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From the Memory Research Unit and Stroke Unit, Department of Neurology,
University of Helsinki (Finland).
Background and Purpose—Frequency of
poststroke dementia is high, and stroke considerably increases the risk
of dementia. The risk factors for dementia related to stroke are still
incompletely understood. We sought to examine clinical determinants of
poststroke dementia in a large well-defined stroke cohort.
Methods—The study group comprised 337 of 486 consecutive patients
aged 55 to 85 years who 3 months after ischemic stroke
completed a comprehensive neuropsychological test battery and MRI,
including structured medical, neurological, and laboratory evaluations;
clinical mental status examination; interview of a knowledgeable
informant; detailed history of risk factors; and evaluation of stroke
type, localization, and syndrome. The DSM-III definition for dementia
was used.
Results—Frequency of any poststroke dementia was 31.8%
(107/337), that of stroke-related dementia (mixed Alzheimer's
disease plus vascular dementia excluded) was 28.4% (87/306), and that
of dementia after first-ever stroke was 28.9% (79/273). The patients
with poststroke dementia were older and more often had a low level of
education, history of prior cerebrovascular disease and stroke, left
hemispheric stroke (reflecting laterality), major dominant stroke
syndrome (reflecting laterality and size), dysphasia, gait impairment,
and urinary incontinence. The demented patients were also more
frequently current smokers, had lower arterial blood
pressure values, and more frequently had an orthostatic
reaction compared with the nondemented stroke patients. The correlates
of dementia in logistic regression analysis were dysphasia
(odds ratio [OR], 5.6), major dominant stroke syndrome (OR, 5.0),
history of prior cerebrovascular disease (OR, 2.0), and low educational
level (OR, 1.1). When we excluded those with cerebrovascular disease
plus Alzheimer's disease or those with recurrent stroke, the
order of correlates remained the same. When the patients with dysphasia
(n=30) were excluded, the correlates were major dominant syndrome (OR,
4.6) and low educational level (OR, 1.1).
Conclusions—Our data suggest that a single explanation for
poststroke dementia is not adequate; rather, multiple factors including
stroke features (dysphasia, major dominant stroke syndrome), host
characteristics (educational level), and prior cerebrovascular disease
each independently contribute to the risk.
© 1998 American Heart Association, Inc.
Original Contributions
Clinical Determinants of Poststroke Dementia
Key Words: cerebral ischemia • dementia • diagnosis • Finland
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