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The determinants and longitudinal course of post-stroke mild cognitive impairment

Published online by Cambridge University Press:  01 November 2009

PERMINDER S. SACHDEV ,
XIAOHUA CHEN ,
HENRY BRODATY ,
CLAIRE THOMPSON ,
ANNETTE ALTENDORF  and
WEI WEN
PERMINDER S. SACHDEV*
Affiliation:
School of Psychiatry and Brain and Ageing Program, University of New South Wales, Randwick, New South Wales Neuropsychiatric Institute, University of New South Wales, Randwick, New South Wales The Prince of Wales Hospital; Primary Dementia Collaborative Research Centre, University of New South Wales, Coogee, New South Wales
XIAOHUA CHEN
Affiliation:
School of Psychiatry and Brain and Ageing Program, University of New South Wales, Randwick, New South Wales Neuropsychiatric Institute, University of New South Wales, Randwick, New South Wales
HENRY BRODATY
Affiliation:
The Prince of Wales Hospital; Primary Dementia Collaborative Research Centre, University of New South Wales, Coogee, New South Wales Academic Department for Old Age Psychiatry, University of New South Wales, Randwick New South Wales
CLAIRE THOMPSON
Affiliation:
The Prince of Wales Hospital; Primary Dementia Collaborative Research Centre, University of New South Wales, Coogee, New South Wales Academic Department for Old Age Psychiatry, University of New South Wales, Randwick New South Wales
ANNETTE ALTENDORF
Affiliation:
Academic Department for Old Age Psychiatry, University of New South Wales, Randwick New South Wales
WEI WEN
Affiliation:
School of Psychiatry and Brain and Ageing Program, University of New South Wales, Randwick, New South Wales Neuropsychiatric Institute, University of New South Wales, Randwick, New South Wales
*
*Correspondence and reprint requests to: Perminder S. Sachdev, NPI, Prince of Wales Hospital, Barker Street, Randwick NSW 2031, Australia. E-mail: p.sachdev@unsw.edu.au.
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Abstract

While post-stroke dementia has been extensively investigated, the large number of patients with mild cognitive impairment (MCI) following stroke has received less attention, and reports on the longitudinal course of such impairment are inconsistent in their findings. We examined patients with MCI (n = 45) or no cognitive impairment (NCI) (n = 59), based on consensus criteria following detailed neuropsychological assessments and magnetic resonance imaging (MRI) scans, and compared them with healthy control subjects (n = 84), all of whom were assessed at two time points, 3 years apart. The MCI at baseline in this group was judged to be vascular in etiology (vaMCI). Incident dementia was diagnosed in 24.4% of vaMCI and 8.5% of NCI subjects and no control subjects over 3 years, giving a rate of conversion of approximately 8% per year in post-stroke vaMCI. The vaMCI group showed greater decline in logical memory than the NCI group. Within the vaMCI group, those who developed dementia had great decline in language and executive function. Compared with NCI patients, those with vaMCI had more vascular risk factors and more white matter hyperintensities on MRI at baseline, but did not differ in their brain or hippocampal volumes. Neither MRI volumetric measures nor interval cerebrovascular events predicted decline in function. The major determinant of decline and categorical transition was impaired performance at baseline, suggesting that those with mild impairment post-stroke are more vulnerable to subsequent decline. (JINS, 2009, 15, 915–923.)

Keywords

Vascular cognitive impairmentMild cognitive impairmentDementiaStrokeProgressionMRI brain scanWhite matter hyperintensities
Type
MCI Series
Information
Journal of the International Neuropsychological Society , Volume 15 , Issue 6 , November 2009 , pp. 915 - 923
Copyright
Copyright © The International Neuropsychological Society 2009

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