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@ARTICLE{Filler:266783,
author = {Filler, Jule and Georgakis, Marios K and Dichgans, Martin},
title = {{R}isk factors for cognitive impairment and dementia after
stroke: a systematic review and meta-analysis.},
journal = {The lancet / Healthy longevity},
volume = {5},
number = {1},
issn = {2666-7568},
address = {London},
publisher = {Elsevier},
reportid = {DZNE-2024-00041},
pages = {e31 - e44},
year = {2024},
abstract = {Cognitive impairment and dementia are highly prevalent
among stroke survivors and represent a major burden for
patients, carers, and health-care systems. We studied the
risk factors for post-stroke cognitive impairment (PSCI) and
dementia (PSD) beyond the well established risk factors of
age and stroke severity.In this systematic review and
meta-analysis we conducted a systematic literature search
from database inception until Sept 15, 2023. We selected
prospective and retrospective cohort studies, post-hoc
analyses from randomised controlled trials, and nested
case-control studies of patients with acute stroke
(ischaemic, haemorrhagic, and transient ischaemic attack),
exploring associations between risk factors at baseline and
PSCI or PSD over a follow-up period of at least 3 months.
Study quality was assessed using the Newcastle-Ottawa
quality assessment scale. We calculated pooled relative
risks (RRs) with random-effects meta-analyses and performed
subgroup, meta-regression, and sensitivity analyses. This
study was preregistered with PROSPERO, CRD42020164959.We
identified 162 eligible articles for our systematic review,
of which 113 articles (89 studies, 160 783 patients) were
eligible for meta-analysis. Baseline cognitive impairment
was the strongest risk factor for PSCI (RR 2·00, $95\%$ CI
1·66-2·40) and PSD (3·10, 2·77-3·47). We identified
diabetes (1·29, 1·14-1·45), presence or history of atrial
fibrillation (1·29, 1·04-1·60), presence of moderate or
severe white matter hyperintensities (WMH; 1·51,
1·20-1·91), and WMH severity (1·30, 1·10-1·55, per SD
increase) as treatable risk factors for PSCI, independent of
age and stroke severity. For PSD, we identified diabetes
(1·38, 1·10-1·72), presence of moderate or severe WMH
(1·55, 1·01-2·38), and WMH severity (1·61, 1·20-2·14,
per SD increase) as treatable risk factors. Additional risk
factors included lower educational attainment, previous
stroke, left hemisphere stroke, presence of three or more
lacunes, brain atrophy, and low baseline functional status.
Associations of risk factors with PSD were weaker in studies
conducted and published more recently. We found substantial
interstudy heterogeneity and evidence of reporting bias.Our
results highlight the importance of cognitive impairment in
the acute phase after stroke for long-term prediction of
PSCI and PSD. Treatable risk factors include diabetes,
atrial fibrillation, and markers of cerebral small vessel
disease (ie, white matter hyperintensities and lacunes).
Future trials should explore these risk factors as potential
targets for prevention of PSCI and PSD.German Research
Foundation.},
keywords = {Humans / Brain Ischemia: complications / Brain Ischemia:
psychology / Prospective Studies / Retrospective Studies /
Atrial Fibrillation: complications / Stroke: complications /
Stroke: epidemiology / Cognitive Dysfunction: etiology /
Cognitive Dysfunction: complications / Risk Factors /
Dementia: epidemiology / Dementia: etiology / Diabetes
Mellitus},
cin = {AG Dichgans},
ddc = {610},
cid = {I:(DE-2719)5000022},
pnm = {353 - Clinical and Health Care Research (POF4-353)},
pid = {G:(DE-HGF)POF4-353},
typ = {PUB:(DE-HGF)16},
pubmed = {pmid:38101426},
doi = {10.1016/S2666-7568(23)00217-9},
url = {https://pub.dzne.de/record/266783},
}