What are the mechanisms for post-stroke dementia?

Dementia is becoming an increasingly common disorder in our ageing population and is a much more heterogeneous condition than has long been assumed. Above all neurodegenerative disorders, Alzheimer's disease and vascular disorders contribute the most to this important cause of chronic disability and share many features including in the predominant risk factor—age. 1 Iadecola C Gorelick PB Converging pathogenic mechanisms in vascular and neurodegenerative dementia. Stroke. 2003; 34: 335-337 Crossref PubMed Scopus (174) Google Scholar With regard to the vascular aspect of dementia, neither the 1950s concept of chronic cerebral hypoperfusion attributed to atherosclerosis of cerebral arteries, nor the emphasis during the 1970s and 1980s on the risk of recurrent strokes causing multi-infarct dementia, reflect our current knowledge about the pathobiological complexity of dementia in general and of post-stroke dementia in particular. Prevalence, incidence, and factors associated with pre-stroke and post-stroke dementia: a systematic review and meta-analysisAfter study methods and case mix are taken into account, reported estimates of the prevalence of dementia are consistent: 10% of patients had dementia before first stroke, 10% developed new dementia soon after first stroke, and more than a third had dementia after recurrent stroke. The strong association of post-stroke dementia with multiple strokes and the prognostic value of other stroke characteristics highlight the central causal role of stroke itself as opposed to the underlying vascular risk factors and, thus, the likely effect of optimum acute stroke care and secondary prevention in reducing the burden of dementia. Full-Text PDF