Post-stroke Dementia: Epidemiology, Mechanisms and Management

Abstract

Summary: Post-stroke dementia (PSD) is a clinical entity that encompasses all types of dementia following an index stroke, which may affect up to one third of stroke survivors. Unlike physical disability after stroke, cognitive function usually worsens over time and are often overlooked with detrimental impacts on the quality of life of survivors. The risk factors for post-stroke dementia are multifactorial and includes genetic predisposition, demographic factors (like older age and lower education status), pre-stroke cognitive and functional status, prior transient ischemic attack or stroke, vascular risk factors, characteristics and medical diseases associated with complications of stroke. Neuroimaging determinants are global cerebral atrophy or regional atrophy like hippocampal atrophy or medial temporal lobe atrophy, white matter lesions and changes, silent infarcts, lacunar infarcts and microbleeds. The mechanism of post-stroke dementia remains unknown and its neuropathology is poorly defined. Post-stroke dementia patients may benefit from target treatment of dementia with anti-dementia drugs as well as prevention and treatment of strokes. This review focus on the epidemiology, presumed mechanisms, recent studies on biomarkers, diagnostic workup and promising management strategies with functional outcome for post-stroke dementia. Keywords: dementia, mechanism, risk factors, stroke, treatment