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Clinical determinants of dementia related to stroke
T K Tatemichi1, D W Desmond, M Paik
1Department of Neurology, Columbia-Presbyterian Medical Center, New York, NY.
Insights
Dementia affects over a quarter of ischemic stroke survivors, linked to age, prior stroke, diabetes, and specific brain lesion locations, particularly on the left hemisphere.
Area of Science:
- Neurology
- Neuroscience
- Gerontology
Background:
- Stroke is a leading cause of long-term disability.
- Dementia is a common and debilitating consequence of stroke.
- Understanding risk factors for post-stroke dementia is crucial for prevention and management.
Purpose of the Study:
- To identify clinical factors associated with dementia 3 months after acute ischemic stroke.
- To determine the independent contribution of demographic, vascular, and stroke-related features to post-stroke dementia.
Main Methods:
- Cross-sectional study of 251 patients 3 months post-ischemic stroke.
- Dementia diagnosis using modified DSM-III-R criteria with comprehensive assessments.
- Logistic regression analysis to identify independent predictors of dementia.
Main Results:
- Dementia diagnosed in 26.3% of patients.
- Significant associations found with older age, lower education, and race.
- Prior stroke (OR=2.7) and diabetes mellitus (OR=2.6) were independent risk factors.
- Lacunar infarction (OR=2.7) and left-sided lesions (OR=4.7) were associated with dementia.
- Major dominant hemispheral syndrome (OR=3.9) also independently predicted dementia.
Conclusions:
- Post-ischemic stroke dementia results from multiple factors.
- Both small subcortical and large cortical infarcts contribute, especially in specific left-hemisphere regions.
- Demographic and vascular risk factors play a significant role in the development of dementia after stroke.
Abstract:
Among 251 patients examined 3 months after the onset of acute ischemic stroke, we diagnosed dementia in 66 (26.3%) by using modified DSM-III-R criteria based on neuropsychological, neurological, functional, and psychiatric examinations. We used a logistic regression model to derive odds ratios (ORs) for clinical factors independently related to dementia in this cross-sectional sample. Dementia was significantly associated with age, education, and race. A history of prior stroke (OR = 2.7) and diabetes mellitus (OR = 2.6) was also independently related to dementia, but hypertension and cardiac disease were not. Stroke features associated with dementia included lacunar infarction compared with all other subtypes combined (OR = 2.7) and hemispheric laterality in relation to brainstem or cerebellar location. There was a predominance of dementia in patients with left-sided lesions (OR = 4.7), an effect not explained by aphasia. Dementia was especially common with infarctions in the left posterior cerebral and anterior cerebral artery territories. A major dominant hemispheral syndrome (reflecting size and laterality) was also independently associated with dementia (OR = 3.9). We suggest that dementia after ischemic stroke is a result of multiple independent factors, including both small subcortical and large cortical infarcts especially involving the left medial frontal and temporal regions, with additional contributions by demographic and vascular risk factors.