Dementia In People Research Articles

Pharmacological Approaches to the Treatment of Dementia in Down Syndrome: A Systematic Review of Randomized Clinical Studies.

Down Syndrome (DS) is considered the most frequent form of Intellectual Disability, with important expressions of cognitive decline and early dementia. Studies on potential treatments for dementia in this population are still scarce. Thus, the current review aims to synthesize the different pharmacological approaches that already exist in the literature, which focus on improving the set of symptoms related to dementia in people with DS. A total of six studies were included, evaluating the application of supplemental antioxidant therapies, such as alpha-tocopherol; the use of acetylcholinesterase inhibitor drugs, such as donepezil; N-methyl-d-aspartate (NMDA) receptor antagonists, such as memantine; and the use of vitamin E and a fast-acting intranasal insulin. Two studies observed important positive changes related to some general functions in people with DS (referring to donepezil). In the majority of studies, the use of pharmacological therapies did not lead to improvement in the set of symptoms related to dementia, such as memory and general functionality, in the population with DS.

A novel approach to type 3 diabetes mechanism: The interplay between noncoding RNAs and insulin signaling pathway in Alzheimer's disease.

Today, growing evidence indicates that patients with type 2 diabetes (T2D) are at a higher risk of developing Alzheimer's disease (AD). Indeed, AD as one of the main causes of dementia in people aged more than 65 years can be aggravated by insulin resistance (IR) and other metabolic risk factors related to T2D which are also linked to the function of the brain. Remarkably, a new term called "type 3 diabetes" has been suggested for those people who are diagnosed with AD while also showing the symptoms of IR and T2D. In this regard, the role of genetic and epigenetic changes associated with AD has been confirmed by many studies. On the other hand, it should be noted that the insulin signaling pathway is highly regulated by various mechanisms, including epigenetic factors. Among these, the role of noncoding RNAs (ncRNAs), including microRNAs and long noncoding RNAs has been comprehensively studied with respect to the pathology of AD and the most well-known underlying mechanisms. Nevertheless, the number of studies exploring the association between ncRNAs and the downstream targets of the insulin signaling pathway in the development of AD has notably increased in recent years. With this in view, the present study aimed to review the interplay between different ncRNAs and the insulin signaling pathway targets in the pathogenesis of AD to find a new approach in the field of combining biomarkers or therapeutic targets for this disease.

Dementia in People with Severe/Profound Intellectual (and Multiple) Disabilities: Practice-Based Observations of Symptoms

ABSTRACT Introduction Observable dementia symptoms are hardly studied in people with severe/profound intellectual (and multiple) disabilities (SPI(M)D). Insight in symptomatology is needed for timely signaling/diagnosis. This study aimed to identify practice-based observations of dementia symptoms in this population. Methods Care professionals and family members were invited to complete a survey about symptoms. Quantitatively analyzed survey data were further deepened through semi-structured interviews with care professionals having vast experience in signaling/diagnosing dementia in this population. Symptoms were categorized using a symptom matrix. Results Survey respondents and interviewees frequently observed a decline in activities of daily living (ADL) functioning and behavioral and psychological changes, like increased irritability, anxiety, apathy and decreased eating/drinking behavior. Cognitive symptoms were particularly recognized in persons with verbal communication and/or walking skills. To lesser extent motor changes and medical comorbidities were reported. Conclusion Increased insight in dementia symptoms contributes to developing a dedicated screening instrument for dementia in people with SPI(M)D.

Participatory design and evaluation of virtual reality physical rehabilitation for people living with dementia

Emerging research confirms the need for technologically enhanced solutions to support non-pharmacological interventions which can improve the quality of life, the mental and physical health of demented people. Several types of research examined if virtual reality can be an effective solution. This paper aims to present the cyclic process of prototyping, testing, analysing, and refining the VR system in real-world clinical settings. Seven people with moderate to severe dementia were recruited. The experiment required the patients to attend three virtual reality iterations of rapid prototyping with user testing. All three iterations involved training activities with upper body movements similar to their usual physical training. A mixed-methods design measured affect and emotional behaviour using the Observed Emotion Rating Scale and the Visual Analog Scale. Content analysis was conducted following observations and interviews. During each iteration of rapid prototyping with user testing, quantitative measurements of performance, independence and time were recorded. Eye tracking and movement information were captured by the system. Finally, a simplified version of the presence and usability scales evaluated the system. The results of this study provide further evidence that virtual reality can play a significant role in the improvement of people’s with dementia physical training and emotional health when is appropriately designed. The results present the vital factors which should be incorporated in a virtual reality system which are: 1) a simple interactions modality; 2) visible visual targets and continuous feedback; 3) personalized virtual environments; 4) personalized range of movements.

Diagnosing Alzheimer Dementia in People with Down Syndrome in Accordance with ICD, DSM V and A/T/N System

Due to a triplication of the amyloid precursor protein (APP) gene on chromosome 21, most people with Down's Syndrome (DS) are at high risk of developing an Alzheimer type of dementia associated with Down's Syndrome (DS-AD). The diagnostic process of DS-AD is challenging due to the high variability of symptoms ranging from memory deficits to social withdrawal or aggression, as well as a broad spectrum of differential diagnoses. Currently, ICD-10, DSM-V and the novel A(amyloid)/T(tau)/N (neurodegeneration) system are available for classifying dementia, although DS-AD is not represented as a specific entity in any of these systems. Here, we discuss challenges in arriving at a diagnosis of Alzheimer dementia in people with DS in accordance with these diagnostic systems.

Time Trends in Incidence of Reported Memory Concerns and Cognitive Decline: A Cohort Study in UK Primary Care.

PurposeTo investigate time trends in incidence of recorded memory concerns (MC) and cognitive decline (CD) in a UK older population presenting to primary care with no prior diagnosis of dementia. To determine the risk of developing dementia in people with recorded memory concern and cognitive decline.Patients and methodsWe included individuals aged 65–99 years who contributed to data within the IQVIA medical research database from 1st January 2009 to 31st December 2018. We reported crude incidence rates for MC (study population n=1,310,838) and CD (n=1,348,796). We conducted survival analysis to estimate the risk of developing dementia using fine-grey sub-distribution hazard model with competing risk of death.ResultsWe identified 55,941 individuals (4.3%) with a record of incident MC; rates were fairly stable over the decade of study. We identified 14,869 people (1.1%) with a record of incident CD, and these rates increased from 1.29/1000 PYAR (95% CI 1.21 to 1.38) in 2009 to 3.49/1000 PYAR (95% CI 3.30 to 3.68) in 2018. Within 3 years of follow up from the first record of MC, 45.5% of individuals received a diagnosis of dementia, while of those with a record of CD, 51.7% received a dementia diagnosis. Women, people in older age groups and those living in more deprived areas were more likely to have a record of MC or CD, and their symptoms were more likely to progress to a dementia diagnosis.ConclusionIncidence rates of MC and CD estimated from routinely collected primary care data are lower than those reported in community surveys, suggesting that a minority of people who experience memory loss consult their GP and have it recorded. Our findings indicate that those who do report concerns to primary care, especially women, those in older age groups and those in more deprived areas, are at a higher risk for developing dementia.

Association between Social Activity and Development of Dementia in Hearing Impairment: A Cohort Study in Japan from Japan Gerontological Evaluation Study.

We aimed to clarify the association between social activity and the development of dementia in older adults by hearing-impaired (HI) status. We applied a community-based prospective cohort study over 6 years as part of the Japan Gerontological Evaluation Study. The study included 53,549 participants aged 65 years and older who did not require long-term care. A baseline questionnaire survey was conducted; explanatory variables included physical and social activities, and the objective variable was dementia onset assessed by standardized protocol. Cox regression models were used to calculate hazard ratios (HRs) for dementia stratified by HI status. During the follow-up period, 6013 (11.2%) participants developed dementia. Analyses revealed increased dementia risk for participants with HI who participated in the following activities less than once a month: sport groups (HR 2.17, 95% CI 1.53-3.08), hobby groups (HR 1.70, 95% CI 1.34-2.17), going out (HR 2.19, 95% CI 1.51-3.17), and meeting with friends (HR 1.27, 95% CI 1.06-1.53). HI and lack of social activity increase the risk of dementia. The study results indicate that there is an association between low social activity and the development of dementia in people with HI; the strongest associations were found for low participation in sports and hobby groups.

Alzheimer Disease: Standard of Diagnosis, Treatment, Care, and Prevention.

Alzheimer disease (AD) is the most frequent cause of dementia in people 60 y old or older. This white paper summarizes the current standards of AD diagnosis, treatment, care, and prevention. Cerebrospinal fluid and PET measures of cerebral amyloidosis and tauopathy allow the diagnosis of AD even before dementia (prodromal stage) and provide endpoints for treatments aimed at slowing the AD course. Licensed pharmacologic symptomatic drugs enhance cholinergic pathways and moderate excess of glutamatergic transmission to stabilize cognition. Disease-modifying experimental drugs moderate or remove brain amyloidosis, but so far with modest clinical effects. Nonpharmacologic interventions and a healthy lifestyle (diet, socioaffective inclusion, cognitive stimulation, physical exercise, and others) provide some beneficial effects. Prevention targets mainly modifiable dementia risk factors such as unhealthy lifestyle, cardiovascular-metabolic and sleep-wake cycle abnormalities, and mental disorders. A major challenge for the future is telemonitoring in the real world of these modifiable risk factors.

Resilience in People with Lewy Body Disorders and Their Care Partners: Association with Mental Health, Relationship Satisfaction, and Care Burden.

The emergence of cognitive impairment and dementia in people with Lewy body spectrum disorders (LBS) significantly impacts the quality of life of the individual and their care partner. Coping well with the condition may depend, in part, on the degree of psychological resilience or capacity to ‘bounce back’ from adversity. We explored resilience in people with Parkinson’s disease mild cognitive disorder or dementia, or dementia with Lewy bodies, and their care partners, and its relation to outcomes related to their mental well-being and quality of life. This exploratory, cross-sectional study recruited 76 participant-dyads. Resilience, quality of life, depression, anxiety, and relationship satisfaction were evaluated in both members of the dyad. In care partners, care burden and stress were also assessed. Over 70% of both care partners and recipients reported high levels of resilience. Lower resilience in both members of the dyad was associated with higher anxiety and lower quality of life. Additionally, lower resilience in care partners was associated with lower well-being, relationship satisfaction, and higher burden and stress. Resilience in persons with LBS and their care partners is important to consider when assessing mental health, relationship, and care burden outcomes, acting as a focus of intervention to support positive outcomes.

Sleep Biomarkers Help Predict the Development of Alzheimer Disease.

Middle-aged or older adults who self-report sleep-wake disorders are at an increased risk for incident dementia, mild cognitive impairment, and Alzheimer disease. Dementia in people with mild cognitive impairment and Alzheimer disease who complain of sleep-wake disorders progress faster than those without sleep-wake disorders. Removal of amyloid-beta and tau tangles occurs preferentially in non-rapid eye movement 3 sleep and fragmented or insufficient sleep may lead to accumulation of these neurotoxins even in preclinical stages. Selective atrophy in the medial temporal lobe on brain MRI has been shown to predict impaired coupling of slow oscillations and sleep spindles. Impaired slow wave-spindle coupling has been shown to correlate with impaired overnight memory consolidation. Whereas, a decrease in the amplitude of 0.6 to 1 Hz slow wave activity predicts higher cortical Aβ burden on amyloid PET scans. Overexpression of the wake-promoting neurotransmitter orexin may predispose patients with mild cognitive impairment and Alzheimer disease to increased wakefulness, decreasing time they need to clear from the brain the neurotoxic accumulation of amyloid-beta and especially tau. More research exploring these relationships is needed and continuing.

Ketogenic dietary lifestyle intervention effects on sleep, cognition, and behavior in mild cognitive impairment: Study design.

IntroductionSleep and diet are modifiable risk factors for Alzheimer's disease (AD) that may be salient areas for the development of preventive intervention strategies against dementia in people with mild cognitive impairment (MCI). Sleep disturbances account for up to 15% of the population attributable risk for AD. Diet influences sleep quality, such that diets high in sugars, fat, and processed food affect sleep quality and cognition in older adults. The combination of poor sleep and diet health may increase risk for dementia in people with MCI, yet it is unknown how intervening on diet may influence sleep health.MethodsThe MCI Sleep Study assesses longitudinal changes in objective and subjective measures of sleep between two investigational diet groups in the Brain Energy for Amyloid Transformation in Alzheimer's Disease study: the modified Mediterranean ketogenic diet (MMKD) and the American Heart Association diet. Objective sleep assessments include an in‐home sleep study using the WatchPAT Central Plus (Itamar Medical, Ltd) at baseline and the end of the 4‐month diet intervention. Subjective sleep questionnaires include the Epworth Sleepiness Scale and Pittsburgh Sleep Quality Index. The MCI Sleep Study outcome measures include longitudinal change in cognitive performance, mood, behavior, and quality of life.ResultsStudy recruitment is currently ongoing. We hypothesize the low‐carb MMKD diet to have a beneficial impact on sleep health in individuals with MCI. Pre‐ and post‐diet changes in sleep metrics across diet groups will be examined using mixed effects analysis of variance models.DiscussionEarly assessment of chronic sleep and diet behaviors may be vital in understanding when interventions are necessary and the lifestyle modifications that should accompany future AD prevention and therapy recommendations.

Memory-driven eye movements prospectively predict dementia in people at risk of Alzheimer's disease.

Oculomotor behaviors linked to cognitive performance revealed neurocognitive features of Alzheimer's disease (AD) that can enhance the accuracy of its assessment and diagnosis. A sample of 107 participants (i.e., 65 mild cognitive impairment [MCI] and 42 controls) were recruited and followed up for 40 months. At baseline, they underwent assessment with the ViewMind digital biomarker, which draws cognitive-related patterns of eye movement while people perform the visual short-term memory binding task. Baseline data predicted that 36 patients with MCI would progress to the AD clinical syndrome (ADS Progressing). The remaining 29 MCI patients were predicted to remain as MCI or progress to other forms of dementia. After 40 months of follow-up, 94% of ADS Progressing patients had received a diagnosis of dementia, whereas none of the non-ADS Progressing had. The analysis of eye movement behavior combined with cognitive markers for AD can effectively predict progression to ADS among patients with MCI.

Spanish version of the Frontotemporal Dementia Knowledge Scale: adaptation and validation.

Frontotemporal dementia (FTD) is a neurodegenerative disease and is one of the most common causes of dementia in people under 65. There is often a significant diagnostic delay, as FTD can be confused with other psychiatric conditions. A lack of knowledge regarding FTD by health professionals is one possible cause for this diagnostic confusion. The aim of this study was to adapt and validate the Frontotemporal Dementia Knowledge Scale (FTDKS) in Spanish. A translation was done, following cross-cultural adaptation guidelines, which consisted of forward translation, blind back translation, and an analysis by a committee of experts. For the present study, 134 professionals from different health areas responded the Spanish version of the FTDKS. The statistical analysis was performed using R version 4.0.0 "Arbor day" and the Psych, sjPlot packages. The Spanish version of the FTDKS had good reliability and internal consistency (Cronbach alpha 0.74.). The sample's mean score was 19.78 (range = 4-32, SD 6.3) out of a maximum of 36 points. The results obtained show that the Spanish version has good psychometric properties. The FTDKS is applicable in our environment and can be a useful tool to evaluate the knowledge of health professionals regarding frontotemporal dementia.

Informant-based assessment instruments for dementia in people with intellectual disability: A systematic review and standardised evaluation

BackgroundDementia in people with intellectual disability (ID) is frequent but hard to recognise. Evidence-based recommendations for suitable instruments are lacking. AimsThe present study set out to evaluate informant-based dementia assessment instruments and to provide evidence-based recommendations for instruments most suitable in clinical practice and research. Method and proceduresA systematic review was conducted across ten international electronic databases. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines, including a risk of bias assessment, was applied to extract information and to evaluate measurement properties and the quality of available evidence. Outcomes and resultsIn total, 42 studies evaluating 18 informant-based assessment instruments were analysed. For screening purposes, we recommend the Behavioral and Psychological Symptoms of Dementia in Down Syndrome Scale (BPSD-DS), the Cognitive Scale for Down Syndrome (CS-DS), and the Dementia Screening Questionnaire for Individuals with Intellectual Disabilities (DSQIID). For a more thorough dementia assessment, we recommend the Cambridge Examination for Mental Disorders of Older People with Down’s Syndrome and Others with Intellectual Disabilities (CAMDEX-DS). Conclusions and implicationsOur study informs clinicians and researchers about adequate, well-evaluated dementia assessment instruments for people with ID, and highlights the need for high quality studies, especially regarding content validity.

A Brief Review on Dementia

Dementia is a cognition decline that interferes with daily life functions. It is a syndrome cause of dementia is neurological and some medical conditions. Sometimes other diseases can contribute to dementia. Dementias of the neurodegenerative kind are common in adults, while injury to brain and brain tumors are common in students. In recent years, there have been advancements in neuroimaging and the correlation of clinics with pathology, and in the development of biomarkers, doctors still await modifying therapies for neurodegenerative dichasia.
 There have been only a few articles on dementia within the IJP.
 Most of the patients found are above the age of 60. Therefore, community-based interventions for the management of diseases like dementia are essential. The effectiveness of those resolves must be acknowledged. Also, the danger factors for dementia should be identified.
 It is statically proved that folks will suffer from dementia more within the near future. Thus research during this field is significant for developing service and training. This paper aims to review research published on dementia in people above 40 years.
 The cases of dementia increase with the increase in age of the person. Dementia makes people more and more dependent on others. Dementia is increasing challenges to our society and healthcare system. Clinical and pathological criteria for the significant dementia-causing diseases overlap significantly. The emergence of symptoms decades into the pathophysiological process hamper targeted disease therapy. A significant number of research initiatives are underway to identify potential biomarkers of disease processes earlier. The association of both overt cognitive decline and underlying pathophysiological processes with normal aging complicates identifying disease processes early within the spectrum of normal aging.
 Once the diagnosis is established, prognostic measures are required and are still lacking, as disease trajectories between individuals can vary greatly. Globally, governments recognize these challenges. Investment and research infrastructure are beginning to reflect the scale of the need. Drugs conferring symptomatic benefit are available, and memory service structures exist to diagnose dementias and guide management. The personal impact of dementia on patients and families is also increasingly recognized, with discussion in the media surrounding famous sufferers and dramatizations in literature and film. Herein we attempt to describe the current landscape of dementia.

Incidence and prevalence of coexistent retinal diseases and cognitive impairment or dementia: A systematic review

AbstractBackgroundAs chronic and progressive age‐related diseases, there are commonalities between age‐related macular degeneration (AMD), glaucoma, and diabetic retinopathy (DR), and cognitive impairment (CI) and dementia. We undertook a systematic review to quantify such associations.MethodMEDLINE, EMBASE, PsycINFO and CINAHL were searched (from inception to June 2020) for observational studies reporting incidence or prevalence of AMD, glaucoma or DR in people with CI or dementia, and CI or dementia among people with AMD, glaucoma or DR. A 9‐item quality assessment tool was used to categorize studies as having low, moderate or high risk of bias. Rates of comorbid disease were extracted and presented in forest plots. Prospero registration [CRD42020189484].ResultOf 6,803 abstracts reviewed, 76 were considered for full‐text analysis, of which 47 were included for syntheses. There were 27 and 20 assessed as having low and moderate risk of bias, respectively.Incidence of dementia in people with age‐related retinal diseases ranged from 9.5 to 20 (AMD), from 1.1 to 11.6 (glaucoma) and was 32.9 (DR) per 1000 person‐years, respectively (Figure 1). There were no reports on the incidence of CI in AMD, glaucoma or DR, nor of retinal diseases in CI or dementia.There were two studies reporting prevalence of AMD or glaucoma in people with CI (Figure 2). Prevalence of DR in those with CI ranged from 11.4% to 70.1%. Prevalence of AMD, glaucoma and DR among people with dementia ranged from 1.4% to 52.6%, from 0.2% to 25.9% and from 11 to 20%, respectively.Prevalence of CI in people with AMD, glaucoma and DR ranged from 8.4% to 52.4%, from 2.8% to 90.2% and from 3.9% to 45.2%, respectively (Figure 3). Prevalence of dementia in people with AMD, glaucoma and DR ranged from 9.9% to 62.6%, 2.5% to 3% and 0.8% to 12.5%, respectively.ConclusionThere are wide ranging estimates of incidence and prevalence of retinal diseases in relation to CI/dementia. Further research is required to better understand the reasons for such variations.

Prevalence of dementia in people with migration background in Europe

AbstractBackgroundThe proportion of elderly people with migration background increases, therefore it can be assumed that the proportion of people with migration background and dementia will increase as well. So far, prevalence data for dementia and migration on an European level is only scarcely available. This study is part of a project to create an EU‐atlas on dementia and migration and depicts the prevalence data on dementia and migration in the 27 EU and 4 EFTA member states as well as the UK.MethodPrevalence data will be estimated based on dementia prevalences of the country the people are living in and the number of people with a migration background from different ethnicities in that country.ResultAn extensive collection of information about dementia and migration depicting prevalence of dementia in people with a migration background on a European level will be provided.ConclusionObtaining this information can help to uncover gaps in the health care systems and communities on an European level by highlighting a vulnerable population that is not receiving the attention and support that it needs. This can serve as a starting point to see where action must be taken and may therefore lead to better health care for people with migration background and dementia.

Super‐agers in memory are not necessarily super‐agers in other cognitive domains

AbstractBackgroundSuperAgers are individuals who, despite their advanced age, retain superior cognitive performance. Although there is no consensus on how to define SuperAgers, identifying such individuals remains an important research question as they may help us identify protective factors against cognitive impairment that may be amenable to intervention strategies. Here we explore whether ‘SuperAgers’ who are the best performers in a test of memory, show equally exceptional performance in other cognitive domains.MethodParticipants are from The 90+ Study, a longitudinal study of aging and dementia in people 90 and older. Out of 1,134 participants in the study, the 349 with normal cognition at baseline were included in these analyses. Cognitive diagnosis was based on clinical examination and mental status exam independent of the tests investigated here. We evaluated performance in tests of verbal memory (9‐item California Verbal Learning Test‐long delay [CVLT]), executive function (Trails B), language (15‐item Boston naming test [BNT]), and attention (Digit Span backward [DSB]). For each test, we determined whether participants were in the top quartile of performance (SuperAgers). We investigated whether SuperAgers according to memory were also SuperAgers in other domains. We also tested whether being a SuperAger was related to age, sex, or education.Result47 participants were in the top quartile of CVLT with a perfect score of 9 and were classified as memory‐SuperAgers. Of these 47 participants, 8 (17%) were also in the top quartile for Trails B, 14 (30%) in the top quartile for BNT, and 12 (26%) in the top quartile of DSB (Figure). None of the 349 participants were in the top quartile for all four tests and only 13 participants (4%) were in the top quartile for three tests (Figure). Younger age was associated with being a SuperAger for CVLT, Trails B, & BNT and female sex was associated with being a memory‐SuperAger (CVLT) (Table). Education was not associated with being a SuperAger for any test.ConclusionIn this oldest‐old cohort, those who perform exceptionally well in a memory test do not perform equally well in other cognitive tests suggesting that the biological and sociodemographic determinants of superior performance will vary by cognitive domain.

Transition to dementia in people with late‐life depression compared to older people with other mental illnesses

AbstractBackgroundDepression is highly prevalent in dementia and has been reported as a risk factor for dementia. Given the growth of the older population and a potential link between depression and dementia, it is important to understand the health profiles and related service use, especially for possible treatment and prevention strategies. The objectives of this study were to examine the transition to dementia and to compare the health and service use profiles in people with late‐life depression and older people with other mental illness and.MethodA retrospective population‐based study using 13 years of linked health data including 55,717 people aged 65 or older hospitalised with depression and 104,068 people aged 65 or older hospitalised with other mental illness. Logistic regression and cox proportional hazard models were used to analyse the risk of dementia.ResultThe most prominent differences between the two groups were the rates of delirium and self‐harm with a six times lower rate of delirium in people with late‐life depression and an eight times higher rate of self‐harm compared to those with other mental illness. Inpatients with late‐life depression had an increased risk of subsequent dementia by 12% compared to inpatients with other mental illnesses. Besides late‐life depression, only two other conditions, diabetes and cerebrovascular accidents, were associated with an increased risk for dementia.ConclusionInpatients with late‐life depression have an increased risk of dementia compared to older inpatients with other mental illness. Our findings highlight the importance of clinical management and prevention of self‐harm and delirium. The growing ageing population, along with the high prevalence of mental illness and comorbidities in older adults, has significant implications for the planning and equipping of health services to meet the needs of affected individuals.

Sex differences in predictors for cognitive decline and dementia in people with stroke or transient ischemic attack in the PROGRESS trial.

Stroke and transient ischemic attack confer greater risk of cognitive decline and dementia. We used data from the Perindopril Protection Against Recurrent Stroke Study (PROGRESS), a blood pressure-lowering randomized controlled trial in stroke/transient ischemic attack. We evaluated overall and sex-specific differences in treatment effects for cognitive decline/dementia, as well as associations with vascular and stroke-specific predictors,considering death as a competing risk. Multinomial logistic regression was used to estimate overall and sex-specific odds ratios (OR) (95% confidence intervals (CI)) for treatment effects and predictors associated with the risk of cognitive decline/dementia, and the women-to-men ratio of odds ratio (RORs). Over a median four years, 763 cognitive decline/dementia (30.9% women) were recorded in 5888 participants. Women had lower odds of cognitive decline/dementia than men (OR 0.78, 95%CI 0.63-0.95). Active treatment was associated with lower odds of cognitive decline/dementia (0.84, 0.72-0.98), with no evidence of sex difference. Higher education (0.96,0.94-0.98 (per year)) and baseline Mini-Mental State Examination (MMSE)) were associated with lower odds of cognitive decline/dementia (0.84,0.82-0.86 (per point higher)). Higher diastolic blood pressure (1.11,1.02-1.20 (per 10 mmHg)), low estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2 (1.27,1.03-1.58), and peripheral arterial disease (1.78,1.26-2.52) were associated with higher odds of cognitive decline/dementia. APOE ɛ4 was not associated with cognitive decline/dementia (1.05 (0.85-1.30)). Low eGFR was more strongly associated with cognitive decline/dementia in women than men (RORs, 1.60 (1.03-2.48)). Diabetes was more strongly associated with men than women. Several risk factors were associated with cognitive decline/dementia in people with prior stroke/transient ischemic attack, with notable sex differences. Long-term cognitive sequelae of stroke should be considered to strengthen joint prevention strategies for stroke, cognitive decline, and dementia.Trial Registration: This trial was not registered because enrolment began before 1 July 2005.