Post-stroke dementia is a condition that is treated in several ways. Pharmacological treatment is most often used, but psychotherapeutic effects and rehabilitation are also of great importance. How is PSD treated? How can I reduce my risk of post-stroke dementia? What is the prognosis of patients with PSD?
Post-stroke dementiais a disease for whichtreatmentis multi-pathway. Pharmacological treatment is the most commonly used treatment. Psychotherapeutic impact and rehabilitation are also important. These measures help to slow the progression of the disease and improve the quality of life of patients. However, it should be remembered that they cannot be fully healed.
Post-stroke dementia - treatment
Improvement was observed in patients with post-stroke dementia after treatment with the cholinesterase inhibitors: acetylcholinesterase and butyrylcholinesterase, which are used in the pharmacological treatment of Alzheimer's disease. These are drugs that slow the progression of the disease. Studies show that in the first year after starting treatment, patients with Alzheimer's show some improvement in mental and physical function compared to untreated patients. However, there are still no studies on the secondary prevention of stroke in people with PSD and the use of cholinesterase inhibitors or other drugs in the course of this type of dementia.
Lowering blood pressure may indirectly influence PSD treatment by reducing recurrence of strokes and the development of Alzheimer's disease.
Post-stroke dementia - prognosis
Studies show that the survival rate in people with post-stroke dementia compared to people without dementia is significantly lower - 16 months after stroke, the cumulative survival rate in patients with PSD is 20.4%, and in patients without dementia it is 72.6 %. The cumulative 5-year survival rate in people with post-stroke dementia is 39%, while in people without dementia this figure rises to 75%. The presence of dementia 3 months after stroke has also been shown to be associated with an increased risk of recurrent stroke.
Post-stroke dementia - prophylaxis
Primary and secondary stroke prevention is the best way to reduce your risk of dementiaafter impact.
In primary prevention, the most important are blood pressure control and treatment of already existing arterial hypertension, as well as the prevention of atherosclerosis. It is also important to treat disorders of the lipid metabolism, which includes, among others, reducing excess weight, as it is very important to maintain a proper body weight in the prevention of strokes. Treatment of cardiovascular diseases (including antithrombotic prevention in patients with atrial fibrillation and treatment of ischemic heart disease, myocardial infarction) also plays an important role in stroke prevention, as does smoking cessation and reducing alcohol consumption. It is also important to properly treat people struggling with diabetes.
In turn, secondary prevention should include:
- lifestyle and risk factor modification
- antiplatelet and anticoagulant treatment
- surgical treatment of thrombotic changes in carotid arteries
Based on: Klimkowicz-Morawiec A., Szczudlik A.,Post-stroke dementia , [in:]Dementia. Theory and practice , pp. edited by Leszek J., Wrocław 2011