence, Diagnosis, and Treatment

Overview

Journal Degener Neurol Neuromuscul Dis

Publisher Dove Medical Press

Date 2020 Jul 17

PMID 32669898

Citations 13

Authors

Susanna Melkas

Hanna Jokinen

Marja Hietanen

Timo Erkinjuntti

Affiliations

Soon will be listed here.

Abstract

Three aspects of poststroke cognitive impairment and dementia are discussed in this review: prevalence; diagnosis; and treatment. The aim is to increase awareness of poststroke cognitive impairment in order to further stimulate strategies to recognize the condition and to prevent its progression. Approximately two-thirds of all middle-aged and elderly stroke patients develop cognitive impairment, and one in three develops dementia. The standard reference for diagnosis is a detailed neuropsychological examination. Short screening tests have been used for both clinical and research purposes, but their sensitivity is limited and there is no consensus as to which test is the most appropriate. The treatment of poststroke cognitive impairment and dementia is based on effective treatment of vascular risk factors, including lifestyle modification when needed.

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References

OBrien J, Erkinjuntti T, Reisberg B, Roman G, Sawada T, Pantoni L . Vascular cognitive impairment. Lancet Neurol. 2003; 2(2):89-98. DOI: 10.1016/s1474-4422(03)00305-3. View

Salvadori E, Pasi M, Poggesi A, Chiti G, Inzitari D, Pantoni L . Predictive value of MoCA in the acute phase of stroke on the diagnosis of mid-term cognitive impairment. J Neurol. 2013; 260(9):2220-7. DOI: 10.1007/s00415-013-6962-7. View

Bour A, Rasquin S, Boreas A, Limburg M, Verhey F . How predictive is the MMSE for cognitive performance after stroke?. J Neurol. 2010; 257(4):630-7. PMC: 2848722. DOI: 10.1007/s00415-009-5387-9. View

Ballard C, Rowan E, Stephens S, Kalaria R, Kenny R . Prospective follow-up study between 3 and 15 months after stroke: improvements and decline in cognitive function among dementia-free stroke survivors >75 years of age. Stroke. 2003; 34(10):2440-4. DOI: 10.1161/01.STR.0000089923.29724.CE. View

Makin S, Turpin S, Dennis M, Wardlaw J . Cognitive impairment after lacunar stroke: systematic review and meta-analysis of incidence, prevalence and comparison with other stroke subtypes. J Neurol Neurosurg Psychiatry. 2013; 84(8):893-900. PMC: 3717603. DOI: 10.1136/jnnp-2012-303645. View

Alexopoulos G, Kiosses D, Klimstra S, Kalayam B, Bruce M . Clinical presentation of the "depression-executive dysfunction syndrome" of late life. Am J Geriatr Psychiatry. 2002; 10(1):98-106. View

Chollet F, Tardy J, Albucher J, Thalamas C, Berard E, Lamy C . Fluoxetine for motor recovery after acute ischaemic stroke (FLAME): a randomised placebo-controlled trial. Lancet Neurol. 2011; 10(2):123-30. DOI: 10.1016/S1474-4422(10)70314-8. View

Gold G, Kovari E, Herrmann F, Canuto A, Hof P, Michel J . Cognitive consequences of thalamic, basal ganglia, and deep white matter lacunes in brain aging and dementia. Stroke. 2005; 36(6):1184-8. DOI: 10.1161/01.STR.0000166052.89772.b5. View

Pantoni L, Basile A, Pracucci G, Asplund K, Bogousslavsky J, Chabriat H . Impact of age-related cerebral white matter changes on the transition to disability -- the LADIS study: rationale, design and methodology. Neuroepidemiology. 2004; 24(1-2):51-62. DOI: 10.1159/000081050. View

10.

Leys D, Henon H, Mackowiak-Cordoliani M, Pasquier F . Poststroke dementia. Lancet Neurol. 2005; 4(11):752-9. DOI: 10.1016/S1474-4422(05)70221-0. View

11.

Gorelick P, Scuteri A, Black S, DeCarli C, Greenberg S, Iadecola C . Vascular contributions to cognitive impairment and dementia: a statement for healthcare professionals from the american heart association/american stroke association. Stroke. 2011; 42(9):2672-713. PMC: 3778669. DOI: 10.1161/STR.0b013e3182299496. View

12.

Dufouil C, Chalmers J, Coskun O, Besancon V, Bousser M, Guillon P . Effects of blood pressure lowering on cerebral white matter hyperintensities in patients with stroke: the PROGRESS (Perindopril Protection Against Recurrent Stroke Study) Magnetic Resonance Imaging Substudy. Circulation. 2005; 112(11):1644-50. DOI: 10.1161/CIRCULATIONAHA.104.501163. View

13.

Kokmen E, Whisnant J, OFallon W, Chu C, Beard C . Dementia after ischemic stroke: a population-based study in Rochester, Minnesota (1960-1984). Neurology. 1996; 46(1):154-9. DOI: 10.1212/wnl.46.1.154. View

14.

Mok V, Chang C, Wong A, Lam W, Richards P, Wong K . Neuroimaging determinants of cognitive performances in stroke associated with small vessel disease. J Neuroimaging. 2005; 15(2):129-37. DOI: 10.1177/1051228404274304. View

15.

Rasquin S, Lodder J, Verhey F . The effect of different diagnostic criteria on the prevalence and incidence of post-stroke dementia. Neuroepidemiology. 2005; 24(4):189-95. DOI: 10.1159/000084711. View

16.

Boecker H . On the emerging role of neuroimaging in determining functional and structural brain integrity induced by physical exercise: impact for predictive, preventive, and personalized medicine. EPMA J. 2012; 2(3):277-85. PMC: 3405390. DOI: 10.1007/s13167-011-0093-y. View

17.

Snowdon D, Greiner L, Mortimer J, Riley K, Greiner P, Markesbery W . Brain infarction and the clinical expression of Alzheimer disease. The Nun Study. JAMA. 1997; 277(10):813-7. View

18.

Tatemichi T, Paik M, Bagiella E, Desmond D, Pirro M, Hanzawa L . Dementia after stroke is a predictor of long-term survival. Stroke. 1994; 25(10):1915-9. DOI: 10.1161/01.str.25.10.1915. View

19.

Oksala N, Jokinen H, Melkas S, Oksala A, Pohjasvaara T, Hietanen M . Cognitive impairment predicts poststroke death in long-term follow-up. J Neurol Neurosurg Psychiatry. 2009; 80(11):1230-5. DOI: 10.1136/jnnp.2009.174573. View

20.

Malouf R, Birks J . Donepezil for vascular cognitive impairment. Cochrane Database Syst Rev. 2004; (1):CD004395. DOI: 10.1002/14651858.CD004395.pub2. View