Abstract
ABSTRACT.Various mechanisms contribute to dementia after first ischemic stroke as lesions on strategic areas of cognition and stroke premorbidity.Objectives: Assessing clinical and neuroimaging predictors of dementia after first ischemic stroke and its relation to stroke location, subtypes and severity.Methods: Eighty first ischemic stroke patients were included. Forty patients with dementia after first stroke and forty patients without dementia according to DSM-IV diagnostic criteria of vascular dementia. All patients were subjected to general and neurological assessment, National Institute Health Stroke Scale (NIHSS) for stroke severity, Montreal Cognitive Assessment (MoCA) scale for cognition assessment, MRI brain and Trial of Org 10172 in acute stroke treatment (TOAST) classification for stroke subtypes.Results: Left hemispheric ischemic stroke, strategic infarctions, diabetes mellitus and stroke of anterior circulation were found to be independent risk factors for dementia after first ischemic stroke (OR=3.09, 95%CI 1.67-10.3, OR=2.33, 95%CI 1.87-8.77, OR=1.88, 95%CI 1.44-4.55, OR=1.86, 95%CI 1.45-6.54, respectively). Hypertension, dyslipidemia, smoking, ischemic heart disease, high NIHSS score and large vessel infarction were significantly higher among post stroke dementia patients. However, on binary logistic regression, they did not reach to be independent risk factors.Conclusion: Stroke location (left stroke, strategic infarction, anterior circulation stroke) and diabetes mellitus could be predictors of dementia after first ischemic stroke, but stroke severity, stroke subtypes, hypertension, dyslipidemia, smoking and ischemic heart could not.
Highlights
Post-stroke dementia (PSD) is a common cause of dementia, with a prevalence ranging from 6 to 32%.1 It is a syndrome of multiple cognitive domains deficits including memory, may occur within three months after clinical stroke, affects daily functioning, quality of life, and ability to return to work, and increases the mortality rate after stroke by three times.[2]
The primary objectives of this study were assessing the relation between dementia after first ischemic stroke and stroke location, stroke subtype, stroke severity and stroke risk factors
All subjects underwent neurological history (stressing on risk factors of stroke as diabetes mellitus (DM), hypertension (HTN), smoking, dyslipidemia, ischemic heart disease (IHD) and atrial fibrillation (AF)) and examination expressing the initial stroke severity by National Institutes of Health Stroke Scale (NIHSS) which is composed of 11 items, with a score between 0 and 2 or 0 and 3 or 0 and 4 given to each item
Summary
Post-stroke dementia (PSD) is a common cause of dementia, with a prevalence ranging from 6 to 32%.1 It is a syndrome of multiple cognitive domains deficits including memory, may occur within three months after clinical stroke, affects daily functioning, quality of life, and ability to return to work, and increases the mortality rate after stroke by three times.[2]. Post-stroke dementia (PSD) is a common cause of dementia, with a prevalence ranging from 6 to 32%.1 It is a syndrome of multiple cognitive domains deficits including memory, may occur within three months after clinical stroke, affects daily functioning, quality of life, and ability to return to work, and increases the mortality rate after stroke by three times.[2] Dementia and stroke relationship remains complex since several synergistic or cumulative mechanisms are involved as strategic vascular brain lesions, metabolic or vascular risk factors, previous silent infarcts, leukoaraiosis, accelerated pre-existing degenerative lesions, coincidence of Alzheimer’s pathology, endothelial dysfunction, blood–brain barrier impairment, and neuroinflammation.[3] Strategic infarctions are infarctions at areas related to cognition and behavior as frontal, temporal lobe, and hippocampus.[4] Early detection of cognitive problems following stroke helps cognitive rehabilitation and decreases mortality.[5]. The primary objectives of this study were assessing the relation between dementia after first ischemic stroke and stroke location (strategic infarction, side of stroke), stroke subtype (anterior or posterior/large vessel or small vessel or cardioembolic), stroke severity and stroke risk factors. Secondary objectives involved evaluating which of the previous factors could be predictors of dementia after first ischemic stroke
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