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Post-stroke dementia - a comprehensive review.

Milija D Mijajlović1, Aleksandra Pavlović2, Michael Brainin3

  • 1Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, Dr Subotica 6, 11000, Belgrade, Serbia. milijamijajlovic@yahoo.com.

BMC Medicine
|January 19, 2017
PubMed
Summary
This summary is machine-generated.

Post-stroke dementia (PSD) affects many survivors. Current diagnostic tools and biomarkers lack specificity, and effective treatments are still under investigation, highlighting the need for stroke prevention.

Keywords:
BiomarkersCognitive impairmentDefinitions and classificationDementiaDiagnosisInterventionsNeuroimagingStroke

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Area of Science:

  • Neurology
  • Neuroscience
  • Geriatrics

Background:

  • Post-stroke dementia (PSD) or post-stroke cognitive impairment (PSCI) affects up to one-third of stroke survivors.
  • Existing definitions for PSCI and PSD vary, with a proposed label for PSD as any dementia temporally related to stroke.
  • Few instruments are specific to PSD, necessitating careful selection of assessment tools based on evaluation goals.

Purpose of the Study:

  • To review current understanding and diagnostic approaches for post-stroke dementia (PSD).
  • To discuss the utility of various cognitive assessment tools, biomarkers, and neuroimaging techniques in PSD diagnosis.
  • To explore potential prevention and treatment strategies for PSD.

Main Methods:

  • Literature review of definitions, diagnostic tools, biomarkers, and neuroimaging in PSD.
  • Analysis of cognitive screening instruments (e.g., MoCA) and diagnostic batteries (e.g., NINDS VCI).
  • Evaluation of biomarkers (genetic, CSF, serum, inflammatory, microRNA) and neuroimaging modalities (CT, MRI, advanced MRI, PET).

Main Results:

  • No specific biomarkers currently robustly discriminate PSD or differentiate it from Alzheimer's disease dementia.
  • Neuroimaging, particularly MRI, is crucial for detecting pathological changes like small vessel disease and network alterations.
  • Quantitative imaging can differentiate vascular from degenerative dementia, and detect inflammatory changes potentially involved in PSD development.

Conclusions:

  • Comprehensive PSD evaluation requires assessing pre-stroke cognition, mood, and functional status alongside cognitive function.
  • Stroke prevention remains the primary strategy for PSD prevention.
  • While various treatments have been studied, none show convincing efficacy, and lifestyle interventions require further large-scale trials.