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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},
}