DN2M » Stroke

Stroke

Dementia is one of the major causes of dependency in stroke patients. About one in ten patients have dementia before their first stroke, one in ten develops new dementia after their first stroke and more than one in three develops dementia after a recurrent stroke. As vascular causes of cognitive impairment are common, and often preventable, patients could benefit from early detection and therapy, and an accurate diagnosis of cognitive impairment and dementia is therefore a challenge after stroke. Patient-related variables associated with an increased risk of dementia after stroke are increasing age, low education level, dependency before stroke, pre-stroke cognitive decline without dementia, diabetes mellitus, atrial fibrillation, myocardial infarction, epileptic seizures, sepsis, cardiac arrhythmias, congestive heart failure, silent cerebral infarcts, global and medial temporal lobe atrophy, and white matter changes. Stroke-related variables associated with an increased risk of dementia after stroke are severity, volume, location, and recurrence.

Dementia in stroke patients may be due to vascular lesions, Alzheimer pathology, white matter changes, or summation of these lesions. Stroke patients with dementia have higher mortality rates, and are more often functionally impaired.

The objectives of our research in stroke patients is to determine at the acute stage of stroke, what are the factors associated with the risk of dementia, and the mechanisms of dementia, to elaborate therapeutic strategies to decrease the burden of cognitive impairment after stroke.

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From vascular risk factors to dementia.

Vascular risk factors  (1st line) - genetics and environmental - predispose to the development of lesions of the heart and vessels (2nd line) either non specific (heart diseases, atheroma, lipohyalinosis) or specific of the brain vessels (amyloid angiopathies). The vascular lesions can sometimes lead to brain lesions (3rd line) such as apparently silent lesions (leuco-araiosis, microbleeds, silent infarcts, atrophy), strokes (cerebral infarcts or cerebral haemorrhages), amyloid plaques and neurofibrillary tangles. The brain lesions may sometimes lead to clinical impairment (cognitive decline and dementia).