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From the Departments of Neurology and Pathology (Dr. Desmond), SUNY Downstate Medical Center, Brooklyn; and the Departments of Neurology (Drs. Moroney, Sano, Mohr, Aboumatar, Hauser, and Stern), Biostatistics (Dr. Paik and Ms. Tseng), Psychiatry (Drs. Sano, Williams, Remien, and Stern), and Radiology (Dr. Chan), and the Gertrude H. Sergievsky Center (Drs. Moroney, Sano, Hauser, and Stern), Columbia University, College of Physicians and Surgeons, New York, NY.
Address correspondence and reprint requests to Dr. Desmond, SUNY Downstate Medical Center, 450 Clarkson Ave., Box 25, Brooklyn, NY 11203-2098; e-mail: dwdesmond{at}usa.net
OBJECTIVE: To investigate the frequency and clinical determinants of dementia after ischemic stroke.
METHODS: The authors administered neurologic, neuropsychological, and functional assessments to 453 patients (age 72.0 ± 8.3 years) 3 months after ischemic stroke. They diagnosed dementia using modified Diagnostic and Statistical Manual of Mental Disorders, 3rd ed., revised criteria requiring deficits in memory and two or more additional cognitive domains as well as functional impairment.
RESULTS: The authors diagnosed dementia in 119 of the 453 patients (26.3%). Regarding dementia subtypes, 68 of the 119 patients (57.1%) were diagnosed with vascular dementia, 46 patients (38.7%) were diagnosed with AD with concomitant stroke, and 5 patients (4.2%) had dementia for other reasons. Logistic regression suggested that dementia was associated with a major hemispheral stroke syndrome (OR 3.0), left hemisphere (OR 2.1) and right hemisphere (OR 1.8) infarct locations versus brainstem/cerebellar locations, infarcts in the pooled anterior and posterior cerebral artery territories versus infarcts in other vascular territories (OR 1.7), diabetes mellitus (OR 1.8), prior stroke (OR 1.7), age 80 years or older (OR 12.7) and 70 to 79 years (OR 3.9) versus 60 to 69 years, 8 or fewer years of education (OR 4.1) and 9 to 12 years of education (OR 3.0) versus 13 or more years of education, black race (OR 2.6) and Hispanic ethnicity (OR 3.1) versus white race, and northern Manhattan residence (OR 1.6).
CONCLUSIONS: Dementia is frequent after ischemic stroke, occurring in one-fourth of the elderly patients in the authors’ cohort. The clinical determinants of dementia include the location and severity of the presenting stroke, vascular risk factors such as diabetes mellitus and prior stroke, and host characteristics such as older age, fewer years of education, and nonwhite race/ethnicity. The results also suggest that concomitant AD plays an etiologic role in approximately one-third of cases of dementia after stroke.
Key words: Stroke—Cerebrovascular disease—Dementia—Vascular dementia—AD.
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