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Meta-Analysis
. 2018 Nov;14(11):1416-1426.
doi: 10.1016/j.jalz.2018.06.3061. Epub 2018 Aug 31.

Stroke and dementia risk: A systematic review and meta-analysis

Elżbieta Kuźma  1 , Ilianna Lourida  1 , Sarah F Moore  1 , Deborah A Levine  2 , Obioha C Ukoumunne  3 , David J Llewellyn  4
Affiliations
Meta-Analysis

Stroke and dementia risk: A systematic review and meta-analysis

Elżbieta Kuźma et al. Alzheimers Dement. 2018 Nov.

Abstract

Introduction: Stroke is an established risk factor for all-cause dementia, though meta-analyses are needed to quantify this risk.

Methods: We searched Medline, PsycINFO, and Embase for studies assessing prevalent or incident stroke versus a no-stroke comparison group and the risk of all-cause dementia. Random effects meta-analysis was used to pool adjusted estimates across studies, and meta-regression was used to investigate potential effect modifiers.

Results: We identified 36 studies of prevalent stroke (1.9 million participants) and 12 studies of incident stroke (1.3 million participants). For prevalent stroke, the pooled hazard ratio for all-cause dementia was 1.69 (95% confidence interval: 1.49-1.92; P < .00001; I2 = 87%). For incident stroke, the pooled risk ratio was 2.18 (95% confidence interval: 1.90-2.50; P < .00001; I2 = 88%). Study characteristics did not modify these associations, with the exception of sex which explained 50.2% of between-study heterogeneity for prevalent stroke.

Discussion: Stroke is a strong, independent, and potentially modifiable risk factor for all-cause dementia.

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Conflict of interest statement

Declaration of interest

We have no conflicts of interest.

Figures

Fig. 1.
Fig. 1.
Flowchart of search results and study retrieval
Fig. 2.
Fig. 2.
Meta-analysis of hazard ratios of prevalent stroke compared to no prevalent stroke on incident all-cause dementia Data presented as hazard ratios with corresponding weight for each study in the meta-analysis because number of stroke events, dementia cases and total number of participants was not always available in original included studies. Hazard ratio estimate for the study by Hayden and colleagues [34] was obtained in Review Manager using the generic inverse-variance method and is different from that obtained from a discrete-time survival model reported in the original study (i.e. HR = 3.23, CI = 1.74–5.64). The appendix shows the corresponding funnel plot. IV, inverse-variance estimation method; CI, confidence interval; EC, extended cohort; FHS, Framingham Heart Study; HRS, Health and Retirement Study; OC, original cohort; SALSA, Sacramento Area Latino Study on Aging.
Fig. 3.
Fig. 3.
Meta-analysis of odds ratios of prevalent stroke compared to no prevalent stroke on incident all-cause dementia Data presented as odds ratios with corresponding weight for each study in the meta-analysis because number of stroke events, dementia cases and total number of participants was not always available in original included studies. The appendix shows the corresponding funnel plot. IV, inverse-variance estimation method; CI, confidence interval.
Fig. 4.
Fig. 4.
Meta-analysis of risk ratios of incident stroke compared to no incident stroke on incident all-cause dementia Data presented as risk ratios with corresponding weight for each study in the meta-analysis because number of stroke events, dementia cases and total number of participants was not always available in original included studies. The appendix shows the corresponding funnel plot. IV, inverse-variance estimation method; CI, confidence interval.
See this image and copyright information in PMC

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