Dementia in patients hospitalized with stroke: rates, time course, and clinico-pathologic factors

被引:77
作者
Pendlebury, Sarah T. [1 ,2 ]
机构
[1] John Radcliffe Hosp, Stroke Prevent Res Unit, NIHR Oxford Biomed Res Ctr, Oxford OX3 9DU, England
[2] Univ Oxford, Stroke Prevent Res Unit, Nuffield Dept Clin Neurosci, Oxford, England
关键词
associated factors; dementia; dementia subtype; stroke; PREDICT COGNITIVE DECLINE; WHITE-MATTER CHANGES; BASE-LINE FREQUENCY; POSTSTROKE DEMENTIA; ISCHEMIC-STROKE; PREEXISTING DEMENTIA; CLINICAL DETERMINANTS; PRESTROKE DEMENTIA; RISK-FACTORS; CEREBRAL INFARCTS;
D O I
10.1111/j.1747-4949.2012.00837.x
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Stroke is a risk factor for dementia and dementia predisposes to stroke. Dementia prevalence in subjects with stroke is comparable with that seen in stroke-free subjects who are 10 years older. Although overall there is heterogeneity between studies of prestroke and poststroke dementia, stratifying by study method and clinical criteria (e.g. inclusion/exclusion of prestroke dementia, first ever vs. any vs. recurrent stroke) results in reasonably consistent estimates. Pooled dementia rates from studies of consecutive patients hospitalized with stroke indicate that around 10% have dementia prior to first stroke and 10% have new dementia in the first year after first-ever stroke with highest rates (over 30%) seen after recurrent stroke. After the immediate high-risk poststroke period, rates of new incident dementia are lower but remain elevated at around four times the background risk. Factors associated with prestroke and poststroke dementia are broadly similar but age, medial temporal lobe atrophy, female sex, and family history are more strongly associated with prestroke dementia suggesting a greater role for degenerative pathology. Poststroke dementia is associated with factors indicating a reduced cognitive reserve (prestroke cognitive decline, premorbid disability, low education, white matter disease, and atrophy) and is also strongly associated with stroke factors (lesion size, multiple lesions, and stroke recurrence) and complications of stroke (delirium, seizures, hypotension, systemic illness and incontinence) indicating the likely impact of optimal acute stroke care and secondary prevention in reducing the burden of dementia. Future studies are needed to clarify the interaction between degenerative, vascular, and systemic processes in the development of stroke-associated dementia.
引用
收藏
页码:570 / 581
页数:12
相关论文
共 86 条
[31]  
GUR AY, 1994, ACTA NEUROL SCAND, V90, P263
[32]   Poststroke dementia -: Incidence and relationship to prestroke cognitive decline [J].
Hénon, H ;
Durieu, I ;
Guerouaou, D ;
Lebert, F ;
Pasquier, F ;
Leys, D .
NEUROLOGY, 2001, 57 (07) :1216-1222
[33]   Confusional state in stroke -: Relation to preexisting dementia, patient characteristics, and outcome [J].
Hénon, H ;
Lebert, F ;
Durieu, I ;
Godefroy, O ;
Lucas, C ;
Pasquier, F ;
Leys, D .
STROKE, 1999, 30 (04) :773-779
[34]   Preexisting dementia in stroke patients - Baseline frequency, associated factors, and outcome [J].
Henon, H ;
Pasquier, F ;
Durieu, I ;
Godefroy, O ;
Lucas, C ;
Lebert, F ;
Leys, D .
STROKE, 1997, 28 (12) :2429-2436
[35]   Influence of prestroke dementia on early and delayed mortality in stroke patients [J].
Hénon, H ;
Durieu, I ;
Lebert, F ;
Pasquier, F ;
Leys, D .
JOURNAL OF NEUROLOGY, 2003, 250 (01) :10-16
[36]   Incidence and determinants of poststroke dementia as defined by an informant interview method in a hospital-based stroke registry [J].
Inzitari, D ;
Di Carlo, A ;
Pracucci, G ;
Lamassa, M ;
Vanni, P ;
Romanelli, M ;
Spolveri, S ;
Adriani, P ;
Meucci, I ;
Landini, G ;
Ghetti, A .
STROKE, 1998, 29 (10) :2087-2093
[37]   Risk of rapid global functional decline in elderly patients with severe cerebral age-related white matter changes - The LADIS study [J].
Inzitari, Domenico ;
Simoni, Michela ;
Pracucci, Giovanni ;
Poggesi, Anna ;
Basile, Anna Maria ;
Chabriat, Hugues ;
Erkinjuntti, Timo ;
Fazekas, Franz ;
Ferro, Jose M. ;
Hennerici, Michael ;
Langhorne, Peter ;
O'Brien, John ;
Barkhof, Frederik ;
Visser, Marieke C. ;
Wahlund, Lars-Olof ;
Waldemar, Gunhild ;
Wallin, Anders ;
Pantoni, Leonardo .
ARCHIVES OF INTERNAL MEDICINE, 2007, 167 (01) :81-88
[38]  
Jin Ya-Ping, 2006, Alzheimers Dement, V2, P171, DOI 10.1016/j.jalz.2006.03.006
[39]   Imaging of amyloid burden and distribution in cerebral amyloid angiopathy [J].
Johnson, Keith A. ;
Gregas, Matt ;
Becker, John A. ;
Kinnecom, Catherine ;
Salat, David H. ;
Moran, Erin K. ;
Smith, Erin E. ;
Rosand, Jonathan ;
Rentz, Dorene M. ;
Klunk, William E. ;
Mathis, Chester A. ;
Price, Julie C. ;
DeKosky, Steven T. ;
Fischman, Alan J. ;
Greenberg, Steven M. .
ANNALS OF NEUROLOGY, 2007, 62 (03) :229-234
[40]   Incidence of pre- and poststroke dementia: Cracow stroke registry [J].
Klimkowicz, A ;
Dziedzic, T ;
Slowik, A ;
Szczudlik, A .
DEMENTIA AND GERIATRIC COGNITIVE DISORDERS, 2002, 14 (03) :137-140