Skip to main content

Advertisement

SpringerLink
Log in

Stroke and cognition

  • Published:
Current Atherosclerosis Reports Aims and scope Submit manuscript

Abstract

Several studies confirm cognitive impairment and dementia to be increased after stroke in the elderly. Although not necessarily involving memory deficits, the frequency of cognitive impairments may occur in up to 30% of stroke survivors at 3 months. This impairment may be confounded by preexisting cognitive decline or dementia. By contrast, cognitive changes and dementia are widely recognized in familial forms of stroke, such as cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). Several factors, including type of stroke, recurrent episodes, the site and laterality of the lesion(s), volume of cerebral infarction, medial temporal lobe atrophy, and coexistent neurodegenerative pathology predict the degree of impairment. Aphasia, diabetes mellitus, atrial fibrillation, and depression are listed among other biologic factors that further exacerbate cognition and affect long-term survival. There is no clear consensus whether genetic factors, such as the apolipoprotein E ε4 allele or angiotensin converting enzyme gene polymorphisms, modify cognitive changes or stroke outcome. Although several neurotransmitter systems may be affected in post-stroke dementia, the amelioration of cholinergic function is a worthy target.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Chui H: Vascular dementia, a new beginning: shifting focus from clinical phenotype to ischemic brain injury. Neurol Clin 2000, 18: 951–978.

    Article  PubMed  CAS  Google Scholar 

  2. Desmond DW: Vascular dementia: a construct in evolution. Cerebrovasc Brain Metab Rev 1996, 8: 296–325.

    PubMed  CAS  Google Scholar 

  3. Leys D, Erkinjuntti T, Desmond DW, et al.: Vascular dementia: the role of cerebral infracts. Alzheimer Disease and Associated Disord 1999, 13(suppl 3): S38–348.

    Article  Google Scholar 

  4. Censori B, Manara O, Agostinis C, et al.: Dementia after stroke. Stroke 1996, 27: 1205–1210.

    PubMed  CAS  Google Scholar 

  5. Tatemichi T: Dementia. In Stroke Syndromes. Edited by Bogousslavsky J, Caplan L. Cambridge: Cambridge University Press; 1995:169–181.

    Google Scholar 

  6. Tatemichi TK, Desmond DW, Paik M, et al.: Clinical determinants of dementia related to stroke. Ann Neurol 1993, 33: 568–575.

    Article  PubMed  CAS  Google Scholar 

  7. Pohjasvaara T, Erkinjuntti T, Vataja R, Kaste M: Dementia three months after stroke. Baseline frequency of different definitions of dementia in the Helsinki Stroke Aging Memory Study (SAM) cohort. Stroke 1997, 28: 785–792.

    PubMed  CAS  Google Scholar 

  8. Pohjasvaara T, Erkinjuntti T, Ylikoski R, et al.: Clinical determinants of poststroke dementia. Stroke 1998, 29: 75–81.

    PubMed  CAS  Google Scholar 

  9. Desmond SW, Moroney JT, Paik MC, et al.: Frequency and clinical determinants of dementia after ischemic stroke. Neurology 2000, 54: 1124–1131.

    PubMed  CAS  Google Scholar 

  10. Barba R, Martinez-Espinosa S, Rodriguez-Garcia E, et al.: Poststroke dementia: clinical featurres and risk factors. Stroke 2000, 31: 1494–1501.

    PubMed  CAS  Google Scholar 

  11. Bornstein NM, Gur AY, Treves TA, et al.: Do silent brain infarctions predict the development of dementia after first ischemic stroke? Stroke 1996, 27: 904–905.

    PubMed  CAS  Google Scholar 

  12. Masuda J, Nabika T, Notsu Y: Silent stroke: pathogenesis, genetic factors and clinical implications as a risk factor. Curr Opin Neurol 2001, 14: 77–82.

    Article  PubMed  CAS  Google Scholar 

  13. Lincoln NB, Gladman JR, Berman P, et al.: Functional recovery of community stroke patients. Disabil Rehabil 2000, 22: 135–139.

    Article  PubMed  CAS  Google Scholar 

  14. Starr JM, Nicolson C, Anderson K, et al.: Correlates of informant-rated cognitive decline after stroke. Cerebrovasc Dis 2000, 10: 214–220.

    Article  PubMed  CAS  Google Scholar 

  15. Andersen G, Vestergaard K, Riis Jÿ, Ingeman-Nielsen M: Intellectual impairment in the first year following stroke, compared to an age-matched population sample. Cerebrovasc Dis 1996, 6: 363–369.

    Google Scholar 

  16. Tatemichi TK, Paik M, Bagiella E, et al.: Risk of dementia after stroke in a hospitalized cohort: results of a longitudinal study. Neurology 1994, 44: 1885–1891.

    PubMed  CAS  Google Scholar 

  17. Kokmen E, Whisnant JP, O’Fallon WN, et al.: Dementia after ischemic stroke: a population-based study in Rochester, Minnesota (1960-1984). Neurology 1996, 46: 154–159.

    PubMed  CAS  Google Scholar 

  18. Pohjasvaara T, Mantyla R, Aronen HJ, et al.: Clinical and radiological determinants of prestroke cognitive decline in a stroke cohort. J Neurol Neurosurg Psychiatry 1999, 67: 742–748.

    PubMed  CAS  Google Scholar 

  19. Hénon H, Pasquier F, Durieu I, et al.: Pre-existing dementia in stroke patients: baseline frequency, associated factors and outcome. Stroke 1997, 28: 2429–2436.

    PubMed  Google Scholar 

  20. Hénon H, Pasquier F, Durieu I, et al.: Medial temporal lobe atrophy in stoke patients. Relationship with pre-existing dementia. J Neurol Neurosurg Psychiatry 1998, 65: 641–647.

    PubMed  Google Scholar 

  21. Moroney JT, Bagiella E, Tatemichi TK, et al.: Dementia after stroke increases the risk of long-term stroke recurrence. Neurology 1997, 48: 1317–1325.

    PubMed  CAS  Google Scholar 

  22. Zhu L, Fratiglioni L, Guo Z, et al.: Incidence of stroke in relation to cognitive function and dementia in the Kungsholmen Project. Neurology 2000, 54: 2103–2107.

    PubMed  CAS  Google Scholar 

  23. Kauhanen ML, Korpelainen JT, Hiltunen P, et al.: Aphasia, depression, and non-verbal cognitive impairment in ischaemic stroke. Cerebrovasc Dis 2000, 10: 455–461.

    Article  PubMed  CAS  Google Scholar 

  24. Tomlinson B, Blessed G, Roth M: Observations on the brains of demented old people. J Neurol Sci 1970, 11: 205–242.

    Article  PubMed  CAS  Google Scholar 

  25. Yamanaka K, Fukuyama H, Kimura J: Abulia from unilateral capsular genu infarction: report of two cases. J Neurol Sci 1996, 143: 181–184.

    Article  PubMed  CAS  Google Scholar 

  26. Leys D: White matter changes and post-stroke dementia. Dementia 1998, 9: 25–29.

    Google Scholar 

  27. Pohjasvaara T, Mantyla R, Salonen O, et al.: How complex interactions of ischemic brain infarcts, white matter lesions, and atrophy relate to poststroke dementia. Arch Neurol 2000, 57: 1295–1300.

    Article  PubMed  CAS  Google Scholar 

  28. Liu CK, Miller BL, Cummings JL, et al.: A quantitative MRI study of vascular dementia. Neurology 1992, 42: 138–143.

    PubMed  CAS  Google Scholar 

  29. Reed BR, Eberling JL, Mungas D, et al.: Frontal lobe hypometabolism predicts cognitive decline in patients with lacunar infarcts. Arch Neurol 2001, 58: 493–497.

    Article  PubMed  CAS  Google Scholar 

  30. Meikle R, Herholz K, Grond M, et al.: Severity of vascular dementia is related to volume of metabolically impaired tissue. Arch Neurol 1992, 49: 909–913.

    Google Scholar 

  31. Loeb C, Gandolfo C, Croce R, Conti M: Dementia associated with lacunar infarction. Stroke 1992, 23: 1225–1229.

    PubMed  CAS  Google Scholar 

  32. Fein G, Di Sclafani V, Tanabe J, et al.: Hippocampal and cortical atrophy predict dementia in subcortical ischemic vascular disease. Neurology 2000, 55: 1626–1635.

    PubMed  CAS  Google Scholar 

  33. Esiri MM, MacDonald B, Morris J, et al.: Neuropathological assessment of the lesions of significance in vascular dementia. J Neurol Neurosurg Psychiatry 1997, 63: 749–753.

    PubMed  CAS  Google Scholar 

  34. Skoog I: A review of blood pressure and ischaemic white matter lesions. Dementia 1998, 9: 13–17.

    Google Scholar 

  35. Englund E: Neuropathology of white matter changes in Alzheimer disease and vascular dementia. Dementia 1998, 9(suppl 1): 6–12.

    Google Scholar 

  36. Ballard C, McKeith I, O’Brien J, et al.: Neuropathological substrates of dementia and depression in vascular dementia, with particular focus on cases with small infarct volumes. Dementia Geriatr Cogn Disord 2000, 11: 59–65.

    Article  CAS  Google Scholar 

  37. Yoshitake T, Kiyohara Y, Kato I, et al.: Incidence and risk factors of vascular dementia and Alzheimer’s disease in a defined elderly Japanese population: the Hisayama Study. Neurology 1995, 45: 1161–1168.

    PubMed  CAS  Google Scholar 

  38. Barber R, Scheltens P, Gholkar A, et al.: White matter lesions on magnetic resonance imaging in dementia with Lewy bodies, Alzheimer’s disease, vascular dementia, and normal aging. J Neurol Neurosurg Psychiatry 1999, 67: 66–72.

    PubMed  CAS  Google Scholar 

  39. Nolan KA, Lino MM, Seligmann AW, Blas JP: Absence of vascular dementia in an autopsy series from a dementia clinic. J Am Geriatr Soc 1998, 46: 597–604.

    PubMed  CAS  Google Scholar 

  40. Kalaria RN: Advances in molecular genetics and pathology of cerebrovascular disorders. Trends Neurosci 2001, 24: 392–400.

    Article  PubMed  CAS  Google Scholar 

  41. Brun A: Pathology and pathophysiology of cerebrovascular dementia: pure subgroups of obstructive and hypoperfusive aetiology. Dementia 1994, 5: 145–147.

    PubMed  CAS  Google Scholar 

  42. Desmond DW, Moroney JT, Lynch T, et al.: The natural history of CADASIL: a pooled analysis of previoulsy published cases. Neurology 1999, 30: 1230–1233.

    CAS  Google Scholar 

  43. Catto AJ, McCormack LJ, Mansfield MW, et al.: Apolipoprotein E polymorphism in cerebrovascular disease. Acta Neurol Scand 2000, 101: 399–404.

    Article  PubMed  CAS  Google Scholar 

  44. McCarron MO, Delong D, Alberts MJ: APOE genotype as a risk factor for ischemic cerebrovascular disease: a meta-analysis. Neurology 1999, 53: 1308–1311.

    PubMed  CAS  Google Scholar 

  45. Frisoni GB: Apolipoprotein E e 4 allele in Alzheimer’s disease and vascular dementia. Dementia 1994, 5: 240–242.

    PubMed  CAS  Google Scholar 

  46. Higuchi S, Arai H, Nakagawa T, et al.: The apolipoprotein E gene in Binswanger’s disease and vascular dementia. Clin Genet 1996, 5: 459–461.

    Google Scholar 

  47. Kokubo Y, Chowdhury AH, Date C, et al.: Age-dependent association of apolipoprotein E genotypes with stroke subtypes in Japanese rural population. Stroke 2000, 6: 1299–1306.

    Google Scholar 

  48. Van der Cammen TJ, Verschoor CJ, van Loon CP, et al.: Risk of left ventricular dysfunction in patients with probable Alzheimer’s disease with APOE e4 allele. J Am Geriatr Soc 1998, 46: 962–967.

    PubMed  Google Scholar 

  49. Slooter AJ, Cruts M, Ott A, et al.: The effect of APOE on dementia is not through atherosclerosis: the Rotterdam Study. Neurology 1999, 53: 1593–1595.

    PubMed  CAS  Google Scholar 

  50. Dik MG, Deeg DJ, Bouter LM, et al.: Stroke and apolipoprotein E epsilon4 are independent risk factors for cognitive decline: a population-based study. Stroke 2000, 31: 2431–2436.

    PubMed  CAS  Google Scholar 

  51. Perry EK, Gibson PH, Blessed G, et al.: Neurotransmitter enzyme abnormalities in senile dementia. J Neurol Sci 1977, 34: 247–265.

    Article  PubMed  CAS  Google Scholar 

  52. Wallin A: Neurotransmitter deficits in a non-multi infarct category of vascular dementia. Acta Neurol Scand 1989, 79: 397–406.

    Article  PubMed  CAS  Google Scholar 

  53. Hesse C, Rosengren L, Andreasen N, et al.: Transient increase in total tau but not phospo-tau in human cerebrospinal fluid after acute stroke. Neurosci Lett 2001, 297: 187–190.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. CBV Group, Wolfson Research Centre, Newcastle General Hospital, Westgate Road, NE4 6BE, Newcastle upon Tyne, United Kingdom

    Raj N. Kalaria FRCPath & Clive Ballard FRCPsych

Authors
  1. Raj N. Kalaria FRCPath
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Clive Ballard FRCPsych
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kalaria, R.N., Ballard, C. Stroke and cognition. Curr Atheroscler Rep 3, 334–339 (2001). https://doi.org/10.1007/s11883-001-0028-5

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11883-001-0028-5

Keywords

Search

Navigation