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a Department of Neurology, Stroke Unit, France, b Department of
Neurology, Correspondence to: Dr Florence Pasquier, Department of Neurology, Memory unit, Hôpital
Roger Salengro, F-59037 Lille, France. Telephone 0033 320 44 5785; fax
0033 320 44 6028; email pasquier{at}chru-lille.fr
Received 23 December 1997 and in revised form 7 April 1998;
Accepted 13 May 1998
OBJECTIVE
The links between stroke and
Alzheimer's disease seem to be closer than expected by chance. In a
previous study it was shown that up to 16% of patients admitted for
stroke had pre-existing dementia. Medial temporal lobe atrophy (MTLA)
is strongly associated with Alzheimer's disease. The aim of this study
was to determine the prevalence of MTLA and its relation with
pre-existing dementia.
METHODThe study was conducted on 170 consecutive
stroke patients (87 women; median age 75 years; 152 infarcts), who
underwent non-contrast CT with temporal lobe oriented 2 mm contiguous
slices at admission. A cut off point of 11.5 mm was used to
differentiate patients with and without MTLA. Pre-existing dementia was
assessed using the informant questionnaire on cognitive decline in the
elderly (IQCODE) with a cut off score of 104.
RESULTSNinety four patients (55.3%) had
MTLA, of whom 23 (24.5%) had pre-existing dementia; of 76 patients
without MTLA, only four (5.3%) had pre-existing dementia (p=0.0007).
The logistic regression analysis with MTLA as dependent variable
found the following independent variables: increasing age (p<0.05),
and global cerebral atrophy scores (p<0.01). The IQCODE scores just
reached significance (p=0.05).
CONCLUSIONStroke patients with MTLA are
more likely to have pre-existing dementia; this suggests that
Alzheimer's disease might contribute to the dementia syndrome. A
longitudinal follow up is now necessary to determine whether stroke
patients with MTLA and without pre-existing dementia are at increased
risk of Alzheimer's disease over subsequent years.
© 1998 by Journal of Neurology, Neurosurgery, and Psychiatry
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