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September 2006

Stroke and Memory Decline: A Question of Degenerative or Vascular Origin

Arch Neurol. 2006;63(9):1347-1348. doi:10.1001/archneur.63.9.1347-b

Reitz and colleagues1 reported the results of a very interesting community-based study involving 1271 elderly persons without dementia or cognitive decline in New York, in which a history of stroke was related to a progressive decline in memory and abstract/visuospatial performance, particularly among men and those without an apolipoprotein E ε4 allele. The authors discussed these results as consistent with studies showing an increased risk of Alzheimer disease (AD) in persons with stroke,2 postulating that if stroke is related to a higher risk of AD, it must be related to a decline in memory, and suggesting a degenerative origin for the memory performance decline associated with stroke. In the Italian Longitudinal Study on Aging (ILSA),3 we evaluated 2963 individuals from a population-based sample and found no association between stroke and incident mild cognitive impairment. However, there was a nonsignificant trend for stroke as a risk factor of progression of mild cognitive impairment to dementia, and among those who progressed to dementia, 60% progressed to AD and 33% to vascular dementia. These findings confirm those of Reitz and colleagues suggesting that, in a predementia syndrome with a cognitive pattern similar to AD and with a central role for memory decline, stroke may also influence the rate of progression to dementia both of degenerative or vascular origin.

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