Is stroke a neurovascular neurodegenerative disease?
People destined to have a stroke have what I call ‘brain rot’ occurring for a decade prior to their sentinel event.
The Rotterdam Study continues giving, giving and giving.
Over 12 years of follow-up study participants who suffered a first-ever stroke deviated from stroke-free control subjects up to 10 years before stroke diagnosis in cognition and daily functioning. It is quite remarkable that significant deviations were seen in scores of the Mini-Mental State Examination from up to 6.4 years before the stroke. Deviations for the Stroop were at 5.7 years, the Purdue Pegboard at 3.8 years and the basic and instrumental activities of daily living (BADL and IADL) at 2.2 and 3.0 years, respectively. This means that people destined to have a stroke have what I call ‘brain rot’ occurring for a decade prior to their sentinel event.
This means that the vascular risk factors that lead to stroke are shredding brain reserve and are having functional effects in these at-risk individuals. Therefore stroke is just a manifestation of neurovascular neurodegenerative disease and has a prodromal phase similar to other neurodegenerative diseases. The obvious question we need to ask is, could effective interventions in the prodromal phase slow down this trajectory and more importantly prevent the stroke?
Heshmatollah et al. Long-term trajectories of decline in cognition and daily functioning before and after stroke. J Neurol Neurosurg Psychiatry. 2021 Jul 6;jnnp-2021-326043.
Objective: Although knowledge on poststroke cognitive and functional decline is increasing, little is known about the possible decline of these functions before stroke. We determined the long-term trajectories of cognition and daily functioning before and after stroke.
Methods: Between 1990 and 2016, we repeatedly assessed cognition (Mini-Mental State Examination (MMSE), 15-Word Learning, Letter-Digit Substitution, Stroop, Verbal Fluency, Purdue Pegboard) and basic and instrumental activities of daily living (BADL and IADL) in 14 712 participants within the population-based Rotterdam Study. Incident stroke was assessed through continuous monitoring of medical records until 2018. We matched participants with incident stroke to stroke-free participants (1:3) based on sex and birth year. Trajectories of cognition and daily functioning of patients who had a stroke 10 years before and 10 years after stroke and the corresponding trajectories of stroke-free individuals were constructed using adjusted linear mixed effects models.
Results: During a mean follow-up of 12.5±6.8 years, a total of 1662 participants suffered a first-ever stroke. Patients who had a stroke deviated from stroke-free controls up to 10 years before stroke diagnosis in cognition and daily functioning. Significant deviations before stroke were seen in scores of MMSE (6.4 years), Stroop (5.7 years), Purdue Pegboard (3.8 years) and BADL and IADL (2.2 and 3.0 years, respectively).
Conclusion: Patients who had a stroke have steeper declines in cognition and daily functioning up to 10 years before their first-ever stroke compared with stroke-free individuals. Our findings suggest that accumulating intracerebral pathology already has a clinical impact before stroke.
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General Disclaimer: Please note that the opinions expressed here are those of Professor Giovannoni and do not necessarily reflect the positions of the Barts and The London School of Medicine and Dentistry nor Barts Health NHS Trust and are not meant to be interpreted as personal clinical advice.
Is stroke a neurovascular neurodegenerative disease?
Couldn’t this just be because poor cardiovascular health makes stroke more likely and cardiovascular health is a major component of brain health (“what is good for the heart is good for the brain”)? Did they look at how cardiovascular health differed between the stroke and non-stroke populations?
Having seen people in their late teens and early 20s present with strokes I don't think this definition is totally correct