We appreciate the data that Talelli and Ellul share regarding their study from Patras, Greece, on cognitive change after stroke as assessed by the Mini-Mental State Examination. It is well recognized that stroke may result in cognitive change, particularly because even minor residual focal deficits from ischemic infarcts may affect language, memory, or visuospatial function (eg, those areas tested on the Mini-Mental State Examination). When examining for cognitive change within 1 year of stroke, it is not surprising that the effect of the stroke itself, including stroke size, dominates any effects of other vascular risk variables. Our findings are that stroke is a risk factor for AD, especially in combination with the presence of underlying vascular risks.1 We concur that follow-up information on the Patras group may be useful with regard to assessing the development of AD. We also agree that examination of other risk factors such as common carotid artery intima media thickness, which provides a measure of extracranial atherosclerosis, might be of use in such analysis. Clearly there is a need for further research investigating the mechanisms by which stroke might increase the risk of AD.
Honig LS, Mayeux R. Are Patients With Cognitive Impairment After Stroke at Increased Risk for Developing Alzheimer Disease?—Reply. Arch Neurol. 2004;61(6):983–984. doi:10.1001/archneur.61.6.983-c
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