back to 2012, vol. 18, b. 3
Journal of IMAB - Annual Proceeding (Scientific Papers)
Publisher: Peytchinski, Gospodin Iliev
ISSN: 1312 773X (Online)
Issue: 2012, vol. 18, book 3;
Subject Collection: Medicine
Page: 290-297
DOI: 10.5272/jimab.2012183.290
Published online: 29 September 2012

J of IMAB. 2012; 18(3):290-297
Maya Danovska1, Boyko Stamenov1, Margarita Alexandrova2, Dora Peychinska1
1) Department of Neurology, University Hospital – Pleven, Bulgaria
2) Department of Biophysics, Medical University, Pleven, Bulgaria.

Stroke patients are at higher risk of developing cognitive impairment. Cognitive dysfunctions, especially progressive ones, worsen stroke prognosis and outcome. A longitudinal follow-up of cognitive disorders, however, is rendered difficult by their heterogeneity and the lack of definitions generally agreed upon. Stroke is a major cause of cognitive deficit. The identification of risk factors, clinical determinants and laboratory markers of post-stroke cognitive deficit may help detect patients at increased risk of cognitive deterioration, and prevent or delay the occurrence of post-stroke cognitive impairments. Though inflammatory processes have been implicated in the pathogenesis of stroke, their role in the complex pathophysiological mechanisms of post-stroke cognitive impairment is not completely understood. Evidence suggests that elevated serum C-reactive protein is associated with both the increased risk of stroke and post-stroke cognitive deficit. The hypothesis of a possible relationship between markers of systemic inflammation and cognitive dysfunctions raises the question of how rational the option of applying non-steroidal anti-inflammatory drugs in a proper therapeutic window will be, especially during the acute phase of stroke, to prevent cognitive decline and dementia.

Key words: stroke, cognitive impairment, dementia, inflammation, CRP.

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Please cite this article as: Danovska M, Stamenov B, Alexandrova M, Peychinska D. POST-STROKE COGNITIVE IMPAIRMENT - PHENOMENOLOGY AND PROGNOSTIC FACTORS. J of IMAB. 2012; 18(3):290-297. doi: 10.5272/jimab.2012183.290.

1. Murray CJ, Lopez AD. Global mortality, disability and the contribution of risk factors. Global burden of disease study. Lancet 1997 May 17;349(9063):1436-42. [PubMed] [CrossRef]
2. Titianova E, Velcheva I, B. Stamenov B.Treatment of Acute Ischemic Stroke with Thrombolysis in Bulgaria. Neurosonology and Cerebral Hemodynamics. 2010; 6(1):9-14. [in Bulgarian]
3. Desmond DW, Moroney JT, Sano M, Stern Y. Incidence of dementia after ischemic stroke. Stroke2002 Sep;33(9):2254-2262. [PubMed] [CrossRef]
4. Tatemichi TK, Desmond DW, Paik M, Figueroa M, Gropen TI, Stern Y, et al. Determinants of dementia related to stroke. Ann Neurol 1993 Jun;33(6):568-575. [PubMed]
5. Hadjiev D.  Neuroprotection in cerebral ischemia- current concepts and perspectives. Neurosonology and cerebral hemodinamics. 2007; 3(1);5-11. [in Bulgarian]
6. Grant I, Adams KM. Neuropsychological Assessment of Neuropsychiatric and Neuromedical Disorders. OxfordUniversity Press US, 2009; 315-319.
7. Hennerichi M. What are the mechanisms for post-stroke dementia? Lancet Neurol. 2009 Nov;8(11): 973-975. [PubMed] [CrossRef]
8. Haring HP. Cognitive impairment after stroke. Curr Opin Neurol 2002 Feb,15(1):79-83. [PubMed]
9. Vakhnina NV, Nikitina LY, Parfenov VA, Yakhno NN. Post-stroke cognitive impairment. Neurosci Behav Physiol 2009 Oct;39(8):719-72. [PubMed] [CrossRef]
10. Hachinski V. Vascular dementia: a radical redefinition. Dementia 1994 May-Aug;5(3-4):130-2. [PubMed]
11. Stephan BC, Mathews FE, Khaw KT, Dufuil C, Brayne C. Beyond mild cognitive impairment: vascular cognitive impairment, no dementia(VCIND). Alzheimers Res Ther 2009 Jul 9;1(1):4. [PubMed]
12. Roman GC, Tatemichi TK, Erkinjuntti T, Cummings JL, Masdeu JC, Garcia JH, et al. Vascular dementia: diagnostic criteria for research studies. Report of the NINDS-AIREN International Workshop Neurology 1993 Feb; 43 (2):250-60. [PubMed]
13. Bowler JV. Modern concept of vascular cognitive impairment. Br Med Вull. 2007; 83:291-305. [PubMed] [CrossRef]
14. Leys D, Henon H, Mackowiak-Cordoliani MA, Pasquier. Poststroke dementia. Lancet Neurol. 2005 Nov;4(11):752-759. [PubMed] [CrossRef]
15. Pasi M, Poggesi A, Salvadori E, Pantoni L. Post-stroke dementia and cognitive impairment. Front Neurol Neurosci. 2012; 30:65-9. Epub 2012 Feb 14. [PubMed] [CrossRef]
16. Serrano S, Domingo J, Rodriguez-Garcia E, Castro MD, del Ser T. Frequency of cognitive impairment without dementia in patients with stroke. Stroke 2007 Jan;38(1):105-110. [PubMed] [CrossRef]
17. John SM, Gaiane MR, Helmut L. Vascular dementia. Wiley- Blackwell 2001 1-19.
18. Lodder Y. Poststroke cognition and the flight against the hard problem: vascular neurologists, enter the arena! Stroke 2007 Jan;38(1):7-8. [PubMed] [CrossRef]
19. Hachinski V, Iadecola C, Petersen RC, Breteler MM, Nyenhuis DL, Black SE, et al. National Institute of Neurological Disorders and Stroke-Canadian Stroke Network vascular cognitive impairment harmonization standard. Stroke 2006 Sep;37(9):2220-41. Epub 2006 Aug 17. [PubMed] [CrossRef]
20. O’Brien J, Erkinjuntti T, Reisberg B, Roman G, Sawada T, Pantoni L, et al. Vascular cognitive impairment. Lancet Neurol 2003 Feb;2(2):89-98. [PubMed] [CrossRef]
21. Sachdev PS, Brodaty H, Valenzuela MJ, Lorentz L, Looi JC, Berman K, et al. Clinical determinants of stroke and mild cognitive impairment following ischemic stroke: the Sydney Stroke Study. Dement Geriatr Cogn Disord 2006; 21(5-6):275-83.Epub 2006 Feb10. [PubMed] [CrossRef]
22. Zhao QL, Zhou Y, Wang YL, Dong KH, Wang YJ. A new diagnostic algorithm for vascular cognitive impairment: the proposed criteria and evaluation of its reliability and validity. Chin Med J (Engl) 2010 Feb;123(3):311-9.
23. Cumming T, Blomstrand C, Bernhardt J, Linden T. The NIH Stroke Scale can establish cognitive function after stroke. Cerebrovasc Dis 2010; 30 (1): 7-14.
24. Cumming T, Brodtmann A. Dementia and stroke: the present and future epidemic. Intern J of Stroke 2010; 5:453-454.
25. Erkinjuntti T. Vascular cognitive deterioration and stroke. Cerebrovasc Dis 2007; 24 Suppl 1:189-94.
26. Jellinger KA, Attems J. Prevalance and pathology of vascular dementia in the oldest-old. JAlzheimers Dis 2010. Aug 6.
27. Nunes B, Silva RD, Cruz VT et al. Prevalence and pattern of cognitive impairment in rural and urban populations from Northern Portugal. BMC Neurol 2010 Jun 11; 10-42.
28. Ballard C, Rowan E, Stephens S, Kalaria R, Kenny R. Prospective follow up study between 3 and 15 months after stroke: improvements and decline in cognitive function among dementia-free stroke survivors >75 years of age. Stroke 2003; 34: 2440-2445.
29. Snaphaan L., de Leeuw F. Poststroke memory function in non-demented patients: a systemic review on frequency and neuroimaging correlates. Stroke 2007 38:198-203.
30. Tang W, Chan S, Chiu H, Ungvari G, Wong K, Kwok T. Emotional incontinence in Chinese stroke patients: diagnosis, frequency, clinical and radiological correlates. J Neurol 2004; 251:865-69.
31. Gottesman R, Hillis A. Predictors of cognitive dysfunction resulting from ischemic stroke. Lancet Neurol 2010; 9: 895-905.
32. Hillis A, Kleinman J, Newhart M. et al. Restoring cerebral blood flow reveals neural regions critical for naming. J Neurosci 2006; 26: 8069-73.
33. Lee B, Kim E, Ku B et al. Cognitive impairments in patients with hemispatial neglect from acute right hemispheric stroke. Cogn Behav Neurol 2008; 21:73-76.
34. Lesniak M, Bak T, Czepiel W, Seniow J, Czlonkowska A. Frequency and prognostic value of cognitive disorders in stroke patients. Dement Geriatr Cogn Disord 2008; 26:356-63.
35. Nys G, van Zandvoort M, de Kort P, Jansen B, de Haan E, Kappelle L. Cognitive disorders in acute stroke: prevalence and clinical determinants. Cerebrovasc Dis 2007; 23:408-16.
36. Nys G, van Zandvoort M, Algra A, Kappelle, de Haan E. Cognitive and functional outcome after intravenous recombinant tissue plasminogen activator treatment in patients with a first symptomatic brain infarct. J Neurol 2006; 253:237-41.
37. Linden T, Skoog I, Faderberg B, Steen B, Blomstrand C. Cognitive impairment and dementia 20 months after stroke. Neuroepidemiology 2004; 23:45-52.
38. Sachdev P, Chen X, Brodaty H, Thompson C, Altendorf A, Wen W. The determinants and longitudinal course of post-stroke mild cognitive impairment. J Int Neuropsychol Soc 2009;15: 915-23.
39. Troncoso J, Zonderman A, Resnick S, Crain B, Pletnikova O, O’Brien R. Effects of infarcts on dementia in the Baltimore Longitudinal Study of Aging. Ann Neurol 2008; 64:168-76.
40. Pendlebury S, Rothwell P. Prevalence, incidence and factors associated with pre-stroke and post-stroke dementia: a systematic review and meta-analysis. Lancet Neurol 2009; 8: 1006-18.
41. Moroney J, Bagiella E, Tatemichi T, Paik M, Stern Y, Desmond D. Dementia after stroke increases the risk of long-term stroke recurrence. Neurology 1997; 48:1317-25.
42. Zhou D, Wang J, Deng J, Chao C, Chen M. Frequency and risk factors of vascular cognitive impairment three months after ischemic stroke in China: the Chogqing Stroke Study. Neuroepidemiology 2005; 24(1-2):87-95.
43. Desmond D, Moroney J, Sano M, Stern Y. Mortality in patients with dementia after ischemic stroke. Neurology 2002; 59: 537-543.
44. Henon H, Durieu I, Guerouaou D, Lebert P, Pasquier P, Leys D. Post-stroke dementia: incidence and relationship to pre-stroke cognitive decline. Neurology 2001; 57:1216-22.
45. Duron E, Hanon O. Vascular risk factors, cognitive decline and dementia. Vasc Health Risk Manag 2008; 4:363-381.
46. Potluri R, Natalwala A, Uppal H, Heun R. Different risk factors in vascular dementia and ischemic stroke. Neuroepidemiology 2009; 32:80.
47. Sundar U, Advani S. Post-stroke cognitive impairment at 3 months. Ann Indian Acad Neurol 2010; 13:42-6.
48. Tzoиrio C, Anderson C, Chapman N et al. Effects of blood pressure lowering with perindopril and indipamide therapy on dementia and cognitive decline in patients with cerebrovascular disease. Arch Intern Med 2003; 163:1069-75.
49. Rasquin S, Verhey F, van Oostenbrugge R, Lousberg R, Lodder J. Demographic and CT scan features related to cognitive impairment in the first year after stroke. J Neurol Neurosurg Psychiatry 2004; 75:1562-67.
50. Ivan C, Sudha S, Beiser A et al. Dementia after stroke: the Framingham Study. Stroke 2004; 35: 1264-68.
51. Rosenberg G. Inflammation and white matter damage in vascular cognitive impairment. Stroke 2009;40:S20.
52. Rost  N, Wolf P, Kase C et al. Plasma concentrations of C-reactive protein and risk of ischemic stroke and transient ischemic attack: the Framingham Study. Stroke 2001; 32:2575-79.
53. Kuo H, Yen C, Chang C, Kuo C Kuo J, Sorond F. Relation of C-reactive protein to stroke, cognitive disorders, and depression in the general population: systematic review and meta-analysis. Lancet Neurol 2005;4:371-80.
54. Еlkind M. Inflammatory mechanisms of stroke. Stroke 2010; 41(1): S3-S8.
55. Wright C, Moon Y, Paik M et al. Inflammatory markers of vascular risk as correlates of leukoariosis. Stroke 2009;40:3466-3471.
56. Gorelick P. Role of inflammation in cognitive impairment: results of observational epidemiological studies and clinical trials. Ann N Y Acad Sci 1207 (2010): 155-162.
57. Kalaria R. Cellular, molecular and neuropathological findings in post-stroke dementia. J Neurobiol Sci 2009; 283:274.
58. Gorelick P, MD, Bowler J. Advances in Vascular Cognitive Impairment 2007.Stroke2008;39:279-282.
59. Schneider J, Boyle Z, Arvanitakis Z, Bienias J, Bennett D. Subcortical infarcts, Alzheimer’s disease, pathology and memory function in older persons. Ann Neurol 2007; 62:59-66.
60. Di Napoli M, Papa F, Bocola V. C-reactive protein in ischemic stroke. Stroke 2001; 32: 917.
61. Komulainen P, Lakka T, Kivipelto M et al. Serum high sensitivity C-reactive protein and cognitive function in elderly women. Age Ageing 2007; 36(4):443-8.
62. Duong T, Acton P, Johnson R. The in vitro neuronal toxicity of pentraxins associated with Alzheimer’s disease brain lesions. Brain Res 1998; 813:303-12.
63. Xu G, Zhou Z, Zhu W, Fan X, Liu X. Plasma C-reactive protein is related to cognitive deterioration and dementia in patients with mild cognitive impairment. J of Neurol Sci 2009;284: 77-80.
64. Wersching H, Duning T, Lohmann H et al. Serum C-reactive protein is linked to cerebral microstructural integrity and cognitive function. Neurology 2010; 74:1022-1029.
65. Paul A, Ko K, Li L et al. C-reactive protein accelerates the progression of atherosclerosis in apolipoprotein E-deficient mice. Circulation 2004; 109: 647-55.
66. Ross R. Atherosclerosis: an inflammatory disease. 1999; 340:115-26.
67. Fornage M, Chiang Y, Meara E, Psaty B, Reiner A, Sisicovick D. Biomarkers of inflammation and MRI defined small vessel disease of the brain: the cardiovascular health study. Stroke 2008; 39:1952-1959.
68. Hoshi T, Kitagawa K, Yamagami H, Furokado S, Hougaku H, Hori M. Relations of high sensitivity C-reactive protein and interleukin-6 levels with silent brain infarction. Stroke 2005; 36:768-772.
69. Engelhart M, Geerlings M, Meijer J et al. Inflammatory proteins in plasma and the risk of dementia: the Rotterdam study. Arch Neurol 2004; 61:668-72.
70. Ravaglia P, Forti P, Maioli F, Brunetti N, Martelli M. Serum C-reactive protein and cognitive function in healthy elderly Italian community dwellers. J Gerontol A Biol Sci Med Sci 2005; 60(8):1017-1021.
71. Tilvis R, Kahonen-Vare  M , Jolkkonen J, Valvanne J, Pitkala K, Strandberg T. Predictors of cognitive decline and mortality in aged people over a 10-year period . J Gerontol A Biol Sci Med Sci 2004; 59:268-74.
72. Schmidt R, Schmidt H, Curb J, Masaki K, White L, Launer L. Early inflammation and dementia: a 25-year follow-up of the Honolulu-Asia Ageing Study. Ann Neurol 2002; 52: 168-74.
73. Yaffe K, Lindquist K, Penninx B et al. Inflammatory markers and cognition in well-functioning African-American and white elders. Neurology 2003; 61:76-80.
74. Teunissen C, van Boxtel M, Bosma H, et al. Inflammation markers in relation to cognition in a healthy aging population. J Neuroimmunol 2003; 134:142-50

Accepted for publication: 19 May 2012
Issue published online: 29 September 2012

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