Filler Jule, Georgakis Marios K, Janowitz Daniel, Duering Marco, Fang Rong, Dewenter Anna, Bode Felix J, Stoesser Sebastian, Kindler Christine, Hermann Peter, Nolte Christian H, Liman Thomas G, Kerti Lucia, Bernkopf Kathleen, Ikenberg Benno, Glanz Wenzel, Wagner Michael, Spottke Annika, Waegemann Karin, Goertler Michael, Wunderlich Silke, Endres Matthias, Zerr Inga, Petzold Gabor C, Dichgans Martin
Institute for Stroke and Dementia Research (ISD), LMU University Hospital, LMU Munich, Munich, Germany.
Graduate School for Systemic Neurosciences, Ludwig-Maximilians-University, Munich, Germany.
Lancet Reg Health Eur. 2025 Aug 19;56:101428. doi: 10.1016/j.lanepe.2025.101428. eCollection 2025 Sep.
Stroke survivors frequently experience subsequent cognitive impairment or dementia. We aimed to identify risk factors for post-stroke dementia (PSD) and cognitive impairment (PSCI) within 5 years after stroke.
The DEMDAS (German Center for Neurological Diseases (DZNE) mechanisms of dementia after stroke) study is a prospective cohort of stroke patients admitted to six German tertiary stroke centres between May 1, 2011 and January 31, 2019. Eligible dementia-free patients with ischaemic or haemorrhagic stroke underwent baseline examinations and regular clinical, neuropsychological, and neuroimaging follow-ups over 5 years, with the last follow-ups completed in January 2024. PSD was the primary outcome, determined by comprehensive cognitive testing, patient and informant interviews, and review of medical records. The secondary outcomes were early-onset PSD (3-6 months), delayed-onset PSD (>6 months), and PSCI. Associations between baseline risk factors and PSD were assessed using Cox regression models adjusted for age, sex, education, and stroke severity.
Of 736 patients (245 [33%] female, mean age 68·0 years [SD 11·2], median admission National Institutes of Health Stroke Scale (NIHSS) 3 [IQR 1-5]), 557 (76%) were followed up until death or the end of the study, and 706 (96%) contributed to the PSD analysis. During a median of 5·0 years [IQR 3·3-5·1] of follow-up, 55 new dementia cases were diagnosed (6-month incidence: 3·1% [1·8-4·5], 5-year incidence: 8·8% [6·5-11·1]), of which 21 (38%) were classified as early-onset PSD. The 5-year risk of PSD was associated with older age (HR 1·13 [95% CI 1·08-1·18] per year), higher stroke severity (1·08 [1·03-1·13] per point on NIHSS), lower educational attainment (1·16 [1·05-1·28] per year), acute phase cognitive impairment (5·86 [2·21-15·58]), lower Barthel Index (1·10 [1·05-1·16] per 5 points less), atrial fibrillation (1·91 [1·10-3·30]), metabolic syndrome (MetS, 2·05 [1·15-3·64]), particularly reduced high-density lipoprotein cholesterol (HDL-C, 2·61 [1·50-4·52]) and pre-/diabetes mellitus (2·13 [1·13-4·00]), imaging markers of small vessel disease, and stroke recurrence during follow-up (2·36 [1·16-4·83]). Patients who received acute reperfusion treatment had a 65% lower risk of PSD than those who did not (0·35 [0·16-0·77]). While factors related to the severity of the index stroke were more strongly associated with early-onset PSD, MetS showed a stronger association with delayed-onset PSD. The association between MetS and PSD was independent of stroke recurrence and consistent across age subgroups, with 5-year cumulative incidence ranging from 1·7% (0·0-4·0) in patients ≤65 years without MetS to 24·5% (14·3-33·4) in patients ≥74 years with MetS.
The risk of dementia after stroke is multifactorial, with differing risk profiles for early-onset and delayed-onset PSD. Metabolic syndrome, including reduced HDL-C, emerged as a novel risk factor and potential target for PSD prevention.
German Center for Neurodegenerative Diseases (DZNE).
中风幸存者经常会出现后续的认知障碍或痴呆。我们旨在确定中风后5年内发生中风后痴呆（PSD）和认知障碍（PSCI）的风险因素。
DEMDAS（德国神经疾病中心（DZNE）中风后痴呆机制）研究是一项前瞻性队列研究，纳入了2011年5月1日至2019年1月31日期间入住德国六个三级中风中心的中风患者。符合条件的无痴呆的缺血性或出血性中风患者接受了基线检查，并在5年内进行了定期的临床、神经心理学和神经影像学随访，最后一次随访于2024年1月完成。PSD是主要结局，通过全面的认知测试、患者及 informant 访谈以及病历审查来确定。次要结局为早发性PSD（3 - 6个月）、迟发性PSD（>6个月）和PSCI。使用针对年龄、性别、教育程度和中风严重程度进行调整的Cox回归模型评估基线风险因素与PSD之间的关联。
在736例患者中（245例[33%]为女性，平均年龄68.0岁[标准差11.2]，入院时美国国立卫生研究院卒中量表（NIHSS）中位数为3[四分位间距1 - 5]），557例（76%）随访至死亡或研究结束，706例（96%）纳入PSD分析。在中位随访时间5.0年[四分位间距3.3 - 5.1]期间，诊断出55例新的痴呆病例（6个月发病率：3.1%[1.8 - 4.5]，5年发病率：8.8%[6.5 - 11.1]），其中21例（38%）被归类为早发性PSD。PSD的5年风险与年龄较大（每年HR 1.13[95%CI 1.08 - 1.18]）、中风严重程度较高（NIHSS每增加1分，HR 1.08[1.03 - 1.13]）、教育程度较低（每年HR 1.
