Prevalence of dementia in ischaemic or mixed stroke populations: systematic review and meta-analysis

Craig, L., Hoo, Z. L., Yan, T. Z., Wardlaw, J. and Quinn, T. J. (2022) Prevalence of dementia in ischaemic or mixed stroke populations: systematic review and meta-analysis. Journal of Neurology, Neurosurgery and Psychiatry, 93(2), pp. 180-187. (doi: 10.1136/jnnp-2020-325796) (PMID:34782389) (PMCID:PMC8784999)

Abstract

An understanding of the epidemiology of poststroke dementia (PSD) is necessary to inform research, practice and policy. With increasing primary studies, a contemporary review of PSD could allow for analyses of incidence and prevalence trends. Databases were searched using a prespecified search strategy. Eligible studies described an ischaemic or mixed stroke cohort with prospective clinical assessment for dementia. Pooled prevalence of dementia was calculated using random-effects models at any time after stroke (primary outcome) and at 1 year (range: 6-18 months), stratified for inclusion of prestroke dementia. Meta-regression explored the effect of year of study. Sensitivity analyses removed low-quality or outlier studies. Of 12 505 titles assessed, 44 studies were included in the quantitative analyses. At any time point after stroke, the prevalence of PSD was 16.5% (95% CI 10.4% to 25.1%) excluding prestroke dementia and 22.3% (95% CI 18.8% to 26.2%) including prestroke dementia. At 1 year, the prevalence of PSD was 18.4% (95% CI 7.4% to 38.7%) and 20.4% (95% CI 14.2% to 28.2%) with prestroke dementia included. In studies including prestroke dementia there was a negative association between dementia prevalence and year of study (slope coefficient=-0.05 (SD: 0.01), p<0.0001). Estimates were robust to sensitivity analyses. Dementia is common following stroke. At any point following stroke, more than one in five people will have dementia, although a proportion of this dementia predates the stroke. Declining prevalence of prestroke dementia may explain apparent reduction in PSD over time. Risk of dementia following stroke remains substantial and front-loaded, with high prevalence at 1 year post event.

• Item Type: Articles
• Additional Information: JW receives funding from the UK Dementia Research Institute (which is funded by DRI, funded by the UK Medical Research Council, Alzheimer’s Society and Alzheimer’s Research UK), the Fondation Leducq (16 CVD 05) and the British Heart Foundation (RE/18/5/34216).
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Craig, Dr Louise and Quinn, Professor Terry and Hoo, Mr Zhi Liang
• Authors: Craig, L., Hoo, Z. L., Yan, T. Z., Wardlaw, J., and Quinn, T. J.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Journal Name: Journal of Neurology, Neurosurgery and Psychiatry
• Publisher: BMJ Publishing Group
• ISSN: 0022-3050
• ISSN (Online): 1468-330X
• Published Online: 15 November 2021
• Copyright Holders: Copyright © 2021 The Authors
• First Published: First published in Journal of Neurology, Neurosurgery and Psychiatry 93(2): 180-187
• Publisher Policy: Reproduced under a Creative Commons License