Journal
ALZHEIMERS & DEMENTIA
Volume 12, Issue 11, Pages 1167-1176Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jalz.2016.05.007
Keywords
Delayed-onset dementia; Stroke; Transient ischemic attack; Small vessel disease; Alzheimer's disease
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Funding
- Health and Health Services Research Fund of the Food and Health Bureau of the Government of the HKSAR [0708041]
- Lui Che Woo Institute of Innovative Medicine
- Therese Pei Fong Chow Research Centre for Prevention of Dementia
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Introduction: Patients surviving stroke without immediate dementia are at high risk of delayed onset dementia. Mechanisms underlying delayed-onset dementia are complex and may involve vascular and/or neurodegenerative diseases. Methods: Dementia-free patients with stroke and/or transient ischemic attack (TIA; n = 919) were studied for 3 years prospectively, excluding those who developed dementia 3 to 6 months after stroke and/or TIA. Results: Forty subjects (4.4%) developed dementia during the study period. Imaging markers of severe small vessel disease (SVD), namely presence of >= 3 lacunes and confluent white matter changes; history of hypertension and diabetes mellitus independently predicted delayed-onset dementia after adjustment for age, gender, and education. Only 6 of 31 (19.4%) subjects with delayed cognitive decline harbored Alzheimer's disease like Pittsburg compound B (PiB) retention. Most PiB cases (16/25, 64%) had evidence of severe SVD. Discussion: Severe SVD contributes importantly to delayed-onset dementia after stroke and/or TIA. Future clinical trials aiming to prevent delayed-onset dementia after stroke and/or TIA should target this high-risk group. (C) 2016 The Alzheimer's Association. Published by Elsevier Inc. All rights reserved.
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