Skip to main content

Advertisement

SpringerLink
Log in

Stroke Risk and Vascular Dementia in South Asians

  • Cardiovascular Disease and Stroke (S. Prabhakaran, Section Editor)
  • Published:
Current Atherosclerosis Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

South Asians (SA) are at a higher risk for stroke and vascular dementia due to the disproportionate burden of diabetes, hypertension, and dyslipidemia. This review summarizes the rationale for screening, early detection, and aggressive control of metabolic factors, and critically examines the published literature on primary and secondary stroke prevention.

Recent Findings

South Asians have a higher prevalence of diabetes than non-SA. SA with diabetes are at a higher risk of recurrent ischemic stroke and have a higher incidence of stroke-related dementia compared to non-South Asians.

Summary

South Asians are one of the fastest-growing ethnic groups worldwide with an unusually increased risk of heart disease and stroke. An accurate assessment of those at risk of stroke and cognitive impairment is urgently needed to plan preventive strategies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: •• Of major Importance

  1. Banerjee S, Biram R, Chataway J, Ames D. South Asian strokes: lessons from the St Mary’s stroke database. QJM. 2010;103(1):17–21.

    Article  PubMed  CAS  Google Scholar 

  2. Hsu RT, Ardron ME, Brooks W, Cherry D, Taub NA, Botha JL. The 1996 Leicestershire Community Stroke & Ethnicity Study: differences and similarities between South Asian and white strokes. Int J Epidemiol. 1999;28(5):853–8.

    Article  PubMed  CAS  Google Scholar 

  3. •• Khan NA, Quan H, Hill MD, Pilote L, McAlister FA, Palepu A, et al. Risk factors, quality of care and prognosis in South Asian, East Asian and White patients with stroke. BMC Neurol. 2013;13:74. Using a population-based registry of stroke patients in Ontario, Canada, vascular risk factors and outcomes were examined for stroke patients, comparing South Asians and Whites .

    Article  PubMed  PubMed Central  Google Scholar 

  4. King H, Aubert RE, Herman WH. Global burden of diabetes, 1995-2025: prevalence, numerical estimates, and projections. Diabetes Care. 1998;21(9):1414–31.

    Article  PubMed  CAS  Google Scholar 

  5. Simmons D, Williams DR, Powell MJ. Prevalence of diabetes in a predominantly Asian community: preliminary findings of the Coventry diabetes study. BMJ. 1989;298(6665):18–21.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  6. Gunarathne A, Patel JV, Potluri R, Gammon B, Jessani S, Hughes EA, et al. Increased 5-year mortality in the migrant South Asian stroke patients with diabetes mellitus in the United Kingdom: the West Birmingham stroke project. Int J Clin Pract. 2008;62(2):197–201.

    Article  PubMed  CAS  Google Scholar 

  7. Gunarathne A, Patel JV, Gammon B, Gill PS, Hughes EA, Lip GY. Ischemic stroke in South Asians: a review of the epidemiology, pathophysiology, and ethnicity-related clinical features. Stroke. 2009;40(6):e415–23.

    Article  PubMed  Google Scholar 

  8. Khealani BA, Khan M, Tariq M, Malik A, Siddiqi AI, Awan S, et al. Ischemic strokes in Pakistan: observations from the national acute ischemic stroke database. J Stroke Cerebrovasc Dis. 2014;23(6):1640–7.

    Article  PubMed  Google Scholar 

  9. •• Dhamoon MS, Zhou L, Stamplecoski M, Kapral M, Shah B. Stroke recurrence among south Asians with diabetes in Ontario, Canada. Int J Stroke: Off J Int Stroke Soc. 2016. A large, population-based longitudinal analysis of outcomes after first stroke with diabetes, comparing South Asian ethnicity to others;11:890–7.

    Article  Google Scholar 

  10. Deleu D, Hamad AA, Kamram S, El Siddig A, Al Hail H, Hamdy SM. Ethnic variations in risk factor profile, pattern and recurrence of non-cardioembolic ischemic stroke. Arch Med Res. 2006;37(5):655–62.

    Article  PubMed  Google Scholar 

  11. Hachinski V, Norris JW. Vascular dementia: an obsolete concept. Commentary. Curr Opin Neurol. 1994;7(1):3–4.

    Article  PubMed  CAS  Google Scholar 

  12. O'Brien JT, Erkinjuntti T, Reisberg B, Roman G, Sawada T, Pantoni L, et al. Vascular cognitive impairment. Lancet Neurol. 2003;2(2):89–98.

    Article  PubMed  Google Scholar 

  13. Black S, Gao F, Bilbao J. Understanding white matter disease: imaging-pathological correlations in vascular cognitive impairment. Stroke. 2009;40(3 Suppl):S48–52.

    Article  PubMed  Google Scholar 

  14. Ivan CS, Seshadri S, Beiser A, Au R, Kase CS, Kelly-Hayes M, et al. Dementia after stroke: the Framingham study. Stroke. 2004;35(6):1264–8.

    Article  PubMed  Google Scholar 

  15. Pendlebury ST. Dementia in patients hospitalized with stroke: rates, time course, and clinico-pathologic factors. Int J Stroke. 2012;7(7):570–81.

    Article  PubMed  Google Scholar 

  16. Levine DA, Kabeto M, Langa KM, Lisabeth LD, Rogers MA, Galecki AT. Does stroke contribute to racial differences in cognitive decline? Stroke. 2015;46(7):1897–902.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Prabhakaran S, Wright CB, Yoshita M, Delapaz R, Brown T, DeCarli C, et al. Prevalence and determinants of subclinical brain infarction: the northern Manhattan study. Neurology. 2008;70(6):425–30.

    Article  PubMed  CAS  Google Scholar 

  18. Vermeer SE, Longstreth WT, Koudstaal PJ. Silent brain infarcts: a systematic review. The Lancet Neurology. 2007;6(7):611–9.

    Article  PubMed  Google Scholar 

  19. Vermeer SE, Prins ND, den Heijer T, Hofman A, Koudstaal PJ, Breteler MM. Silent brain infarcts and the risk of dementia and cognitive decline. N Engl J Med. 2003;348(13):1215–22.

    Article  PubMed  Google Scholar 

  20. Prins ND, Scheltens P. White matter hyperintensities, cognitive impairment and dementia: an update. Nat Rev Neurol. 2015;11(3):157–65.

    Article  PubMed  Google Scholar 

  21. Brickman AM, Reitz C, Luchsinger JA, Manly JJ, Schupf N, Muraskin J, et al. Long-term blood pressure fluctuation and cerebrovascular disease in an elderly cohort. Arch Neurol. 2010;67(5):564–9.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Fleischman DA, Yang J, Arfanakis K, Arvanitakis Z, Leurgans SE, Turner AD, et al. Physical activity, motor function, and white matter hyperintensity burden in healthy older adults. Neurology. 2015;84(13):1294–300.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  23. Gouw AA, van der Flier WM, Fazekas F, van Straaten EC, Pantoni L, Poggesi A, et al. Progression of white matter hyperintensities and incidence of new lacunes over a 3-year period: the leukoaraiosis and disability study. Stroke. 2008;39(5):1414–20.

    Article  PubMed  Google Scholar 

  24. Longstreth WT Jr, Arnold AM, Beauchamp NJ Jr, Manolio TA, Lefkowitz D, Jungreis C, et al. Incidence, manifestations, and predictors of worsening white matter on serial cranial magnetic resonance imaging in the elderly: the cardiovascular health study. Stroke. 2005;36(1):56–61.

    Article  PubMed  Google Scholar 

  25. Kanaya AM, Herrington D, Vittinghoff E, Ewing SK, Liu K, Blaha MJ, et al. Understanding the high prevalence of diabetes in U.S. south Asians compared with four racial/ethnic groups: the MASALA and MESA studies. Diabetes Care. 2014;37(6):1621–8.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  26. Gezmu T, Schneider D, Demissie K, Lin Y, Gizzi MS. Risk factors for acute stroke among South Asians compared to other racial/ethnic groups. PLoS One. 2014;9(9):e108901.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  27. Sewdarsen M, Vythilingum S, Jialal I, Becker P. Lipid and lipoprotein abnormalities in South African Indian men with myocardial infarction. Cardiology. 1991;78(4):348–56.

    Article  PubMed  CAS  Google Scholar 

  28. Enas EA. Lipoprotein(a)is an important genetic risk for coronary artery disease in Asian Indians. Am J Cardiol. 2001;88(2):201–2.

    Article  PubMed  CAS  Google Scholar 

  29. Enas EA, Chacko V, Pazhoor SG, Chennikkara H, Devarapalli HP. Dyslipidemia in South Asian patients. Curr Atheroscler Rep. 2007;9(5):367–74.

    Article  PubMed  CAS  Google Scholar 

  30. Jafar TH. Blood pressure, diabetes, and increased dietary salt associated with stroke—results from a community-based study in Pakistan. J Hum Hypertens. 2006;20(1):83–5.

    Article  PubMed  CAS  Google Scholar 

  31. Tuomilehto J, Li N, Dowse G, Gareeboo H, Chitson P, Fareed D, et al. The prevalence of coronary heart disease in the multi-ethnic and high diabetes prevalence population of Mauritius. J Intern Med. 1993;233(2):187–94.

    Article  PubMed  CAS  Google Scholar 

  32. Patel JV, Lim HS, Gunarathne A, Tracey I, Durrington PN, Hughes EA, et al. Ethnic differences in myocardial infarction in patients with hypertension: effects of diabetes mellitus. QJM. 2008;101(3):231–6.

    Article  PubMed  CAS  Google Scholar 

  33. Whisnant JP, Wiebers DO, O'Fallon WM, Sicks JD, Frye RL. A population-based model of risk factors for ischemic stroke: Rochester, Minnesota. Neurology. 1996;47(6):1420–8.

    Article  PubMed  CAS  Google Scholar 

  34. Dalal PM, Dalal KP, Rao SP, et al. Strokes in westcentral: a prospective case-control study of “Risk Factors” (A problem of developing countries). In: Bartko B, ed. Neurology in Europe. London: John Libbey and Co Ltd 1989:16–20.

  35. Banerjee TK, Mukherjee CS, Sarkhel A. Stroke in the urban population of Calcutta—an epidemiological study. Neuroepidemiology. 2001;20(3):201–7.

    Article  PubMed  CAS  Google Scholar 

  36. Das SK, Banerjee TK. Stroke: Indian scenario. Circulation. 2008;118(25):2719–24.

    Article  PubMed  Google Scholar 

  37. Gupta R, Joshi P, Mohan V, Reddy KS, Yusuf S. Epidemiology and causation of coronary heart disease and stroke in India. Heart. 2008;94(1):16–26.

    Article  PubMed  CAS  Google Scholar 

  38. Mateen FJ, Carone M, Alam N, Streatfield PK, Black RE. A population-based case-control study of 1250 stroke deaths in rural Bangladesh. Eur J Neurol. 2012;19(7):999–1006.

    Article  PubMed  CAS  Google Scholar 

  39. Miah AH, Sutradhar SR, Ahmed S, Bhattacharjee M, Alam MK, Bari MA, et al. Seasonal variation in types of stroke and its common risk factors. Mymensingh Med J. 2012;21(1):13–20.

    PubMed  CAS  Google Scholar 

  40. Kaul S, Venketswamy P, Meena AK, Sahay R, Murthy JM. Frequency, clinical features and risk factors of lacunar infarction (data from a stroke registry in South India). Neurol India. 2000;48(2):116–9.

    PubMed  CAS  Google Scholar 

  41. O'Donnell MJ, Xavier D, Liu L, Zhang H, Chin SL, Rao-Melacini P, et al. Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study. Lancet. 2010;376(9735):112–23.

    Article  PubMed  Google Scholar 

  42. Vibha D, Prasad K. Cerebrovascular disease in South Asia—part II: Risk factors and prevention. JRSM Cardiovasc Dis. 2012;1(8) https://doi.org/10.1258/cvd.2012.012026.

  43. Bhopal R, Unwin N, White M, Yallop J, Walker L, Alberti KG, et al. Heterogeneity of coronary heart disease risk factors in Indian, Pakistani, Bangladeshi, and European origin populations: cross sectional study. BMJ. 1999;319(7204):215–20.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  44. Khattar RS, Swales JD, Senior R, Lahiri A. Racial variation in cardiovascular morbidity and mortality in essential hypertension. Heart. 2000;83(3):267–71.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  45. Whitty CJ, Brunner EJ, Shipley MJ, Hemingway H, Marmot MG. Differences in biological risk factors for cardiovascular disease between three ethnic groups in the Whitehall II study. Atherosclerosis. 1999;142(2):279–86.

    Article  PubMed  CAS  Google Scholar 

  46. Gerstein HC, Anand S, Yi QL, Vuksan V, Lonn E, Teo K, et al. The relationship between dysglycemia and atherosclerosis in South Asian, Chinese, and European individuals in Canada: a randomly sampled cross-sectional study. Diabetes Care. 2003;26(1):144–9.

    Article  PubMed  Google Scholar 

  47. Kanaya AM, Wassel CL, Mathur D, Stewart A, Herrington D, Budoff MJ, et al. Prevalence and correlates of diabetes in South Asian Indians in the United States: findings from the metabolic syndrome and atherosclerosis in South Asians living in America study and the multi-ethnic study of atherosclerosis. Metab Syndr Relat Disord. 2010;8(2):157–64.

    Article  PubMed  CAS  Google Scholar 

  48. Kelemen LE, Anand SS, Hegele RA, Stampfer MJ, Rosner B, Willett WC, et al. Associations of plasma homocysteine and the methylenetetrahydrofolate reductase C677T polymorphism with carotid intima media thickness among South Asian, Chinese and European Canadians. Atherosclerosis. 2004;176(2):361–70.

    Article  PubMed  CAS  Google Scholar 

  49. Gunarathne A, Patel JV, Kausar S, Gammon B, Hughes EA, Lip GY. Glycemic status underlies increased arterial stiffness and impaired endothelial function in migrant South Asian stroke survivors compared to European Caucasians: pathophysiological insights from the West Birmingham stroke project. Stroke. 2009;40(7):2298–306.

    Article  PubMed  Google Scholar 

  50. Kain K, Catto AJ, Grant PJ. Clustering of thrombotic factors with insulin resistance in south Asian patients with ischaemic stroke. Thromb Haemost. 2002;88(6):950–3.

    PubMed  CAS  Google Scholar 

  51. Khan M, Rasheed A, Hashmi S, Zaidi M, Murtaza M, Akhtar S, et al. Stroke radiology and distinguishing characteristics of intracranial atherosclerotic disease in native South Asian Pakistanis. Int J Stroke. 2013;8(Suppl A100):14–20.

    Article  PubMed  Google Scholar 

  52. Moussouttas M, Aguilar L, Fuentes K, Anyanwu B, Manassarians H, Papamitsakis N, et al. Cerebrovascular disease among patients from the Indian subcontinent. Neurology. 2006;67(5):894–6.

    Article  PubMed  CAS  Google Scholar 

  53. Kaul S, Alladi S, Jabeen SA, Bandaru VS, Ankem U, Mekala S, et al. Intracranial large artery disease is the most common stroke sybtype: Hyderabad Stroke Registry (India). Ann Indian Acad Neurol. 2018 (In Press).

  54. De Silva DA, Woon FP, Lee MP, Chen CP, Chang HM, Wong MC. South Asian patients with ischemic stroke: intracranial large arteries are the predominant site of disease. Stroke. 2007;38(9):2592–4.

    Article  PubMed  Google Scholar 

  55. Razzaq AA, Khan BA, Baig SM. Ischemic stroke in young adults of South Asia. J Pak Med Assoc. 2002;52(9):417–22.

    PubMed  CAS  Google Scholar 

  56. Kulshreshtha A, Anderson LM, Goyal A, Keenan NL. Stroke in South Asia: a systematic review of epidemiologic literature from 1980 to 2010. Neuroepidemiology. 2012;38(3):123–9.

    Article  PubMed  Google Scholar 

  57. Pandian JD, Singh G, Bansal R, Paul BS, Singla M, Singh S, et al. Establishment of population-based stroke registry in Ludhiana city, Northwest India: feasibility and methodology. Neuroepidemiology. 2015;44(2):69–77.

    Article  PubMed  Google Scholar 

  58. Hashmi M, Khan M, Wasay M. Growing burden of stroke in Pakistan: a review of progress and limitations. Int J Stroke. 2013;8(7):575–81.

    Article  PubMed  Google Scholar 

  59. Biswas M, Sen S, Simmons J. Etiology and risk factors of ischemic stroke in Indian-American patients from a hospital-based registry in New Jersey, USA. Neurology Asia. 2009;14(2):81–6.

    Google Scholar 

  60. Palaniappan L, Wang Y, Fortmann SP. Coronary heart disease mortality for six ethnic groups in California, 1990–2000. Ann Epidemiol. 2004;14(7):499–506.

    Article  PubMed  Google Scholar 

  61. Rafnsson SB, Bhopal RS, Agyemang C, Fagot-Campagna A, Harding S, Hammar N, et al. Sizable variations in circulatory disease mortality by region and country of birth in six European countries. Eur J Pub Health. 2013;23(4):594–605.

    Article  Google Scholar 

  62. Wild SH, Fischbacher C, Brock A, Griffiths C, Bhopal R. Mortality from all causes and circulatory disease by country of birth in England and Wales 2001-2003. J Public Health (Oxf). 2007;29(2):191–8.

    Article  CAS  Google Scholar 

  63. Bos V, Kunst AE, Keij-Deerenberg IM, Garssen J, Mackenbach JP. Ethnic inequalities in age- and cause-specific mortality in the Netherlands. Int J Epidemiol. 2004;33(5):1112–9.

    Article  PubMed  Google Scholar 

  64. Fischbacher CM, Steiner M, Bhopal R, Chalmers J, Jamieson J, Knowles D, et al. Variations in all cause and cardiovascular mortality by country of birth in Scotland, 1997–2003. Scott Med J. 2007;52(4):5–10.

    Article  PubMed  CAS  Google Scholar 

  65. Dalal PM, Malik S, Bhattacharjee M, Trivedi ND, Vairale J, Bhat P, et al. Population-based stroke survey in Mumbai, India: incidence and 28-day case fatality. Neuroepidemiology. 2008;31(4):254–61.

    Article  PubMed  CAS  Google Scholar 

  66. Das S, Paul N, Hazra A, Ghosal M, Ray BK, Banerjee TK, et al. Cognitive dysfunction in stroke survivors: a community-based prospective study from Kolkata, India. J Stroke Cerebrovasc Dis. 2013;22(8):1233–42.

    Article  PubMed  Google Scholar 

  67. Das SK, Banerjee TK, Biswas A, Roy T, Raut DK, Mukherjee CS, et al. A prospective community-based study of stroke in Kolkata, India. Stroke. 2007;38(3):906–10.

    Article  PubMed  Google Scholar 

  68. Ray BK, Hazra A, Ghosal M, Banerjee T, Chaudhuri A, Singh V, et al. Early and delayed fatality of stroke in Kolkata, India: results from a 7-year longitudinal population-based study. J Stroke Cerebrovasc Dis. 2013;22(4):281–9.

    Article  PubMed  Google Scholar 

  69. Kalaria RN, Maestre GE, Arizaga R, Friedland RP, Galasko D, Hall K, et al. Alzheimer's disease and vascular dementia in developing countries: prevalence, management, and risk factors. Lancet Neurol. 2008;7(9):812–26.

    Article  PubMed  PubMed Central  Google Scholar 

  70. Pendlebury ST, Rothwell PM. Prevalence, incidence, and factors associated with pre-stroke and post-stroke dementia: a systematic review and meta-analysis. Lancet Neurol. 2009;8(11):1006–18.

    Article  PubMed  Google Scholar 

  71. Pohjasvaara T, Erkinjuntti T, Vataja R, Kaste M. Dementia three months after stroke. Baseline frequency and effect of different definitions of dementia in the Helsinki stroke aging memory study (SAM) cohort. Stroke. 1997;28(4):785–92.

    Article  PubMed  CAS  Google Scholar 

  72. Tatemichi TK, Desmond DW, Mayeux R, Paik M, Stern Y, Sano M, et al. Dementia after stroke: baseline frequency, risks, and clinical features in a hospitalized cohort. Neurology. 1992;42(6):1185–93.

    Article  PubMed  CAS  Google Scholar 

  73. Chaya S, Alladi S, Santhoshi CH, Shailaja M, Kaul S. Progression of cognitive impairment after stroke: A hospital based longitudinal study from a Memory clinic and Stroke registry. 4th Annual conference of Indian Stroke Association, Hyderabad. 2009.

  74. Pasture O, Onkia O. Canadian Study of Health and Aging: study methods and prevalence of dementia. CMAJ. 1994;150(6):899–913.

  75. Shaji S, Bose S, Verghese A. Prevalence of dementia in an urban population in Kerala, India. Br J Psychiatry. 2005;186:136–40.

    Article  PubMed  CAS  Google Scholar 

  76. Sahadevan S, Saw SM, Gao W, Tan LC, Chin JJ, Hong CY, et al. Ethnic differences in Singapore’s dementia prevalence: the stroke, Parkinson's disease, epilepsy, and dementia in Singapore study. J Am Geriatr Soc. 2008;56(11):2061–8.

    Article  PubMed  Google Scholar 

  77. •• Alladi S, Kaul S, Meena AK, Somayajula S, Umadevi M, Reddy JM. Pattern of vascular dementia in India: study of clinical features, imaging, and vascular mechanisms from a hospital dementia registry. J Stroke Cerebrovasc Dis. 2006;15(2):49–56. A study from a dementia registry in India with clinical features and imaging characteristics of vascular dementia

    Article  PubMed  Google Scholar 

  78. de Silva HA, Gunatilake SB, Smith AD. Prevalence of dementia in a semi-urban population in Sri Lanka: report from a regional survey. Int J Geriatr Psychiatry. 2003;18(8):711–5.

    Article  PubMed  Google Scholar 

  79. Feldman H, Levy AR, Hsiung GY, Peters KR, Donald A, Black SE, et al. A Canadian cohort study of cognitive impairment and related dementias (ACCORD): study methods and baseline results. Neuroepidemiology. 2003;22(5):265–74.

    Article  PubMed  CAS  Google Scholar 

  80. Islam MN, Moniruzzaman M, Khalil MI, Basri R, Alam MK, Loo KW, et al. Burden of stroke in Bangladesh. Int J Stroke. 2013;8(3):211–3.

    Article  PubMed  Google Scholar 

  81. Brun A. Pathology and pathophysiology of cerebrovascular dementia: pure subgroups of obstructive and hypoperfusive etiology. Dementia. 1994;5(3–4):145–7.

    PubMed  CAS  Google Scholar 

  82. Alladi S, Kaul S, Meena AK, Somayajula S, Umadevi M, Reddy JM. Pattern of vascular dementia in India: study of clinical features, imaging, and vascular mechanisms from a hospital dementia registry. J Stroke Cerebrovasc Dis. 2006;15(2):49–56.

    Article  PubMed  Google Scholar 

  83. Bandyopadhyay TK, Biswas A, Roy A, Guin DS, Gangopadhyay G, Sarkhel S, et al. Neuropsychiatric profiles in patients with Alzheimer's disease and vascular dementia. Ann Indian Acad Neurol. 2014;17(3):325–30.

    Article  PubMed  PubMed Central  Google Scholar 

  84. Alladi SIG, Dutt A, Ellajosyula R, Ghosh A, Nehra A, et al. Harmonizing research in vascular cognitive impairment across educational levels and languages. Ann Indian Acad Neurol. 2015;18(2):S18–S 40.

    Google Scholar 

  85. Hachinski V, Iadecola C, Petersen RC, Breteler MM, Nyenhuis DL, Black SE, et al. National Institute of Neurological Disorders and Stroke-Canadian stroke network vascular cognitive impairment harmonization standards. Stroke. 2006;37(9):2220–41.

    Article  PubMed  Google Scholar 

  86. Alladi S, Kaul S, Mekala S. Vascular cognitive impairment: current concepts and Indian perspective. Ann Indian Acad Neurol. 2010;13(Suppl 2):S104–8.

    Article  PubMed  PubMed Central  Google Scholar 

  87. Chaudhari TS, Verma R, Garg RK, Singh MK, Malhotra HS, Sharma PK. Clinico-radiological predictors of vascular cognitive impairment (VCI) in patients with stroke: a prospective observational study. J Neurol Sci. 2014;340(1–2):150–8.

    Article  PubMed  Google Scholar 

  88. Sundar U, Adwani S. Post-stroke cognitive impairment at 3 months. Ann Indian Acad Neurol. 2010;13(1):42–6.

    Article  PubMed  PubMed Central  Google Scholar 

  89. Debette S, Seshadri S, Beiser A, Au R, Himali JJ, Palumbo C, et al. Midlife vascular risk factor exposure accelerates structural brain aging and cognitive decline. Neurology. 2011;77(5):461–8.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  90. Afzal S, Bojesen SE, Nordestgaard BG. Reduced 25-hydroxyvitamin D and risk of Alzheimer's disease and vascular dementia. Alzheimers Dement. 2014;10(3):296–302.

    Article  PubMed  Google Scholar 

  91. de Lau LM, Smith AD, Refsum H, Johnston C, Breteler MM. Plasma vitamin B12 status and cerebral white-matter lesions. J Neurol Neurosurg Psychiatry. 2009;80(2):149–57.

    Article  PubMed  Google Scholar 

  92. Prabhakar P, Chandra SR, Supriya M, Issac TG, Prasad C, Christopher R. Vitamin D status and vascular dementia due to cerebral small vessel disease in the elderly Asian Indian population. J Neurol Sci. 2015;359(1–2):108–11.

    Article  PubMed  CAS  Google Scholar 

  93. Ray L, Khemka VK, Behera P, Bandyopadhyay K, Pal S, Pal K, et al. Serum homocysteine, dehydroepiandrosterone sulphate and lipoprotein (a) in Alzheimer’s disease and vascular dementia. Aging Dis. 2013;4(2):57–64.

    PubMed  PubMed Central  Google Scholar 

  94. Rosenberg GA, Bjerke M, Wallin A. Multimodal markers of inflammation in the subcortical ischemic vascular disease type of vascular cognitive impairment. Stroke. 2014;45(5):1531–8.

    Article  PubMed  PubMed Central  Google Scholar 

  95. Seshadri S, Wolf PA, Beiser AS, Selhub J, Au R, Jacques PF, et al. Association of plasma total homocysteine levels with subclinical brain injury: cerebral volumes, white matter hyperintensity, and silent brain infarcts at volumetric magnetic resonance imaging in the Framingham offspring study. Arch Neurol. 2008;65(5):642–9.

    Article  PubMed  PubMed Central  Google Scholar 

  96. Paternoster L, Chen W, Sudlow CL. Genetic determinants of white matter hyperintensities on brain scans: a systematic assessment of 19 candidate gene polymorphisms in 46 studies in 19,000 subjects. Stroke. 2009;40(6):2020–6.

    Article  PubMed  Google Scholar 

  97. Schmidt H, Freudenberger P, Seiler S, Schmidt R. Genetics of subcortical vascular dementia. Exp Gerontol. 2012;47(11):873–7.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  98. Mansoori N, Tripathi M, Alam R, Luthra K, Ramakrishnan L, Parveen S, et al. IL-6-174 G/C and ApoE gene polymorphisms in Alzheimer’s and vascular dementia patients attending the cognitive disorder clinic of the all India Institute of Medical Sciences, New Delhi. Dement Geriatr Cogn Disord. 2010;30(6):461–8.

    Article  PubMed  CAS  Google Scholar 

  99. Mansoori N, Tripathi M, Luthra K, Alam R, Lakshmy R, Sharma S, et al. MTHFR (677 and 1298) and IL-6-174 G/C genes in pathogenesis of Alzheimer's and vascular dementia and their epistatic interaction. Neurobiol Aging. 2012;33(5):1003. e1–8

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurology, University of California, San Francisco, San Francisco, CA, USA

    Vineeta Singh

  2. San Francisco General Hospital, University of California, San Francisco, Building 1, Room 101, 1001 Potrero Avenue, San Francisco, CA, 94110, USA

    Vineeta Singh

  3. Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Mandip S. Dhamoon

  4. Department of Neurology, National Institute for Mental Health and Neurosciences, Bangalore, Karnataka, India

    Suvarna Alladi

Authors
  1. Vineeta Singh
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mandip S. Dhamoon
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Suvarna Alladi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Vineeta Singh.

Ethics declarations

Conflict of Interest

Vineeta Singh, Mandip S Dhamoon, and Suvarna Alladi declare no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Topical Collection on Cardiovascular Disease and Stroke

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Singh, V., Dhamoon, M.S. & Alladi, S. Stroke Risk and Vascular Dementia in South Asians. Curr Atheroscler Rep 20, 43 (2018). https://doi.org/10.1007/s11883-018-0745-7

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11883-018-0745-7

Keywords

Search

Navigation