Post-stroke dementia – a comprehensive review
Top Cited Papers
Open Access
- 18 January 2017
- journal article
- review article
- Published by Springer Science and Business Media LLC in BMC Medicine
- Vol. 15 (1), 1-12
- https://doi.org/10.1186/s12916-017-0779-7
Abstract
Post-stroke dementia (PSD) or post-stroke cognitive impairment (PSCI) may affect up to one third of stroke survivors. Various definitions of PSCI and PSD have been described. We propose PSD as a label for any dementia following stroke in temporal relation. Various tools are available to screen and assess cognition, with few PSD-specific instruments. Choice will depend on purpose of assessment, with differing instruments needed for brief screening (e.g., Montreal Cognitive Assessment) or diagnostic formulation (e.g., NINDS VCI battery). A comprehensive evaluation should include assessment of pre-stroke cognition (e.g., using Informant Questionnaire for Cognitive Decline in the Elderly), mood (e.g., using Hospital Anxiety and Depression Scale), and functional consequences of cognitive impairments (e.g., using modified Rankin Scale). A large number of biomarkers for PSD, including indicators for genetic polymorphisms, biomarkers in the cerebrospinal fluid and in the serum, inflammatory mediators, and peripheral microRNA profiles have been proposed. Currently, no specific biomarkers have been proven to robustly discriminate vulnerable patients (‘at risk brains’) from those with better prognosis or to discriminate Alzheimer’s disease dementia from PSD. Further, neuroimaging is an important diagnostic tool in PSD. The role of computerized tomography is limited to demonstrating type and location of the underlying primary lesion and indicating atrophy and severe white matter changes. Magnetic resonance imaging is the key neuroimaging modality and has high sensitivity and specificity for detecting pathological changes, including small vessel disease. Advanced multi-modal imaging includes diffusion tensor imaging for fiber tracking, by which changes in networks can be detected. Quantitative imaging of cerebral blood flow and metabolism by positron emission tomography can differentiate between vascular dementia and degenerative dementia and show the interaction between vascular and metabolic changes. Additionally, inflammatory changes after ischemia in the brain can be detected, which may play a role together with amyloid deposition in the development of PSD. Prevention of PSD can be achieved by prevention of stroke. As treatment strategies to inhibit the development and mitigate the course of PSD, lowering of blood pressure, statins, neuroprotective drugs, and anti-inflammatory agents have all been studied without convincing evidence of efficacy. Lifestyle interventions, physical activity, and cognitive training have been recently tested, but large controlled trials are still missing.Keywords
This publication has 122 references indexed in Scilit:
- Cognitive profile in patients with a first-ever lacunar infarct with and without silent lacunes: a comparative studyBMC Neurology, 2013
- The Role of Citicoline in Neuroprotection and Neurorepair in Ischemic StrokeBrain Sciences, 2013
- Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegenerationThe Lancet Neurology, 2013
- Effect of B Vitamins and Lowering Homocysteine on Cognitive Impairment in Patients With Previous Stroke or Transient Ischemic AttackStroke, 2013
- Cognitive stimulation to improve cognitive functioning in people with dementiaEmergencias, 2012
- Neuroprotective and Anti-Oxidative Effects of the Hemodialysate Actovegin on Primary Rat Neurons in VitroNeuroMolecular Medicine, 2011
- Matrix Metalloproteinases Are Associated With Increased Blood–Brain Barrier Opening in Vascular Cognitive ImpairmentStroke, 2011
- Improvements in Cognitive Function Following Cardiac Rehabilitation for Older Adults With Cardiovascular DiseaseInternational Journal of Neuroscience, 2010
- Inflammatory mechanisms in ischemic stroke: role of inflammatory cellsJournal of Leukocyte Biology, 2010
- Effects of aspirin plus extended-release dipyridamole versus clopidogrel and telmisartan on disability and cognitive function after recurrent stroke in patients with ischaemic stroke in the Prevention Regimen for Effectively Avoiding Second Strokes (PRoFESS) trial: a double-blind, active and placebo-controlled studyThe Lancet Neurology, 2008