Stroke-heart syndrome and risk of incident dementia among patients with first-ever ischemic stroke. a territory-wide population-based cohort study

Introduction: The risk of dementia in patients with ischemic stroke and early cardiovascular complications (i.e., stroke-heart syndrome [SHS]) remains underexplored. Methods: Patients with first-ever ischemic stroke in Hong Kong between 2005 and 2020 were included. Multivariable Fine-Gray competing risk analysis was performed after 1:1 propensity score matching to evaluate the association between SHS and the risk of dementia. Results: Of the 130,605 included patients with ischemic stroke, 12,696 (9.7%) patients developed SHS. Patients with SHS had a 19% increased risk of dementia compared to those without SHS at 1 year post-stroke, driven mainly by vascular dementia. This increased risk gradually declined and became non-significant after 3 years post-stroke. Appropriate antithrombotic therapy and comorbidities optimization were associated with a 32% reduced dementia risk in patients with SHS. Discussion: SHS is associated with an increased risk of incident dementia. Appropriate antithrombotic therapy and comorbidities optimization post-stroke may reduce this heightened risk of cognitive impairment. Highlights: Association between stroke-heart syndrome (SHS) and dementia was evaluated in a population-based cohort. Development of SHS associated with a 19% increased 1 year risk of dementia. The increased risk of dementia gradually declined with each year of follow-up. Integrated post-stroke management may reduce this heightened risk of cognitive impairment.