ABSTRACT
Specific medical management focuses on the prevention of further cerebral damage. Most of the interventions discussed here have other benefits than purely on the outcome of cerebral damage. These include various vascular outcomes, particularly cardiac disease. Cerebrovascular disease is a marker for poor vascular health and there is now increasing evidence that these patients benefit from aggressive treatment, more so than those asymptomatic individuals who share similar magnitude of risk factors. This may be particularly so for patients with cerebrovascular disease and dementia. A study by Tatemichi et al (1994) demonstrated that the mortality rate was 19 deaths per 100 person-years for people who had a stroke that was complicated by dementia, compared to 6.9 deaths per hundred person-years who had a stroke which was uncomplicated by dementia. The relative risk for death associated with dementia was 3.9 (95% CI 1.8, 5.4). As well as mortality, dementia after stroke increases the risk of long term stroke recurrence (Moroney et al, 1997) with a relative risk of 2.7 (95% CI 1.4, 5.4) for recurrent stroke in those individuals who had dementia following their initial stroke.
