Understanding and preventing the development of post-stroke dementia

Abstract

Post-stroke dementia (PSD) is a clinical entity but it now appears that most of PSD may be categorized as vascular dementia. The well-established relationship between vascular factors and dementia provides a rationale for the implementation of intervention and prevention efforts. Larger primary prevention trials related to lifestyle factors are warranted in association with dementia. Published clinical trials have not been promising and there is meager information on whether PSD can be prevented through the use of pharmacological agents. Control of vascular disease risk and prevention of recurrent strokes are obviously key to reducing the burden of cognitive decline and dementia after stroke. However, modern imaging and analysis techniques will help to elucidate the mechanism of PSD and establish better treatment.

Keywords::

• Alzheimer’s disease
• cognitive impairment
• dementia
• microinfarct
• neuroimaging
• post-stroke dementia
• stroke
• vascular dementia
• white matter

Acknowledgement

Authors are grateful to Y Yamamoto (Oska, Japan) for reproducing Figure 1.

Financial & competing interests disclosure

Research presented in this review was supported by grants from the Medical Research Council UK and Alzheimer’s Research UK. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Post-stroke dementia (PSD) is a clinical entity that encompasses all types of dementia following an index stroke.

• The type of stroke can be either ischemic, hemorraghic or hypoperfusive.

• The risk factors of PSD are multifactorial, which include older age, low education, vascular comorbidities, prior or recurrent stroke, pre-stroke dependency and cognitive impairment.

• Cognitive impairment before the index stroke is called pre-stroke dementia, which may be caused by vascular burden as well as insidious neurodegenerative changes.

• High-resolution MRI will elucidate microinfarcts, which would be important substrates of PSD.

• There is a clear need for effective treatments for PSD.

• Primary prevention trials related to lifestyle factors are greatly warranted in association with dementia after stroke.

• A combination therapy may be developed to target multiple components such as vascular risk factors, several neurotransmitters and even neuroregeneration.