6 ISC NEWS DAY 1 | WEDNESDAY, FEBRUARY 5, 2025 StrokeConference.org #ISC25 Post-stroke cognitive impairment (PSCI) is common and disabling. Research suggests stroke might increase a person’s risk of dementia up to 50-fold. In fact, risk of dementia is higher than the risk of recurrent stroke. But in the absence of specific treatments for PSCI, aggressively preventing recurrent stroke by controlling vascular risk factors is a critical strategy to preserve mental acuity after stroke, according to Deborah A. Levine, MD, MPH, FACP, professor of medicine and neurology at the University of Michigan Medical School in Ann Arbor. On Wednesday, Levine will present “Epidemiology of Post-Stroke Cognitive Impairment: Prevalence, Trajectories and Outcomes” as part of the session “Post-Stroke Cognitive Impairment and Dementia: New Insights, Challenges and Opportunities.” Stroke can cause acute declines in executive function, memory, language, visuospatial function and processing speed, Levine said. About half the people who survive the acute phase of a stroke are left with significant cognitive dysfunction, including more than one-third of patients with moderate to severe stroke who have dementia at one year out. Even years after a stroke, more than 50% of patients report cognitive impairment. Estimates indicate stroke may lead to dementia diagnoses an average of 10 years earlier, compared with people who have not had strokes, and up to 25 years earlier in those who have had severe strokes. But even in the absence of dementia, PSCI is associated with increased mortality, disability and dependence, and worse quality of life. “We need more research to identify effective treatments to prevent and slow PSCI,” Levine said. Until such treatments are identified, Levine said, physicians should focus on preventing recurrent stroke by controlling patients’ vascular risk factors including high blood pressure, high cholesterol, diabetes and atrial fibrillation. “Recurrent strokes substantially increase post-stroke cognitive impairment and dementia risks. There is some evidence that cognitive rehabilitation can help improve language and comprehension deficits acutely after stroke,” she said. “We need more high-quality studies of cognitive rehabilitation to know what specific treatments, doses and durations are most effective, in which patients and during what time windows after stroke.” Levine’s research has found that higher post-stroke blood glucose levels were associated with faster post-stroke cognitive decline, independent of pre-stroke glucose and cognition levels. This suggests that improving glycemic control in stroke survivors is a potential strategy to reduce PSCI, though more research is needed, she said. Meanwhile, a randomized clinical trial has shown that isosorbide mononitrate and cilostazol reduced cognitive impairment after lacunar ischemic stroke, Levine said, suggesting that targeting cerebrovascular endothelial function might stem cognitive impairment in patients with symptomatic cerebral small vessel disease. Yet it’s clear that hyperacute stroke treatments won’t eradicate the cognitive consequences of stroke — there is significant residual disability even in patients who receive them, said Eric Smith, MD, FAHA, professor of neurology, radiology and community health sciences at the University of Calgary department of clinical neurosciences. That indicates a multimodal approach is needed to improve PSCI outcomes, said Smith, who will discuss “Cerebral Small Vessel Disease and Relationship to Post-Stroke Cognitive Outcomes — Epidemiology, Imaging, Biomarkers and Potential Therapeutic Targets” at the session Wednesday. “Pre-existing conditions, some of which may not even be recognized by the patient, can have a significant impact on the risk for post-stroke cognitive impairment,” Smith said. “Studies show that more than half of patients with their first symptomatic stroke have evidence on brain imaging of prior, silent strokes. For many patients, what they think is their first stroke is actually their second or third. We often refer to these imagingdefined strokes as ‘covert’ because they weren’t recognized by the patient but can have important, but insidious, effects on cognition.” In patients with new-onset dementia after stroke, signs of cerebral small vessel disease are more common than Alzheimer’s disease, Smith said. Post-Stroke Cognitive Impairment and Dementia: New Insights, Challenges and Opportunities 7:30-9 a.m. Wednesday, Feb. 5 Room 502A UPCOMING SESSION Levine Smith Become an AHA Certified Professional PAID ADVERTISEMENT Visit us at ISC in HeadQuarters and the VIP Lounge @Booth #1049 to learn more! Offer gold standard telehealth stroke care. Improve quality and consistency of care in telehealth stroke. Sign up to be a beta tester or volunteer in the development of the Stroke Coordinator Certification for a free hat. In Development: Stroke Coordinator Certification Overcoming post-stroke cognitive impairment Promise lies in the prevention of recurrent strokes. ISC News is produced for the American Heart Association/American Stroke Association’s International Stroke Conference by Ascend Media, LLC (ascendmedia.com). 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