Remember that philosophical conundrum: If a tree falls in a forest and no one is around, does it make a sound? Likewise, if someone has a silent stroke but doesn't lose any function, does it matter? In other words, is it really a stroke without clinical loss? Well, in one of those strange twists of fate & technology, I was able to read USAToday's version of a study to be published tomorrow in Neurology linking silent strokes to memory loss but unable to access the actual study itself last Friday while using satellite internet. So much for technology. I guess I should be happy I could even read the online newspaper.
In any case, the authors obtained brain MRIs of 658 participants (avg age 80yo) of an ongoing prospective cohort study of community dwelling elders who had no diagnosis or demonstrable evidence of dementia. All then underwent a very thorough battery of neurocognitive tests. After running through the typical statistical measures, the authors concluded that brain infarcts without obvious clinical loss were associated with smaller hippocampuses (hippocampi?) which in term were associated with poorer memory & cognitive function compared to their cohorts who had not suffered from silent infarcts. This held true regardless of whether the brain infarct was cortical or subcortical, and regardless of the presence or absence of diabetes, heart disease, hypertension, and smoking.
Traditionally, we thought of vascular dementia as different and separate from Alzheimer's disease. However, more recent studies have demonstrated some stabilization of Alzheimer's progression with aggressive management of stroke risk factors. In fact, in a recent study, 4 out of 7 risk factors associated with Alzheimer's disease are also associated with stroke risk. Likewise, this new study certainly gives new importance to discovering if stroke prevention can also prevent memory loss. Time will tell if vascular dementia & Alzheimer's disease are just opposite ends of the spectrum . . .
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