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(Stroke. 2008;39:3.)
© 2008 American Heart Association, Inc.

Editorials

Prestroke Cognitive Function and Cerebrovascular Disease

If They Interact, It May Not Be Through Symptomatic Stroke

Mike O’Sullivan, PhD

From the Neurologische Klinik, Klinikum Groβhadern, Ludwigs Maximilians University, Munich, Germany.

Correspondence to Dr Mike O’Sullivan, Neurologische Klinik, Klinikum Groβhadern, Marchioninistraβe 15, 81377 Munich, Germany. E-mail michael.osullivan@med.uni-muenchen.de

Key Words: cognition • dementia

An extract of the first 250 words of the full text is provided, because this article has no abstract.

See related article, pages 36–41.

In this issue of Stroke, Reitz and coworkers explore the link between incident stroke and dementia in data from the Rotterdam Study.¹ The emphasis on incident stroke is important: previous studies to address this question have recruited patients at the time of stroke so that prestroke cognitive status has been inferred rather than measured directly.^2,3 Therefore, this is the first truly prospective data to assess the relationship between prestroke cognitive decline, stroke and subsequent dementia. Incident stroke led to a doubling of dementia risk over a mean follow-up time of 3.9 years. An approximate doubling of risk has also been found in other cohorts like those from Rochester and Framingham, so this study provides important confirmation of this size of effect.²

Much interest has surrounded the possible mechanisms of this doubling of risk: does stroke have an independent effect or does it accelerate some pre-existing process in the brain? More specifically, does stroke accelerate a pre-existing neurodegenerative process like coincident Alzheimer disease (AD)—a synergy that would fit with the strong epidemiological evidence of the link between vascular risk factors and AD.⁴ In the absence of good biomarkers to diagnose neurodegenerative disease at the time of stroke, one way to assess this question indirectly is to infer some pre-existing process from prestroke cognitive decline.

The most important and interesting finding of the study is that no interaction was seen between prestroke cognitive function and stroke on the risk of subsequent dementia. Readers should not . . . [Full Text of this Article]

Related Article:

Prestroke Cognitive Performance, Incident Stroke, and Risk of Dementia: The Rotterdam Study

Christiane Reitz, Michiel J. Bos, Albert Hofman, Peter J. Koudstaal, and Monique M.B. Breteler
Stroke 2008 39: 36-41. [Abstract] [Full Text] [PDF]