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Strategies to Lower the Risk of Stroke-Related Dementia

(PSYCHIATRIC TIMES) - What is the risk of dementia in patients who have had an ischemic stroke? And which therapies are most effective in reducing this risk? —— MD Population-based epidemiologic studies show that the risk of dementia is 4 to 6 times higher in patients who have had a stroke than in those who have not.1 In hospitalized cohorts, dementia develops in a quarter to a third of patients 3 months after a stroke,2 and up to 60% have impairment in at least 1 cognitive domain. Compared with persons who have not had a stroke, patients with cerebrovascular disease have a 2- to 10-fold higher risk of incident dementia, particularly when multiple infarcts are present.3 In the general population, silent or unrecognized brain infarcts also raise the risk of dementia in the subsequent 3 years,4 perhaps because they are a marker of high risk of additional infarcts.5 Cognitive decline in patients with cerebrovascular disease can result from the stroke itself when a large volume of brain is affected by ischemia or hemorrhage or when the lesion, because of its location in a strategic area, interrupts brain circuits that are critical for cognition. Alternatively, vascular and neurodegenerative changes, which are common in the brains of elderly persons,6 can coexist and lead to a “mixed dementia.”

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