THE President of the African Stroke Organisation (ASO), Prof. Rufus Akinyemi, has warned that as many as one in every two stroke survivors may develop cognitive impairment, including problems with memory, attention, language and executive function.
Akinyemi, a consultant neurologist at the University of Ibadan, spoke during the ASO-WSO Webinar Series on Post-Stroke Dementia, which examined the growing burden of post-stroke cognitive impairment and dementia.
He said cognitive impairment should no longer be regarded as a secondary consequence of stroke because it can significantly affect survivors’ independence, rehabilitation and quality of life.
According to him, studies across several countries have consistently shown a high burden of cognitive impairment among stroke survivors, although prevalence varies according to diagnostic criteria, populations studied and assessment tools used.
Akinyemi said the situation was particularly concerning in Africa, where vascular disease accounts for a significant proportion of the continent’s dementia burden.
According to him, systematic reviews have demonstrated the importance of vascular dementia and vascular cognitive impairment in Africa, although available evidence remains incomplete because many studies were conducted over short periods and involved selected populations.
Despite these limitations, he said, cerebrovascular disease remains an important contributor to dementia on the continent.
He added that the high prevalence of hypertension, diabetes and other vascular risk factors makes vascular cognitive impairment a major public health concern in Africa, while genetic factors may contribute to the potentially higher burden of small-vessel cerebrovascular disease among African populations.
Highlighting findings from the COFAS study conducted in Nigeria between 2010 and 2012, Akinyemi said the research examined cognitive problems associated with vascular brain disease among about 147 stroke survivors and found that approximately 24 per cent had dementia, while another 40 per cent had cognitive impairment without dementia.
The findings, he said, showed that stroke-related cognitive problems could extend beyond the immediate area of the brain damaged by the stroke.
“Post-stroke cognitive impairment is a significant problem,” he said, stressing the need for cognitive assessment to become part of routine stroke care.
The research also found older age and lower educational attainment associated with increased risk, while some dietary and lifestyle factors, including regular fish consumption, appeared protective.
Akinyemi said apparent improvements in cognitive outcomes over time could partly reflect the fact that people with poorer outcomes were more likely to die or drop out of the study.
Explaining the mechanisms underlying post-stroke cognitive impairment, the neurologist said recurrent strokes, multiple infarcts, small-vessel disease, white-matter lesions, cerebral atrophy and strategically located infarcts could all contribute to cognitive decline.
He said research involving brain tissue showed that neurodegenerative pathology alone did not adequately explain why some stroke survivors developed dementia while others did not.
Rather, the findings point to neuroinflammation as an important mechanism in cognitive impairment following stroke.
Stroke can trigger inflammation and oxidative stress, he explained.
, affecting white matter and communication between different parts of the brain and resulting in problems with executive function and other cognitive abilities.
Akinyemi said controlling hypertension, diabetes and abnormal blood lipids before and after stroke remains one of the most important strategies for reducing post-stroke cognitive impairment.
“Hypertension is always the number one risk factor for stroke,” he said, calling for stronger strategies to improve the detection, treatment and control of high blood pressure across Africa.
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He said evidence showing hypertension accounts for a large proportion of the population-attributable risk for stroke suggests that better blood pressure control could prevent a substantial proportion of strokes.
He urged African countries to adopt population-wide strategies for preventing and controlling hypertension rather than relying solely on hospital-based treatment.
The professor also cited SIREN study findings showing an inverse relationship between green-vegetable consumption and hypertension.
Research among stroke survivors, he added, suggested that vegetables and legumes could have protective associations with cognitive performance, describing such dietary measures as potentially inexpensive interventions requiring further investigation.
Akinyemi advised healthcare workers to assess cognitive function as part of long-term stroke management and called for rehabilitation programmes to address cognitive problems alongside physical disabilities.
Rehabilitation, he said, should begin as early as clinically appropriate and involve doctors, nurses, physiotherapists, occupational therapists, psychologists and other professionals.
“Cognitive rehabilitation should be integrated with motor rehabilitation because a patient who walks well but has significant cognitive impairment may still struggle to live independently,” he said.
He also cited evidence supporting cognitive stimulation for people with mild cognitive impairment and early dementia, calling for further research into its application among stroke survivors.
Akinyemi raised concern over dementia stigma in parts of Africa, saying some people living with the condition are wrongly labelled as witches and may face discrimination, abuse and violence.
Such stigma, he said, causes families to hide affected relatives or move them to rural communities, resulting in under-recognition and under-treatment.
He called for more African research into the genetic, biological, social and environmental factors contributing to post-stroke cognitive impairment, as well as the development of affordable, culturally appropriate screening tools for resource-constrained health facilities.
Akinyemi’s central message was that protecting brain health must begin before a stroke occurs and continue throughout recovery.
For Africa, he said, tackling post-stroke dementia requires prevention, early cognitive screening, appropriate rehabilitation, vascular risk-factor control, public education and sustained research.
He urged healthcare providers and policymakers not to regard physical survival from a stroke as the end of treatment but as the beginning of a long-term effort to preserve cognitive function, independence and quality of life.
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