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Semin Neurol 2021; 41(01): 075-084
DOI: 10.1055/s-0040-1722217
Review Article

Cognitive Impairment in Patients with Stroke

Caitlin E. D'Souza 
1   Department of Neurology, Mayo Clinic Florida, Jacksonville, Florida
2   Department of Neurology, Baptist Health, Jacksonville, Florida
,
Melanie R. F. Greenway 
1   Department of Neurology, Mayo Clinic Florida, Jacksonville, Florida
,
Jonathan Graff-Radford
3   Department of Neurology, Mayo Clinic Rochester, Rochester, Minnesota
,
James F. Meschia 
1   Department of Neurology, Mayo Clinic Florida, Jacksonville, Florida
› Author Affiliations Funding Dr. Meschia wishes to acknowledge the generous support he has received from Earl & Nyda Swanson Neurosciences Research Fund and the Harley N. and Rebecca N. Hotchkiss Endowed Fund in Neuroscience Research, Honoring Ken and Marietta.
› Further Information
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Abstract

Despite substantial advances in stroke care, vascular cognitive impairment remains a prominent source of disability. Unlike sensorimotor impairments, cognition often continues to decline after stroke. An aging population will increase the prevalence of vascular cognitive impairment, with stroke playing an important role. Ten percent of patients presenting with stroke have pre-stroke dementia; an additional 10% will develop incident dementia with a first stroke, and 30% with a recurrent stroke. While stroke increases the risk of cognitive impairment, the presence of cognitive impairment also impacts acute stroke treatment and increases risk of poor outcome by nearly twofold. There is substantial overlap in the clinical and pathological aspects of vascular and degenerative dementias in many patients. How they relate to one another is controversial. The treatment of vascular cognitive impairment remains supportive, focusing on treating vascular risk factors. Cognitive rehabilitation after stroke is an area of active research, and existing pharmacologic treatments have limited benefit. Heightened awareness of cognitive impairment in the setting of stroke is imperative for prognostication and management, impetus for research and, ultimately, the discovery of efficacious treatments.

Keywords

stroke - cognitive impairment - dementia - imaging - biomarkers - cerebrovascular disease


Publication History

Article published online:
08 January 2021

© 2021. Thieme. All rights reserved.

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