Delayed-onset dementia after stroke or transient ischemic attack

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• 作者：Vincent C.T. Mok^a ; ^b ; Bonnie Y.K. Lam^a ; ^b ; Zhaolu Wang^a ; Wenyan Liu^a ; Lisa Au^a ; Eric Y.L. Leung^c ; Sirong Chen^c ; Jie Yang^d ; Winnie C.W. Chu^e ; Alexander Y.L. Lau^a ; Anne Y.Y. Chan^a ; Lin Shi^a ; Florence Fan^a ; Sze H. Ma^a ; Vincent Ip^a ; Yannie O.Y. Soo^a ; Thomas W.H. Leung^a ; Timothy C.Y. Kwok^a ; Chi L. Ho^c ; Lawrence K.S. Wong^a ; Adrian Wong^a ; ^b ; ^{adrianwong@cuhk.edu.hk" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Delayed-onset dementia ; Stroke ; Transient ischemic attack ; Small vessel disease ; Alzheimer's disease
• 刊名：Alzheimer's & Dementia
• 出版年：2016
• 出版时间：November 2016
• 年：2016
• 卷：12
• 期：11
• 页码：1167-1176
• 全文大小：987 K

文摘

Patients surviving stroke without immediate dementia are at high risk of delayed-onset dementia. Mechanisms underlying delayed-onset dementia are complex and may involve vascular and/or neurodegenerative diseases.

Methods

Dementia-free patients with stroke and/or transient ischemic attack (TIA; n = 919) were studied for 3 years prospectively, excluding those who developed dementia 3 to 6 months after stroke and/or TIA.

Results

Forty subjects (4.4%) developed dementia during the study period. Imaging markers of severe small vessel disease (SVD), namely presence of ≥3 lacunes and confluent white matter changes; history of hypertension and diabetes mellitus independently predicted delayed-onset dementia after adjustment for age, gender, and education. Only 6 of 31 (19.4%) subjects with delayed cognitive decline harbored Alzheimer's disease–like Pittsburg compound B (PiB) retention. Most PiB cases (16/25, 64%) had evidence of severe SVD.

Discussion

Severe SVD contributes importantly to delayed-onset dementia after stroke and/or TIA. Future clinical trials aiming to prevent delayed-onset dementia after stroke and/or TIA should target this high-risk group.