Progressive dementia after first-ever stroke - A community-based follow-up study

Objectives: To examine the risk and determinants of a progressive dementia syndrome and cognitive impairment not dementia (CIND) in community-based nonaphasic first-ever stroke cases 1 year after stroke, relative to a matched community-based stroke-free group. Methods: Matched cohort design, with cognitive tests given on two occasions 9 months apart to 99 mild-to-moderate first-ever stroke patients and 99 age-and sex-matched people without stroke. At follow-up, progressive dementia or CIND were diagnosed, with judges blinded to stroke/nonstroke status. Results: Progressive dementia was diagnosed in 12.5% of stroke patients and 15.4% of those without strokes (RR 1.1, 95% CI 0.5 to 2.2, p = 0.85). CIND was diagnosed in 37.5% of stroke patients and 17.6% of participants without strokes ( RR 2.1, 95% CI 1.2 to 3.4, p = 0.003). In multivariable regression, age ( p = 0.04) and baseline cognition ( p < 0.001) were independently associated with dementia whereas stroke ( p = 0.002), age ( p = 0.05), baseline cognition ( p = 0.001), and baseline mood ( p = 0.03) were independently associated with CIND at follow-up. Conclusions: In this community-based nonaphasic sample, mild-to moderate first-ever stroke was not associated with the presence of progressive dementia 1 year later, but was clearly associated with a greater risk of cognitive impairment not dementia ( CIND). Baseline mood impairment remained independently associated with CIND at 1 year after taking into account stroke, age, and baseline cognitive ability.