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Delayed poststroke dementia

A 4-year follow-up study

From the Department of Neurological Sciences (Drs. Altieri, Di Piero, Pasquini, Gasparini, Vicenzini, and Lenzi), University of Rome "La Sapienza," and Laboratory of Epidemiology and Biostatistics (Dr. Vanacore), National Health Institute, Rome, Italy.

Address correspondence and reprint requests to Dr. M. Altieri, Department of Neurology, University of Rome "La Sapienza," Viale dell’Univesità 30, 00185 Rome, Italy; e-mail: marta.altieri{at}uniroma1.it

Objective: To assess patients who have had a stroke for the subsequent development of poststroke dementia (PSD) and to determine if the characteristics of delayed PSD (dPSD) vary in the long-term follow-up.

Methods: Nondemented patients were followed from 6 months after stroke onset for 4 years. Dementia was diagnosed by International Classification of Diseases-10 criteria; dementia etiology was diagnosed by the National Institute of Neurological and Communication Disorders and Stroke/Alzheimer’s Disease and Related Disorders Association and National Institute of Neurologic Disorders and Stroke/Association Internationale pour la Recherche et l’Enseignement en Neurosciences criteria. Neuroimaging and neuropsychological tests were repeated annually.

Results: During a 2-year period, 191 stroke patients were enrolled. By the end of the follow-up period, 41 (21.5%) patients had developed dementia. At the Cox regression analysis, dPSD was associated with cortical atrophy (hazard ratio [HR] = 3.4, 95% CI 1.5 to 7.9), age (HR = 3.3, 95% CI 1.4 to 7.8), and multiple ischemic lesions (HR = 2.5, 95% CI 1.2 to 4.8). The Kaplan-Meier analysis showed a significant difference between the incidence of dPSD subtypes (log-rank test; p = 0.002).

Conclusions: During the 4-year follow-up, the incidence of dementia increased gradually, shifting from an Alzheimer disease-type picture in the first years to a vascular dementia type later in years 2 to 4.

Received August 1, 2003. Accepted in final form February 14, 2004.

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