Poststroke dementia - Clinical features and risk factors

Background and Purpose-The goal of the present study was to examine a serie s of putative risk factors of poststrokedementia (PSD), especially those fa ctors usually associated with cerebrovascular disease and degenerative deme ntia, in a series of 251 consecutive unselected stroke patients. Methods-A standard protocol was prospectively applied at admission and 3 mo nths after stroke; this protocol included clinical, functional, and cogniti ve assessments, hemogram and serum biochemistry, ECG and CT exams, apolipop rotein E and an,angiotensin-converting enzyme genotype, and neuropsychologi cal examination. After a neuropsychological examination and an interview wi th a relative, the following diagnostic criteria were used: the Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV for dementia after stro ke, DSM-III-R for previous dementia and dementia stage, and Association Int ernationale pour la Recherche et l'Enseignement en Neurologie (NINDS-AIREN) for vascular dementia. Results-Seventy-five cases (30%) demonstrated dementia at S-month follow up ; 25 of them (10%) had demonstrated dementia before the stroke. Dementia wa s unrelated to type (ischemic/hemorrhagic) or location of stroke, vascular factors (hypertension, diabetes, ischemic heart disease, or hypercholestero lemia), apolipoprotein E or angiotensin-converting enzyme genotype, and ser um homocysteine. Age (odds ratio [OR] 1.1, 95% CI 1.03 to 1.2), previous ne phropathy (OR 6.1, 95% CI 1.5 to 24.3), atrial fibrillation (OR 4.4, 95% CI 1.4 to 13.9), low Canadian Neurological Scale score at discharge (OR 0.5, 95% CI 0.4 to 0.6), and previous mental decline assessed by the shortened S panish version of the Informant Questionnaire on Cognitive Decline in the E lderly (SS-IQCODE; OR 1.2, 95% CI 1.1 to 1.4) were the correlates of dement ia in logistic regression analyses. The same risks factors were found when cases with previous dementia and with hemorrhagic stroke were excluded. Conclusions-Dementia is frequent after ischemic or hemorrhagic stroke. Age, nephropathy, atrial fibrillation, previous mental decline, and stroke seve rity independently contribute to the risk.