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BMC Med. 2017 Jan 18;15(1):11. doi: 10.1186/s12916-017-0779-7.

Post-stroke dementia - a comprehensive review.

Author information

1
Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, Dr Subotica 6, 11000, Belgrade, Serbia. milijamijajlovic@yahoo.com.
2
Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, Dr Subotica 6, 11000, Belgrade, Serbia.
3
Department of Clinical Neurosciences and Preventive Medicine, Danube University Krems, Krems, Austria.
4
Max Planck Institute for Metabolism Research, Cologne, Germany.
5
Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
6
Department of internal medicine, Oslo University Hospital, Ullevål and Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, Bærum, Norway.
7
Department of Neurology, University Hospital Essen, Essen, Germany.
8
Stroke Unit, Department of Neurology, Tel-Aviv Sorasky Medical Center, Tel-Aviv, Israel.
9
Shaare Zedek Medical Center, Jerusalem, Israel.
10
Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands.
11
Department of Neurology and Neurosurgery, McGill University at SMBD Jewish General Hospital and Lady Davis Institute for Medical Research, Montreal, Québec, Canada.
12
Department of Rehabilitation Medicine, Pusan National University School of Medicine, Busan, Republic of Korea.
13
Department of Physical and Rehabilitation Medicine, Sungkyunkwan University School of Medicine, Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea.
14
Department of Neurology, Inha University School of Medicine, Incheon, South Korea.
15
Hallym University Medical Center, Kang Nam Sacred Heart Hospital, Seoul, South Korea.
16
Department of Neurology, Gachon University Gil Medical Center, Incheon, South Korea.
17
Department of Neurology, University Clinical Center Tuzla, School of Medicine University of Tuzla, 75000, Tuzla, Bosnia and Herzegovina.
18
Department of Internal Medicine, University of Michigan and the VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
19
Department of Neurology, Rambam Health Care Campus, Haifa, Israel.
20
Technion Faculty of Medicine, Haifa, Israel.
21
Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.
22
Clinic of Neurology, Clinical Center Nis, Nis, Serbia.
23
U1171-Department of Neurology, University of Lille, Inserm, Faculty of Medicine, Lille University Hospital, Lille, France.
24
Department of Neurology and Medical Rehabilitation, Krasnoyarsk State Medical University named after Professor V.F. Voyno-Yasenetsky, Krasnoyarsk, Russia.
25
Department of Neurosurgery, Clinical Hospital CenterZemun, Belgrade, Serbia.
26
Department of Clinical Neurosciences, "Iuliu Hatieganu" University of Medicine, Clij-Napoca, Romania.
27
Department of Neurology, Tel Aviv University, Ramat Aviv, 69978, Israel.

Abstract

Post-stroke dementia (PSD) or post-stroke cognitive impairment (PSCI) may affect up to one third of stroke survivors. Various definitions of PSCI and PSD have been described. We propose PSD as a label for any dementia following stroke in temporal relation. Various tools are available to screen and assess cognition, with few PSD-specific instruments. Choice will depend on purpose of assessment, with differing instruments needed for brief screening (e.g., Montreal Cognitive Assessment) or diagnostic formulation (e.g., NINDS VCI battery). A comprehensive evaluation should include assessment of pre-stroke cognition (e.g., using Informant Questionnaire for Cognitive Decline in the Elderly), mood (e.g., using Hospital Anxiety and Depression Scale), and functional consequences of cognitive impairments (e.g., using modified Rankin Scale). A large number of biomarkers for PSD, including indicators for genetic polymorphisms, biomarkers in the cerebrospinal fluid and in the serum, inflammatory mediators, and peripheral microRNA profiles have been proposed. Currently, no specific biomarkers have been proven to robustly discriminate vulnerable patients ('at risk brains') from those with better prognosis or to discriminate Alzheimer's disease dementia from PSD. Further, neuroimaging is an important diagnostic tool in PSD. The role of computerized tomography is limited to demonstrating type and location of the underlying primary lesion and indicating atrophy and severe white matter changes. Magnetic resonance imaging is the key neuroimaging modality and has high sensitivity and specificity for detecting pathological changes, including small vessel disease. Advanced multi-modal imaging includes diffusion tensor imaging for fiber tracking, by which changes in networks can be detected. Quantitative imaging of cerebral blood flow and metabolism by positron emission tomography can differentiate between vascular dementia and degenerative dementia and show the interaction between vascular and metabolic changes. Additionally, inflammatory changes after ischemia in the brain can be detected, which may play a role together with amyloid deposition in the development of PSD. Prevention of PSD can be achieved by prevention of stroke. As treatment strategies to inhibit the development and mitigate the course of PSD, lowering of blood pressure, statins, neuroprotective drugs, and anti-inflammatory agents have all been studied without convincing evidence of efficacy. Lifestyle interventions, physical activity, and cognitive training have been recently tested, but large controlled trials are still missing.

KEYWORDS:

Biomarkers; Cognitive impairment; Definitions and classification; Dementia; Diagnosis; Interventions; Neuroimaging; Stroke

PMID:
28095900
PMCID:
PMC5241961
DOI:
10.1186/s12916-017-0779-7
[Indexed for MEDLINE]
Free PMC Article

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