"This study lumps together several studies that have been performed in the last 30 years," Hennerici said. "These studies are of very different quality. From these data, they draw the conclusion that stroke per se has a risk of post-stroke dementia. I question this finding because, according to the data, it is not stroke itself but rather an additional neurodegeneration that is ongoing, or additional changes in the brain in combination with stroke, that produces post-stroke dementia."
Hennerici's interpretation is that treatment of one major risk factor, hypertension, is essential to prevent both stroke and the underlying deterioration of brain function that leads to dementia.
"Hypertension is the best treatable risk factor for dementia and stroke," he said. "It should be addressed even in those patients who are not hypertensive but who have other risk factors, such as diabetes and advanced age. The aging population should be carefully treated with hypertensive agents and also should be advised about methods of dealing with other hypertension risk factors, such as reduced salt intake, exercise and lifestyle changes."
That recommendation drew no argument from Pendlebury. "Yet more aggressive treatment of high blood pressure can help prevent dementia, and also stroke," she said.
The U.S. Centers for Disease Control and Prevention has more on preventing a stroke.
SOURCES: Sarah Pendlebury, M.D., senior clinical fellow, Stroke Prevention Research Unit, John Radcliffe Hospital, Oxford, England; Michael G. Hennerici, M.D., chairman, neurology, University of Heidelberg, Germany; Sept. 23, 2009, The Lancet Neu
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