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@ARTICLE{Filler:280978,
      author       = {Filler, Jule and Georgakis, Marios K and Janowitz, Daniel
                      and Duering, Marco and Fang, Rong and Dewenter, Anna and
                      Bode, Felix J and Stoesser, Sebastian and Kindler, Christine
                      and Hermann, Peter and Nolte, Christian and Liman, Thomas G
                      and Kerti, Lucia and Bernkopf, Kathleen and Ikenberg, Benno
                      and Glanz, Wenzel and Wagner, Michael and Spottke, Annika
                      and Waegemann, Karin and Goertler, Michael and Wunderlich,
                      Silke and Endres, Matthias and Zerr, Inga and Petzold, Gabor
                      C and Dichgans, Martin},
      collaboration = {Investigators, DEMDAS},
      othercontributors = {Wittenberg, Tatjana and Scheitz, Jan F and Prüß, Harald
                          and Sperber, Pia Sophie and Nave, Alexander H and Kufner
                          Ibaroule, Anna and Meißner, Julius N and Ebrahimi, Taraneh
                          and Nordsiek, Julia and Beckonert, Niklas and Schmitz,
                          Matthias and Goebel, Stefan and Bunck, Timothy and
                          Schütte-Schmidt, Julia and Nuhn, Sabine and Volpers,
                          Corinna and Dechent, Peter and Bähr, Matthias and Kopczak,
                          Anna and Wollenweber, Frank and Huber, Christiane and
                          Poppert, Holger and Stöcker, Tony and Neumann, Katja and
                          Speck, Oliver},
      title        = {{R}isk factors for dementia and cognitive impairment within
                      5 years after stroke: a prospective multicentre cohort
                      study.},
      journal      = {The lancet / Regional health. Europe},
      volume       = {56},
      issn         = {2666-7762},
      address      = {[Amsterdam]},
      publisher    = {Elsevier},
      reportid     = {DZNE-2025-01060},
      pages        = {101428},
      year         = {2025},
      abstract     = {Stroke 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).},
      keywords     = {Brain ischaemia (Other) / Cognitive decline (Other) /
                      Dementia (Other) / Dementia epidemiology (Other) / Diabetes
                      (Other) / Metabolic syndrome (Other) / Post-stroke cognitive
                      impairment (Other) / Post-stroke dementia (Other) / Risk
                      factors (Other) / Small vessel disease (Other) / Stroke
                      (Other) / Stroke epidemiology (Other) / Stroke outcomes
                      (Other) / Vascular dementia (Other)},
      cin          = {AG Dichgans / AG Petzold / AG Zerr / Clinical Research
                      (Bonn) / Patient Studies (Bonn) / AG Endres / AG Düzel / AG
                      Wagner},
      ddc          = {610},
      cid          = {I:(DE-2719)5000022 / I:(DE-2719)1013020 /
                      I:(DE-2719)1440011-1 / I:(DE-2719)1011001 /
                      I:(DE-2719)1011101 / I:(DE-2719)1811005 / I:(DE-2719)5000006
                      / I:(DE-2719)1011201},
      pnm          = {353 - Clinical and Health Care Research (POF4-353)},
      pid          = {G:(DE-HGF)POF4-353},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:40893447},
      pmc          = {pmc:PMC12396445},
      doi          = {10.1016/j.lanepe.2025.101428},
      url          = {https://pub.dzne.de/record/280978},
}