Jay Shah, MD

Matz K, Teuschl Y, Firlinger B, Dachenhausen A, Keindl M, Seyfang L, et al. Multidomain Lifestyle Interventions for the Prevention of Cognitive Decline After Ischemic Stroke: Randomized Trial. Stroke. 2015

There is a strong relationship between stroke and dementia. In addition to motor impairments, stroke also leads to cognitive impairment in majority of stroke patients. 30% of such patients deteriorate in a delayed fashion 3-15 months following infarct. Therefore, intervening prior to this deterioration is extremely important in order to decrease risk and progression to dementia. Modifiable vascular risk factors are also linked with an increased risk for cognitive impairment. Therefore, risk factor modification can potentially decrease risk of cognitive decline.

In this study, the authors evaluate whether a 24-month intensive multi-domain intervention can prevent post-stroke cognitive decline compared to standard care. Patients with an ischemic stroke within 3 months were randomly assigned to either group. The intervention consisted of intensive management and motivation for compliance with clinical therapy, blood pressure, lipid and glycemic control, healthy diet, regular physical activity and cognitive training. Cognition was assessed at baseline and 1 and 2 years within the following domains: executive function, working memory, general memory, processing speed and visual spatial ability.

Ultimately, data from 159 patients were obtained (76 intervention and 83 control). At 24 months, 8 patients in the intervention group had cognitive decline compared to 10 in the control group. During the 24 months, participants in the intervention and control group showed no improvement on the Alzheimer’s Disease Assessment Scale-cognitive subscale.

This study did not show a benefit for intensive intervention. This could be due to the relatively low number of patients and thus, the study could have been underpowered to detect an effect. Since dementia is a slowly developing disease, a follow-up period of 24 months may have been too short to capture a difference. Although common for all clinical trials, drop-outs were more frequent in the intervention group in the first year. This, perhaps, suggests the impracticality of intensive intervention due to declining compliance. Furthermore, this type of intervention requires a well-organized medical community with numerous resources. This can be economically unfeasible for many communities.