Post-stroke Dementia Research Articles

Machine learning-based predictive model for post-stroke dementia.

Post-stroke dementia (PSD), a common complication, diminishes rehabilitation efficacy and affects disease prognosis in stroke patients. Many factors may be related to PSD, including demographic, comorbidities, and examination characteristics. However, most existing methods are qualitative evaluations of independent factors, which ignore the interaction amongst various factors. Therefore, the purpose of this study is to explore the applicability of machine learning (ML) methods for predicting PSD. 9 acceptable features were screened out by the Spearman correlation analysis and Boruta algorithm. We developed and evaluated 8 ML models: logistic regression, elastic net, k-nearest neighbors, decision tree, extreme gradient boosting, support vector machine, random forest, and multilayer perceptron. A total of 539 stroke patients were included in this study. Among the 8 models used to predict PSD, extreme gradient boosting and random forest showed the highest area under the curve (AUC) of the receiver operating characteristic curve (ROC), with values of 0.7287 and 0.7285, respectively. The most important features for predicting PSD included age, high sensitivity C-reactive protein, stroke side and location, and the occurrence of cerebral hemorrhage. Our findings suggest that ML models, especially extreme gradient boosting, can best predict the risk of PSD.

Serum anti-NMDA receptor antibodies are linked to memory impairment 12 months after stroke.

Patients suffering from strokes are at increased risk of developing post-stroke dementia. Serum anti-NMDA receptor autoantibodies (NMDAR1-abs) have been associated with unfavorable post-stroke outcomes. However, their effect on specific cognitive domains remains unclear. We used data from the prospective multicenter DZNE-mechanisms after stroke (DEMDAS) cohort, and measured NMDAR1-abs in serum at baseline. Cognitive function was assessed with a comprehensive neuropsychological test battery at 6- and 12-months follow-up. We employed crude and stepwise confounder adjusted linear and logistic regression models as well as generalized estimating equation models (GEE) to determine the relevance of NMDAR1-abs seropositivity on cognitive function after stroke. 10.2% (58/569) DEMDAS patients were NMDAR1-abs seropositive (IgM:n = 44/IgA:n = 21/IgG:n = 2). Seropositivity was not associated with global cognitive impairment after stroke. However, NMDAR1-abs seropositive patients performed lower in the memory domain (βadjusted = -0.11; 95%CI = -0.57 to -0.03) and were at increased risk for memory impairment (ORadjusted = 3.8; 95%CI = 1.33-10.82) compared to seronegative patients, 12 months after stroke. Further, NMDAR1-abs were linked to memory impairment over time in GEE from 6- to 12-months follow-up (ORadjusted = 2.41; 95%CI = 1.05-5.49). Our data suggests that NMDAR1-abs contribute to memory dysfunction 1 year after stroke while not affecting other cognitive subdomains. Hence, antineuronal autoimmunity may be involved in distinct mechanisms of post-stroke memory impairment. Clinical trial name and registration number: The Determinants of Dementia After Stroke (DEMDAS; study identifier on clinical trials.gov: NCT01334749).

A network meta-analysis of different acupuncture therapy in the treatment of poststroke cognitive impairment and dementia.

Poststroke cognitive impairment and dementia (PSCID) is a major cause of stroke-related morbidities and mortalities. Over the last few years, there has been growing evidence supporting the effectiveness of needle-related treatments in PSCID. Our goal was to rate the included therapies and assess the clinical effectiveness of various needle-related treatments in patients with PSCID. We searched PubMed, Web of Science, Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database (VIP), Chinese Biomedical Literature Service System (SinoMed), Wanfang, FDA.gov, and ClinicalTrials.gov. A mix of subject terms and free words was used to search the databases. The retrieval period was from the inception date of the database to February, 2023. We included SRs and MAs from acupuncture RCTs of patients with PSCID. The Cochrane Risk Assessment Scale was used to evaluate the risk of bias in the included studies. State 17.0 was used for network meta-analysis in accordance with the Bayesian framework. There were 34 studies total of 2690 patients. The cumulative ranking curve (SUCRA) revealed that CT + CFT + EA was the most efficient intervention to improve (Mini-Mental State Examination, MMSE) efficiency, followed by CT + CFT + AP to improve (Montreal Cognitive Assessment, MoCA) efficiency, CT + CFT + ACU for improving (Activities of Daily Living scale, ADL) scores, and CT + CFT + EA to improve clinical efficiency. The results show that Different acupuncture methods can improve cognitive function and daily living ability in patients with PSCID. Network meta-analysis revealed that both CT + CFT + ACU and CT + CFT + EA appeared to be more beneficial for daily living activities, while CT + CFT + EA and CT + CFT + AP appeared to be more helpful for cognitive performance in patients with PSCID. Treatments including acupuncture are safer and have a reduced incidence of negative side effects.

The association between caregiver burden, social capital, and family functioning among caregivers of older adults with PSD - A cross-sectional study.

This study aimed to explore the relationships between social capital, family functioning, and caregiver burden in caregivers of older adults with post-stroke dementia (PSD). A cross-sectional correlational study was conducted between November 2017 and April 2018 among 105 caregivers of older adults with PSD using a demographic questionnaire, the Social Capital Scale, Family APGAR Index (APGAR), and Caregiver Burden Inventory (CBI).An independent samples t-test was also utilized to compare caregiver burden based on demographic characteristics. Statistical analysis comprised Pearson correlation analysis and multiple regression analysis using SPSS version 22.0 to identify influencing factors. Significant negative correlations were found between caregiver burden and variables such as social capital (p < .001) and family functioning (p < .01). The results of the multivariate analysis revealed that social capital, physical condition, and duration of caregiving were the main influencing factors (β = 58.162, ΔR2 = 0.289, p < .001). These findings suggest that nurses should continue to prioritize the well-being of patients' families, and collaborative efforts should be made to establish care facilities that cater to both medical and social needs.

Alternative Scenarios for Projected Prevalence of Stroke and Post-Stroke Dementia to 2046 in Ireland: A Model-Based Analysis

Abstract Background Understanding future population need is key for informing stroke service planning. This study aims to evaluate alternative scenarios for future trends in stroke age-specific incidence and case-fatality and estimate impact on projected stroke and post-stroke dementia prevalence in Ireland. Methods We used a probabilistic Markov model to project and track incidence and prevalence of stroke and post-stroke dementia in the Irish population aged 40-89 years to 2046. Using systematic review and observational evidence, we extrapolated trends in stroke age-specific incidence and case-fatality from 1990-2019 to 2016-2046. We defined optimistic, realistic and pessimistic scenarios, including scenarios where trends decelerated over time. Results The stable (pessimistic) scenario indicates a projected 95,278 stroke survivors in 2046 (95% uncertainty interval, UI = 91,404-99,487) (30.1 per 1000 pop), an increase of 53% from 2022 to 2046. The most optimistic scenario would involve a 3.2% increase from 2022 to 2046, to a projected 61,000 survivors. More realistic scenarios based on lower rates of incidence/case-fatality decline, or rates of decline slowing over time, imply an increase ranging between 22.9% and 37.2%. There will be a projected 19,430 with post-stroke dementia in 2046 (95% UI 17,182-21,904), an increase of 69.2% from 2022. In the most optimistic scenario, the increase would be 22.6%, with realistic scenarios implying an increase ranging between 38.9% and 53.2%. Conclusion Future stroke healthcare needs will vary substantially depending on epidemiological trends. A large increase in post-stroke dementia is projected across scenarios. Further work is needed to identify optimal policies to promote continuing decline in stroke incidence.

Poststroke seizures and epilepsy increase the risk of dementia among stroke survivors: A population-based study.

With global aging, the occurrence of stroke and associated outcomes like dementia are on the rise. Seizures and epilepsy are common poststroke complications and have a strong connection to subsequent dementia. This study examines the relationship between poststroke seizures (PSS) or poststroke epilepsy (PSE) and dementia using a national health care database. We conducted a retrospective study using data from the Taiwan National Health Insurance Research Database from 2009 to 2020. We identified acute stroke patients from 2010 to 2015, excluding those with pre-existing neurological conditions. Based on age, sex, stroke severity level, and the year of index stroke, patients with PSS or PSE were matched to those without. The main outcome was incident dementia. This study included 62 968 patients with an average age of 63 years, with males accounting for 62.9%. Of them, 60.3% had ischemic strokes, and 39.7% had hemorrhagic strokes. After an average follow-up period of 5.2 years, dementia developed in 15.9% of patients who had PSS or PSE, as opposed to 8.4% of those without these conditions. A time-dependent Fine and Gray competing risk analysis showed that PSS and PSE were significantly associated with dementia across all stroke types. Subgroup analyses revealed significantly increased risk of dementia across all age groups (<50, 50-64, and ≥65 years), sexes, and various stroke severity levels. The link between PSS or PSE and dementia was particularly pronounced in men, with a less distinct correlation in women. The risk of incident dementia was higher in patients with PSS or PSE. The potential for therapeutic interventions for seizures and epilepsy to reduce poststroke dementia underscores the importance of seizure screening and treatment in stroke survivors.

Suppression of PTBP1 in hippocampal astrocytes promotes neurogenesis and ameliorates recognition memory in mice with cerebral ischemia

The therapeutic potential of suppressing polypyrimidine tract-binding protein 1 (Ptbp1) messenger RNA by viral transduction in a post-stroke dementia mouse model has not yet been examined. In this study, 3 days after cerebral ischemia, we injected a viral vector cocktail containing adeno-associated virus (AAV)-pGFAP-mCherry and AAV-pGFAP-CasRx (control vector) or a cocktail of AAV-pGFAP-mCherry and AAV-pGFAP-CasRx-SgRNA-(Ptbp1) (1:5, 1.0 × 1011 viral genomes) into post-stroke mice via the tail vein. We observed new mCherry/NeuN double-positive neuron-like cells in the hippocampus 56 days after cerebral ischemia. A portion of mCherry/GFAP double-positive astrocyte-like glia could have been converted into new mCherry/NeuN double-positive neuron-like cells with morphological changes. The new neuronal cells integrated into the dentate gyrus and recognition memory was significantly ameliorated. These results demonstrated that the in vivo conversion of hippocampal astrocyte-like glia into functional new neurons by the suppression of Ptbp1 might be a therapeutic strategy for post-stroke dementia.

Dementia after Ischemic Stroke, from Molecular Biomarkers to Therapeutic Options.

Ischemic stroke is a leading cause of disability worldwide. While much of post-stroke recovery is focused on physical rehabilitation, post-stroke dementia (PSD) is also a significant contributor to poor functional outcomes. Predictive tools to identify stroke survivors at risk for the development of PSD are limited to brief screening cognitive tests. Emerging biochemical, genetic, and neuroimaging biomarkers are being investigated in an effort to unveil better indicators of PSD. Additionally, acetylcholinesterase inhibitors, NMDA receptor antagonists, dopamine receptor agonists, antidepressants, and cognitive rehabilitation are current therapeutic options for PSD. Focusing on the chronic sequelae of stroke that impair neuroplasticity highlights the need for continued investigative trials to better assess functional outcomes in treatments targeted for PSD.

Prevalence and determinants of post-stroke psychosis in Aswan: a prospective study

BackgroundPost-stroke psychosis (PSP) is a rare but serious neuropsychiatric condition characterized by delusions and/or hallucinations following a stroke. Despite its impact on prognosis and quality of life, PSP remains underdiagnosed and undertreated, with limited data on its prevalence and risk factors. The purpose of this study is to assess the prevalence and determinants of post-stroke psychosis (PSP), as well as to compare PSP and non-PSP patients in terms of improvement and daily living outcomes. This nested case–control study included 2,624 acute stroke patients from a university hospital between May 2017 and April 2022. Patients who developed PSP within 6 months post-stroke were identified as cases (n = 108), and 119 patients without PSP were randomly selected as controls. Comprehensive assessments included clinical, laboratory, and imaging evaluations at baseline. After 6 months, follow-up evaluations were conducted, including neurological examinations, psychiatric assessments, and stroke severity assessments using the Barthel index (BI). The psychiatric assessments included the Hamilton Depression Rating Scale for depression and the Mini-Mental State Examination for cognitive status.ResultsThe prevalence of PSP was 5.4%. risk factors significantly associated with PSP included older age, male patients, lower education level (≤ 5 years), hemiplegia, sphincter affection, cortical lesion, brain atrophy, small vessel disease, ischemic stroke, post-stroke dementia, and seizures. Non-specified psychosis and delusional disorder were the most common psychosis subtypes. There was a significantly higher percentage of excellent patients in the non-PSP group compared to those who had PSP regarding the observed improvement in the patient's condition. Also, there is a higher percentage of deteriorated patients in the PSP group (46.6%) compared to another group (18.9%) regarding BI.ConclusionPSP is a prevalent post-stroke complication associated with distinct risk factors and poor functional outcomes. Early screening and identification of high-risk patients, along with multidisciplinary management strategies, are crucial for optimizing recovery and quality of life in stroke survivors.

Incident Dementia After Spontaneous Intracerebral Hemorrhage.

Post-stroke cognitive impairment and dementia (PSCID) is a complication that affects long-term functional outcomes after stroke. Studies on dementia after long-term follow-up in stroke have focused predominantly on ischemic stroke, which may be different from the development of dementia after spontaneous intracerebral hemorrhage (ICH). In this review, we summarize the existing data and hypotheses on the development of dementia after spontaneous ICH, review the management of post-ICH dementia, and suggest areas for future research. Dementia after spontaneous ICH has a cumulative incidence of up to 32.0-37.4% at 5 years post-ICH. Although the pathophysiology of post-ICH dementia has not been fully understood, two main theoretical frameworks can be considered: 1) the triggering role of ICH (both primary and secondary brain injury) in precipitating cognitive decline and dementia; and 2) the contributory role of pre-existing brain pathology (including small vessel disease and neurodegenerative pathology), reduced cognitive reserve, and genetic factors predisposing to cognitive dysfunction. These pathophysiological pathways may have synergistic effects that converge on dysfunction of the neurovascular unit and disruptions in functional connectivity leading to dementia post-ICH. Management of post-ICH dementia may include screening and monitoring, cognitive therapy, and pharmacotherapy. Non-invasive brain stimulation is an emerging therapeutic modality under investigation for safety and efficacy. Our review highlights that there remains a paucity of data and standardized reporting on incident dementia after spontaneous ICH. Further research is imperative for determining the incidence, risk factors, and pathophysiology of post-ICH dementia, in order to identify new therapies for the treatment of this debilitating condition.

Association of socioeconomic status and poststroke cognitive function: A systematic review and meta-analysis.

Stroke survivors are at high risk of coping with cognitive problems after stroke. In recent decades, the relationship between socioeconomic status (SES) and health-related outcomes has been a topic of considerable interest. Learning more about the potential impact of SES on poststroke cognitive dysfunction is of great importance. The purpose of this systematic review and meta-analysis was to summarize the association between SES and poststroke cognitive function by quantifying the effect sizes of the existing studies. We searched studies from PubMed, Ovid, Embase, Cochrane, Scopus, and PsychINFO up to January 30th 2024 and the references of relevant reviews. Studies reporting the risk of poststroke cognitive dysfunction as assessed by categorized SES indicators were included. The Newcastle-Ottawa scale and the Agency for Healthcare Research and Quality were used to evaluate the study quality. Meta-analyses using fixed-effect models or random-effect models based on study heterogeneity were performed to estimate the influence of SES on cognitive function after stroke, followed by subgroup analyses stratified by study characteristics. Thirty-four studies were eligible for this systematic review and meta-analysis. Of which, 19 studies reported poststroke cognitive impairment (PSCI) as the outcome, 13 reported poststroke dementia (PSD), one reported both PSCI and PSD, and one reported vascular cognitive impairment no dementia. The findings showed that individuals with lower SES levels had a higher risk of combined poststroke cognitive dysfunction (odds ratio (OR)=1.91, 95% confidence interval (CI)=1.59-2.29), PSCI (OR=2.09, 95% CI=1.57-2.78), and PSD (OR=1.95, 95% CI=1.48-2.57). Subgroup analyses stratified by SES indicators demonstrated the protective effects of education and occupation against the diagnoses of combined poststroke cognitive dysfunction, PSCI, and PSD. Stroke survivors belonging to a low SES are at high risk of poststroke cognitive dysfunction. Our findings add evidence for public health strategies to reduce the risk of poststroke cognitive dysfunction by reducing SES inequalities.

Impact of playful objects on wellbeing, emotions and engagement in patients with dementia and post-stroke cognitive impairment

Stroke is a major public health concern, and finding ways to support the wellbeing and emotional regulation of stroke patients with post-stroke cognitive decline or dementia is vitally important. HUG™ was developed to be used as a psychosocial intervention to reduce anxiety and provide comfort and pleasure to those with cognitive impairment. The aim of the ludic artefacts using gesture and haptics evaluation and making playful objects for wellbeing, emotional regulation and engagement for dementia post-stroke cognitive impairment (LAUGH EMPOWERED PSCI) study, a 2-year collaborative project between the NHS and Sunrise Senior Living, is to improve the lives of older people living with advanced stages of dementia and those living with post-stroke cognitive impairment (PSCI). Post-intervention qualitative data were gathered from NHS health professionals (n=20) via a series of interviews. A qualitative interpretive grounded practical theory methodology underpinned by a ‘compassionate design’ approach was used to analyse qualitative interviews. Two key themes were identified: evidence of improvement in patient care, and difficulties and negative responses to using HUG™ (patient and staff), with respective sub-themes also identified. Findings from this study reveal that HUG™ can be used successfully in a hospital context to improve patient wellbeing and reduce anxiety. Although not every patient who received a HUG™ responded positively, the device did have a significant positive impact on the quality of life and care of those who did. It is clear from this research that, although HUG™ is not the right solution for every patient, it is a useful alternative to prescribed medication for some patients who are anxious and distressed.

Experimental Ischemic Stroke Induces Secondary Bihemispheric White Matter Degeneration and Long-Term Cognitive Impairment.

Clinical studies have identified widespread white matter degeneration in ischemic stroke patients. However, contemporary research in stroke has predominately focused on the infarct and periinfarct penumbra regions. The involvement of white matter degeneration after ischemic stroke and its contribution to post-stroke cognitive impairment and dementia (PSCID) has remained less explored in experimental models. In this study, we examined the progression of locomotor and cognitive function up to 4 months after inducing ischemic stroke by middle cerebral artery occlusion in young adult rats. Despite evident ongoing locomotor recovery, long-term cognitive and affective impairments persisted after ischemic stroke, as indicated by Morris water maze, elevated plus maze, and open field performance. At 4 months after stroke, multimodal MRI was conducted to assess white matter degeneration. T2-weighted MRI (T2WI) unveiled bilateral cerebroventricular enlargement after ischemic stroke. Fluid Attenuated Inversion Recovery MRI (FLAIR) revealed white matter hyperintensities in the corpus callosum and fornix across bilateral hemispheres. A positive association between the volume of white matter hyperintensities and total cerebroventricular volume was noted in stroke rats. Further evidence of bilateral white matter degeneration was indicated by the reduction of fractional anisotropy and quantitative anisotropy at bilateral corpus callosum in diffusion-weighted MRI (DWI) analysis. Additionally, microglia and astrocyte activation were identified in the bilateral corpus callosum after stroke. Our study suggests that experimental ischemic stroke induced by MCAO in young rat replicate long-term cognitive impairment and bihemispheric white matter degeneration observed in ischemic stroke patients. This model provides an invaluable tool for unraveling the mechanisms underlying post-stroke secondary white matter degeneration and its contribution to PSCID.

Prevalence of Dementia and its Correlation with Cognitive Function in Elderly Post-Stroke Patients

BACKGROUND: Post-stroke dementia (PSD) is a clinical entity that encompasses all types of dementia following an index stroke, which may affect up to one third of stroke survivors. Unlike physical disability after stroke, cognitive function usually worsens over time and are often overlooked with detrimental impacts on the quality of life of survivors. MATERIALS AND METHOD: This work is a cross-sectional questionnaire-based study. Elderly post-stroke patients participated in this study. We adopted Dementia Severity Rating Scale (DSRS) and The Mini Mental State Examination (MMSE) we recorded the prevalence of dementia and its correlation with cognitive function in elderly post stroke patients. RESULT: Data of 46 participants was analysed. The mean age group was above 60years, as this study was conducted in elderly post-stroke patients. In this study 41% females and 59% males participated based on the inclusion and exclusion criteria. Two components were collected using Dementia Severity Rating Scale (DSRS) and The Mini Mental State Examination (MMSE). CONCLUSION: The study concluded that in present scenario of post stroke patient. the sub items of questionnaire (MMSE) and (DSRS) have increased values indicating towards risk factor of dementia and cognitive functions in post-stroke elderly patients in Pravara Rural Hospital is mostly when the age increases as shown significant correlation in Group B with age group of 60-70 years. whereas in Group A with age group of 71-80 years shows that there is no significant correlation. Hence, our study concluded that there is a co-relation of dementia and cognitive function in elderly post stroke patients. So, it determines that the correlation between dementia and cognitive function is more significant at age 71-80 hence, statistically proved.

A qualitative study investigating the views of stroke survivors and their family members on discussing post-stroke cognitive trajectories

ABSTRACT Cognitive impairment is common early after stroke but trajectories over the long term are variable. Some stroke survivors make a full recovery, while others retain a stable impairment or decline. This study explored the perceived advantages and disadvantages of discussing potential cognitive trajectories with stroke survivors and their family members. Stroke survivors at least six-months post-stroke were purposively sampled from an existing pool of research volunteers recruited originally for the OCS-Recovery study. They were invited, alongside a family member, to participate in a semi-structured interview. Interviews were audio recorded, transcribed, and analyzed using reflexive thematic analysis. Twenty-six stroke survivors and eleven family members participated. We identified one overarching theme and three related subthemes. The overarching theme was: One size does not fit all. The subthemes were: (1) Hearing about potential cognitive trajectories helps to develop realistic expectations; (2) Discussions about cognitive trajectories may be motivating; (3) Cognitive decline and post-stroke dementia discussions may be anxiety-provoking and depressing. Healthcare professionals should adopt a person-centred approach to sharing information about post-stroke cognitive trajectories. Discussions should be tailored to individual needs and preferences, with dementia-related topics in particular addressed with the utmost selectivity and sensitivity.

Hippocampal capillary pericytes in post-stroke and vascular dementias and Alzheimer’s disease and experimental chronic cerebral hypoperfusion

Neurovascular unit mural cells called ‘pericytes’ maintain the blood-brain barrier and local cerebral blood flow. Pathological changes in the hippocampus predispose to cognitive impairment and dementia. The role of hippocampal pericytes in dementia is largely unknown. We investigated hippocampal pericytes in 90 post-mortem brains from post-stroke dementia (PSD), vascular dementia (VaD), Alzheimer’s disease (AD), and AD-VaD (Mixed) subjects, and post-stroke non-demented survivors as well as similar age controls. We used collagen IV immunohistochemistry to determine pericyte densities and a mouse model of VaD to validate the effects of chronic cerebral hypoperfusion. Despite increased trends in hippocampal microvascular densities across all dementias, mean pericyte densities were reduced by ~25–40% in PSD, VaD and AD subjects compared to those in controls, which calculated to 14.1 ± 0.7 per mm capillary length, specifically in the cornu ammonis (CA) 1 region (P = 0.01). In mice with chronic bilateral carotid artery occlusion, hippocampal pericyte loss was ~60% relative to controls (P < 0.001). Pericyte densities were correlated with CA1 volumes (r = 0.54, P = 0.006) but not in any other sub-region. However, mice subjected to the full-time environmental enrichment (EE) paradigm showed remarkable attenuation of hippocampal CA1 pericyte loss in tandem with CA1 atrophy. Our results suggest loss of hippocampal microvascular pericytes across common dementias is explained by a vascular aetiology, whilst the EE paradigm offers significant protection.

Коморбидный неврологический пациент: в фокусе метаболический синдром

INTRODUCTION. The article discusses the problem of managing patients suffering from metabolic syndrome and chronic cerebrovascular disorders. Metabolic syndrome is an important interdisciplinary problem. Metabolic syndrome significantly increases the incidence of strokes. Systemic metabolic disorders, insulin resistance and oxidative stress, as well as large vessel damage and microangiopathy play an important role. In addition, special attention is paid to low-grade chronic inflammation, which may be associated with the patient’s age. The most important risk factor for the development of acute cerebral ischemia is the combination of components of the metabolic syndrome, in particular, the combination of insulin resistance and arterial hypertension, which increase the likelihood of developing atrial fibrillation and increase the risk of an unfavorable outcome. CONCLUSION. Cognitive impairment is quite common in metabolic syndrome. When treating cognitive impairment as part of metabolic syndrome, it is advisable to use neuroprotectors. The use of citicoline (the drug “Ronocit”) has a clinically significant effect in restoring cognitive functions and reducing the risk of developing post-infarction and post-stroke dementia in patients with metabolic syndrome. The use of various approaches to the treatment of cognitive impairment in metabolic syndrome increases the likelihood of a favorable outcome. It is recommended to use the drugs “Ronocit” and “Cocarnit®” together in the treatment of patients with a predominance of cognitive and asthenic impairments and a clinical symptom complex of diabetic polyneuropathy. KEYWORDS: comorbidity, cognitive disorders, metabolic syndrome

Risk factors for cognitive impairment and dementia after stroke: a systematic review and meta-analysis

Cognitive impairment and dementia are highly prevalent among stroke survivors and represent a major burden for patients, carers, and health-care systems. We studied the risk factors for post-stroke cognitive impairment (PSCI) and dementia (PSD) beyond the well established risk factors of age and stroke severity. In this systematic review and meta-analysis we conducted a systematic literature search from database inception until Sept 15, 2023. We selected prospective and retrospective cohort studies, post-hoc analyses from randomised controlled trials, and nested case-control studies of patients with acute stroke (ischaemic, haemorrhagic, and transient ischaemic attack), exploring associations between risk factors at baseline and PSCI or PSD over a follow-up period of at least 3 months. Study quality was assessed using the Newcastle-Ottawa quality assessment scale. We calculated pooled relative risks (RRs) with random-effects meta-analyses and performed subgroup, meta-regression, and sensitivity analyses. This study was preregistered with PROSPERO, CRD42020164959. We identified 162 eligible articles for our systematic review, of which 113 articles (89 studies, 160 783 patients) were eligible for meta-analysis. Baseline cognitive impairment was the strongest risk factor for PSCI (RR 2·00, 95% CI 1·66-2·40) and PSD (3·10, 2·77-3·47). We identified diabetes (1·29, 1·14-1·45), presence or history of atrial fibrillation (1·29, 1·04-1·60), presence of moderate or severe white matter hyperintensities (WMH; 1·51, 1·20-1·91), and WMH severity (1·30, 1·10-1·55, per SD increase) as treatable risk factors for PSCI, independent of age and stroke severity. For PSD, we identified diabetes (1·38, 1·10-1·72), presence of moderate or severe WMH (1·55, 1·01-2·38), and WMH severity (1·61, 1·20-2·14, per SD increase) as treatable risk factors. Additional risk factors included lower educational attainment, previous stroke, left hemisphere stroke, presence of three or more lacunes, brain atrophy, and low baseline functional status. Associations of risk factors with PSD were weaker in studies conducted and published more recently. We found substantial interstudy heterogeneity and evidence of reporting bias. Our results highlight the importance of cognitive impairment in the acute phase after stroke for long-term prediction of PSCI and PSD. Treatable risk factors include diabetes, atrial fibrillation, and markers of cerebral small vessel disease (ie, white matter hyperintensities and lacunes). Future trials should explore these risk factors as potential targets for prevention of PSCI and PSD. German Research Foundation.

Excessive Sedentary Time Is Associated with Cognitive Decline in Older Patients with Minor Ischemic Stroke.

Cognitive impairment is commonly seen after acute ischemic stroke (AIS). Sedentary behaviors increase the risk of dementia among community dwelling population. This study aims to investigate the association of sedentary behaviors with poststroke cognitive impairment among older adults of minor AIS. This cohort study recruited 594 older subjects with minor AIS from three hospitals in China during February 1, 2016, and December 31, 2018. Participants were followed up for two years and the sedentary time per day was self-reported at the endpoint of follow-up. Cognitive functions were assessed by Mini-Mental State Examination (MMSE). Participants were categorized into the high and low sedentary time group according to the median sedentary time of the participants. At two years of follow-up, the long sedentary time group had significantly lower MMSE scores than the short sedentary time group [median, (95% CI): 21 (18 to 25) versus 22 (18 to 25), p = 0.368]. The long sedentary time group had a higher speed of cognitive decline than the short sedentary time group. Excessive sedentary time was associated with a higher risk of longitudinal cognitive decline (OR: 2.267, 95% CI: 1.594 to 3.225), adjusting for age, sex, education, body mass index, APOE genotype, comorbidities, symptoms of depression, anxiety, and insomnia, baseline MMSE scores and National Institute of Health Stroke Scale scores, cognitive therapy, and TOAST ischemic stroke subtypes. This study identified a possible link between sedentary behaviors and longitudinal cognitive decline among older patients with minor AIS, suggesting that reducing sedentary time might be helpful for preventing poststroke dementia.

Five-year stroke prognosis. Influence of post-stroke delirium and post-stroke dementia on mortality and disability (Research Study – Part of the PROPOLIS Study)

IntroductionWith increasing life expectancy and the rising incidence of stroke in young adults, it is important to know the long-term prognosis of this condition. Post-stroke delirium and post-stroke dementia are common complications of stroke that negatively affect prognosis. The purpose of this study was to evaluate five-year mortality from stroke and to assess the influence of post-stroke delirium and post-stroke dementia on mortality and disability over the five-year period.MethodsConsecutive patients admitted to the stroke unit for acute stroke or transient ischemic attacks were screened for in-hospital delirium. At the three- and twelve-month follow-up, the same patients underwent neurocognitive testing. Diagnoses of in-hospital delirium and dementia after three and twelve months based on DSM-5 criteria. Five years after stroke surviving patients were reevaluated. Outcome assessment included place of stay, current functional status assessed by the modified Rankin Scale (mRS), or death.ResultsAt the five-years of follow-up, data were collected from 575 of 750 patients originally included in the study (76.67%). The mortality rate was 51.65%. In-hospital post-stroke delirium and post-stroke dementia diagnosed three and twelve months after stroke were independent risk factors for death and an increase in mRS score of ≥ 1 or ≥ 2 points. There was no significant association with institutionalization rate.ConclusionsMore than half of post-stroke patients die within five years of follow-up. Post-stroke delirium and post-stroke dementia are associated with an increased risk of death and disability.