Stroke: silent brain infarctions have no clear effect on dementia.

Clinical bottom line (level 2c)

  1. A third of patients with first-ever ischaemic stroke will develop dementia within 5 years.
  2. Silent brain infarctions were not clearly related to dementia.
Bornstein et al: Stroke 1996; 27: 904-905
Expires December 2002

The study

Inception cohort study with objective outcomes, not adjusted for confounding factors, not validated in an independent set of patients.

Setting: general hospital, Israel

175 patients (aged mean 73 years, 55% male) clinical first-ever ischaemic stroke

Excluded if
  • transient ischaemic attack or cerebral haemorrhage
  • died during hospitalisation
  • severe aphasia or coexisting cerebral or serious mental disorders
  • previous cerebral insults
  • cognitive impairment before stroke




    • 100% followed for 5 years
    Outcomes studied:
  • developed dementia diagnosis based on criteria according to the Diagnostic and Statistical Manual of Mental Disorders, edition 3, revised
  • dementia with silent brain infarctions
  • dementia without silent brain infarction

    • 175 patients underwent brain CT examination within 48 hours of admission and were later followed up.

    The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    developed dementia 5 years 56/175 32.0%
    (25.08% to 38.91%)
    dementia with silent brain infarctions 5 years 22/63 34.92%
    (23.14% to 46.69%)
    dementia without silent brain infarction 5 years 34/112 30.36%
    (21.84% to 38.87%)

    Citation

    1. Bornstein NM, Gur AY, Treves TA, et al: Do silent brain infarction predict the development of dementia after first ischaemic stroke?. Stroke 1996; 27: 904-905
    Contributor: Clare Wotton and Musab Hayatli, December 1999
    Reviewer:

    Clinical Question.
    Patient first ischaemic stroke
    Intervention or Exposure silent brain infarction
    Comparison no silent brain infarction
    Outcome dementia