Cognitive impairment after lacunar stroke: systematic review and meta-analysis of incidence, prevalence and comparison with other stroke subtypes

Stephen David James Makin (Corresponding Author), Sarah Turpin, Martin S. Dennis, Joanna M. Wardlaw

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100 Citations (Scopus)

Abstract

BACKGROUND: Cognitive impairment and dementia are common after stroke. It is unclear if risk differs between ischaemic stroke subtypes. Lacunar strokes might be less likely to affect cognition than more severe, larger cortical strokes, except that lacunar strokes are associated with cerebral small vessel disease (SVD), which is the commonest vascular cause of dementia. METHODS: We searched MEDLINE and PsychINFO for studies of mild cognitive impairment (MCI) or dementia after lacunar or cortical ischaemic stroke. We calculated the OR for cognitive impairment/dementia in lacunar versus non-lacunar stroke, and their incidence and prevalence in lacunar stroke as a pooled proportion. FINDINGS: We identified 24 relevant studies of 7575 patients, including 2860 with lacunar stroke; 24% had MCI or dementia post stroke. Similar proportions of patients with lacunar and non-lacunar stroke (16 studies, n=6478) had MCI or dementia up to 4 years after stroke (OR 0.72 (95% CI 0.43 to 1.20)). The prevalence of dementia after lacunar stroke (six studies, n=1421) was 20% (95% CI 9 to 33) and the incidence of MCI or dementia (four studies, n=275) was 37% (95% CI 23 to 53). Data were limited by short follow-up, subtype classification methods and confounding. INTERPRETATION: Cognitive impairment appears to be common after lacunar strokes despite their small size, suggesting that associated SVD may increase their impact. New prospective studies are required with accurate stroke subtyping to assess long term outcomes while accounting for confounders.
Original languageEnglish
Pages (from-to)893-900
Number of pages8
JournalJournal of Neurology, Neurosurgery & Psychiatry
Volume84
Issue number8
Early online date1 Mar 2013
DOIs
Publication statusPublished - Aug 2013

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Lacunar Stroke
Meta-Analysis
Stroke
Incidence
Dementia
Multi-Infarct Dementia
Cerebral Small Vessel Diseases
Cognitive Dysfunction
Vascular Dementia
MEDLINE
Cognition
Prospective Studies

Cite this

@article{25adfa297915446dadf0a7dc05e57d0c,
title = "Cognitive impairment after lacunar stroke: systematic review and meta-analysis of incidence, prevalence and comparison with other stroke subtypes",
abstract = "BACKGROUND: Cognitive impairment and dementia are common after stroke. It is unclear if risk differs between ischaemic stroke subtypes. Lacunar strokes might be less likely to affect cognition than more severe, larger cortical strokes, except that lacunar strokes are associated with cerebral small vessel disease (SVD), which is the commonest vascular cause of dementia. METHODS: We searched MEDLINE and PsychINFO for studies of mild cognitive impairment (MCI) or dementia after lacunar or cortical ischaemic stroke. We calculated the OR for cognitive impairment/dementia in lacunar versus non-lacunar stroke, and their incidence and prevalence in lacunar stroke as a pooled proportion. FINDINGS: We identified 24 relevant studies of 7575 patients, including 2860 with lacunar stroke; 24{\%} had MCI or dementia post stroke. Similar proportions of patients with lacunar and non-lacunar stroke (16 studies, n=6478) had MCI or dementia up to 4 years after stroke (OR 0.72 (95{\%} CI 0.43 to 1.20)). The prevalence of dementia after lacunar stroke (six studies, n=1421) was 20{\%} (95{\%} CI 9 to 33) and the incidence of MCI or dementia (four studies, n=275) was 37{\%} (95{\%} CI 23 to 53). Data were limited by short follow-up, subtype classification methods and confounding. INTERPRETATION: Cognitive impairment appears to be common after lacunar strokes despite their small size, suggesting that associated SVD may increase their impact. New prospective studies are required with accurate stroke subtyping to assess long term outcomes while accounting for confounders.",
author = "Makin, {Stephen David James} and Sarah Turpin and Dennis, {Martin S.} and Wardlaw, {Joanna M.}",
note = "Funding SDJM is supported by a Wellcome Trust Project Grant (WT088134/Z/09/A). JMW is supported by the Scottish Funding Council through the Scottish Imaging Network, A Platform for Scientific Excellence (SINAPSE) Initiative (http://www. sinapse.ac.uk). The study was independent of the funders.",
year = "2013",
month = "8",
doi = "10.1136/jnnp-2012-303645",
language = "English",
volume = "84",
pages = "893--900",
journal = "Journal of Neurology, Neurosurgery & Psychiatry",
issn = "0022-3050",
publisher = "BMJ Publishing Group",
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}

TY - JOUR

T1 - Cognitive impairment after lacunar stroke

T2 - systematic review and meta-analysis of incidence, prevalence and comparison with other stroke subtypes

AU - Makin, Stephen David James

AU - Turpin, Sarah

AU - Dennis, Martin S.

AU - Wardlaw, Joanna M.

N1 - Funding SDJM is supported by a Wellcome Trust Project Grant (WT088134/Z/09/A). JMW is supported by the Scottish Funding Council through the Scottish Imaging Network, A Platform for Scientific Excellence (SINAPSE) Initiative (http://www. sinapse.ac.uk). The study was independent of the funders.

PY - 2013/8

Y1 - 2013/8

N2 - BACKGROUND: Cognitive impairment and dementia are common after stroke. It is unclear if risk differs between ischaemic stroke subtypes. Lacunar strokes might be less likely to affect cognition than more severe, larger cortical strokes, except that lacunar strokes are associated with cerebral small vessel disease (SVD), which is the commonest vascular cause of dementia. METHODS: We searched MEDLINE and PsychINFO for studies of mild cognitive impairment (MCI) or dementia after lacunar or cortical ischaemic stroke. We calculated the OR for cognitive impairment/dementia in lacunar versus non-lacunar stroke, and their incidence and prevalence in lacunar stroke as a pooled proportion. FINDINGS: We identified 24 relevant studies of 7575 patients, including 2860 with lacunar stroke; 24% had MCI or dementia post stroke. Similar proportions of patients with lacunar and non-lacunar stroke (16 studies, n=6478) had MCI or dementia up to 4 years after stroke (OR 0.72 (95% CI 0.43 to 1.20)). The prevalence of dementia after lacunar stroke (six studies, n=1421) was 20% (95% CI 9 to 33) and the incidence of MCI or dementia (four studies, n=275) was 37% (95% CI 23 to 53). Data were limited by short follow-up, subtype classification methods and confounding. INTERPRETATION: Cognitive impairment appears to be common after lacunar strokes despite their small size, suggesting that associated SVD may increase their impact. New prospective studies are required with accurate stroke subtyping to assess long term outcomes while accounting for confounders.

AB - BACKGROUND: Cognitive impairment and dementia are common after stroke. It is unclear if risk differs between ischaemic stroke subtypes. Lacunar strokes might be less likely to affect cognition than more severe, larger cortical strokes, except that lacunar strokes are associated with cerebral small vessel disease (SVD), which is the commonest vascular cause of dementia. METHODS: We searched MEDLINE and PsychINFO for studies of mild cognitive impairment (MCI) or dementia after lacunar or cortical ischaemic stroke. We calculated the OR for cognitive impairment/dementia in lacunar versus non-lacunar stroke, and their incidence and prevalence in lacunar stroke as a pooled proportion. FINDINGS: We identified 24 relevant studies of 7575 patients, including 2860 with lacunar stroke; 24% had MCI or dementia post stroke. Similar proportions of patients with lacunar and non-lacunar stroke (16 studies, n=6478) had MCI or dementia up to 4 years after stroke (OR 0.72 (95% CI 0.43 to 1.20)). The prevalence of dementia after lacunar stroke (six studies, n=1421) was 20% (95% CI 9 to 33) and the incidence of MCI or dementia (four studies, n=275) was 37% (95% CI 23 to 53). Data were limited by short follow-up, subtype classification methods and confounding. INTERPRETATION: Cognitive impairment appears to be common after lacunar strokes despite their small size, suggesting that associated SVD may increase their impact. New prospective studies are required with accurate stroke subtyping to assess long term outcomes while accounting for confounders.

U2 - 10.1136/jnnp-2012-303645

DO - 10.1136/jnnp-2012-303645

M3 - Article

VL - 84

SP - 893

EP - 900

JO - Journal of Neurology, Neurosurgery & Psychiatry

JF - Journal of Neurology, Neurosurgery & Psychiatry

SN - 0022-3050

IS - 8

ER -