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Background: We evaluated whether pre-existing brain damage may explain greater severity in cognitively-impaired patients with ischemic stroke (IS)., Methods: IS patients were retrieved from the population-based registry of Dijon, France. Pre-existing damage (leukoaraiosis, old vascular brain lesions, cortical and central brain atrophy) was assessed on initial CT-scan. Association between prestroke cognitive status defined as no impairment, mild cognitive impairment (MCI), or dementia, and clinical severity at IS onset assessed with the NIHSS score was evaluated using ordinal regression analysis. Mediation analysis was performed to assess pre-existing brain lesions as mediators of the relationship between cognitive status and severity., Results: Among the 916 included patients (mean age 76.8 ± 15.0 years, 54.3% women), those with pre-existing MCI (n = 115, median NIHSS [IQR]: 6 [2-15]) or dementia (n = 147, median NIHSS: 6 [3-15]) had a greater severity than patients without (n = 654, median NIHSS: 3 [1-9]) in univariate analysis (OR=1.69; 95% CI: 1.18-2.42, p = 0.004, and OR=2.06; 95% CI: 1.49-2.84, p < 0.001, respectively). Old cortical lesion (OR=1.53, p = 0.002), central atrophy (OR=1.41, p = 0.005), cortical atrophy (OR=1.90, p < 0.001) and moderate (OR=1.41, p = 0.005) or severe (OR=1.84, p = 0.002) leukoaraiosis were also associated with greater severity. After adjustments, pre-existing MCI (OR=1.52; 95% CI: 1.03-2.26, p = 0.037) or dementia (OR=1.94; 95% CI: 1.32-2.86, p = 0.001) remained associated with higher severity at IS onset, independently of confounding factors including imaging variables. Association between cognitive impairment and severity was not mediated by pre-existing visible brain damages., Conclusion: Impaired brain ischemic tolerance in IS patients with prior cognitive impairment could involve other mechanisms than pre-existing visible brain damage., (Copyright © 2022 Elsevier Masson SAS. All rights reserved.)

Introduction: Understanding the influence of preexisting cognitive impairment on the poststroke outcome is a critical challenge in the context of current aging and growing population. This study aimed to assess long-term survival of patients with acute ischemic stroke (IS) according to their premorbid cognitive status and to identify contributing factors of death., Methods: Patients with IS were prospectively identified among residents of Dijon, France, using a population-based registry (2013-2017). The association between case fatality at 5 years and prestroke cognitive status was assessed by multivariable Cox models adjusted for other clinical characteristics and preexisting brain damage on the initial CT scan including leukoaraiosis, old vascular brain lesions, and cortical and central brain atrophy, as well as major arterial occlusion., Results: 1,049 patients were included (mean age ± SD: 76.3 ± 15.2 years old, 54% women). Case fatality rates at 5 years were 38.1% in patients without cognitive impairment, 65.9% in patients with prior mild cognitive impairment (MCI, n = 132, 12.6%), and 86.6% in patients with dementia (n = 164, 15.6%) (p &lt; 0.001). MCI (HR = 1.39; 95% CI: 1.06-1.81, p = 0.016) and dementia (HR = 1.89; 95% CI: 1.45-2.46, p &lt; 0.001) were both independently associated with higher case fatality after adjustment for clinical variables. The association remained significant after further adjustment for preexisting brain damage and major arterial occlusion (HR = 1.47; 95% CI: 1.10-1.98, p = 0.009, for MCI and HR = 1.90; 95% CI: 1.43-2.53, p &lt; 0.001, for dementia) among patients with available data on the CT scan (n = 916). Factors associated with death were roughly similar across groups., Conclusion: This study highlighted a poor long-term survival of IS patients with preexisting cognitive impairment, independently of other contributing factors of death. It is critical to better understand the trajectory of IS patients with preexisting cognitive impairment and to identify prognostic markers to guide clinicians in their management strategies., (© 2023 S. Karger AG, Basel.)

Introduction: Studies on the association of cancer and risk of dementia are inconclusive due to result heterogeneity and concerns of survivor bias and unmeasured confounding., Methods: This study uses data from the Memento cohort, a French multicenter cohort following persons with either mild or isolated cognitive complaints for a median of 5 years. Illness-death models (IDMs) were used to estimate transition-specific hazard ratios (HRs) and 95% confidence intervals (CIs) for incident cancer in relation to dementia from time since study entry., Results: The analytical sample (N = 2258) excluded 65 individuals without follow-up information. At the end of follow-up, 286 individuals were diagnosed with dementia, 166 with incident cancer, and 95 died. Incident cancer was associated with a reduced risk of dementia (HR = 0.58, 95% CI = 0.35-0.97), with a corresponding E-value of 2.84 (lower CI = 1.21)., Discussion: This study supports a protective relationship between incident cancer and dementia, encouraging further investigations to understand potential underlying mechanisms., (© 2021 The Authors. Alzheimer's & Dementia published by Wiley Periodicals, LLC on behalf of Alzheimer's Association.)

Objective: We assessed the association between pre-stroke cognitive status and 90-day case-fatality., Methods: Patients with ischemic stroke (IS) or spontaneous intracerebral hemorrhage (ICH) were prospectively identified among residents of Dijon, France, between 2013 and 2015, using a population-based registry. Association between pre-stroke cognitive status and case-fatality at 90 days was evaluated using Cox regression., Results: Seven hundred sixty-two patients were identified, and information about pre-stroke cognitive status was obtained for 716 (92.6%) of them, including 603 IS (84.2%) and 113 ICH (15.8%). Before stroke, 99 (13.8%) patients had mild cognitive impairment (MCI) and 98 (13.7%) had dementia. Patients with cognitive impairment were older, had a higher prevalence of several risk factors, more severe stroke, more frequent ICH, and less admission to stroke unit. Case-fatality rate at 90 days was 11.7% in patients without cognitive impairment, 32.3% in MCI patients, and 55.1% in patients with dementia. In multivariable analyses, pre-existing MCI (hazard ratio [HR] 2.22, 95% CI 1.21-4.05, p = 0.009) and dementia (HR 4.35, 95% CI 2.49-7.61, p < 0.001) were both associated with 90-day case-fatality., Conclusion: Pre-stroke MCI and dementia were both associated with increased mortality. These associations were not fully explained by baseline characteristics, pre-stroke dependency, stroke severity or patient management, and underlying reasons need to be investigated., (© 2019 S. Karger AG, Basel.)

Background Outdoor air pollution is now a well-known risk factor for morbidity and mortality, and is increasingly being identified as a major risk factor for stroke. Methods A narrative literature review of the effects of short and long-term exposure to air pollution on stroke and dementia risk and cognitive functioning. Results Ten papers on stroke and 17 on dementia were selected. Air pollution, and in particular small particulate matter, contributes to about one-third of the global stroke burden and about one-fifth of the global burden of dementia. It particularly affects vulnerable patients with other vascular risk factors or a prior history of stroke in low- and medium-income countries. New pathophysiological mechanisms of the cause-effect associations are suggested. Conclusion Air pollution should be considered as a new modifiable cerebrovascular and neurodegenerative risk factor. This massive worldwide public health problem requires environmental health policies able to reduce air pollution and thus the stroke and dementia burden.

Background: Dementia is a frequent condition in stroke patients., Aims: To investigate the effect of dementia on access to diagnostic procedures in ischaemic stroke patients., Methods: All cases of ischaemic stroke from 2006 to 2010 were identified from the population-based Stroke Registry of Dijon, France. Patients' characteristics were recorded, as was the use of brain computed tomography scans, brain magnetic resonance imaging, electrocardiogram, echocardiography, and Doppler ultrasonography of the cervical arteries. Dementia was diagnosed according to Diagnostic and Statistical Manual of Mental Disorders-IV criteria. Logistic regression models were used to evaluate the associations between dementia and the use of the diagnostic procedures., Results: Of the 907 patients recorded, 104 were excluded because of death and inability to test cognition. Among the remaining 803 patients, 149 (18·5%) had dementia. Almost all of the patients underwent a brain computed tomography scan and an electrocardiogram during their stay. In contrast, the use of both Doppler ultrasonography of the cervical arteries (79·2% versus 90·2%, P < 0·001), echocardiography (32·9% versus 43·6%, P = 0·02), and brain magnetic resonance imaging (21·5% versus 34·4%, P < 0·001) were significantly lower in stroke patients with dementia than in those without. In multivariate logistic regression, dementia was associated with a lower use of both Doppler ultrasonography (odds ratio = 0·49; 95% confidence interval: 0·29-0·81, P = 0·005), echocardiography (odds ratio = 0·57; 95% confidence interval: 0·37-0·89, P = 0·012), brain magnetic resonance imaging (odds ratio = 0·55; 95% confidence interval: 0·34-0·89, P = 0·015), and a comprehensive assessment (odds ratio = 0·62; 95% confidence interval: 0·40-0·96, P = 0·033)., Conclusion: Demented patients were less likely to undergo diagnostic procedures after ischaemic stroke. Further studies are needed to determine whether this lower utilization could account for the reported excess in recurrent events in these patients., (© 2012 The Authors. International Journal of Stroke © 2012 World Stroke Organization.)

Although functional recovery and survival after ischemic stroke seem to improve in patients with prior transient ischemic attack (TIA), little is known about the effect of prior TIA on poststroke cognition. To evaluate the impact of prior TIA on dementia, 1697 nonaphasic patients who survived the first month after their first-ever ischemic stroke were identified from the population-based registry of Dijon, France, from 1985 to 2007 and divided into 3 groups according to the time interval between prior TIA and stroke (<4 wk, ≥4 wk, no TIA). Outcome was dementia diagnosed by neurologists using Diagnostic and Statistical Manual of mental disorders-III or IV criteria over the first month after stroke. Multivariate analyses were performed using logistic regression models. The prevalence of dementia after stroke was 20.6% [95% confidence interval (CI), 18.5-22.7], 26.8% (95% CI, 13.3-40.4), and 33.1% (95% CI, 27.3-38.9) among patients without TIA, with a prestroke TIA≥4 weeks, and with a prestroke TIA<4 weeks, respectively. Patients with prestroke TIA<4 weeks (adjusted odds ratio: 1.83; 95% CI, 1.32-2.52; P=0.0003) had a higher risk of dementia than those without TIA.

Background and Purpose:   Dementia is a frequent condition after stroke that may affect the prognosis of patients. Our aim was to determine whether post-stroke dementia was a predictor of 1-year case-fatality and to evaluate factors that could influence survival in demented stroke patients., Methods: From 1985 to 2008, all first-ever strokes were recorded in the population-based stroke registry of Dijon, France (150, 000 inhabitants). Dementia was diagnosed during the first month following stroke, according to DSM-III and DSM-IV criteria. Survival was evaluated at 1 year and multivariate analyses were performed using Cox proportional hazards to identify independent predictive factors., Results:   We recorded 3948 first-ever strokes. Among these stroke patients, 3201 (81%) were testable, and of these, 653 (20.4%) had post-stroke dementia (337 women and 316 men). Demented patients had lower 1-year survival than patients without dementia (82.9% vs. 86.9%, P = 0.013). However, in multivariate analysis, dementia did not appear as an independent predictor of 1-year death. In demented stroke patients, age >80 years old, severe handicap at discharge, recurrent stroke within the first year and subarachnoid haemorrhage were associated with a higher risk of 1-year death, and the risk was lower in the study period 2003-2008., Conclusions:   Dementia after stroke is not independently associated with an increased risk of death at 1 year. In recent years, 1-year case-fatality decreased in demented as well as in and non-demented patients suggesting that improvements in the management of stroke also benefited the most fragile patients., (© 2011 The Author(s). European Journal of Neurology © 2011 EFNS.)

Background and Purpose: No data about temporal change in the prevalence of poststroke dementia are available. We aimed to evaluate trends in the prevalence of early poststroke dementia., Methods: From 1985 to 2008, overall first-ever strokes occurring within the population of the city of Dijon, France (150 000 inhabitants) were recorded. The presence of dementia was diagnosed during the first month after stroke, according to Diagnostic and Statistical Manual of Mental Disorders, Third and Fourth Editions criteria. Time trends were analyzed according to 4 periods: 1985 to 1990, 1991 to 1996, 1997 to 2002, and 2003 to 2008. Logistic regression was used for nonmultivariate analyses., Results: Over the 24 years, 3948 first-ever strokes were recorded. Among patients with stroke, 3201 (81%) were testable of whom 653 (20.4%) had poststroke dementia (337 women and 316 men). The prevalence of nontestable (mostly due to death) patients declined from 28.0% to 10.2% (P<0.0001). Multivariate analysis revealed significant temporal changes in the prevalence of poststroke dementia; prevalence in the second and fourth periods was, respectively, almost half and twice that in the first period. The prevalence of poststroke dementia associated with lacunar stroke was 7 times higher than that in intracerebral hemorrhage but declined over time as did prestroke antihypertensive medication. Age, several vascular risk factors, hemiplegia, and prestroke antiplatelet agents were associated with an increased prevalence of poststroke dementia., Conclusions: This study covering a period of 24 years highlights temporal changes in the prevalence of early dementia after first-ever stroke. These changes may be explained by concomitant determinants of survival and incidence such as stroke care management or prestroke medication.