Clinical Manifestations

Post-stroke cognitive impairment (PSCI) frequently occurs, with a prevalence ranging from 20% to 80%. Amyloid deposition, a hallmark of Alzheimer's disease (AD), is hypothesized to exacerbate cognitive decline in PSCI. This study investigates the impact of amyloid plaques on cognitive deterioration in stroke patients.

A multicenter prospective observational cohort study was conducted involving 192 patients with acute ischemic stroke and cognitive impairment. Participants were divided into amyloid-positive (n = 40) and amyloid-negative (n = 152) groups based on PET scan results. Cognitive function was assessed using MMSE, MoCA, and other neuropsychological tests over a 12-month period, with some patients receiving donepezil treatment.

Amyloid (+) patients had significantly lower initial MMSE scores (19.03±6.30) compared to amyloid (-) patients (21.52±5.56, p = 0.016). After 12 months, the MMSE score in the amyloid (+) group was 19.48±6.70, showing a lesser improvement compared to the amyloid (-), which scored 23.28±5.47 (p = 0.032). Additionally, the CDR-SOB score worsened in the amyloid (+) group (4.31±3.46) compared to the amyloid (-) group (2.63±2.82, p = 0.051). Donepezil treatment led to temporary cognitive improvement in the amyloid-positive group during the first 6 months.

The presence of amyloid plaques in PSCI patients is associated with a faster cognitive decline, as evidenced by the lower MMSE and worsening CDR-SOB scores in the amyloid-positive group. Although donepezil shows short-term cognitive benefits, its impact diminishes over time. Early identification of amyloid deposition could be crucial in guiding personalized therapeutic strategies for managing PSCI effectively.