Post stroke dementia (PSD)
Natan Bornstein, Professor of Neurology Tel-Aviv University, Neurology, Sackler Faculty of Medicine, Israel
Stroke is a major cause of long term physical, cognitive and emotional disability. Stroke and Dementia are the two major causes of Disability Lost Years (DALYs) and account for 36.5% of all population attributable prevalence fractions (PAPF) (1)
Cognitive impairment as a sequella after ischemic stroke is a major issue and might be the only preventable form of dementia of late life. The diagnosis of Post Stroke Dementia (PSD) requires evidence of temporal relation between clinically defined stroke and cognitive decline, presence of focal neurological symptoms and signs and usually fluctuating course. However, the current criteria are insufficient and ill defined. The incidence of PSD varies between studies because of different diagnostic criteria the time of assessment of cognition after the stroke and characteristics of study populations. Still, it is generally accepted that approximately 25% of all ischemic stroke patients will develop dementia within 3-6 months. One out of 3 women and 4 men over the age of 65 will develop either stroke or dementia or both(2). The reported incidence of PSD vary and range between 6-32% in hospital based studies and in about 30% in population based studies which is 3.5 to 4.8 times greater than stroke-free subjects (3). For Mild Cognitive Impairment (MCI) after stroke the incidence range between 17-66% depending on the criteria used and the relative risk is 1.5-2.1 compared to stroke-free controls (4).
Mortality is afflicted by PSD and the mean survival in PSD is approximately 3-5 years. Risk factors for developing PSD include: age, female sex, low level of education, diabetes mellitus, cigarette smoking, white matter changes, left side infarct and volume of infarct. The mechanism of PSD by which stroke patients may develop is still not entirely clear and include: multi-infarcts, strategic single infarct (Thalamus, hippocampus etc.), chronic hypoperfusion and associated degenerative process (Alzheimer’s disease).
There is lack of data regarding primary and secondary prevention of PSD.
Reference
- Sousa et al. Lancet 2009; 374:1821-30
- Seshardi et al. Stroke 2006; 37:345-350
- Srikanth et al. Stroke 2003; 34:1136-43
- Iadecola et al. Acta Neuropathologia; 2010
- Natalia S. Rost et.al – Post-stroke cognitive impairment and Dementia.
Circulation research 2022; 130:1252-1271.
- Kalaria RN et al. Biochim Biophys Acta; 2016
- . Mijajlovic M and Bornstein NM et al. BMC Med ; 2017
Short Bio
EDUCATION:
– 1970-1973 University of Sienna, Medicine, Sienna, Italy
– 1973-1979 Technion Medical School, Hifa, Medicine, MD, 1979. Date of receiving specialization certificate: 11 September, 1984 Title of Doctoral dissertation: Dextran 40 in acute ischemic stroke; Name of Supervisor: Dr. Jacob Vardi
FURTHER EDUCATION:
– 1978-1983 Tel-Aviv University, Sackler Faculty of Medicine, neurology (residence), Israeli Board certified in Neurology, 1983
– 1979-1983 Tel-Aviv University, Sackler Faculty of Medicine, Post graduate studies in Neurology
– 1984-1987 Sunnybrook Medical Center, University of Toronto, M.R.C stroke, Fellowship
ACADEMIC AND PROFESSIONAL EXPERIENCE:
– 1982-1995 Tel-Aviv University, Neurology, instructor
– 1991-present European stroke Conference (ESC), Executive committee
– 1995-1999 Tel-Aviv University, Neurology, Senior lecturer
– 1995 Eliprodil CVD 715 clinical trial, Steering Committee
– 1995-1997 International Stroke Study (IST), Steering Committee
– 1995-1999 American Academy of Neurology, Member of the International Affairs Committee
– 1996 Asymptomatic Carotid Stenosis and Risk of Stroke(ACSRS), Advisory Committee
– 1996-present The Mediterranean Stroke Society (MSS), President
– 1996-2002 EFNS, Management Committee
– 1997-2009 Israeli Neurological Association, Secretary
– 1999-present Tel-Aviv University, Neurology, Associated Professor
– 2001- present European Society Neurosonology and Cerebral Hemodynamics (ESNCH) Executive committee
– 2005-present Neurosonolgy Research Group, Executive committee 2006-present European Master in Stroke Medicine, Member of faculty
– 2006-2008 NEST II clinical Trial, Steering Committee
– 2006-present SENTIS clinical Trial, Steering Committee
– 2006-present CASTA Trial, Steering Committee
– 2006-present Brainsgate clinical Trial, Steering Committee
– 2008- present World Stroke Association (WSO), Vice president
– 2009-present Israeli Neurological Association, Chairman
– 2009-present European Stroke Organization (ESO), Member on the board of directors
– 2010- NEST III clinical Trial, Steering Committee
PROFESSIONAL ACHIEVEMENTS – EDITORIAL BOARD:
– 1991-present Neurological Research Journal, Guest Editor
– 1991-present STROKE, Member of the editorial board
– 1998-present European Journal of Neurology, Member of the editorial board
– 1999-present Journal of Cerebrovascular disease, Member of the editorial board
– 2000-present Journal of Annals of Medical Science, Consulting Editor
– 2001-present Journal of Neurological Science (Turkish), Member of the editorial board
– 2001-present Acta Clinica Croatica, Member of the editorial Counsil
– 2003-present Italian Heart Journal, International Scientific Board
– 2003-present Journal of Neurological Sciences, Guest Editor
– 2004-present Turkish Journal of Neurology, International Advisory Board
– 2005-present Archives of Medical Sciences (AMS) , Member of the Editorial Board
– 2006-present Journal of Cardiovascular Medicine, International Scientific Board
– 2006-present International Journal of Stroke, Editorial Board
– 2006-present Acta Neurologica Scandinavica, Editorial Board
– 2009-present American Journal of Neuroprotection& Neurogeneration (AJNN) Member of the Editorial Board
– 2010 Neurosonology, International Editorial Board
– 2010 Frontiers in Stroke, Review Editor
PROFESSIONAL ACHIEVEMENTS – REVIEWER:
– 1998-present Lancet, Ad Hoc reviewer
– 1998-present Diabetes and its complications, Ad Hoc reviewer
– 1999-present Journal of Neuroimaging, Reviewer
– 1999-present Journal of Neurology, Ad Hoc reviewer
– 2000-present Neurology, Ad Hoc reviewer
– 2003-present Israeli Medical Association Journal (IMAJ), Reviewer
– 2003-present Acta Neurologica Scandinavica, Ad Hoc reviewer
– 2006-present Journal of Neurology, Neurosurgery & Psychiatry, Reviewer
– 2010- European Neurology, Ad Hoc reviewer
MEMBERSHIP IN PROFESSIONAL SOCIETIES:
– 1977-present Israeli Medical Association
– 1983-present The Israeli Neurological Association
– 1985-present Stroke Council of the American Heart Association (Fellow)
– 1986-present American Academy of Neurology
– 1986-present Neurosonology Research Group of the World Federation of Neurology
– 1987-present Stroke Research Group of the World Federation of Neurology
– 1990-2008 International Stroke Society
– 1995-2008 European Stroke Council
– 1995-present Mediterranean Stroke Society (MSS)
– 1998-present European Neurosonology Society
– 2005-present World Stroke Organization (WSO) 2008-present Fellow of the European Stroke organization (FESO)
