1. Poststroke dementia Vikas Dhikav,
MBBS (Rohtak), MD (3-years AIIMS) , PhD (Neurology, PGIMER Delhi), Fellowship Clinical Neuropsychopharmacology,
Director, Memory Clinic Delhi & Honorary Professor, ISM-IUK, Bishkek, Kyrgyzstan.

2. Post stroke dementia
Dementia is one of the major causes of dependency after stroke.
Having a stroke doubles the risk of dementia.
Leys D et al. Lancet Neurol. 2005;4(11):752-9.

3. Post Stroke Dementia…
Cerebrovascular disease is increasingly recognized as a common cause of cognitive impairment and dementia in later life either alone or in conjunction with other pathologies, most often Alzheimer disease.
O'Brien JT. Vascular cognitive impairment. Am J Geriatr Psychiatry. 2006;14(9):

4. Vascular cognitive impairment
Umbrella term  recognizes the broad spectrum of:
Cognitive
Behavioral
changes associated with vascular pathology
O'Brien JT. Am J Geriatr Psychiatry. 2006;14(9):

5. Types of VCIs Cortical Subcortical Strategic infarct Hypoperfusion
Hemorrhagic
Mixed (with AD) type. 

6. Frequency of post stroke dementia?
In a recent study from Northern India, 45% frequency was found.
Chaudhari TS et al., J Neurol Sci. 2014;340(1-2):150-8.

7. Future of post stroke dementia
The prevalence of poststroke dementia -defined as any dementia occurring after stroke-is likely to increase in the future.
Leys D et al. Lancet Neurol. 2005;4(11):752-9.

8. History
Stroke was recognized as an important cause of dementia ≥1 century ago,
Until the 1960s, most cases of dementia were attributed to atherosclerosis.
Now cerebrovascular disease is considered to be the second most common cause of dementia
Post stroke dementia is one of the rare preventable dementias.
Barba R. Stroke. 2000;31(7):

9. Why does VCI occur? Interaction between: Vascular risk factors
Hypertension
Diabetes
Obesity
Dyslipidemia
Parenchymal brain changes
Macro & Micro infarcts
White matter changes
Alladi S. Annals Ind Acad Neurol 2010; S

10. Patient Related Predisposing factors
Increasing age, low education
Dependency before stroke & prestroke cognitive decline without dementia
Diabetes mellitus , Atrial fibrillation, past myocardial infarction
Epileptic seizures
Congestive heart failure, hypertension
Silent cerebral infarcts & white-matter changes
Global and medial-temporal-lobe atrophy
Leys D et al. Lancet Neurol. 2005;4(11):752-9.

11. Stroke Related Predisposing Factors
Stroke severity
Cause
Location
Recurrence

12. Other factors Vascular lesions Alzheimer pathology
White-matter changes
Or combinations of these.

13. Overlap?
Patients who had a stroke and medial temporal lobe atrophy (MTA) more frequently develop dementia than patients without MTA 
Cordoliani-Mackowiak MA. Arch Neurol. 2003;60(4):

14. Indian experience
Older age at first-ever stroke and cortical atrophy are associated with increased risk for dementia 
Das S. Cognitive dysfunction in stroke survivors: a community-based prospective study from Kolkata, India. J Stroke Cerebrovasc Dis. 2013;22(8):

15. Functional outcome? Poor!
Barba R. Stroke. 2000;31(7): ; Alladi S. Annals Ind Acad Neurol 2010; S

16. Mortality?
Patients with PSD have high mortality rates and are likely to be functionally impaired.
Leys D et al., Lancet Neurol. 2005;4(11):752-9.

17. VCI?/Poststroke?/Vascular?
Vascular cognitive impairment (VCI)  entire spectrum of cognitive impairment occurring as a result of cerebrovascular disease.
VCI encompasses not only vascular dementia (VaD), but also mixed dementia and vascular cognitive impairment-no dementia (VCI-ND).
VCI-ND refers to that subgroup of patients who manifest cognitive deficits resulting from cerebrovascular disease, but do not meet the definition of dementia. 

18. Main Types Multi-infarct dementia (MID)
Subcortical ischaemic vascular disease (SIVD)
Strategic infarct subtypes of poststroke VCI 

19. Post stroke depression
Depression was found to be the commonest symptom, irrespective of the subtype or severity of VCI.
Gupta M. Behav Neurol. 2014;2014:

20. BPSD
95% of cases had at least one neuropsychiatric symptom, with depression being the commonest, irrespective of subtype or severity of VCI.
Strategic infarct patients had the lowest frequency of all symptoms.
Gupta M. Behav Neurol. 2014;2014:

21. Survival following stroke dementia?
Around 3 years!

22. Drug treatment
No special drug has been approved for vascular dementia.
Drugs effective in Alzheimer’s are modestly effective in vascular dementias as well.

23. Gaps
There remain fundamental gaps in our understanding of pathophysiology, predicting prognosis and outcome, and in therapeutics. 
O'Brien JT. Am J Geriatr Psychiatry. 2006;14(9):

24. Challenges in post stroke dementias
Clinical Trials, mainly in populations selected using currently accepted criteria for vascular dementia, have generally not been encouraging.
O'Brien JT. Am J Geriatr Psychiatry. 2006;14(9):

25. Management Definitive treatment Control of risk factors e.g.
Nimodipine
Memantine
Cholinesterase inhibitors
Control of risk factors e.g.
Diabetes
Hypertension
Hyperlipidemia

26. Prevention
It is important identify patients at early stages of cognitive impairment, to treat appropriately and prevent progression to frank dementia.
Alladi S. Annals Ind Acad Neurol 2010; S

27. Thank you