Stroke occurring in patients with cognitive impairment or dementia

ABSTRACT

One in six patients admitted for stroke was previously demented. These patients have less access to appropriate stroke care, although little is known about their optimal management.

Objective To determine how pre-stroke cognitive impairment can be detected, its mechanism, and influence on outcome and management.

Methods Literature search.

Results (i) A systematic approach with the Informant Questionnaire of Cognitive Decline in the Elderly is recommended; (ii) Pre-stroke cognitive impairment may be due to brain lesions of vascular, degenerative, or mixed origin; (iii) Patients with pre-stroke dementia, have worse outcomes, more seizures, delirium, and depression, and higher mortality rates; they often need to be institutionalised after their stroke; (iv) Although the safety profile of treatment is not as good as that of cognitively normal patients, the risk:benefit ratio is in favour of treating these patients like others.

Conclusion Patients with cognitive impairment who develop a stroke have worse outcomes, but should be treated like others.

RESUMO

Um em cada seis pacientes internados em decorrência de acidente vascular cerebral (AVC) apresenta diagnóstico prévio de demência. Estes indivíduos têm menor acesso à assistência recomendada para pacientes com AVC, mas pouco ainda se sabe em relação aos cuidados médicos ideais que devem receber.

Objetivo Determinar como o comprometimento cognitivo prévio ao AVC pode ser detectado, qual o mecanismo etiológico subjacente, e as consequências para o prognóstico e para o acompanhamento clínico.

Método Pesquisa bibliográfica.

Resultados (i) O rastreamento sistemático com o Informant Questionnaire of Cognitive Decline in the Elderly é recomendado; (ii) O comprometimento cognitivo preexistente pode ser devido a lesões cerebrais de origem vascular, degenerativa ou mista; (iii) Pacientes com demência prévia ao AVC têm pior prognóstico, maior frequência de crises epilépticas, de delirium e depressão, além de taxas de mortalidade mais altas; eles frequentemente são institucionalizados após o AVC; (iv) Embora a tolerabilidade às medicações não seja tão boa quanto a de pacientes com AVC sem comprometimento cognitivo, a relação risco/benefício é a favor de tratamento similar àquele oferecido aos demais pacientes.

Conclusão Pacientes com comprometimento cognitivo que apresentam AVC têm pior prognóstico, porém eles devem ser tratados de modo semelhante aos demais casos.

stroke - cerebral infarction - cerebral hemorrhage - dementia - mild cognitive impairment

acidente vascular cerebral - infarto cerebral - hemorragia cerebral - demência - comprometimento cognitivo leve

Support:

University Lille 2, CHU Lille, INSERM.

Publication History

Received: 18 September 2016

Accepted: 10 October 2016

Article published online:
05 September 2023

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