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000280978 1001_ $$aFiller, Jule$$b0
000280978 245__ $$aRisk factors for dementia and cognitive impairment within 5 years after stroke: a prospective multicentre cohort study.
000280978 260__ $$a[Amsterdam]$$bElsevier$$c2025
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000280978 520__ $$aStroke survivors frequently experience subsequent cognitive impairment or dementia. We aimed to identify risk factors for post-stroke dementia (PSD) and cognitive impairment (PSCI) within 5 years after stroke.The DEMDAS (German Center for Neurological Diseases (DZNE) mechanisms of dementia after stroke) study is a prospective cohort of stroke patients admitted to six German tertiary stroke centres between May 1, 2011 and January 31, 2019. Eligible dementia-free patients with ischaemic or haemorrhagic stroke underwent baseline examinations and regular clinical, neuropsychological, and neuroimaging follow-ups over 5 years, with the last follow-ups completed in January 2024. PSD was the primary outcome, determined by comprehensive cognitive testing, patient and informant interviews, and review of medical records. The secondary outcomes were early-onset PSD (3-6 months), delayed-onset PSD (>6 months), and PSCI. Associations between baseline risk factors and PSD were assessed using Cox regression models adjusted for age, sex, education, and stroke severity.Of 736 patients (245 [33%] female, mean age 68·0 years [SD 11·2], median admission National Institutes of Health Stroke Scale (NIHSS) 3 [IQR 1-5]), 557 (76%) were followed up until death or the end of the study, and 706 (96%) contributed to the PSD analysis. During a median of 5·0 years [IQR 3·3-5·1] of follow-up, 55 new dementia cases were diagnosed (6-month incidence: 3·1% [1·8-4·5], 5-year incidence: 8·8% [6·5-11·1]), of which 21 (38%) were classified as early-onset PSD. The 5-year risk of PSD was associated with older age (HR 1·13 [95% CI 1·08-1·18] per year), higher stroke severity (1·08 [1·03-1·13] per point on NIHSS), lower educational attainment (1·16 [1·05-1·28] per year), acute phase cognitive impairment (5·86 [2·21-15·58]), lower Barthel Index (1·10 [1·05-1·16] per 5 points less), atrial fibrillation (1·91 [1·10-3·30]), metabolic syndrome (MetS, 2·05 [1·15-3·64]), particularly reduced high-density lipoprotein cholesterol (HDL-C, 2·61 [1·50-4·52]) and pre-/diabetes mellitus (2·13 [1·13-4·00]), imaging markers of small vessel disease, and stroke recurrence during follow-up (2·36 [1·16-4·83]). Patients who received acute reperfusion treatment had a 65% lower risk of PSD than those who did not (0·35 [0·16-0·77]). While factors related to the severity of the index stroke were more strongly associated with early-onset PSD, MetS showed a stronger association with delayed-onset PSD. The association between MetS and PSD was independent of stroke recurrence and consistent across age subgroups, with 5-year cumulative incidence ranging from 1·7% (0·0-4·0) in patients ≤65 years without MetS to 24·5% (14·3-33·4) in patients ≥74 years with MetS.The risk of dementia after stroke is multifactorial, with differing risk profiles for early-onset and delayed-onset PSD. Metabolic syndrome, including reduced HDL-C, emerged as a novel risk factor and potential target for PSD prevention.German Center for Neurodegenerative Diseases (DZNE).
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000280978 650_7 $$2Other$$aBrain ischaemia
000280978 650_7 $$2Other$$aCognitive decline
000280978 650_7 $$2Other$$aDementia
000280978 650_7 $$2Other$$aDementia epidemiology
000280978 650_7 $$2Other$$aDiabetes
000280978 650_7 $$2Other$$aMetabolic syndrome
000280978 650_7 $$2Other$$aPost-stroke cognitive impairment
000280978 650_7 $$2Other$$aPost-stroke dementia
000280978 650_7 $$2Other$$aRisk factors
000280978 650_7 $$2Other$$aSmall vessel disease
000280978 650_7 $$2Other$$aStroke
000280978 650_7 $$2Other$$aStroke epidemiology
000280978 650_7 $$2Other$$aStroke outcomes
000280978 650_7 $$2Other$$aVascular dementia
000280978 7001_ $$aGeorgakis, Marios K$$b1
000280978 7001_ $$0P:(DE-2719)9002557$$aJanowitz, Daniel$$b2$$udzne
000280978 7001_ $$aDuering, Marco$$b3
000280978 7001_ $$aFang, Rong$$b4
000280978 7001_ $$aDewenter, Anna$$b5
000280978 7001_ $$0P:(DE-2719)2811949$$aBode, Felix J$$b6$$udzne
000280978 7001_ $$0P:(DE-2719)9000778$$aStoesser, Sebastian$$b7$$udzne
000280978 7001_ $$0P:(DE-2719)9000373$$aKindler, Christine$$b8$$udzne
000280978 7001_ $$aHermann, Peter$$b9
000280978 7001_ $$0P:(DE-2719)9000234$$aNolte, Christian$$b10
000280978 7001_ $$0P:(DE-2719)9000189$$aLiman, Thomas G$$b11$$udzne
000280978 7001_ $$0P:(DE-2719)2811628$$aKerti, Lucia$$b12$$udzne
000280978 7001_ $$aBernkopf, Kathleen$$b13
000280978 7001_ $$aIkenberg, Benno$$b14
000280978 7001_ $$0P:(DE-2719)2811614$$aGlanz, Wenzel$$b15$$udzne
000280978 7001_ $$0P:(DE-2719)2000057$$aWagner, Michael$$b16$$udzne
000280978 7001_ $$0P:(DE-2719)2811324$$aSpottke, Annika$$b17$$udzne
000280978 7001_ $$0P:(DE-2719)2814124$$aWaegemann, Karin$$b18$$udzne
000280978 7001_ $$aGoertler, Michael$$b19
000280978 7001_ $$aWunderlich, Silke$$b20
000280978 7001_ $$0P:(DE-2719)2811033$$aEndres, Matthias$$b21$$udzne
000280978 7001_ $$0P:(DE-2719)2000058$$aZerr, Inga$$b22$$udzne
000280978 7001_ $$0P:(DE-2719)2810273$$aPetzold, Gabor C$$b23$$udzne
000280978 7001_ $$0P:(DE-2719)2000030$$aDichgans, Martin$$b24$$eLast author$$udzne
000280978 7001_ $$aInvestigators, DEMDAS$$b25$$eCollaboration Author
000280978 7001_ $$aWittenberg, Tatjana$$b26$$eContributor
000280978 7001_ $$aScheitz, Jan F$$b27$$eContributor
000280978 7001_ $$0P:(DE-2719)2810931$$aPrüß, Harald$$b28$$eContributor$$udzne
000280978 7001_ $$aSperber, Pia Sophie$$b29$$eContributor
000280978 7001_ $$aNave, Alexander H$$b30$$eContributor
000280978 7001_ $$aKufner Ibaroule, Anna$$b31$$eContributor
000280978 7001_ $$aMeißner, Julius N$$b32$$eContributor
000280978 7001_ $$0P:(DE-2719)9003076$$aEbrahimi, Taraneh$$b33$$eContributor$$udzne
000280978 7001_ $$aNordsiek, Julia$$b34$$eContributor
000280978 7001_ $$0P:(DE-2719)9002283$$aBeckonert, Niklas$$b35$$eContributor$$udzne
000280978 7001_ $$0P:(DE-2719)9000287$$aSchmitz, Matthias$$b36$$eContributor$$udzne
000280978 7001_ $$aGoebel, Stefan$$b37$$eContributor
000280978 7001_ $$aBunck, Timothy$$b38$$eContributor
000280978 7001_ $$aSchütte-Schmidt, Julia$$b39$$eContributor
000280978 7001_ $$aNuhn, Sabine$$b40$$eContributor
000280978 7001_ $$aVolpers, Corinna$$b41$$eContributor
000280978 7001_ $$aDechent, Peter$$b42$$eContributor
000280978 7001_ $$aBähr, Matthias$$b43$$eContributor
000280978 7001_ $$aKopczak, Anna$$b44$$eContributor
000280978 7001_ $$aWollenweber, Frank$$b45$$eContributor
000280978 7001_ $$aHuber, Christiane$$b46$$eContributor
000280978 7001_ $$aPoppert, Holger$$b47$$eContributor
000280978 7001_ $$0P:(DE-2719)2810538$$aStöcker, Tony$$b48$$eContributor$$udzne
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000280978 773__ $$0PERI:(DE-600)3055963-7$$a10.1016/j.lanepe.2025.101428$$gVol. 56, p. 101428 -$$p101428$$tThe lancet / Regional health. Europe$$v56$$x2666-7762$$y2025
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