Dementia Risk Following Ischemic Stroke: A Systematic Review and Meta-Analysis of Factors Collected at Time of Stroke Diagnosis

Reem Waziry*, Jacqueline J. Claus, Albert Hofman

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

3 Citations (Scopus)

Abstract

Background: The majority of stroke cases are ischemic in origin and ischemic stroke survivors represent a high-risk population for progression to dementia. Objective: To determine incidence rates and predictors of dementia after ischemic stroke. Methods: A systematic review and meta-analysis compliant with Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). Results: 5,843 studies were screened for title and abstract. 292 eligible studies were screened for full text. A total of 22 studies met the inclusion criteria and were included, representing 55,929 ischemic stroke survivors. Cumulative incidence of dementia after stroke was 20% at 5 years, 30% at 15 years, and 48% at 25 years of follow-up. Dementia incidence rates were 1.5 times higher among patients with recurrent ischemic stroke compared to patients with first-time stroke. Predictors of dementia after ischemic stroke included female gender (OR 1.2, 95% CI (1.1, 1.4)), hypertension (1.4, (1.1, 2.0)), diabetes mellitus (1.6, (1.3, 2.1)), atrial fibrillation (1.9, (1.2, 3.0)), previous stroke (2.0, (1.6, 2.6)), presence of stroke lesion in dominant hemisphere (2.4, (1.3, 4.5)), brain stem or cerebellum (OR 0.5, (0.3, 0.9)) or frontal lobe (3.7, (1.2, 12.0)), presence of aphasia (OR 7.9, (2.4, 26.0)), dysphasia (5.8, (3.0, 11.3)), gait impairment (1.7, (1.1, 2.7)), presence of white matter hyperintensities (3.2, (2.0, 5.3)), and medial temporal lobe atrophy (3.9, (1.9, 8.3)). Conclusion: Factors routinely collected for stroke patients are a useful resource for monitoring dementia progression in this population. In the present meta-analysis, cardiovascular factors, stroke location, stroke-related disability and chronic brain changes were predictors of dementia after ischemic stroke.

Original languageEnglish
Pages (from-to)1535-1546
Number of pages12
JournalJournal of Alzheimer's Disease
Volume90
Issue number4
DOIs
Publication statusPublished - 6 Dec 2022

Bibliographical note

Funding Information:
Dr. Waziry is funded through a Clinical Translational Research Scholarship (CTRS) in Cognitive Aging and Age-Related Memory Loss, funded by the McKnight Brain Research Foundation through the American Brain Foundation, in collaboration with the American Academy of Neurology.

Publisher Copyright:
© 2022 - IOS Press. All rights reserved.

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