Pharmacological interventions for reducing the risk of cognitive decline and dementia after stroke/transient ischemic attack: A systematic review.
- 1Alzheimer Centre Limburg, Department of Psychiatry and Neuropsychology, Mental Health and Neuroscience Research Institute (MHeNs), Maastricht University, Maastricht, The Netherlands.
- 2Alzheimer Centre Limburg, Department of Psychiatry and Neuropsychology, Mental Health and Neuroscience Research Institute (MHeNs), Maastricht University, Maastricht, The Netherlands. Electronic address: [email protected].
Abstract
Background
Stroke is a leading cause of death and disability worldwide. Advances in stroke care have improved survival and recovery, but it remains unclear whether pharmacological treatments can prevent long-term consequences including cognitive decline and dementia. This systematic review examined whether pharmacological interventions reduce the risk of cognitive decline, mild cognitive impairment (MCI), or dementia in adults with a history of stroke or symptomatic transient ischemic attack (TIA).Methods
We searched Medline, EMBASE, PsychINFO, and Cochrane Central from inception to January 23, 2025, for systematic reviews and meta-analyses of randomized controlled trials (RCTs). Eligible studies included adults with prior stroke or symptomatic TIA receiving pharmacological interventions, blood pressure-lowering, antithrombotic, and lipid-lowering drugs, compared with placebo, no treatment, or usual care. Primary outcomes were incident dementia, MCI, and cognitive decline assessed at least three months post-event. Methodological quality was assessed with AMSTAR 2, and certainty of evidence using GRADE. The protocol was registered in PROSPERO (CRD420251000825).Results
Of 1343 records screened, 8 systematic reviews met inclusion criteria. The most comprehensive systematic review, including all relevant RCTs, was selected for detailed data extraction. Certainty of evidence was mostly low, with a few exceptions of moderate to high certainty. Across drug classes and outcomes, pharmacological interventions generally showed no meaningful reductions in dementia, MCI, and cognitive decline over a mean follow-up of 2.0-4.9 years.Conclusions
Current evidence does not support pharmacological interventions after a cerebrovascular event for reducing risk of cognitive decline, MCI, or dementia. Further high-quality studies with longer follow-ups are needed.
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BibTeX
@article{rosenau2026pharmacological,
title = {{Pharmacological interventions for reducing the risk of cognitive decline and dementia after stroke/transient ischemic attack: A systematic review.}},
author = {Colin Rosenau and Lieke Bakker and Veerle van Gils and Sebastian Köhler and Kay Deckers},
journal = {The journal of prevention of Alzheimer's disease},
year = {2026},
month = oct,
doi = {10.1016/j.tjpad.2026.100680},
url = {https://europepmc.org/article/MED/42863385},
note = {CC BY},
}
RIS
TY - JOUR
TI - Pharmacological interventions for reducing the risk of cognitive decline and dementia after stroke/transient ischemic attack: A systematic review.
AU - Colin Rosenau
AU - Lieke Bakker
AU - Veerle van Gils
AU - Sebastian Köhler
AU - Kay Deckers
PY - 2026
DA - 2026/10/12
JO - The journal of prevention of Alzheimer's disease
DO - 10.1016/j.tjpad.2026.100680
UR - https://europepmc.org/article/MED/42863385
AB - Background Stroke is a leading cause of death and disability worldwide. Advances in stroke care have improved survival and recovery, but it remains unclear whether pharmacological treatments can prevent long-term consequences including cognitive decline and dementia. This systematic review examined whether pharmacological interventions reduce the risk of cognitive decline, mild cognitive impairment (MCI), or dementia in adults with a history of stroke or symptomatic transient ischemic attack (TIA).Methods We searched Medline, EMBASE, PsychINFO, and Cochrane Central from inception to January 23, 2025, for systematic reviews and meta-analyses of randomized controlled trials (RCTs). Eligible studies included adults with prior stroke or symptomatic TIA receiving pharmacological interventions, blood pressure-lowering, antithrombotic, and lipid-lowering drugs, compared with placebo, no treatment, or usual care. Primary outcomes were incident dementia, MCI, and cognitive decline assessed at least three months post-event. Methodological quality was assessed with AMSTAR 2, and certainty of evidence using GRADE. The protocol was registered in PROSPERO (CRD420251000825).Results Of 1343 records screened, 8 systematic reviews met inclusion criteria. The most comprehensive systematic review, including all relevant RCTs, was selected for detailed data extraction. Certainty of evidence was mostly low, with a few exceptions of moderate to high certainty. Across drug classes and outcomes, pharmacological interventions generally showed no meaningful reductions in dementia, MCI, and cognitive decline over a mean follow-up of 2.0-4.9 years.Conclusions Current evidence does not support pharmacological interventions after a cerebrovascular event for reducing risk of cognitive decline, MCI, or dementia. Further high-quality studies with longer follow-ups are needed.
SN - 2426-0266
ER -