Post-Stroke Cognitive Disorders – A Systematic Review

Analysis

Authors

  • Tifani Antonia Pradhea Faculty of Medicine, Tanjungpura University, Pontianak, Indonesia
  • Intan Dwikarlina Faculty of Medicine, Brawijaya University, Malang, Indonesia
  • Aulia Wiratama Putra Faculty of Medicine, Trisakti University, Jakarta, Indonesia
  • Lisa Agustina Pelita Harapan University Faculty of Medicine, Tangerang, Indonesia
  • Derajat Fauzan Nardian Faculty of Medicine, Sebelas Maret University, Surakarta, Indonesia

DOI:

https://doi.org/10.55175/cdk.v51i12.1239

Keywords:

Post-stroke dementia, post-stroke cognitive impairment, vascular cognitive impairment

Abstract

Introduction: The increasing number of stroke survivors was accompanied by an increase of cognitive impairment incidence as one of the post-stroke long-term consequences. Post-stroke cognitive impairment needs to be highlighted because of impact on reducing the quality of life, especially in the elderly. Methods: Literature was extensively searched across ScienceDirect, PubMed, Google Scholar, and Cochrane databases, using several predetermined keywords. Results and Discussion: Nine articles were analyzed. MMSE and MoCA assessments were used as parameters of post-stroke cognitive impairment. Most patients experience post-stroke cognitive impairment ranging from mild cognitive impairment to vascular dementia or other types of dementia. Risk factors include older age, female, lower and shorter education, location of lesions in the left hemisphere with involvement of certain brain structures, uncontrolled and fluctuating blood pressure, family history of stroke, comorbid diseases, as well as an individualistic social life. Conclusion: Stroke significantly increases the risk of cognitive impairment and
dementia.

Downloads

Download data is not yet available.

References

GBD 2019 Stroke Collaborators, Feigin VL, Stark BA, Johnson CO, Roth GA, Bisignano C, et al. Global, regional, and national burden of stroke and its risk factors, 1990–2019: A systematic analysis for the global burden of disease study 2019. Lancet Neurol. 2021;20(10):795–820. DOI: 10.1016/ S1474-4422(21)00252-0.

Syarfaini, Nildawati, Aeni S, Surahmawati, Adha AS, Amansyah M. Risk factors preparation of stroke incidence in health institution employees who check up at the Health Service EXPO Event Indonesia. Gac Sanit. 2021;35(Suppl 1):S49–52. DOI: 10.1016/j.gaceta.2020.12.014.

Georgakis MK, Fang R, During M, Wollenweber FA, Bode FJ, Stosser S, et al. Cerebral small vessel disease burden and cognitive and functional outcomes after stroke: A multicenter prospective cohort study. Alzheimers Dement J Alzheimers Assoc. 2023;19(4):1152–63. DOI: 10.1002/alz.12744.

Jokinen H, Melkas S, Ylikoski R, Pohjasvaara T, Kaste M, Erkinjuntti T, et al. Post-stroke cognitive impairment is common even after successful clinical recovery. Eur J Neurol. 2015;22(9):1288–94. DOI: 10.1111/ene.12743.

Teuschl Y, Matz K, Brainin M. Prevention of post-stroke cognitive decline: A review focusing on lifestyle interventions. Eur J Neurol. 2013;20(1):35–49. DOI: 10.1111/j.1468-1331.2012.03757.x.

Creavin ST, Wisniewski S, Noel-Storr AH, Trevelyan CM, Hampton T, Rayment D, et al. Mini-mental state examination (MMSE) for the detection of dementia in clinically unevaluated people aged 65 and over in community and primary care populations. Cochrane Database Syst Rev. 2016;2016(1):CD011145. DOI: 10.1002/14651858.CD011145.pub2.

Van Heugten CM, Walton L, Hentschel U. Can we forget the mini-mental state examination? A systematic review of the validity of cognitive screening instruments within one month after stroke. Clin Rehabil. 2015;29(7):694–704. DOI: 10.1177/0269215514553012.

Salvadori E, Cova I, Mele F, Pomati S, Pantoni L. Prediction of post-stroke cognitive impairment by Montreal cognitive assessment (MoCA) performances in acute stroke: comparison of three normative datasets. Aging Clin Exp Res. 2022;34(8):1855–63. DOI: 10.1007/s40520-022-02133-9.

Brainin M, Tuomilehto J, Heiss WD, Bornstein NM, Bath PMW, Teuschl Y, et al. Post-stroke cognitive decline: An update and perspectives for clinical research. Eur J Neurol. 2015; 22(2):229–38:13-6. DOI: 10.1111/ene.12626.

Al-Qazzaz NK, Ali SH, Ahmad SA, Islam S, Mohamad K. Cognitive impairment and memory dysfunction after a stroke diagnosis: A post-strokememory assessment. Neuropsychiatr Dis Treat. 2014;10:1677–91. DOI: 10.2147/NDT.S67184.

Kalaria RN, Akinyemi R, Ihara M. Stroke injury, cognitive impairment and vascular dementia. Biochim Biophys Acta. 2016;1862(5):915–25. DOI: 10.1016/j.bbadis.2016.01.015.

Tan HH, Xu J, Teoh HL, Chan BPL, Seet RCS, Venketasubramanian N, et al. Decline in changing Montreal cognitive assessment (MoCA) scores is associated with post-stroke cognitive decline determined by a formal neuropsychological evaluation. PloS One. 2017;12(3):e0173291. DOI: 10.1371/journal.pone.0173291.

Schneider JA, Wilson RS, Bienias JL, Evans DA, Bennett DA. Cerebral infarctions and the likelihood of dementia from Alzheimer disease pathology. Neurology 2004;62(7):1148–55. DOI: 10.1212/01.wnl.0000118211.78503.f5.

Toledo JB, Arnold SE, Raible K, Brettschneider J, Xie SX, Grossman M, et al. Contribution of cerebrovascular disease in autopsy confirmed neurodegenerative disease cases in the National Alzheimer’s Coordinating Centre. Brain J Neurol. 2013;136(Pt 9):2697–706. DOI: 10.1093/brain/awt188.

Boyle PA, Yu L, Wilson RS, Leurgans SE, Schneider JA, Bennett DA. Person-specific contribution of neuropathologies to cognitive loss in old age. Ann Neurol. 2018;83(1):74–83. DOI: 10.1002/ana.25123.

Jacquin A, Binquet C, Rouaud O, Graule-Petot A, Daubail B, Osseby GV, et al. Post-stroke cognitive impairment: high prevalence and determining factors in a cohort of mild stroke. J Alzheimers Dis JAD. 2014;40(4):1029–38. DOI: 10.3233/JAD-131580.

Fu C, Jin X, Chen B, Xue F, Niu H, Guo R, et al. Comparison of the mini-mental state examination and Montreal cognitive assessment executive subtests in detecting post-stroke cognitive impairment. Geriatr Gerontol Int. 2017;17(12):2329–35. DOI: 10.1111/ggi.13069.18.

Zhu Y, Zhao S, Fan Z, Li Z, He F, Lin C, et al. Evaluation of the mini-mental state examination and the Montreal cognitive assessment for predicting post-stroke cognitive impairment during the acute phase in Chinese minor stroke patients. Front Aging Neurosci. 2020;12:236. DOI: 10.3389/fnagi.2020.00236.

Delavaran H, Jonsson AC, Lovkvist H, Iwarsson S, Elmstahl S, Norrving B, et al. Cognitive function in stroke survivors: A 10-year follow-up study. Acta Neurol Scand. 2017;136(3):187–94. doi: 10.1111/ane.12709.

Cumming TB, Churilov L, Linden T, Bernhardt J. Montreal cognitive assessment and mini-mental state examination are both valid cognitive tools in stroke. Acta Neurol Scand. 2013;128(2):122–9. DOI: 10.1111/ane.12084.

Shen YJ, Wang WA, Huang FD, Chen J, Liu HY, Xia YL, et al. The use of MMSE and MoCA in patients with acute ischemic stroke in clinical. Internat J Neurosci. 2016;126(5):442-7. DOI: 10.3109/00207454.2015.1031749.

Chaurasia RN, Sharma J, Pathak A, Mishra VN, Joshi D. Poststroke cognitive decline: A longitudinal study from a tertiary care center. J Neurosci Rural Pract. 2019;10(3):459–64. DOI: 10.1055/s-0039-1697872.

Yan Z, Xu S, Wei D, He X, Li C, Zhang Y, et al. Comparison of three cognitive assessment methods in post-stroke aphasia patients. Front Psychol. 2022;13:896095. doi: 10.3389/fpsyg.2022.896095.

Omran MSL, Ibrahim NHM, Zaki MA. Cognitive impairment after first-ever ischemic stroke. Al-Azhar Assiut Med J [Internet]. 2022;20(4). https://journals.lww.com/aamj/fulltext/2022/20040/cognitive_impairment_after_first_ever_ischemic.5.aspx.

Levine DA, Galecki AT, Langa KM, Unverzagt FW, Kabeto MU, Giordani B, et al. Trajectory of cognitive decline after incident stroke. JAMA. 2015;314(1):41–51. DOI: 10.1001/jama.2015.6968.

Portegies MLP, Wolters FJ, Hofman A, Ikram MK, Koudstaal PJ, Ikram MA. Prestroke vascular pathology and the risk of recurrent stroke and poststroke dementia. Stroke. 2016; 47(8): 2119–22. DOI: 10.1161/STROKEAHA.116.014094.

Guo X, Ostling S, Kern S, Johansson L, Skoog I. Increased risk for dementia both before and after stroke: A population-based study in women followed over 44 years. Alzheimers Dement J Alzheimers Assoc. 2018; 14(10): 1253–60. DOI: 10.1016/j.jalz.2018.05.009.

Divya KP, Menon RN, Varma RP, Sylaja PN, Thomas B, Kesavadas C, et al. Post-stroke cognitive impairment - A cross-sectional comparison study between mild cognitive impairment of vascular and non-vascular etiology. J Neurol Sci. 2017;372:356–62. DOI: 10.1016/j.jns.2016.10.031.

Lo JW, Crawford JD, Desmond DW, Bae HJ, Lim JS, Godefroy O, et al. Long-term cognitive decline after stroke: An individual participant data meta-analysis. Stroke. 2022; 53(4): 1318–27. DOI: 10.1161/STROKEAHA.121.035796.

Pinter D, Enzinger C, Gattringer T, Eppinger S, Niederkorn K, Horner S, et al. Prevalence and short-term changes of cognitive dysfunction in young ischaemic stroke patients. Eur J Neurol. 2019;26(5):727–32. DOI: 10.1111/ene.13879.

Sachdev PS, Lipnicki DM, Crawford JD, Wen W, Brodaty H. Progression of cognitive impairment in stroke/TIA patients over 3 years. J Neurol Neurosurg Psychiatry. 2014;85(12):1324–30. DOI: 10.1136/jnnp-2013-306776.

Pase MP, Satizabal CL, Seshadri S. The role of improved vascular health in the declining incidence of dementia. Stroke. 2017;48(7):2013–20. DOI: 10.1161/STROKEAHA.117.013369.

Buvarp D, Rafsten L, Abzhandadze T, Sunnerhagen KS. A prospective cohort study on longitudinal trajectories of cognitive function after stroke. Sci Rep. 2021;11(1):17271. DOI: 10.1038/s41598-021-96347-y.

Roberts RO, Knopman DS, Mielke MM, Cha RH, Pankratz VS, Christianson TJH, et al. Higher risk of progression to dementia in mild cognitive impairment cases who revert to normal. Neurology. 2014; 82(4): 317–25. DOI: 10.1212/WNL.0000000000000055.

He A, Wang Z, Wu X, Sun W, Yang K, Feng W, et al. Incidence of post-stroke cognitive impairment in patients with first-ever ischemic stroke: A multicenter cross-sectional study in China. Lancet Reg Health – West Pac [Internet]. 2023 Apr 01 [cited 2023 Oct 25];33. Available from: https://www.thelancet.com/journals/lanwpc/article/PIIS2666-6065(23)00005-6/fulltext.

Dharmasaroja PA, Limwongse C, Charernboon T. Incidence and risk factors of vascular dementia in Thai stroke patients. J Stroke Cerebrovasc Dis. 2020;29(8):104878. DOI: 10.1016/j.jstrokecerebrovasdis.2020.104878.

Morrison HW, White MM, Rothers JL, Taylor-Piliae RE. Examining the associations between post-stroke cognitive function and common comorbid conditions among stroke survivors. Int J Environ Res Public Health. 2022;19(20):13445. DOI: 10.3390/ijerph192013445.

Tu Q, Ding B, Yang X, Bai S, Tu J, Liu X, et al. The current situation on vascular cognitive impairment after ischemic stroke in Changsha. Arch Gerontol Geriatr. 2014;58(2):236–47. DOI: 10.1016/j.archger.2013.09.006.

Onadja Y, Atchessi N, Soura BA, Rossier C, Zunzunegui MV. Gender differences in cognitive impairment and mobility disability in old age: A cross-sectional study in Ouagadougou, Burkina Faso. Arch Gerontol Geriatr. 2013;57(3):311–8. DOI: 10.1016/j.archger.2013.06.007.

Rost NS, Brodtmann A, Pase MP, van Veluw SJ, Biffi A, Duering M, et al. Post-stroke cognitive impairment and dementia. Circ Res. 2022;130(8):1252–71. DOI: 10.1161/CIRCRESAHA.122.319951.

Mirza SS, Portegies MLP, Wolters FJ, Hofman A, Koudstaal PJ, Tiemeier H, et al. Higher education is associated with a lower risk of dementia after a stroke or TIA. The Rotterdam study. Neuroepidemiology. 2016;46(2):120–7. DOI: 10.1159/000443649.

Weaver NA, Kuijf HJ, Aben HP, Abrigo J, Bae HJ, Barbay M, et al. Strategic infarct locations for post-stroke cognitive impairment: A pooled analysis of individual patient data from 12 acute ischaemic stroke cohorts. Lancet Neurol. 2021;20(6):448–59. DOI: 10.1016/S1474-4422(21)00060-0.

Renjen PN, Gauba C, Chaudhari D. Cognitive impairment after stroke. Cureus 2015;7(9):e335. DOI: 10.7759/cureus.335.

El-Sheik WM, El-Emam AI, El-Rahman AAEGA, Salim GM. Predictors of dementia after first ischemic stroke. Dement Neuropsychol. 2021;15(2):216–22. DOI: 10.1590/1980-57642021dn15-020009.

Gaussoin SA, Pajewski NM, Chelune G, Cleveland ML, Crowe MG, Launer LJ, et al. Effect of intensive blood pressure control on subtypes of mild cognitive impairment and risk of progression from SPRINT study. J Am Geriatr Soc. 2022;70(5):1384–93. DOI: 10.1111/jgs.17583.

Cooper C, Sommerlad A, Lyketsos CG, Livingston G. Modifiable predictors of dementia in mild cognitive impairment: A systematic review and meta-analysis. Am J Psychiatry. 2015; 172(4): 323–34. DOI: 10.1176/appi.ajp.2014.14070878.

Ihle-Hansen H, Thommessen B, Fagerland MW, Oksengard AR, Wyller TB, Engedal K, et al. Blood pressure control to prevent decline in cognition after stroke. Vasc Health Risk Manag. 2015;11:311–6. DOI: 10.2147/VHRM.S82839.

Ou YN, Tan CC, Shen XN, Xu W, Hou XH, Dong Q, et al. Blood pressure and risks of cognitive impairment and dementia: A systematic review and meta-analysis of 209 prospective studies. Hypertens Dallas Tex 1979. 2020;76(1):217–25. DOI: 10.1161/HYPERTENSIONAHA.120.14993.

Kim Y, Lim JS, Oh MS, Yu KH, Lee JS, Park JH, et al. Blood pressure variability is related to faster cognitive decline in ischemic stroke patients: PICASSO subanalysis. Sci Rep. 2021;11(1):5049. DOI: 10.1038/s41598-021-83945-z.

Kim JH, Go SM, Seo SW, Kim SH, Chin J, Moon SY, et al. Survival in subcortical vascular dementia: Predictors and comparison to probable Alzheimer’s disease in a tertiary memory clinic population. Dement Geriatr Cogn Disord. 2015;40(3–4):210–21. DOI: 10.1159/000434626.

She R, Yan Z, Hao Y, Zhang Z, Du Y, Liang Y, et al. Comorbidity in patients with first-ever ischemic stroke: Disease patterns and their associations with cognitive and physical function. Front Aging Neurosci. 2022;14: 887032. DOI: 10.3389/fnagi.2022.887032.

Cheng Y, Zhu H, Chen J, Li L, Liu C, Gao Y, et al. Serum TG/HDL-C level at the acute phase of ischemic stroke is associated with post-stroke cognitive impairment. Neurol Sci Off J Ital Neurol Soc Ital Soc Clin Neurophysiol. 2022;43(10):5977–84. DOI: 10.1007/s10072-022-06267-6.

Yang Z, Wang H, Edwards D, Ding C, Yan L, Brayne C, et al. Association of blood lipids, atherosclerosis and statin use with dementia and cognitive impairment after stroke: A systematic review and meta-analysis. Ageing Res Rev. 2020;57:100962. DOI: 10.1016/j.arr.2019.100962.

Kim KY, Shin KY, Chang KA. Potential biomarkers for post-stroke cognitive impairment: A systematic review and meta-analysis. Int J Mol Sci. 2022;23(2):602. DOI: 10.3390/ijms23020602.

Ball EL, Shah M, Ross E, Sutherland R, Squires C, Mead GE, et al. Predictors of post-stroke cognitive impairment using acute structural MRI neuroimaging: A systematic review and meta-analysis. Int J Stroke Off J Int Stroke Soc. 2023;18(5):543–54. DOI: 10.1177/17474930221120349.

Teng Z, Dong Y, Zhang D, An J, Lv P. Cerebral small vessel disease and post-stroke cognitive impairment. Int J Neurosci. 2017;127(9):824–30. DOI: 10.1080/00207454.2016.1261291.

Arba F, Quinn T, Hankey GJ, Ali M, Lees KR, Inzitari D, et al. Cerebral small vessel disease, medial temporal lobe atrophy and cognitive status in patients with ischaemic stroke and transient ischaemic attack. Eur J Neurol. 2017;24(2):276–82. DOI: 10.1111/ene.13191.

Chen ZC, Wu H, Wang XD, Zeng Y, Huang G, Lv Y, et al. Association between marital status and cognitive impairment based on a cross-sectional study in China. Int J Geriatr Psychiatry. 2022;37(1). DOI: 10.1002/gps.5649.

Abdin E, Chong SA, Peh CX, Vaingankar JA, Chua BY, Verma S, et al. The mediational role of physical activity, social contact and stroke on the association between age, education, employment and dementia in an Asian older adult population. BMC Psychiatry. 2017;17(1):98. DOI: 10.1186/s12888-017-1272-8.

Narasimhalu K, Lee J, Leong YL, Ma L, De Silva DA, Wong MC, et al. Inflammatory markers and their association with post stroke cognitive decline. Int J Stroke Off J Int Stroke Soc. 2015;10(4):513–8. DOI: 10.1111/ijs.12001.

Huang LC, Hsieh SW, Tsai CC, Chen CH, Yang YH. The role of cilostazol and inflammation in cognitive impairment after ischemic stroke. Am J Alzheimers Dis Other Demen. 2021;36:15333175211016185. DOI: 10.1177/15333175211016185.

Lee M, Lim JS, Kim CH, Lee SH, Kim Y, Hun Lee J, et al. High neutrophil-lymphocyte ratio predicts post-stroke cognitive impairment in acute ischemic stroke patients. Front Neurol. 2021;12:693318. DOI: 10.3389/fneur.2021.693318.

Lo JW, Crawford JD, Desmond DW, Godefroy O, Jokinen H, Mahinrad S, et al. Profile of and risk factors for poststroke cognitive impairment in diverse ethnoregional groups. Neurology 2019;93(24):e2257–71. DOI: 10.1212/WNL.0000000000008612.

Published

05-12-2024

How to Cite

Pradhea, T. A., Dwikarlina, I., Putra, A. W., Agustina, L., & Nardian, D. F. (2024). Post-Stroke Cognitive Disorders – A Systematic Review: Analysis. Cermin Dunia Kedokteran, 51(12), 714–721. https://doi.org/10.55175/cdk.v51i12.1239