![]() ![]() ![]() The Perindopril Protection against Recurrent Stroke Study (PROGRESS) randomised clinical trial reported that active blood pressure management was associated with a 19% risk reduction in cognitive decline. Emerging evidence suggests that appropriate secondary prevention of recurrent events may reduce the burden of post-stroke cognitive impairment and progression to dementia. ![]() In a systematic review and meta-analysis, Pendlebury and Rothwell showed that 10% of patients had dementia before first stroke, 10% developed dementia in the year after first stroke and over one-third of patients developed dementia after recurrent stroke. Because vascular risk factors are treatable and, in some instances preventable, it may be possible to prevent, postpone, or mitigate vascular cognitive impairment (VCI), as well as the vascular exacerbation of Alzheimer’s disease. Up to 34% of patients with dementia show significant vascular pathology. Cognitive impairment can have a significant impact on quality of life and activities of daily living by reducing the degree of independence of the individual and is associated with long-term morbidity and disability. However longitudinal evidence in the United Kingdom has demonstrated the long-term prevalence of cognitive impairment in stroke, with prevalence rates of 22% at five years and 21% at 14 years reported, highlighting the persistent pervasiveness of cognitive deficits. A degree of cognitive impairment is often evident in the immediate aftermath of stroke with many deficits resolving over the initial recovery period. Estimation of the prevalence of post-stroke cognitive impairments is difficult given the range of potential deficits, including memory, attention, and visuospatial ability, thus reported rates have varied from 30-50%. However strategies for restoration of cognitive dysfunction receive significantly less attention with cognitive rehabilitation post-stroke arguably the “lost dimension” of stroke rehabilitation. Restoration of physical function in stroke is widely researched, with evidence demonstrating significant improvements following physical rehabilitation. Stroke is the second most common cause of death in the world after ischaemic heart disease and the leading cause of acquired disability, with over half of patients remaining physically dependent following a stroke and approximately two-thirds having some form of neurological impairment at five years post-stroke. Neuropsychological rehabilitation post-stroke is also required as part of stroke rehabilitation models to meet the burden of post-stroke cognitive impairment. Encouragingly, aspects of secondary prevention were identified that may be protective in reducing the incidence of cognitive impairment post-stroke. Conclusionsįindings reveal levels of cognitive impairment at 6 months post-stroke that are concerning. 26-.68) were associated with reduced likelihood of cognitive impairment, however increasing number of total prescribed medications was moderately associated with poorer cognitive impairment (OR = 1.12, 95% CI 1.04-1.19). 44-.96) and prescription of anticoagulant therapy (OR = .41, 95% CI. Treatment with antihypertensive medications (OR = .65, 95% CI. Over half of the sample (56.6%) were found to have cognitive impairment, with significant associations between cognitive impairment and female sex (odds ratio (OR) = 1.6, 95% CI 1.01-2.57) and history of cerebrovascular disease (OR = 2.22, 95% CI 1.38-3.59). Two-hundred and fifty-six stroke patients were assessed at six months. Cognitive impairment was measured using the Montreal Cognitive Assessment (MoCA). Participants were assessed at six months following an ischaemic stroke as part of the Action on Secondary Prevention Interventions and Rehabilitation in Stroke study (ASPIRE-S), which examined the secondary preventive and rehabilitative profile of patients in the community post-stroke. The aim of this study was to profile cognitive impairment of stroke survivors at six months, and to identify factors associated with cognitive impairment post-stroke, focusing on indicators of adequate secondary prevention and psychological function. Recent evidence suggests that optimising secondary prevention adherence is a critical factor in preventing recurrent stroke and the incidence of stroke-related cognitive impairment and dementia. Cognitive impairment commonly occurs in the acute phase post-stroke, but may persist with over half of all stroke survivors experiencing some form of long-term cognitive deficit. ![]()
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