Stroke is one of the main causes of disability. Research and interventions have been historically focused on physical disabilities, whereas cognitive impairment has been somewhat neglected. A minor stroke can even affect daily performance, quality of life, and return to work. The stroke survivors are at higher risk of developing some type of cognitive impairment.
Stroke is acknowledged as one of the main causes of disability in adults throughout the world. It is the second most common cause of cognitive impairment, where only Alzheimer’s disease is more prevalent. The risk of developing a stroke that can lead to dementia in people of 65 years of age is observed in 1 of every 3 males and in 1 of every 2 females.
Silent cerebral infarctions are common findings in patients in this age group. According to the study of Grau-Olivares and Arboix, the ischemic vascular disease of small vessels must be considered as a severe condition, prodrome of subcortical ischemia, instead of a relatively benign disorder, as was considered before. Recent studies show that the proportion of dementia caused by a vascular disease in in the range between 36 and 67 %. Additionally, the patients with a first stroke show cognitive impairment in most than half of the cases, and more than 55 % of them meet criteria of cognitive impairment. The presence of multiple and silent infarctions in patients with a first stroke is also an independent predictor of the poor performance of executive functions and of other cognitive tests, like verbal memory.
Acute damage of the tissue can obviously affect cognition. Physical impairment tends to improve to a greater or lesser extent after a stroke is suffered. However, cognitive impairment tends to worsen progressively. Accordingly, a neuropsychophysiological assessment is required that assesses the function in detail and collaborates to understand the regions, circuits, and neuronal types compromised and have the possibility to generate a therapeutic plan that leads to their rehabilitation.
There are currently several therapeutic options available that reduce the damage caused by a stroke, reducing inflammation and favoring neuronal regeneration.
- Blanco-Rojas, Lorena, et al. “Cognitive Profile in Patients with a First-Ever Lacunar Infarct with and without Silent Lacunes: a Comparative Study.” BMC Neurology, vol. 13, no. 1, 2013, doi:10.1186/1471-2377-13-203.
- Bornstein, N. M., et al. “Do Silent Brain Infarctions Predict the Development of Dementia After First Ischemic Stroke?” Stroke, vol. 27, no. 5, Jan. 1996, pp. 904–905., doi:10.1161/01.str.27.5.904.
- Fride, Y., et al. “What Are the Correlates of Cognition and Participation to Return to Work after First Ever Mild Stroke?” Topics in Stroke Rehabilitation, vol. 22, no. 5, 2015, pp. 317–325., doi:10.1179/1074935714z.0000000013.
- Grau-Olivares, Marta, and AdriÃ Arboix. “Mild Cognitive Impairment in Stroke Patients with Ischemic Cerebral Small-Vessel Disease: a Forerunner of Vascular Dementia?” Expert Review of Neurotherapeutics, vol. 9, no. 8, 2009, pp. 1201–1217., doi:10.1586/ern.09.73.
- Greenberg, David A., and Kunlin Jin. “Growth Factors and Stroke.” NeuroRX, vol. 3, no. 4, 2006, pp. 458–465., doi:10.1016/j.nurx.2006.08.003.
- Henon, H., et al. “Poststroke Dementia.” Cerebrovascular Diseases, vol. 22, no. 1, 2006, pp. 61–70., doi:10.1159/000092923.
- Lanfranconi, S., et al. “Growth Factors in Ischemic Stroke.” Journal of Cellular and Molecular Medicine, vol. 15, no. 8, Aug. 2009, pp. 1645–1687., doi:10.1111/j.1582-4934.2009.00987.x.
- Lees, R., et al. “Cognitive and Mood Assessment in Stroke Research: Focused Review of Contemporary Studies.” Stroke, vol. 43, no. 6, 2012, pp. 1678–1680., doi:10.1161/strokeaha.112.653303.
- Mckevitt, C., et al. “Self-Reported Long-Term Needs After Stroke.” Stroke, vol. 42, no. 5, 2011, pp. 1398–1403., doi:10.1161/strokeaha.110.598839.
- Mijajlović, Milija D., et al. “Post-Stroke Dementia-a Comprehensive Review.” BMC Medicine, vol. 15, no. 1, 2017, doi:10.1186/s12916-017-0779-7.
- Pollock, Alex, et al. “Top Ten Research Priorities Relating to Life after Stroke.” The Lancet Neurology, vol. 11, no. 3, 2012, p. 209., doi:10.1016/s1474-4422(12)70029-7.
- Ritchie, Craig W, et al. “Dementia Trials and Dementia Tribulations: Methodological and Analytical Challenges in Dementia Research.” Alzheimer's Research & Therapy, vol. 7, no. 1, 2015, p. 31., doi:10.1186/s13195-015-0113-6.
- Seshadri, Sudha, and Philip A Wolf. “Lifetime Risk of Stroke and Dementia: Current Concepts, and Estimates from the Framingham Study.” The Lancet Neurology, vol. 6, no. 12, 2007, pp. 1106–1114., doi:10.1016/s1474-4422(07)70291-0.
- Strong, Kathleen, et al. “Preventing Stroke: Saving Lives around the World.” The Lancet Neurology, vol. 6, no. 2, 2007, pp. 182–187., doi:10.1016/s1474-4422(07)70031-5.
- Pasquier F, Hénon H, Leys D. Risk factors and mechanisms of post-stroke dementia. Rev Neurol. 1999;155(9):749–753.
- Pendlebury, Sarah T, and Peter M Rothwell. “Prevalence, Incidence, and Factors Associated with Pre-Stroke and Post-Stroke Dementia: a Systematic Review and Meta-Analysis.”The Lancet Neurology, vol. 8, no. 11, 2009, pp. 1006–1018., doi:10.1016/s1474-4422(09)70236-4.