Cognitive impairment in patients with cerebrovascular disease: A white paper from the links between stroke ESO Dementia Committee

Useless, you tell us cognitive impairment exists quite often in stroke but give us no solutions to prevent or recover from such impairment.

Cognitive impairment in patients with cerebrovascular disease: A white paper from the links between stroke ESO Dementia Committee

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Ana Verdelho, Joanna Wardlaw, Aleksandra Pavlovic, ...

First Published February 28, 2021 Review Article Find in PubMed 

https://doi.org/10.1177/23969873211000258

Article information

Abstract

Purpose

Many daily-life clinical decisions in patients with cerebrovascular disease and cognitive impairment are complex. Evidence-based information sustaining these decisions is frequently lacking. The aim of this paper is to propose a practical clinical approach to cognitive impairments in patients with known cerebrovascular disease.

Methods

The document was produced by the Dementia Committee of the European Stroke Organisation (ESO), based on evidence from the literature where available and on the clinical experience of the Committee members. This paper was endorsed by the ESO.

Findings

Many patients with stroke or other cerebrovascular disease have cognitive impairment, but this is often not recognized. With improvement in acute stroke care, and with the ageing of populations, it is expected that more stroke survivors and more patients with cerebrovascular disease will need adequate management(NO,NO,NO. We want cures of cognitive impairment.) of cognitive impairment of vascular etiology. This document was conceived for the use of strokologists and for those clinicians involved in cerebrovascular disease, with specific and practical hints concerning diagnostic tools, cognitive impairment management and decision on some therapeutic options.

Discussion and conclusions: It is essential to consider a possible cognitive deterioration in every patient who experiences a stroke. Neuropsychological evaluation should be adapted to the clinical status. Brain imaging is the most informative biomarker concerning prognosis. Treatment should always include adequate secondary prevention.

Keywords

Stroke, small vessel disease, cerebrovascular disease, cognitive impairment, dementia

Introduction

Vascular risk factors are recognized as one of the main determinants of cognitive impairment associated with ageing.^1,2 Cognitive impairment (CI) due to cerebrovascular disease (CVD) can exist after stroke or in the context of chronic CVD without previous stroke, representing a leading concern of patients and caregivers.³ Although acute stroke care has evolved substantially over the last decades, post-stroke cognitive impairment (PSCI) remains frequently underdiagnosed as it may be overlooked in the presence of other distressing signs (for instance motor or visual symptoms). Consequently, cognitive impact of acute stroke is often underestimated. Moreover, subtle and progressive decline might also be caused by vascular lesions (e.g. either lesions related to small vessel disease (SVD), repetitive minor injuries, or vascular consequences of systemic failure as for instance cardiac insufficiency). Stroke clinicians are well trained in the identification of stroke, but do not always recognize the myriad of cognitive and behavioural symptoms that accompany stroke in the acute and chronic phases.