Determinants of post‐stroke cognitive impairment: analysis from VISTA

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Excerpt

Post‐stroke cognitive impairment (PSCI) is a term that refers to patients who develop cognitive deficits after stroke. It represents an important subset of patients with vascular cognitive impairment and can progress to dementia in up to a third of stroke patients.1 Post‐stroke dementia is one of the main causes of functional dependency2 and mortality after stroke.5 It is therefore important to seek for factors associated with PSCI that, if modified, may prevent progression of cognitive deficits.
Several factors have been associated with post‐stroke cognitive deficits.4 Pendlebury and Rothwell reviewed 73 cohort studies of post‐stroke dementia in a total of 7511 patients and found that most predictors of post‐stroke dementia were related to the stroke itself (haemorrhagic stroke, left hemisphere stroke, dysphasia, stroke severity and infarct volume), the number of strokes (previous stroke, multiple infarcts and recurrent stroke) and the complications of stroke (incontinence, early seizures, acute confusion, hypoxic ischaemic episodes and hypotension). Others factors included demographic features (older age, low educational attainment, previous cognitive decline and premorbid disability) and vascular risk factors (diabetes and atrial fibrillation).6 However, there was substantial heterogeneity among the studies in terms of setting, inclusion or exclusion of patients with prestroke dementia, whether only first‐ever, any or only recurrent strokes were included, and the method of dementia diagnosis. Moreover, relationship between clinical stroke features of the acute event (i.e. stroke symptoms) and cognitive performance is less well described.
The aim of the present study was to expand the above findings for post‐stroke dementia in a large and independent data set and to specifically investigate the associations between demographic, clinical and stroke features and PSCI in patients with recent stroke or transient ischaemic attack.

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