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(Stroke. 2002;33:2254.)
© 2002 American Heart Association, Inc.

Original Contributions

Incidence of Dementia After Ischemic Stroke

Results of a Longitudinal Study

David W. Desmond, PhD; Joan T. Moroney, MD, MRCPI; Mary Sano, PhD Yaakov Stern, PhD

From the Departments of Neurology and Pathology, SUNY Downstate Medical Center, Brooklyn, NY (D.W.D.); Department of Clinical Neurosciences, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland (J.T.M.); and Departments of Neurology and Psychiatry and the Gertrude H. Sergievsky Center, Columbia University, College of Physicians and Surgeons, New York, NY (M.S., Y.S.).

Correspondence to Dr David W. Desmond, SUNY Downstate Medical Center, 450 Clarkson Ave, Box 25, Brooklyn, NY 11203. E-mail dwdesmond{at}usa.net

Background and Purpose— A number of cross-sectional epidemiological studies have reported that one fourth of elderly patients meet criteria for dementia 3 months after ischemic stroke, but few longitudinal studies of the incidence of dementia after stroke have been performed. We conducted the present study to investigate the incidence and clinical predictors of dementia after ischemic stroke.

Methods— We administered neurological, neuropsychological, and functional assessments annually to 334 ischemic stroke patients (age, 70.4±7.5 years) and 241 stroke-free control subjects (age, 70.6±6.5 years), all of whom were nondemented in baseline examinations. We diagnosed incident dementia using modified Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition criteria requiring deficits in memory and 2 additional cognitive domains, as well as functional impairment.

Results— The crude incidence rate of dementia was 8.49 cases per 100 person-years in the stroke cohort and 1.37 cases per 100 person-years in the control cohort. A Cox proportional-hazards analysis found that the relative risk (RR) of incident dementia associated with stroke was 3.83 (95% CI, 2.14 to 6.84), adjusting for demographic variables and baseline Mini-Mental State Examination score. Within the stroke cohort, intercurrent medical illnesses associated with cerebral hypoxia or ischemia were independently related to incident dementia (RR, 4.40; 95% CI, 2.20 to 8.85), adjusting for recurrent stroke, demographic variables, and baseline Mini-Mental State Examination score.

Conclusions— The risk of incident dementia is high among patients with ischemic stroke, particularly in association with intercurrent medical illnesses that might cause cerebral hypoxia or ischemia, suggesting that cerebral hypoperfusion may serve as a basis for some cases of dementia after stroke.

Editorial Comment

José G. Merino, MD, MPhil, Guest Editor

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