New Study Unveils Tool to Detect Post-Stroke Dementia Risk

News Study offers potential to detect post-stroke dementia risk A ‘simple, practical tool’ that may help to predict dementia risk in stroke survivors has been developed through an international study led by Sydney researchers. Researchers say the tool – which uses routinely collected clinical data – can reliably predict a person’s risk of developing dementia within five years of stroke, providing the opportunity for crucial early intervention. The study, led by researchers from the University of New South Wales (UNSW) and published in the Neurology journal, analysed data from more than 2600 stroke survivors across 12 studies in 10 countries – including Asia, Australia, Africa, Europe and the US – as part of the global Stroke and Cognition Consortium (STROKOG), with the aim of developing a model for predicting dementia risk. The participants had a mean age of 67 years and were followed for a median of two years, during which time 655 developed dementia. Researchers found that a combination of simple factors – including age, sex, education, stroke severity, diabetes and history of prior stroke – reliably estimated a stroke survivor’s risk of developing dementia within five years, when the data was used in an Excel-based calculator. Lead author Jess Lo, from the UNSW Centre for Healthy Brain Ageing (CHeBA), said as most stroke aftercare focuses on physical recovery, ‘equally disabling’ subtle or delayed cognitive changes can be easily missed. However, up to 60% of stroke survivors experience some cognitive impairment within the first year after stroke, and nearly one in three will develop dementia within five years. This means ‘early detection is key’, said Ms Lo. ‘If we can identify people at highest risk, we can intervene earlier, adapt care plans and potentially delay progression to dementia,’ she said. ‘This is a simple, practical tool that could help doctors identify which patients are most at risk, so they can prioritise cognitive monitoring, early intervention and support.’ At present, the tool is available to Neurology subscribers for download. A GP with a special interest in dementia and honorary medical advisor for Dementia Australia, Dr Marita Long, agrees that cognitive changes can often be overlooked, as cognitive assessment is not ‘embedded’ in stroke recovery care. ‘We’ve got to be mindful that there’s only so many tools we can use, but I think whatever can help to reinforce addressing well-established risk factors for dementia, we should be incorporating this into our care,’ Dr Long told newsGP. ‘While a tool may be really helpful, we should always be thinking about these well-established risk factors for dementia and how we can incorporate dementia risk reduction and have a low threshold for doing a comprehensive cognitive assessment for patients with any concerns. ‘For someone who’s had a stroke, we should be embedding cognitive assessments in their post-stroke care.’ Senior author and Co-Director of CHeBA, Professor Perminder Sachdev, said while the tool is promising, it needs further validation before it can be recommended for routine clinical use. However, he said it has the potential to help inform health policy and resource planning, such as helping GPs to prioritise follow-up cognitive assessment for patients identified by the tool as being at higher risk. ‘Screening for cognitive impairment in stroke patients is currently recommended, but it is often not implemented due to limited resources,’ he said. ‘This tool enables stroke clinicians to quickly estimate a patient’s five-year risk of developing dementia. ‘This approach could allow earlier intervention and potentially improve quality of life for stroke survivors and their families.’ Dr Long said the study highlights the need for GPs to keep in mind the increased risk of cognitive impairment in stroke survivors. ‘GPs are gaining confidence and becoming much more proactive in performing cognitive assessments,’ she said. ‘When you’re caring for patients post-stroke, you’ve got to be thinking of so many things – secondary prevention, the physical recovery, returning to driving and work – so cognitive decline is another issue to add into the mix. ‘It’s increasingly obvious that we’re not going to have enough specialists to meet the need to diagnose everyone with dementia given our ageing population, so there is a place for general practice to make the diagnosis of dementia.’ Log in below to join the conversation.