Kognitive Dysfunktion nach Schlaganfall

Zusammenfassung

Eine kognitive Dysfunktion nach Schlaganfall besteht häufig und korreliert mit der Lokalisation und dem Ausmaß des Schlaganfalls sowie mit dem Zeitpunkt der Erhebung, die anhand standardisierter und etablierter Testverfahren erfolgen sollte. Eine kognitive Dysfunktion nach Schlaganfall ist im Kontext einer so genannten post-stroke dementia für das funktionelle Outcome relevant. Zudem ist das Bestehen einer kognitiven Dysfunktion mit einer erhöhten Wahrscheinlichkeit für ein Schlaganfallrezidiv assoziiert. Kognitive Defizite als mögliche Folge eines Schlaganfalls sollte daher auch abseits von Komplex- und Rehabilitationsbehandlungen Beachtung finden, zumal in Deutschland bis dato kein ambulantes Nachsorgekonzept nach stattgehabtem Schlaganfall etabliert wurde. Nicht nur zerebrovaskuläre Ereignisse selbst, sondern auch das Bestehen vaskulärer Risikofaktoren wie Herzinsuffizienz, Vorhofflimmern, Hypercholesterinämie und Niereninsuffizienz können zur Entwicklung einer kognitiven Funktionsstörung beitragen und eine kognitive Dysfunktion nach Schlaganfall verstärken. Die bestmögliche Therapie bekannter vaskulärer Risikofaktoren und eine gesunde Lebensweise sind im Kontext bis dato fehlender spezifischer medikamentöser Therapien einer kognitiven Dysfunktion nach Schlaganfall angezeigt. Eine gezielte Rehabilitation kann zur Erhaltung und Verbesserung kognitiver Funktionen bei kognitiver Dysfunktion nach Schlaganfall beitragen. Prospektive (randomisierte) Schlaganfallstudien sollten eine standardisierte Erfassung kognitiver Endpunkte einschließen und bestenfalls auf die Entwicklung präventiver Therapiestrategien für die kognitive Dysfunktion abzielen.

Abstract

Cognitive dysfunction after stroke is a common clinical finding and correlates with stroke localization and severity of stroke, as well as the timing of the cognitive assessment, which should be performed using standardized and established testing procedures. Cognitive dysfunction after stroke is relevant to functional outcome in the context of so-called post-stroke dementia. Importantly, the presence of cognitive dysfuntion is associated with an increased likelihood of recurrent stroke. Therefore, cognitive deficits as a possible consequence of stroke should necessarily get attention also beyond acute stroke care and early rehabilitation, particularly, as there is no stroke aftercare concept established in Germany to date. Not only cerebrovascular events themselves, but also the presence of corresponding vascular risk factors (e. g. atrial fibrillation, heart failure, hypercholesterolemia, and renal insufficiency) may contribute to the development and exacerbation of cognitive dysfunction after stroke. As long as a specific medical treatment approach for post-stroke cognitive dysfunction is not available, optimized treatment of risk factors and a healthy lifestyle have to be recommended. In addition, targeted rehabilitation after stroke may support improvement of cognitive function. Prospective (randomized) stroke trials should implement a standardized assessment of cognitive endpoints, and ideally focus on preventive therapeutic strategies for post-stroke cognitive dysfunction.

Schlüsselwörter

Vaskuläre Demenz - Magnetresonanztomographie - Neuropsychologische Testung - Mikroangiopathie - post stroke dementia

Key words

vascular dementia - magnetic resonance imaging - cognitive assessment - white matter lesions - post stroke dementia

Publication History

Received: 12 June 2023

Accepted: 14 September 2023

Article published online:
19 October 2023

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