Vascular cognitive impairment

2020 ◽  
pp. 454-463
Author(s):  
Joanne A. Byars ◽  
Ricardo E. Jorge
Keyword(s):  
Risk Factor ◽  
Cognitive Impairment ◽  
Vascular Risk Factor ◽  
Vascular Cognitive Impairment ◽  
Severe Form ◽  
Functional Change ◽  
Vascular Pathology ◽  
Vascular Risk ◽  
Risk Factor Modification ◽  
Factor Modification

Vascular cognitive impairment (VCI)—vascular dementia (VasD) in its severe form—is cognitive impairment due to cerebral ischaemic or haemorrhagic disease. VasD is the second most common cause of dementia in the United States. VCI and Alzheimer’s disease can coexist and synergistically worsen each other. Clinical features of VCI can vary, depending on which areas of the brain the vascular pathology affects. Individuals without a history of clinical stroke can still have VCI; small-vessel cerebrovascular disease can present as an insidious cognitive decline, rather than an abrupt functional change. Neuroimaging plays a key role in diagnosing VCI and distinguishing it from other aetiologies of cognitive impairment. Aggressive vascular risk factor modification helps prevent VCI and improves outcomes in VCI, and represents the most important intervention for this condition. Early detection of VCI maximizes the effectiveness of vascular risk factor modification. Cholinesterase inhibitors and memantine may offer some cognitive benefit in VCI.

Abstract P207: Medication Use for Secondary Stroke Prevention and Vascular RIsk Factor Modification Remains Low Among Americans

Circulation ◽  
2013 ◽  
Vol 127 (suppl_12) ◽  
Author(s):  
Karen C Albright ◽  
Rikki M Tanner ◽  
Amelia K Boehme ◽  
T. Mark Beasley
Keyword(s):  
Risk Factor ◽  
Stroke Prevention ◽  
Medication Use ◽  
Prescription Medication ◽  
Vascular Risk Factor ◽  
Secondary Stroke Prevention ◽  
Vascular Risk ◽  
Risk Factor Modification ◽  
History Of ◽  
Factor Modification

Background: With a US prevalence of 795,000 strokes per year and stroke recurrence rates up to 20%, the objective of this study was to determine the prevalence of prescription medication use for secondary stroke prevention and vascular risk factor modification among noninstitutionalized US adults and compare medication use in Whites and Blacks. Methods: A cross-sectional study was performed as part of the National Health and Nutrition Examination Survey (NHANES) 2009-2010. Demographic, disease, and prescription medication use were obtained via a standardized interview. Participants were asked if they had ever been told by a health professional that they had hypertension, diabetes, high cholesterol, or a stroke. Additionally, participants were asked if they had taken or used any prescription medicine in the past month as well as the names of each prescription medication. Statistical analyses used NHANES sample weights to provide prevalence estimates for the US population. Results: Among 11,375 participants (21% Black, 47.6% men, age 20-80), medication use for secondary stroke prevention and vascular risk factors remained low (Table 1). Participants who reported taking either an antiplatelet agent or an anticoagulant with a history of stroke remained low (7.9% Whites vs 6.2% Blacks). More Blacks with hypertension reported taking blood pressure lowering agents (38.9 vs 36.1% Whites). Diabetic medication use was lower in Blacks reporting a history of diabetes (24.5 vs 25.7% Whites). Medication use rates were lowest in participants reporting high cholesterol, with more Whites reporting use of a cholesterol lowering medication (19.3 vs 14.6%; p<0.001). Conclusion: Despite the prevalence of stroke and vascular risk factors, only a small proportion of people at risk are on medications for secondary stroke prevention and vascular risk factor modification. Overall, Blacks were taking fewer medications for secondary stroke prevention and vascular risk factor modification with the exception of anti-hypertension medication.

Vascular risk factor and vascular cognitive impairment: What is the relationship?

2000 ◽  
Vol 21 ◽  
pp. 170
Author(s):  
Kellee A. Howard ◽  
Susan A. Kirkland ◽  
Patrick R. Montgomery ◽  
David Hogan ◽  
Howard Feldman ◽  
...  
Keyword(s):  
Risk Factor ◽  
Cognitive Impairment ◽  
Vascular Risk Factor ◽  
Vascular Cognitive Impairment ◽  
Vascular Risk ◽  
The Relationship

scholarly journals Hypertension and Its Impact on Stroke Recovery: From a Vascular to a Parenchymal Overview

2019 ◽  
Vol 2019 ◽  
pp. 1-14 ◽  
Author(s):  
Benjamin Maïer ◽  
Nathalie Kubis
Keyword(s):  
Risk Factor ◽  
Vascular Risk Factor ◽  
Vascular Cognitive Impairment ◽  
Stroke Recovery ◽  
Stroke Outcome ◽  
Vascular Risk ◽  
Cell Responses ◽  
The Impact ◽  
Worse Prognosis

Hypertension is the first modifiable vascular risk factor accounting for 10.4 million deaths worldwide; it is strongly and independently associated with the risk of stroke and is related to worse prognosis. In addition, hypertension seems to be a key player in the implementation of vascular cognitive impairment. Long-term hypertension, complicated or not by the occurrence of ischemic stroke, is often reviewed on its vascular side, and parenchymal consequences are put aside. Here, we sought to review the impact of isolated hypertension or hypertension associated to stroke on brain atrophy, neuron connectivity and neurogenesis, and phenotype modification of microglia and astrocytes. Finally, we discuss the impact of antihypertensive therapies on cell responses to hypertension and functional recovery. This attractive topic remains a focus of continued investigation and stresses the relevance of including this vascular risk factor in preclinical investigations of stroke outcome.

Multifactorial Vascular Risk Factor Intervention to Prevent Cognitive Impairment after Stroke and TIA: A 12-month Randomized Controlled Trial

2012 ◽  
Vol 9 (7) ◽  
pp. 932-938 ◽  
Author(s):  
Hege Ihle-Hansen ◽  
Bente Thommessen ◽  
Morten W. Fagerland ◽  
Anne R. Øksengård ◽  
Torgeir B. Wyller ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Risk Factor ◽  
Cognitive Impairment ◽  
Controlled Trial ◽  
Vascular Risk Factor ◽  
Vascular Risk ◽  
Randomized Controlled

scholarly journals Can Cardiovascular Risk Management be improved by Shared Care with General Practice to Prevent Cognitive Decline Following Stroke/TIA? A feasibility randomised controlled Trial (SERVED Memory)

2020 ◽  
Author(s):  
William Davison ◽  
Phyo K Myint ◽  
Yoon K Loke ◽  
Garth Ravenhill ◽  
David A Turner ◽  
...  
Keyword(s):  
Risk Factor ◽  
Cognitive Impairment ◽  
Randomised Trial ◽  
Vascular Risk Factor ◽  
Vascular Risk ◽  
Risk Factor Management ◽  
Post Stroke ◽  
Observational Cohort ◽  
Normal Cognition

Abstract BackgroundCognitive impairment and dementia following cerebrovascular disease are increasingly common in the UK. One potential strategy to prevent post-stroke cognitive decline is multimodal vascular risk factor management. However, its efficacy remains uncertain and its application in vulnerable patients with incident cerebrovascular disease and early cognitive impairment has not been assessed.The primary aim of this study was to assess the feasibility of recruitment and retention of patients with early cognitive impairment post-stroke or transient ischaemic attack (TIA) to a trial of enhanced vascular risk factor management combining primary and secondary care.MethodsIn this single centre, open label trial adults with a recent stroke or TIA and mild cognitive impairment (MCI) were randomised 1:1 to a three-monthly multimodal vascular risk factor intervention jointly delivered by the trial team and General Practitioner (GP), or control (defined as usual care from the GP). Chosen risk factors were blood pressure (BP), total cholesterol, blood glucose (HbA1C) in those with diabetes, and heart rate and adequacy of anticoagulation in those with atrial fibrillation (AF). Similar patients with normal cognition were enrolled in an embedded observational cohort and also received usual care from the GP. Repeat cognitive screening was undertaken in all participants after 12 months.ResultsSeventy three participants were recruited to the randomised trial and 94 to the observational cohort (21.8% of those screened). From the randomised trial 35/73 (47.9%) dropped out before final follow-up. In all groups guideline based rates of risk factor control were mostly poor at baseline and did not significantly improve during follow-up. The observational cohort demonstrated greater decline in cognitive test scores at 12 months, with no difference between the randomised groups.ConclusionsRecruitment to such a study was feasible, but retention of participants was difficult and generally poor rates of risk factor control suggested insufficient application of the intervention. Consequently, successful scaling up of the trial would require protocol changes with less reliance on primary care services. Any future trial should include participants with normal cognition post-stroke as they may be at greatest risk of cognitive decline.Trial RegistrationISRCTN, ISRCTN42688361. Registered 16 April 2015, https://www.isrctn.com/ISRCTN42688361

scholarly journals Can cardiovascular risk management be improved by shared care with general practice to prevent cognitive decline following stroke/TIA? A feasibility randomised controlled trial (SERVED memory)

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
William J. Davison ◽  
Phyo K. Myint ◽  
Yoon K. Loke ◽  
Garth Ravenhill ◽  
David Turner ◽  
...  
Keyword(s):  
Risk Factor ◽  
Cognitive Impairment ◽  
Cognitive Decline ◽  
Randomised Trial ◽  
Vascular Risk Factor ◽  
Vascular Risk ◽  
Risk Factor Management ◽  
Post Stroke ◽  
Observational Cohort

Abstract Background Cognitive impairment and dementia following cerebrovascular disease are increasingly common in the UK. One potential strategy to prevent post-stroke cognitive decline is multimodal vascular risk factor management. However, its efficacy remains uncertain and its application in vulnerable patients with incident cerebrovascular disease and early cognitive impairment has not been assessed. The primary aim of this study was to assess the feasibility of recruitment and retention of patients with early cognitive impairment post-stroke or transient ischaemic attack (TIA) to a trial of enhanced vascular risk factor management combining primary and secondary care. Methods In this single centre, open label trial adults with a recent stroke or TIA and mild cognitive impairment (MCI) were randomised 1:1 to a three-monthly multimodal vascular risk factor intervention jointly delivered by the trial team and General Practitioner (GP), or control (defined as usual care from the GP). Chosen risk factors were blood pressure (BP), total cholesterol, blood glucose (HbA1C) in those with diabetes, and heart rate and adequacy of anticoagulation in those with atrial fibrillation (AF). Similar patients with normal cognition were enrolled in an embedded observational cohort and also received usual care from the GP. Repeat cognitive screening was undertaken in all participants after 12 months. Results Seventy three participants were recruited to the randomised trial and 94 to the observational cohort (21.8% of those screened). From the randomised trial 35/73 (47.9%) dropped out before final follow-up. In all groups guideline based rates of risk factor control were mostly poor at baseline and did not significantly improve during follow-up. The observational cohort demonstrated greater decline in cognitive test scores at 12 months, with no difference between the randomised groups. Conclusions Recruitment to such a study was feasible, but retention of participants was difficult and generally poor rates of risk factor control suggested insufficient application of the intervention. Consequently, successful scaling up of the trial would require protocol changes with less reliance on primary care services. Any future trial should include participants with normal cognition post-stroke as they may be at greatest risk of cognitive decline. Trial registration ISRCTN, ISRCTN42688361. Registered 16 April 2015.

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