1. Intellect and emotion after Stroke
Hunter Stroke Services
Newcastle, NSW
28 October 2008
Thomas Lindn

2. Thomas Linden
CRF @ NSRI 2008
Swedish MD
Neurology and Psychiatry
PhD neurology
MScepidemiology
Neurorehabilitation @ Sahlgrenska Univ Hosp, Gothenburg, Sweden
3. A global disease
4. Post-stroke cognitive impairment and dementia
Not new
Not rare
Not unimportant
Not untreatable
Not fully known
5. Cognitive impairments in stroke patients a new finding?
dullness of mindforgetfulnessand foolishness as a sequele of apoplexy Thomas Willis described in 1672
Worse rehabilitation in cognitively impairedAdams GF, Lancet 1963
Advice and support to cognitively imaired and carers often neglected
Ebrahim S, Int Disabil Stud 1987.
Cognitive impairment after stroke analysed in many studies
More complex pathogenesis
Relation to other cognitive disorders
6. Cognitiveimpairment
7. A blurredpicture

Seriouscognitiveimparimentscanexistwithoutdementiacriteriabeingfulfilled

(Kotila 1986, Ritchie 1988).

To focus on dementia as diagnosticcriteriumwillthereforelead to underestimation of the frequency of cognitiveimpairment

(Bowler&Hachinski 1995).
Moorhouse&Rockwood, 2008
8. Semanticquagmire
Arteriosclerotic dementia
Mass effect
Multi-infarct dementia
Vascular dementia (VaD)
Vascular cognitive impairment (VCI)
Vascular cognitive disorder (VCD)
Cognitive-impairment-no-dementia (CIND)
Post-stroke dementia (PSD)
Sub-cortical vascular dementia (SCVD)
Mixed vascular dementia
Jellinger 2008
?
9. Cognitiveimpairmentcommon after stroke
Dementia in population studies
Pooled 11 European studies 6.4%(Lobo, Neurology, 2000)CSHA: IR 0.6-1.5%/Y in 70+(Herbert, Stroke 2000)Black>White; Triple in 10Y(Taylor, NeurobiolAg, 2004)31% @ 5 years (Henon, Neurology, 2001)
VaD of all dementias
CSHA 12% + 13% mixed
Rockwood et al, Neurology 2000
Double the frequency of AD in Japan
Ueda, Stroke 1992
VaD after stroke
Prevalence range 14-32% (Bowler, Lancet Neurology 2008)20% @ 3 months (Barba, Stroke 2000)18% @ 20 months (Linden, Neuroepid, 2004)31% @ 5 years (Henon, Neurology, 2001)VCI
50% in addition to VaD
10. Authopsy studies of VaD/VCI
Jellinger 2005
Markesbery 11%
Mirsen 17%
Riekse 12%
Seno 35%
11. Clinical diagnosis
12. Cognitive profiles

Alzheimers disease/MCI

13. Anterograde memory 14. Spatial abilities 15. Gait and motor OKVascualar Dementia/VCI
Executive problems
Attention
Psychomotor speed
Emotional lability

Apraxia

16. Aphasia 17. Depression