Abstract
Vascular mechanisms are increasingly recognized in the pathophysiology of Alzheimer’s disease (AD), but less is known about the occurrence of stroke in AD patients. We aimed to quantify the risk of stroke in patients with AD and compare the incidence rates (IR) of stroke in individuals without AD. Systematic search of Embase and MEDLINE between 1970 and 2020. Inclusion criteria: reports with ≥ 50 patients with non-familial AD, which reported the occurrence of stroke (all types) and/or ischemic stroke and/or intracerebral hemorrhage (ICH) during follow-up. Meta-analyses of pooled data using random-effects model were performed. IR were calculated for each study. Incidence rate ratios (IRR) were calculated for studies presenting a control-group without AD. Among 5109 retrieved studies, 29 (0.6%) fulfilled the inclusion criteria, reporting a total of 61,824 AD patients. In AD patients the IR were 15.4/1000 person-years for stroke (all types), 13.0/1000 person-years for ischemic stroke and 3.4/1000 person-years for ICH. When compared to controls without AD, incidence rate for ICH in AD patients was significantly higher (IRR = 1.67, 95%CI 1.43–1.96), but similar for ischemic stroke. Incident stroke is not a rare event in AD population. AD is associated with an increased risk of intracerebral hemorrhage which warrants further clarification.
Highlights
Vascular mechanisms are increasingly recognized in the pathophysiology of Alzheimer’s disease (AD), but less is known about the occurrence of stroke in AD patients
Four articles which reported incident stroke for a matched control population without AD were included in the meta-analyses of Incidence rate ratios (IRR) (35,261 AD patients, 46,289 matched controls)
The main findings consist of the pooled incidence rates of stroke in patients with AD: 15.4 strokes of all types per 1000 person-years (95%CI 10.6–20.3), 13.0 ischemic strokes per 1000 person-years (95%CI 7.6–18.5) and 3.4 intracerebral hemorrhage (ICH) per 1000 person-years (95%CI 2.3–4.6)
Summary
Vascular mechanisms are increasingly recognized in the pathophysiology of Alzheimer’s disease (AD), but less is known about the occurrence of stroke in AD patients. When compared to controls without AD, incidence rate for ICH in AD patients was significantly higher (IRR = 1.67, 95%CI 1.43–1.96), but similar for ischemic stroke. A question that remains open is whether patients with AD, due to the aforementioned vascular involvement, present a higher lifetime risk of experiencing cerebral macrovascular complications such as ischemic stroke and intracerebral hemorrhage (ICH). One previous meta-analysis studied the incidence of ischemic stroke and ICH in patients with AD, but presented several methodological limitations, such as the inclusion of studies with partially overlapping populations, inclusion of a study with patients with other causes of dementia and the exclusion of studies which did not report stroke subtype[15]. We performed a systematic review of available literature and conducted a meta-analysis of studies which reported incident stroke in AD patients
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
