Abstract
Cognitive impairment is a common complication observed after a stroke. Currently there are no definitively proven pharmacologic therapies for recovery from post-stroke cognitive impairment and vascular dementia. In this meta-analysis, we evaluated the efficacy and safety of cholinesterase inhibitors in their improvement of cognition in patients with post-stroke cognitive impairment and vascular dementia. We conducted a meta-analysis using seven eligible studies from 305 published articles. We investigated the differences in Mini–Mental State Examination (MMSE) and Alzheimer’s Disease Assessment Scale-Cognitive subscale (ADAS-Cog) scores, before and after cholinergic augmentation in patients with post-stroke cognitive impairment and vascular dementia. MMSE and ADAS-cog scores were also compared during the subsequent follow-up periods. MMSE score of patients with post-stroke cognitive impairment was increased after cholinergic augmentation throughout the 24 weeks with mean differences [MD] of 3.000, 1.732, 1.578 1.516, and 1.222, at 4, 4–8, 8–12, 12–18, and 18–24 weeks, respectively. In addition, ADAS-cog scores decreased at 6, 12, 18, and 24 weeks by pharmaceutical augmentation, but not with placebo with mean differences [MD] of -2.333, -2.913, -2.767, -2.416, and -1.859, respectively. This meta-analysis shows that acetylcholinesterase inhibitors maintain a stable pattern of improved cognitive function in patients with post stroke cognitive impairment and vascular dementia without the increased risk of side effects.
Highlights
Post-stroke cognitive impairment is a common complication observed after stroke
Mean differences (MD) of Mini–Mental State Examination (MMSE) score in post-stroke cognitive impairment and vascular dementia with cholinergic augmentation were significantly increased throughout the 24 weeks: 3.000 (95% confidence interval [confidence interval https (CI)] 2.135 to 3.865) at 4 weeks, 1.732 at 4–8 weeks, 1.578 at 8–12 weeks, 1.516 at 12–18 weeks, and 1.222 at 18–24 weeks (Table 2 and Fig 2)
Significant improvements of MMSE score were found between cholinergic augmentation and placebo groups in patients at 4 weeks with post stroke cognitive impairment and vascular dementia
Summary
Post-stroke cognitive impairment is a common complication observed after stroke. The prevalence of dementia within the first year after stroke ranges from 9% to 30% [1]. The prevalence of cognitive impairment with no dementia may be much higher. Post-stroke cognitive impairment can be a risk factor for vascular dementia. The prevalence of new-onset dementia shortly after a first incidence of stroke is about 10% after a recurrent stroke excluding.
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