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EDUCATION ON NEUROLOGY
POST STROKE
COGNITIVE &
BEHAVIOR
IMPAIRMENT
STROKE Death
30% population
in the world Disability
Fungsi
Behavior Cognition
Eksekutif
Subtype 1: large vessel Subtype II:. Subtype III
occlusion •Arteriolosclerosis, lipohyalinosis, • ‘strategic’ infarction
• Atherothromboembolism hypertensive, arteriosclerotic, (thalamus and hippocampus)
• Artery-to-artery, embolism or amyloid or collagen angiopathy • Cardioembolism and
cardioembolism. •40-50% intracranial small vessel
• 20-40% •Hypertension, DM, hyperlipidaemia, disease
• Hypertension, carotid artery hyperhomocysteinaemia, CKD, • 10-15%
disease or atherosclerosis, AF infection and OSA, obesity, smoking,
and CAD •Most of stroke survival
Kalaria, Biochimica et Biophysica Acta 1862 (2016)
AD and Stroke Sharing Common Risk Factors
• Hypertension, diabetes, smoking,
hypercholesterolemia, heavy alcohol
consumption and APOE4 isoforms.
• CVD increases the risk of developing AD
dementia or vascular dementia by 3x
• Hypertension is a consistent CVD risk
factor for developing stroke and dementia.
Dopamin, Serotonin,&
Dopamin & Asetilkolin
Noradrenergik
Nukleus kaudatus Nukleus akumbens Nukleus kaudatus
45.2
38.1 38.06
35.5
32.9
31
27.7
23.9
14.8 15.5
13.5
9
First ever stroke
Recurrent stroke
Abe’s BPSD Score-Ina
(Diadaptasi dan disesuaikan oleh Anam, 2017)
APPETITE
NIGHTTIME BEHAVIOR
ABERRANT MOTOR BEHAVIOR
IRRITABILITY
DISINHIBITION
APATHY
ELATION
ANXIETY
DEPRESSION
AGITATION
HALLUCINATION
DELUSION
Anam, 2017
0 10 20 30 40 50
Medication Level of Comments Recommendation
Evidence
Donepezil Class IIa, level Modest benefit for cognitive scores, less Donepezil can be used to
A, for pure^ strong evidence for functional improve cognition in VaD
improvement. Doses studied: 5 and 10
VaD mg/day.
Galantamine Class IIa, level Modest benefit in cognitive measures in Galantamine can be used
A For mixed pure VaD. Benefit in both cognition and to improve cognition and
function in mixed dementia. Doses functional abilities in
dementia; studied; titration up to 24 mg/day. mixed dementia
class IIb for (AD+VaD)
Pure VaD
Rivastigmine Class IIa, level Modest benefit on cognitive measures in Rivastigmine can be used
Memantine Afor "pure" VaD pure VaD. Doses studied: 1–4 and 6– to improve cognition in
12mg/day. Modest cognitive benefits VaD. Role of Memantine
only. Doses studied; titration up to 20 in VaD yet to be clarified
mg/day
ARTEMIDA Trial
(A Randomized Trial of Efficacy, 12 Months International Double-Blind Actovegin)
Alla Guekht; Ingmar Skoog; Sally Edmundson; Vladimir Zakharov; Amos D. Korczyn,
Stroke. 2017;48:1262-1270
• Aim to assess benefit of Actovegin in The primary end point: change from
patients who have had an ischemic baseline in ADAS-Cog score
stroke 5-7 days before.
•Patients ≥ 60 years of age with a MOCA
score of ≤ 25 points
Actovegin group:
248 patients (2000mg/day) i.v. infusion
for 7days followed by 1200-mg tablets to
12 months)
3 6 12
Placebo group:
255 patients with standard treatment for
12 months)
ARTEMIDA Trial
Stroke. 2017;48:1262-1270