London, United Kingdom 2013 3 Behavioral disorders and post-stroke dementia 8:50 - 9:00 Long-term effects of secondary prevention on cognitive function in stroke patients A. Douiri1, C. McKevitt2, E.S. Emmett3, A.G. Rudd4, C.D.A. Wolfe5 NIHR-BRC and King’s Colleg London, London, UNITED KINGDOM1,King’s Colleg London, London, UNITED KINGDOM2, King’s Colleg London, London, UNITED KING-DOM3, King’s Colleg London, London, UNITED KINGDOM4, NIHR-BRC and King’s Colleg London, London, UNITED KINGDOM5 Background Limited long-term follow-up data exist on the impact of secondary prevention drug therapies on cognitive function in patients after first ever stroke. The aim of this study is to determine the effect of secondary prevention on cognitive function after stroke. Methods Data were collected between 1995 and 2011 (n=4413) from the community-based South Lon-don Stroke Register covering an inner-city multi-ethnic source population of 271,817 inhabi-tants. Patients were assessed for cognition using Abbreviated Mental Test or Mini Metal State Examination at 3 months and annually thereafter. A longitudinal analysis was used to investi-gate the relationship between the cognitive function and post-stroke secondary prevention ther-apy over time. The analyses were adjusted for age, sex, ethnicity, socioeconomic status, case-mix, stroke sub-type, and time-dependent variables, vascular risk factors, disability and stroke recurrence. Results Mean age was 70 (SD:15) years, 2,181 (49%) were female and 1137 (26%) died within the first 3 months. In multivariate longitudinal analysis, post-stroke cognitive impairment was signifi-cantly reduced in association with anticoagulants (relative risk RR: 0.8, 95%CI 0.69-0.87), lipid-lowering (RR: 0.9, 95%CI 0.78-0.94), antiplatelets (RR: 0.9, 95%CI 0.77-0.96 in dual therapies) and antihypertensives (RR: 0.9, 95%CI 0.81-0.98 in combination therapies). Bor-derline significant associations were noted between post-stroke cognitive impairment and treat-ments with antihypertensive or antiplatelet monotherapy. Atrial fibrillation was independently associated with an increased risk of cognitive impairment (RR: 1.13, 95% CI 1.01-1.27). Conclusions Optimal medication therapy management after stroke was associated with reduced risk of cog-nitive impairment after stroke. Secondary prevention drugs do not have any major effect on cognitive function in atrial fibrillation stroke patients. Cerebrovasc Dis 2013; 35 (suppl 3)1-854 187 2 Behavioral disorders and post-stroke dementia 8:40 - 8:50 Long-term risk of dementia after TIA and stroke: current estimates from a large popula-tion- based study S.T. Pendlebury1, P-J. Chen2, Z. Mehta3, P.M Rothwell4 for the Oxford Vascular Study Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences, Ox-ford, UNITED KINGDOM1,Stroke Prevention Research Unit, Nuffield Department of Clini-cal Neurosciences, Oxford, UNITED KINGDOM2, Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences, Oxford, UNITED KINGDOM3, Stroke Prevention Re-search Unit, Nuffield Department of Clinical Neurosciences, Oxford, UNITED KINGDOM4 BACKGROUND: Previous studies have shown that risk of dementia early after stroke is high and is associated with stroke-related factors, such as lesion size and number. Late post-stroke dementia may be more related to vascular risk factors and non-lesional pathology. Incidence of late post-event dementia might therefore follow a similar trajectory after TIA. We therefore examined rates of dementia after all TIA and stroke in a large population-based study with fol-low- up to 5 years. METHODS: In a population-based study of all TIA and stroke (Oxford Vascular Study), pa-tients recruited from 2002-2007 had functional and cognitive assessment at baseline and 1, 6, 12 months, 2 and 5 years (up to 2012), including the mini-mental-state-examination (MMSE) and Montreal Cognitive assessment (MoCA). To identify dementia occurring between fol-low- up visits, or in patients missing visits, all primary care and hospital medical records were also hand-searched. Dementia was defined as MMSE<24 with associated functional impair-ment not solely caused by stroke, and/or a clinical diagnosis of dementia. RESULTS: In 1247 patients (mean age 75+13 years, 47% male, 32% TIA), 94 (8%) had pre-stroke dementia, 190 (16%) of the remainder developed new post-stroke dementia within one year and 341 (30%) by 5 years. One-year incidence of dementia was lowest in TIA without prior stroke (8.4%, 5.3-11.4), intermediate after first ever stroke (17.9%, 14.8-21.1) and high-est after recurrent stroke (26.1%, 17.8-34.3). Rates had increased to 15.6% (11.5-19.7), 30.5% (26.4-34.6) and 44.3% (33.8-54.8) respectively by 5 years. CONCLUSIONS: Early risk of dementia was higher after stroke than TIA, in keeping with the hypothesis of a lesional effect. However, subsequent incidence of new dementia was also lower after TIA, suggesting differences in susceptibility and/or underlying cerebral pathology, which require further research.
Karger_ESC London_2013
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