TOPLINE:

The risk for post-stroke dementia (PSD) arose from multiple factors, with distinct profiles seen for early- and delayed-onset cases. Notably, metabolic syndrome (MetS)­ — particularly low high-density lipoprotein cholesterol (HDL-C) levels — emerged as a novel risk factor and a promising target for PSD prevention.

METHODOLOGY:

• Researchers conducted a prospective, multicentre, hospital-based cohort study across six German tertiary stroke centres between May 2011 and January 2019 to identify risk factors for PSD over 5 years.
• The analysis included 736 patients (mean age, 68.0 years; 33.3% women) hospitalised for ischaemic or haemorrhagic stroke and no preexisting dementia.
• Participants underwent baseline and serial follow-up assessments, including clinical, cardiometabolic, neuropsychological, and neuroimaging evaluations.
• The primary outcome was incident PSD; key secondary outcomes included early-onset PSD (diagnosed at 3-6 months post-stroke) and delayed-onset PSD (diagnosed at more than 6 months post-stroke).

TAKEAWAY:

• Over 5 years, 55 patients developed incident PSD, yielding a 5-year cumulative incidence of 8.8% (95% CI, 6.5%-11.1%). Of these 55 patients, 38.2% were classified as those with early-onset PSD and 61.8% were classified as those with delayed-onset PSD.
• Significant contributors to PSD included age ≥ 74 years (adjusted hazard ratio [aHR], 4.76), higher stroke severity at admission (aHR, 2.68), acute phase cognitive impairment (aHR, 5.86), presence of diabetes (aHR, 2.28), MetS (aHR, 2.05), reduced HDL-C levels (aHR, 2.61), and stroke recurrence (aHR, 2.36; P ≤ .05 for all).
• Early-onset PSD was more strongly associated with initial stroke severity and atrial fibrillation, and delayed-onset PSD was strongly driven by modifiable cardiometabolic factors, specifically MetS and stroke recurrence.

IN PRACTICE:

"Our findings highlight the multifactorial nature of PSD risk and emphasise time-dependent differences in the importance of individual risk factors," the authors wrote.

SOURCE:

This study was led by Jule Filler, Institute for Stroke and Dementia Research, LMU University Hospital, LMU Munich, Munich, Germany. It was published online on August 19, 2025, in The Lancet Regional Health - Europe.

LIMITATIONS:

The study protocol's demanding requirements, including serial MRI scanning and detailed cognitive testing, led to an overrepresentation of patients with milder strokes. The attrition rate was relatively high, which may have introduced bias.

DISCLOSURES:

This study was funded by the German Center for Neurodegenerative Diseases. Several authors reported consulting for various pharmaceutical companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.