Delayed-onset dementia after stroke or transient ischemic attack.
Patients surviving stroke without immediate dementia are at high risk of delayed-onset dementia. Mechanisms underlying delayed-onset dementia are complex and may involve vascular and/or neurodegenerative diseases.



Dementia-free patients with stroke and/or transient ischemic attack (TIA; n = 919) were studied for 3 years prospectively, excluding those who developed dementia 3 to 6 months after stroke and/or TIA.



Forty subjects (4.4%) developed dementia during the study period. Imaging markers of severe small vessel disease (SVD), namely presence of ≥3 lacunes and confluent white matter changes; history of hypertension and diabetes mellitus independently predicted delayed-onset dementia after adjustment for age, gender, and education. Only 6 of 31 (19.4%) subjects with delayed cognitive decline harbored Alzheimer's disease-like Pittsburg compound B (PiB) retention. Most PiB cases (16/25, 64%) had evidence of severe SVD.



Severe SVD contributes importantly to delayed-onset dementia after stroke and/or TIA. Future clinical trials aiming to prevent delayed-onset dementia after stroke and/or TIA should target this high-risk group.
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China; Therese Pei Fong Chow Research Centre for Prevention of Dementia, Hong Kong SAR, China.
Vincent C T
VCT
Mok
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China; Therese Pei Fong Chow Research Centre for Prevention of Dementia, Hong Kong SAR, China.
Bonnie Y K
BYK
Lam
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China.
Zhaolu
Z
Wang
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China.
Wenyan
W
Liu
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China.
Lisa
L
Au
Department of Nuclear Medicine, Hong Kong Sanatorium and Hospital, Hong Kong SAR, China.
Eric Y L
EYL
Leung
Department of Nuclear Medicine, Hong Kong Sanatorium and Hospital, Hong Kong SAR, China.
Sirong
S
Chen
Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and Ministry of Education of China, Institute of Neuroscience and the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
Jie
J
Yang
Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong SAR, China.
Winnie C W
WCW
Chu
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China.
Alexander Y L
AYL
Lau
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China.
Anne Y Y
AYY
Chan
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China.
Lin
L
Shi
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China.
Florence
F
Fan
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China.
Sze H
SH
Ma
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China.
Vincent
V
Ip
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China.
Yannie O Y
YOY
Soo
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China.
Thomas W H
TWH
Leung
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China.
Timothy C Y
TCY
Kwok
Department of Nuclear Medicine, Hong Kong Sanatorium and Hospital, Hong Kong SAR, China.
Chi L
CL
Ho
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China.
Lawrence K S
LKS
Wong
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China; Therese Pei Fong Chow Research Centre for Prevention of Dementia, Hong Kong SAR, China. Electronic address: adrianwong@cuhk.edu.hk.
Adrian
A
Wong
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000814:Aniline Compounds; D001057:Apolipoproteins E / Q000235:genetics; D001921:Brain / Q000000981:diagnostic imaging; D003704:Dementia / Q000000981:diagnostic imaging / Q000209:etiology*; D005260:Female; D019788:Fluorodeoxyglucose F18; D005500:Follow-Up Studies; D006801:Humans; D002546:Ischemic Attack, Transient / Q000150:complications* / Q000000981:diagnostic imaging / Q000523:psychology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010618:Phenanthrolines; D049268:Positron-Emission Tomography; D011446:Prospective Studies; D020521:Stroke / Q000150:complications* / Q000000981:diagnostic imaging / Q000523:psychology; D013844:Thiazoles; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D055815:Young Adult
C475519:2-(4'-(methylamino)phenyl)-6-hydroxybenzothiazole; D000814:Aniline Compounds; D001057:Apolipoproteins E; D010618:Phenanthrolines; D013844:Thiazoles; D019788:Fluorodeoxyglucose F18
Alzheimer's disease; Delayed-onset dementia; Small vessel disease; Stroke; Transient ischemic attack