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001     280978
005     20250924102920.0
024 7 _ |a 10.1016/j.lanepe.2025.101428
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024 7 _ |a pmid:40893447
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024 7 _ |a pmc:PMC12396445
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037 _ _ |a DZNE-2025-01060
041 _ _ |a English
082 _ _ |a 610
100 1 _ |a Filler, Jule
|b 0
245 _ _ |a Risk factors for dementia and cognitive impairment within 5 years after stroke: a prospective multicentre cohort study.
260 _ _ |a [Amsterdam]
|c 2025
|b Elsevier
336 7 _ |a article
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336 7 _ |a ARTICLE
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336 7 _ |a Journal Article
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520 _ _ |a 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).
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650 _ 7 |a Brain ischaemia
|2 Other
650 _ 7 |a Cognitive decline
|2 Other
650 _ 7 |a Dementia
|2 Other
650 _ 7 |a Dementia epidemiology
|2 Other
650 _ 7 |a Diabetes
|2 Other
650 _ 7 |a Metabolic syndrome
|2 Other
650 _ 7 |a Post-stroke cognitive impairment
|2 Other
650 _ 7 |a Post-stroke dementia
|2 Other
650 _ 7 |a Risk factors
|2 Other
650 _ 7 |a Small vessel disease
|2 Other
650 _ 7 |a Stroke
|2 Other
650 _ 7 |a Stroke epidemiology
|2 Other
650 _ 7 |a Stroke outcomes
|2 Other
650 _ 7 |a Vascular dementia
|2 Other
700 1 _ |a Georgakis, Marios K
|b 1
700 1 _ |a Janowitz, Daniel
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|u dzne
700 1 _ |a Duering, Marco
|b 3
700 1 _ |a Fang, Rong
|b 4
700 1 _ |a Dewenter, Anna
|b 5
700 1 _ |a Bode, Felix J
|0 P:(DE-2719)2811949
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700 1 _ |a Stoesser, Sebastian
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700 1 _ |a Kindler, Christine
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700 1 _ |a Hermann, Peter
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700 1 _ |a Nolte, Christian
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700 1 _ |a Liman, Thomas G
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700 1 _ |a Kerti, Lucia
|0 P:(DE-2719)2811628
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700 1 _ |a Bernkopf, Kathleen
|b 13
700 1 _ |a Ikenberg, Benno
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700 1 _ |a Glanz, Wenzel
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700 1 _ |a Wagner, Michael
|0 P:(DE-2719)2000057
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700 1 _ |a Spottke, Annika
|0 P:(DE-2719)2811324
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700 1 _ |a Waegemann, Karin
|0 P:(DE-2719)2814124
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700 1 _ |a Goertler, Michael
|b 19
700 1 _ |a Wunderlich, Silke
|b 20
700 1 _ |a Endres, Matthias
|0 P:(DE-2719)2811033
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700 1 _ |a Zerr, Inga
|0 P:(DE-2719)2000058
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700 1 _ |a Petzold, Gabor C
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700 1 _ |a Dichgans, Martin
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700 1 _ |a Investigators, DEMDAS
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700 1 _ |a Wittenberg, Tatjana
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700 1 _ |a Scheitz, Jan F
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700 1 _ |a Prüß, Harald
|0 P:(DE-2719)2810931
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700 1 _ |a Sperber, Pia Sophie
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700 1 _ |a Nave, Alexander H
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700 1 _ |a Kufner Ibaroule, Anna
|b 31
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700 1 _ |a Meißner, Julius N
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700 1 _ |a Ebrahimi, Taraneh
|0 P:(DE-2719)9003076
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700 1 _ |a Nordsiek, Julia
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700 1 _ |a Beckonert, Niklas
|0 P:(DE-2719)9002283
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700 1 _ |a Schmitz, Matthias
|0 P:(DE-2719)9000287
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700 1 _ |a Goebel, Stefan
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700 1 _ |a Bunck, Timothy
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700 1 _ |a Schütte-Schmidt, Julia
|b 39
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700 1 _ |a Nuhn, Sabine
|b 40
|e Contributor
700 1 _ |a Volpers, Corinna
|b 41
|e Contributor
700 1 _ |a Dechent, Peter
|b 42
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700 1 _ |a Bähr, Matthias
|b 43
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700 1 _ |a Kopczak, Anna
|b 44
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700 1 _ |a Wollenweber, Frank
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700 1 _ |a Huber, Christiane
|b 46
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700 1 _ |a Poppert, Holger
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700 1 _ |a Stöcker, Tony
|0 P:(DE-2719)2810538
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700 1 _ |a Neumann, Katja
|0 P:(DE-2719)2810407
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700 1 _ |a Speck, Oliver
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773 _ _ |a 10.1016/j.lanepe.2025.101428
|g Vol. 56, p. 101428 -
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