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Dementia after first stroke
B Censori1, O Manara, C Agostinis
1Neurologia 2, Ospedali Riuniti, Bergamo, Italy.
Insights
Dementia is common after a first ischemic stroke in individuals under 80. Aphasia frequently co-occurs, impacting dementia diagnosis and screening efforts.
Area of Science:
- Neurology
- Neuroscience
- Public Health
Background:
- Cognitive deficits significantly impact post-stroke quality of life.
- Dementia is a potential consequence of ischemic stroke.
Purpose of the Study:
- To determine the frequency of dementia 3 months after a first ischemic stroke.
- To identify risk factors and correlates of post-stroke dementia in patients aged 40-79.
Main Methods:
- Consecutive series of 146 non-demented patients (40-79 years) after first ischemic stroke.
- Clinical assessment and CT scans performed 3 months post-stroke.
- Dementia diagnosed using National Institute of Neurological Disorders and Stroke and AIREN criteria, with aphasia cases not excluded initially.
Main Results:
- Fifteen patients (13.6%) were diagnosed with dementia.
- Excluding aphasia cases, dementia frequency was 5.0%.
- Significant correlates included age (60-69), diabetes, aphasia, large middle cerebral artery infarction, and frontal lobe lesions.
Conclusions:
- Dementia is relatively frequent after a first ischemic stroke in individuals under 80.
- Aphasia is often associated with post-stroke dementia, complicating diagnosis.
- Screening for dementia post-stroke requires careful consideration of aphasia presence.
Background And Purpose:
Cognitive deficits may significantly worsen the quality of life after stroke. Our aim was to determine the frequency of dementia in a consecutive series of previously nondemented patients between the ages of 40 and 79 years at 3 months after a first ischemic stroke.
Methods:
All patients admitted to our department during an 18-month period who met the above criteria were visited and tested and underwent a CT scan 3 months after their stroke. Dementia was diagnosed according to criteria of the National Institute of Neurological Disorders and Stroke and AIREN, but cases with aphasia were not excluded.
Results:
Of 304 patients admitted for stroke, 146 were eligible for study. Eleven refused to participate, 25 were dead at 3 months, and 110 were tested. Fifteen patients were demented (13.6%; 95% confidence interval [CI], 7.8% to 21.5%), and six had severe isolated aphasia, neglect, or memory deficit (5.4%). Excluding patients with aphasia, 5.0% of cases showed dementia (95% CI, 1.6% to 11.3%). The frequency of dementia was 24.6% (95% CI, 14.5% to 37.3%), considering only patients with supratentorial lesions and with residual deficits of elementary functions (paresis, sensory deficits) at the time of examination. Demented patients had significantly more diabetes (P<.029), atrial fibrillation (P=.032), aphasia at entry (P<.001), large middle cerebral artery infarctions (P=.001), and a more severe neurological deficit at entry (P=.003) and at 3 months (P=.001). At CT scan, demented patients had a larger mean volume of the recent lesion (P<.001) and more lesions in the frontal lobe (P=.041). An exploratory multivariate analysis selected age between 60 and 69 years (odds ratio [OR], 45.8; 95% CI, 2.9 to 726.0), diabetes (OR 59.4; 95% CI, 4.3 to 821.0), aphasia (OR, 14.8; 95% CI, 2.0 to 111.0), a large middle cerebral artery infarction (OR, 30.0; 95% CI, 2.7 to 334.0), and lesions of the frontal lobe (OR, 9.8; 95% CI, 1.3 to 72.8) as significant independent correlates of poststroke dementia.
Conclusions:
Dementia is relatively frequent after a clinical first stroke in persons younger than 80 years, and aphasia is very often associated with poststroke dementia. If aphasic patients are not considered, it may be necessary to screen a very large number of subjects to collect an adequate sample of demented cases.