ESOC 2025 | Preventing cognitive decline after stroke using secondary stroke prevention strategies
Terence Quinn, MD, MRCP, MBCHB (hons), University of Glasgow, Glasgow, UK, discusses strategies to treat cognitive decline in patients who have had a stroke. He highlights the importance of secondary stroke prevention to prevent subsequent cognitive decline, and notes that the challenge now is to improve implementation of these treatments. This interview took place at the 11th European Stroke Organisation Conference (ESOC) in Helsinki, Finland.
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Transcript
Having established that this is a problem, we now need to think about what we can do about it? And we can think about interventions in two ways. We can think about prevention and we can also think about treatment. Unfortunately, our options for treatment at the moment are really quite limited. There are treatments for all-cause dementia, and because much of what we call vascular cognitive impairment also has other forms of cognitive impairment adding to the picture, so for example, many people with vascular cognitive impairment also have a degree of amyloid plaque or have a degree of alpha-synuclein, so the treatments that we use in other forms of dementia may have some effect in vascular cognitive impairment, but the effect is modest, and we’re talking about treatments that only have a modest effect to begin with...
Having established that this is a problem, we now need to think about what we can do about it? And we can think about interventions in two ways. We can think about prevention and we can also think about treatment. Unfortunately, our options for treatment at the moment are really quite limited. There are treatments for all-cause dementia, and because much of what we call vascular cognitive impairment also has other forms of cognitive impairment adding to the picture, so for example, many people with vascular cognitive impairment also have a degree of amyloid plaque or have a degree of alpha-synuclein, so the treatments that we use in other forms of dementia may have some effect in vascular cognitive impairment, but the effect is modest, and we’re talking about treatments that only have a modest effect to begin with. So, at the moment, and the landscape is changing, at the moment our options for treatment really are limited. So I think the biggest return on investment is around prevention. And actually, prevention is relatively simple. If we can prevent recurrent stroke, we can prevent cognitive decline. Because at the heart of things, the etiology of lots of post-stroke cognitive decline is very simply that people have had strokes, and we have very good, very potent evidence-based primary and secondary prevention for stroke. I think the question now is how do we get better at implementing? How do we make sure that we use all of those evidence-based treatments to prevent strokes in the first place and therefore as a secondary benefit prevent cognitive decline?
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Disclosures
I chair Data Safety Monitoring Committees for trials in dementia run by NovoNordisk. I receive no personal payment for this work.
