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Meta-Analysis
. 2013 Aug;84(8):893-900.
doi: 10.1136/jnnp-2012-303645. Epub 2013 Mar 1.

Cognitive impairment after lacunar stroke: systematic review and meta-analysis of incidence, prevalence and comparison with other stroke subtypes

Stephen David James Makin  1 , Sarah Turpin, Martin S Dennis, Joanna M Wardlaw
Affiliations
Meta-Analysis

Cognitive impairment after lacunar stroke: systematic review and meta-analysis of incidence, prevalence and comparison with other stroke subtypes

Stephen David James Makin et al. J Neurol Neurosurg Psychiatry. 2013 Aug.

Abstract

Background: Cognitive impairment and dementia are common after stroke. It is unclear if risk differs between ischaemic stroke subtypes. Lacunar strokes might be less likely to affect cognition than more severe, larger cortical strokes, except that lacunar strokes are associated with cerebral small vessel disease (SVD), which is the commonest vascular cause of dementia.

Methods: We searched MEDLINE and PsychINFO for studies of mild cognitive impairment (MCI) or dementia after lacunar or cortical ischaemic stroke. We calculated the OR for cognitive impairment/dementia in lacunar versus non-lacunar stroke, and their incidence and prevalence in lacunar stroke as a pooled proportion.

Findings: We identified 24 relevant studies of 7575 patients, including 2860 with lacunar stroke; 24% had MCI or dementia post stroke. Similar proportions of patients with lacunar and non-lacunar stroke (16 studies, n=6478) had MCI or dementia up to 4 years after stroke (OR 0.72 (95% CI 0.43 to 1.20)). The prevalence of dementia after lacunar stroke (six studies, n=1421) was 20% (95% CI 9 to 33) and the incidence of MCI or dementia (four studies, n=275) was 37% (95% CI 23 to 53). Data were limited by short follow-up, subtype classification methods and confounding.

Interpretation: Cognitive impairment appears to be common after lacunar strokes despite their small size, suggesting that associated SVD may increase their impact. New prospective studies are required with accurate stroke subtyping to assess long term outcomes while accounting for confounders.

Keywords: Cognition; Dementia; Stroke.

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Figures

Figure 1
Figure 1
Flow diagram of search strategy and results.
Figure 2
Figure 2
Odds of cognitive impairment in lacunar stroke versus cortical stroke.
Figure 3
Figure 3
Funnel plot demonstrating that the heterogeneity was not due to publication bias. This figure is only reproduced in colour in the online version.
Figure 4
Figure 4
Sensitivity analysis: OR of cognitive impairment in lacunar against cortical stroke for studies with particular characteristics.
See this image and copyright information in PMC

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