The Oxford Vascular Study
Post-stroke dementia (PSD) is a highly prevalent after transient ischaemic attack and stroke. However, aetiology and prediction remain uncertain.
First, a systematic review (SR) and meta-analysis (MA) was performed to identify comorbidities previously associated with PSD. Second, the population-based Oxford Vascular Study (OXVASC) was used to examine associations between individual comorbidities or multimorbidity (defined as 2+ comorbidities identified from SR or the Charlson Comorbidity Index (CCI)) and PSD. Crude and adjusted (age and sex) odds ratios (ORs) were obtained by logistic regression.
28 studies reported data on comorbidity status at stroke/TIA onset and PSD on follow up. Based on pooled estimates, PSD was predicted by hypertension (28 studies; OR 1.27 95%CI 1.14–1.43), diabetes (26 studies; OR 1.49 95%CI 1.32-1.68), atrial fibrillation (18 studies; OR 1.90 95%CI 1.64-2.20), ischaemic heart disease (15 studies; OR 1.20 95%CI 1.01-1.42), and peripheral vascular disease (8 studies; OR 2.09 95%CI 1.54-2.83), but not by hyperlipidaemia (12 studies; OR 0.71 95%CI 0.60-0.83). While crude estimates in OXVASC were largely similar, only diabetes remained significant after adjustment (ORadjusted 1.59 95%CI 1.16 - 2.17). Patients with multimorbidity, using either cardiovascular comorbidities identified by SR or the CCI, had greater odds of PSD compared to those without comorbidities (ORcrude 2.07, 95%CI 1.54-2.77 and ORcrude 1.38 95%CI 1.07-1.78, respectively).
Cardiovascular multimorbidity may help predict patients at greater risk of PSD, and diabetes appears to be a key aetiological risk factor for PSD.
Not applicable