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Review
. 2016 Mar 24:12:105-16.
doi: 10.2147/VHRM.S75306. eCollection 2016.

Cognitive impairment and stroke in elderly patients

Daniele Lo Coco  1 , Gianluca Lopez  1 , Salvatore Corrao  2
Affiliations
Review

Cognitive impairment and stroke in elderly patients

Daniele Lo Coco et al. Vasc Health Risk Manag. .

Abstract

We reviewed current knowledge about the interaction between stroke and vascular risk factors and the development of cognitive impairment and dementia. Stroke is increasingly recognized as an important cause of cognitive problems and has been implicated in the development of both Alzheimer's disease and vascular dementia. The prevalence of cognitive impairment after stroke is high, and their combined effects significantly increase the cost of care and health resource utilization, with reflections on hospital readmissions and increased mortality rates. There is also substantial evidence that vascular risk factors (such as hypertension, diabetes, obesity, dyslipidemia, and tobacco smoking) are independently associated with an increased risk of cognitive decline and dementia. Thus, a successful management of these factors, as well as optimal acute stroke management, might have a great impact on the development of cognitive impairment. Notwithstanding, the pathological link between cognitive impairment, stroke, and vascular risk factors is complex and still partially unclear so that further studies are needed to better elucidate the boundaries of this relationship. Many specific pharmacological treatments, including anticholinergic drugs and antihypertensive medications, and nonpharmacological approaches, such as diet, cognitive rehabilitation, and physical activity, have been studied for patients with vascular cognitive impairment, but the optimal care is still far away. Meanwhile, according to the most recent knowledge, optimal stroke care should also include cognitive assessment in the short and long term, and great efforts should be oriented toward a multidisciplinary approach, including quality-of-life assessment and support of caregivers.

Keywords: aging; cerebrovascular disease; cognitive function; dementia; vascular risk factors.

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Figures

Figure 1
Figure 1
Interconnected relationship between cerebrovascular disease and Alzheimer’s disease (AD) in the genesis of dementia in elderly patients. Abbreviations: VaD, vascular dementia; WMH, white matter hyperintensities.
Figure 2
Figure 2
The potential role of vascular risk factors in the development of dementia in elderly patients.
Figure 3
Figure 3
Potential mechanisms underlying the association between stroke and dementia. Abbreviation: BBB, blood–brain barrier.
See this image and copyright information in PMC

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