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(Stroke. 2004;35:2436-a.)
© 2004 American Heart Association, Inc.

Letters to the Editor

Does Preventing Stroke Prevent All Kinds of Dementia?

Ailsa Hospital, Ayr, United Kingdom

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

To the Editor:

The recent publication in Stroke regarding dementia after stroke¹ makes interesting observations. However, there are some points in the article to which I would like to draw attention.

First, the subgroup analysis in the text mentions that the 4 allele for apolipoprotein E (ApoE) genotype was present in 17.3% of the cases and in 22% of the controls. Table 1 in the article seems to have a printing error in that the above percentages have been reversed in the table (ie, 22% of cases and 17% of controls have 4 allele for ApoE genotype).

Second, the changing denominators in Table 1 show that a lot of baseline data were actually missing. A mention of this would have been appropriate in the limitations of the study.

Last, it seems logical to conclude that the prevention of stroke would reduce the burden of vascular dementia. The authors conclude that primary and secondary prevention of stroke should significantly decrease the risk of all dementia. I wonder how valid that observation could be. It is true that a proportion of stroke cases had Alzheimer disease (AD), but the proportion of AD still remained higher among controls. There is no statistical analysis in this particular study to suggest that stroke increases the incidence of AD or precipitates AD in a vulnerable individual; ie, it is possible that the stroke patients with AD would have developed AD even if the stroke were prevented. Perhaps a study to compare AD patients with and . . . [Full Text of this Article]

Sudha Seshadri, MD; Alexa Beiser, PhD; Cristina S. Ivan, MD; Rhoda Au, PhD; Carlos S. Kase, MD; Margaret Kelly-Hayes, RN EdD Philip A. Wolf, MD

Boston University School of Medicine, Boston, Mass