Research Reveals Treatable Risk Factors to Prevent Dementia

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Research Reveals Treatable Risk Factors to Prevent Dementia After Stroke in 160,783 Patients

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Research Reveals Treatable Risk Factors to Prevent Dementia After Stroke in 160,783 Patients

After a Stroke, How to Avoid Dementia? Study of 160,783 Individuals Reveals Treatable Risk Factors!

Stroke is a neurological disorder caused by inadequate blood supply to the brain, resulting from either blockage or rupture of blood vessels. It has high incidence and disability rates. In recent years, the global prevalence of stroke has been on the rise, making it the leading cause of death in Chinese residents and the second leading cause globally. One-third of stroke patients succumb to the condition, and survivors often experience varying degrees of disability, significantly impacting their lives.

Results from the ARCOS-IV follow-up analysis indicate that a staggering 80% of stroke survivors may develop Post-Stroke Cognitive Impairment (PSCI) within four years of the stroke. Additionally, a systematic review and meta-analysis suggest that up to 40% of stroke survivors may experience Post-Stroke Dementia (PSD) within one year of the stroke. Effectively managing long-term symptoms in stroke survivors, including PSCI and PSD, has become a crucial research focus in the field of rehabilitation.

Previous research data suggests that age and stroke severity are uncontrollable risk factors for PSCI and PSD. However, there is currently insufficient research evidence regarding other risk factors, especially treatable ones, for PSCI and PSD. Clearly identifying the risk factors for PSCI and PSD after a stroke is of paramount importance for accurately predicting the occurrence of related events and formulating effective prevention strategies.

A recent analysis study published in The Lancet Healthy Longevity, a sub-journal of The Lancet, reveals that actively intervening in diabetes, atrial fibrillation (AF), and moderate or severe white matter hyperintensities (WMH, a key imaging marker of cerebral small vessel disease) in stroke patients may effectively prevent the onset of PSCI and PSD.

The study, incorporating 113 publications involving 160,783 stroke patients published before September 15, 2023, conducted a systematic review and meta-analysis using MEDLINE and Cochrane databases. The researchers assessed the quality of cohort studies using the modified Newcastle-Ottawa Quality Assessment Scale (NOS), with a median NOS score of 5 for the included studies.

Analysis results indicate that impaired cognitive function at baseline is the strongest risk factor for PSCI after a stroke. Furthermore, diabetes, AF, moderate or severe WMH, and the severity of WMH are treatable risk factors for PSCI. Other significant risk factors for PSCI include age, stroke severity, education level, stroke history, brain atrophy, left hemisphere stroke, baseline cognitive function status (based on the Montreal Cognitive Assessment score), neurological function recovery after stroke (based on the modified Rankin Scale score), baseline physical function status, and baseline urinary incontinence.

After multiple comparison corrections, the analysis results still show significant correlations between PSCI and diabetes, WMH severity, age, education level, stroke history, left hemisphere stroke, impaired baseline cognitive function, and poor neurological function recovery after stroke.

The results also highlight that impaired baseline cognitive function is the strongest risk factor for PSD after a stroke. Additionally, diabetes, moderate or severe WMH, and WMH severity are treatable risk factors for PSD. Other significant risk factors for PSD include age, stroke severity, education level, stroke history, pre-stroke cognitive impairment, ≥3 cerebral cavities, medial temporal lobe atrophy, and left hemisphere stroke.

After multiple comparison corrections, the analysis results still show a significant correlation between PSD and age and impaired baseline cognitive function.

Meta-analysis results for Population Attributable Fraction (PAF) suggest that impaired baseline cognitive function has the highest attributable risk in both PSCI and PSD, estimated at 36.6% and 21.3%, respectively. Additionally, treatable risk factors (including diabetes, AF, and WMH) have a PAF range of 3% to 13% in both PSCI and PSD.

In conclusion, the current analysis results indicate that, apart from age and stroke severity, there are numerous other risk factors for PSCI and PSD. Impaired baseline cognitive function is strongly correlated with both conditions. Further analysis reveals that diabetes, AF, moderate or severe WMH, and WMH severity are treatable risk factors, while lower education level, stroke history, left hemisphere stroke, and poor neurological function recovery after stroke are predictive factors for PSCI and PSD.

Research Reveals Treatable Risk Factors to Prevent Dementia After Stroke in 160,783 Patients

Reference:

[1] Jule Filler et al., Risk factors for cognitive impairment and dementia after stroke: a systematic review and meta-analysis. The Lancet Healthy Longevity. Doi: 10.1016/S2666-7568(23)00217-9

(source:internet, reference only)

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