Cognitive impairment and stroke in elderly patients

Figures & data

Table 1 Risk factors for stroke

Nonmodifiable risk factors	Modifiable risk factors
Age	Hypertension
Sex	Diabetes
Low birth weight	Dyslipidemia
Race/ethnicity	Obesity
Family history (including intracranial aneurysms)	Metabolic syndrome
	Diet and nutrition
Genetic predisposition (including Fabry disease, sickle cell disease, CADASIL, coagulopathies)	Cigarette smoking
	Alcohol consumption
	Physical inactivity
	Obstructive sleep apnea
	Large artery atherosclerosis:
	Extracranial carotid disease
	Extracranial vertebrobasilar disease
	Intracranial atherosclerosis
	Arterial fibrillation
	Aortic atherosclerosis
	Patent foramen ovale
	Prosthetic heart valves
	Valvular heart disease
	Cardiomyopathy
	Acute myocardial infarction
	Hypercoagulability
	Hyperhomocysteinemia
	Antiphospholipid antibody syndrome

Abbreviation: CADASIL, cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy.

Figure 1 Interconnected relationship between cerebrovascular disease and Alzheimer’s disease (AD) in the genesis of dementia in elderly patients.

Abbreviations: VaD, vascular dementia; WMH, white matter hyperintensities.

Table 2 The concept of vascular cognitive impairment (VCI)

Vascular cognitive impairment, no dementia (vascular mild cognitive impairment)

Poststroke dementia

Vascular dementia

Multi-infarct dementia

Strategic infarct dementia (eg, thalamus and hippocampus)

Cerebral small vessel disease (subcortical ischemic vascular dementia or Binswanger’s disease)

Hypoperfusion dementia

Hemorrhagic dementia

Alzheimer’s disease with cerebrovascular disease (mixed dementia)

Figure 2 The potential role of vascular risk factors in the development of dementia in elderly patients.

Figure 3 Potential mechanisms underlying the association between stroke and dementia.

Abbreviation: BBB, blood–brain barrier.

Table 3 Current knowledge gaps and future directions in stroke–dementia interaction

Area of uncertainty	Knowledge gap	Future direction
Insights into pathogenetic mechanisms	The mechanisms linking stroke and cerebrovascular disease to cognitive impairment and dementia are still partially obscure	Basic science studies, clinical surveys, as well as neuroimaging and genetic studies are awaited
Efficacy and feasibility of preventive strategies	Although stroke and dementia prevention and treatment are a worldwide priority, we still do not know how many cases can be effectively prevented, and which are the most effective interventions (changes in lifestyle and health behavior, pharmacological management of cardiovascular risk factors, neuroprotective drugs, etc)	Epidemiological studies and clinical trials are warranted
Effective treatments and interventions	At present, there is no specific pharmacological treatment approved for the treatment of vascular cognitive impairment, and efficacy of nonpharmacological approaches is still under study	Future clinical trials are expected to assess the efficacy of both new pharmacological and nonpharmacological treatments, as well as the effects of multidomain approaches
Implementation of enhanced patient care	Stroke and dementia are major causes of mortality and disability. Consequent reflections on physical, psychological, and social domains of health and well-being of both patient and caregiver are still insufficiently investigated in clinical practice	Targeted interventions aimed at quality of life and caregiver support should be stimulated