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Cited by 329Dementia and Cognitive Impairment ResearchNeurological Disease Mechanisms and TreatmentsAcute Ischemic Stroke Management

Dementia Three Months After Stroke: Baseline Frequency and Effect of Different Definitions of Dementia in the Helsinki Stroke Aging Memory Study (SAM) Cohort

Pohjasvaara, Tarja, Erkinjuntti, Timo, Vataja, Risto, Kaste, Markku·1997·Stroke
DOI 10.1161/01.str.28.4.785
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Abstract

Background and Purpose Vascular dementia is a common cause of dementia, and cerebrovascular disease is related to a higher risk of dementia. The frequency of dementia associated with ischemic stroke and the effects of different definitions of dementia in the diagnosis are still incompletely known. We evaluated the frequency of cognitive decline and dementia 3 months after ischemic stroke in a large stroke cohort. Methods Our cohort consisted of consecutively admitted ischemic stroke patients (n=486) aged 55 to 85 years in the Helsinki (Finland) Stroke Aging Memory Study (SAM). Subjects were assessed by structured medical, neurological, and radiological examinations and interview with a close informant, as well as by the Mini-Mental State Examination and detailed clinical mental status examination of defined cognitive domains. The criteria for dementia were those of the Diagnostic and Statistical Manual of Mental Disorders (DSM) (DSM-III, DSM-III-R, and DSM-IV), the National Institute of Neurological Disorders and Stroke–Association Internationale pour la Recherche et l’Enseignement en Neurosciences (NINDS-AIREN), and the International Classification of Diseases, 10th Revision (ICD-10). Results We found that 451 (92.8%) of the patients were testable, 239 (49.2%) of the patients were women, and the mean age was 71.2 years. Any cognitive decline was present in 61.7%. In the groups aged 55 to 64, 65 to 74, and 75 to 85 years, the frequency of any cognitive decline was 45.7%, 53.8%, and 74.1% ( P =.0008), respectively. The frequency of dementia was 25.5% by DSM-III, 20.0% by DSM-III-R, 18.4% by DSM-IV, 21.1% by NINDS-AIREN, and 6.0% by ICD-10 criteria. The frequency increased with increasing age: by the DSM-III definition, frequency in the aforementioned age groups was 19.3%, 23.7%, and 25.5%, respectively ( P =.014). There was an overlap in the cases diagnosed as demented according to the different guidelines. Compared with standard diagnosis, the DSM-III was the most sensitive and ICD-10 the most specific. Concordance was moderate between the DSM criteria and NINDS-AIREN criteria but was poor between ICD-10 and the other criteria. Conclusions Cognitive decline and dementia were frequent in the cohort of ischemic stroke patients, and the frequency increased with increasing age. Different definitions gave different frequency estimates, and overlap in the cases was observed. Our findings question the validity of current criteria for dementia in the setting of cerebrovascular disease and emphasize the need for further debate and studies to refine the categories of cognitive impairment related to cerebrovascular disease.

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  • The commonly used VaD criteria sets differ substantially in their requirements, so prevalence estimates can vary by many orders of magnitude when applied to the same dataset.

    “Fourth, the criteria sets differ significantly on the requirements for levels of cognitive impairment, number and location of strokes, neuroimaging abnormalities and neurological features, such that when applied to the same data set, the prevalence estimates can vary by many orders of magnitude.15,16”

    From Diagnostic Criteria for Vascular Cognitive Disorders: A VASCOG Statement (2014) · cites this paper as [16]

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Authors
Pohjasvaara, T., Erkinjuntti, T., Vataja, R., & Kaste, M.
Affiliations
University of Helsinki (FI)
ORCID
Venue
Stroke
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
1997-04
Volume
28
Issue
4
Pages
785-792
ISSN
  • 0039-2499 (ISSN-L)
  • 1524-4628
DOI
10.1161/01.str.28.4.785
OpenAlex
W2007293928
Cited by
328
References
44
Citations by year
2024: 3 · 2023: 2 · 2022: 6 · 2021: 7 · 2020: 5 · 2019: 7 · 2018: 9 · 2017: 9 · 2016: 5 · 2015: 14 · 2014: 9 · 2013: 8 · 2012: 15
FWCI
13.46
Type
journal article
Language
en
Open access
closed
Locations
  • Stroke (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
  • Life Sciences › Neuroscience › Neurology › Neurological Disease Mechanisms and Treatments
  • Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
Keywords
vascular dementia, ischemic stroke, post-stroke dementia, cognitive decline, DSM-III, DSM-III-R, DSM-IV, NINDS-AIREN criteria, ICD-10 diagnostic criteria, diagnostic agreement, sensitivity and specificity, elderly stroke patients
MeSH terms
Aged, Aging, Cerebrovascular Disorders, Dementia, Female, Finland, Humans, Male, Memory, Middle Aged, Terminology as Topic, Psychiatric Status Rating Scales, Cohort Studies, Incidence

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