Psychiatry Research EG

Stroke remains a major healthcare problem. Approximately 795 000 people in the United States have stroke each year. About 610 000 are first events, and 6.4 million Americans are stroke survivors [1]. Stroke is also a leading cause of functional impairments, with 20% of survivors requiring institutional care after 3 months and 15–30% being permanently disabled. Effective prevention remains the best approach for reducing the burden of stroke. Primary prevention is particularly important because greater than 77% of strokes are first events [2]. Cognitive decline after stroke is more common than stroke recurrence. Stroke doubles the risk of dementia and is a major contributor to vascular cognitive impairment (VCI) and vascular dementia [3]. There are few prospective data on the long-term cognitive changes and predictors of incident dementia after a first stroke [4]. Stroke is not only a preventable but also a treatable disease. However, as the treatment is only safe and licensed within the first 3 h after stroke, advancements neurologic services are needed, with an emphasis on immediate care [5]. Fewer studies have focused on the behavioral and cognitive manifestations after stroke and these disorders are often overlooked in clinical practice. Frequently occurring symptoms are personality changes [6] and neuropsychiatric disorders, such as poststroke depression, anxiety disorders, or apathy [7]. In addition, neuropsychological disorders, such as amnesia, executive dysfunction, or unilateral neglect, are common clinical manifestations after stroke and may be the single or dominant presenting features [8]. Most studies on the relation between stroke and cognitive impairment have reported on vascular dementia or poststroke dementia in general. The concept of vascular dementia has recently been discarded by most researchers because of the inconsistent criteria used to define vascular dementia [9] and because the level of cognitive impairment required for a diagnosis of dementia does not allow early identification of patients with less severe but seriously invalidating cognitive disturbances [10]. Subsequently, a range of conceptsthat include milder forms of cognitive impairment have been developed over the past few years, such as VCI [11], ‘mild cognitive impairment’ [12], or ‘cognitive impairment, no dementia’ (CIND) [13]. Although these concepts are preferable to that of vascular dementia, they will attempt to capture a very diverse phenomenon under one header, resulting in poor prognostic value and confusion in the literature. Moreover, these concepts do not provide information on the nature of the underlying cognitive disorder and the specific disability that might arise from these deficits. Nevertheless, early diagnosis of specific cognitive deficits such as amnesia or executive dysfunction could be very important to determine an appropriate discharge destination and in particular to facilitate rehabilitation. Also, interventions aimed at restoring specific cognitive functions can be initiated at an earlier stage, as studies have shown that the brain displays a heightened sensitivity to rehabilitation early after the stroke as compared with later stages [14,15]. Although the brain is capable of reorganization and significant cognitive recovery may occur in the first months after stroke, many patients do not show improvement at all or even show deterioration in the long term [16], resulting in poststroke dementia [17]. Clinical criteria for VCI as well as vascular CIND are still lacking, and major discussions are ongoing in this field. Detection of cognitive impairment has two difficulties: a neuropsychological battery fitted to the VCI profile is yet to be established and limits from normal cognition are still undefined [18]. Although clinical criteria are still undefined, considerable work has been carried out to determine the frequency, characteristics, and evolution of VCI and V-CIND. Importantly, there is a growing interest in V-CIND, because patients with only mild cognitive deficits also have significant disability, may be at an increased risk of cognitive deterioration, and have more opportunities for treatment and prevention [19]. There are few prospective data from population-based studies on the long-term cognitive changes and predictors of incident dementia after a first stroke. It is also uncertain whether early poststroke cognitive status is associated with a high risk of future incident dementia. The aim of this study was to determine the frequency of CIND after intracerebral hemorrhagic stroke and to study their evolution toward dementia (transitions in cognitive state) during a 2-year follow-up.