Highlights
- •Aphasia was associated with an increased risk of developing vascular dementia in patients with first-episode stroke but not dementia of non-vascular type.
- •The association between aphasia and risk of vascular dementia did not differ by age and sex.
- •The strength of the association between aphasia and vascular dementia was similar among patients with ischemic and hemorrhagic stroke.
Abstract
Background and purpose
Although findings from published studies suggest post-stroke aphasia is associated
with an increased risk of dementia, few studies have evaluated its association in
a nationally representative cohort with long-term follow-up. No studies have reported
data by type of stroke. Therefore, we examined the association between post-stroke
aphasia and the risk of developing dementia.
Methods
Using claims data from Taiwan's universal health insurance program, a cohort of patients
≥18 years old with an initial hospitalization for stroke in 2002–2005 were identified
and followed up until December 31, 2016. Patients with newly diagnosed aphasia during
stroke hospitalization or within 6 months of discharge were defined as the aphasia
group. Cox proportional hazards models were used to estimate hazard ratios (HRs) for
developing overall, vascular, and non-vascular dementia in patients with and without
post-stroke aphasia.
Results
During a median follow-up period of 7.9 and 8.6 years for the aphasia (n=17063) and
non-aphasia groups (n=105940), respectively, overall dementia incidence was similar,
whereas vascular dementia incidence was higher in the aphasia group (7.52 vs. 5.52
per 1000 person-years). The adjusted HRs (95% confidence intervals) were 1.11 (1.06–1.17),
1.42 (1.31–1.53), and 0.94 (0.88–1.01) for overall, vascular, and non-vascular dementia,
respectively. The association between aphasia and the risk of vascular dementia did
not differ by stroke type (P for interaction=0.43). The analysis of 16856 propensity score-matched pairs revealed
similar results.
Conclusion
Patients with post-stroke aphasia have an increased risk of developing vascular dementia
irrespective of the type of stroke.
Key Words
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References
- Post-stroke dementia - a comprehensive review.BMC Med. 2017; 15: 11
- Post-stroke aphasia prognosis: a review of patient-related and stroke-related factors.J Eval Clin Pract. 2012; 18: 689-694
- Dementia after first stroke.Stroke. 1996; 27: 1205-1210
- Frequency and clinical determinants of dementia after ischemic stroke.Neurology. 2000; 54: 1124-1131
- Incidence and determinants of poststroke dementia as defined by an informant interview method in a hospital-based stroke registry.Stroke. 1998; 29: 2087-2093
- Risk of dementia after a first-ever ischemic stroke: A 3-year longitudinal study.Cerebrovas Dis. 1997; 7: 48-52
- Study on frequency and predictors of dementia after ischemic stroke: the Chongqing stroke study.J Neurol. 2004; 251: 421-427
- Clinical determinants of poststroke dementia.Stroke. 1998; 29: 75-81
- Incidence and prevalence of dementia associated with transient ischaemic attack and stroke: analysis of the population-based Oxford Vascular Study.Lancet Neurol. 2019; 18: 248-258
- Nationwide population science: lessons from the Taiwan National Health Insurance Research Database.JAMA Intern Med. 2015; 175: 1527-1529
- Speech and language therapy for aphasia following stroke.Cochrane Database Syst Rev. 2016; (2016)Cd000425
- Language recovery following stroke.Clin Neuropsychol. 2019; 33: 928-947
- Gender and age differences and the trend in the incidence and prevalence of dementia and Alzheimer's disease in Taiwan: A 7-year National Population-Based Study.Biomed Res Int. 2019; (2019)5378540
- Validity of death certificate and hospital discharge ICD codes for dementia diagnosis: the multi-ethnic study of atherosclerosis.Alzheimer Dis Assoc Disord. 2017; 31: 168-172
- Developing a stroke severity index based on administrative data was feasible using data mining techniques.J Clin Epidemiol. 2015; 68: 1292-1300
- A comparison of 12 algorithms for matching on the propensity score.Stat Med. 2014; 33: 1057-1069
- The performance of different propensity score methods for estimating marginal hazard ratios.Stat Med. 2013; 32: 2837-2849
- Long-term risk of dementia among survivors of ischemic or hemorrhagic stroke.Stroke. 2017; 48: 180-186
- Neurological signs in relation to type of cerebrovascular disease in vascular dementia.Stroke. 2008; 39: 317-322
- Ischemia in broca area is associated with broca aphasia more reliably in acute than in chronic stroke.Stroke. 2010; 41: 325-330
- Models and mechanisms of vascular dementia.Exp Neurol. 2015; 272: 97-108
- Chronic cerebral hypoperfusion: a key mechanism leading to vascular cognitive impairment and dementia. Closing the translational gap between rodent models and human vascular cognitive impairment and dementia.Clin Sci (Lond). 2017; 131: 2451-2468
- Evidence of demyelination in mild cognitive impairment and dementia using a direct and specific magnetic resonance imaging measure of myelin content.Alzheimers Dement. 2018; 14: 998-1004
- Leukoaraiosis is associated with a decline in language abilities in chronic aphasia.Neurorehabil Neural Repair. 2019; 33: 718-729
- White matter degeneration in vascular and other ageing-related dementias.J Neurochem. 2018; 144: 617-633
- The effect of aphasia upon personality traits, depression and anxiety among stroke patients.J Affect Disord IF3. 2015; 172 (432): 312-314
- Prevalence and predictors of post-stroke mood disorders: a meta-analysis and meta-regression of depression, anxiety and adjustment disorder.Gen Hosp Psychiatry. 2017; 47: 48-60
- Depression and the risk of vascular dementia: a population-based retrospective cohort study.Int J Geriatr Psychiatry. 2017; 32: 556-563
- Late-life depression and risk of vascular dementia and Alzheimer's disease: systematic review and meta-analysis of community-based cohort studies.Br J Psychiatry. 2013; 202: 329-335
- Incidence of aphasia in ischemic stroke.Neuroepidemiology. 2022;
- Incidence and profile of inpatient stroke-induced aphasia in Ontario, Canada.Arch Phys Med Rehabil. 2010; 91: 196-202
- Poststroke aphasia frequency, recovery, and outcomes: a systematic review and meta-analysis.Arch Phys Med Rehabil. 2016; 97 (e8): 2188-2201
- Validity of dementia and Alzheimer's disease diagnoses in Finnish national registers.Alzheimers Dement. 2014; 10: 303-309
Article info
Publication history
Published online: October 22, 2022
Accepted:
October 16,
2022
Received in revised form:
September 25,
2022
Received:
April 13,
2022
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2022.106838
Copyright
© 2022 Elsevier Inc. All rights reserved.
