Stroke dan Demensia: Koneksi Vaskular, Mekanisme Biologis, dan Penanganan Klinis
Keywords:
stroke, demensia, koneksi vaskular, obstructive sleep apneaSynopsis
Gangguan tidur yang dikenal dengan Obstructive Sleep Apnea (OSA) sering dianggap remeh, hanya dipandang sebagai masalah mendengkur atau rasa lelah yang tidak kunjung hilang. Padahal, dalam bidang kesehatan saraf dan pembuluh darah, OSA memiliki hubungan yang sangat erat dengan penyakit stroke. Hubungan ini bersifat timbal balik. OSA dapat meningkatkan risiko seseorang mengalami stroke, sementara stroke itu sendiri bisa memperburuk atau bahkan memunculkan OSA pada orang yang sebelumnya tidak mengalaminya. OSA terjadi ketika saluran napas bagian atas mengalami penyumbatan berulang selama tidur. Akibatnya, pernapasan berhenti sesaat dan tubuh kekurangan oksigen. Kondisi ini bukan hanya mengganggu kualitas tidur, tetapi juga menimbulkan tekanan besar pada sistem pembuluh darah dan otak. Jika tidak ditangani, OSA dapat menimbulkan lingkaran masalah yang berbahaya. Risiko stroke akan meningkat, dan setelah stroke gangguan tidur ini bisa semakin parah. Memahami hubungan timbal balik ini sangat penting. OSA merupakan salah satu faktor risiko stroke yang paling sering ditemui. Sayangnya, banyak kasus OSA yang tidak terdeteksi atau tidak ditangani dengan baik dalam praktik sehari-hari. Akibatnya, pasien kehilangan kesempatan untuk mencegah komplikasi serius yang sebenarnya bisa dihindari dengan diagnosis dan terapi yang tepat.
References
Abbadessa, G., Brigo, F., Clerico, M., De Mercanti, S., Trojsi, F., Tedeschi, G., et al. (2021). Digital therapeutics in neurology. Journal of Neurology, 269, 1209–1224. [https://doi.org/10.1007/s00415-021-10608-4]
Abbott, A. L., Silvestrini, M., Topakian, R., Golledge, J., Brunser, A. M., de Borst, G. J., et al. (2017). Optimizing the definitions of stroke, transient ischemic attack, and infarction for research and application in clinical practice. Frontiers in Neurology, 8, 537. [https://doi.org/10.3389/fneur.2017.00537]
Aderinto, N., Abraham, I. C., Ukoaka, B. M., Moradeyo, A., Udam, N. G., Aboje, J. E.,et al. (2025). Emerging role of gene therapy in stroke recovery. Brain Network Disorders, 1, 100010. [https://doi.org/10.1016/j.bnd.2025.03.002]
Adeoye, O., Nyström, K. V., Yavagal, D. R., Luciano, J., Nogueira, R. G., Zorowitz, R. D.,et al. (2019). Recommendations for the establishment of stroke systems of care: A 2019 update. Stroke, 50(7), e187–e210. [https://doi.org/10.1161/STR.0000000000000173]
Affandi, I. G., Gunadharma, S., Ong, A. (2020). Faktor yang memengaruhi kejadian epilepsi pascastroke di RSUP Dr. Hasan Sadikin. Neurona, 37(2), 107–114. [https://doi.org/10.52386/neurona.v37i2.112]
Aiyagari, V., Gorelick, P. B. (2009). Management of blood pressure for acute and recurrent stroke. Stroke, 40(6), 2251–2256.[https://doi.org/10.1161/STROKEAHA.108.531574]
Ali, I., Bhatti, R. (2025). Effectiveness of physiotherapy in post-stroke rehabilitation. Journal of Pharma and Biomedics, 3(2), 141–151.
American Stroke Association. (2021). Stroke and pseudobulbar affect. American Heart Association. [https://www.stroke.org/en/about-stroke/effects-of-stroke/emotional-effects-of-stroke/pseudobulbar-affect]
Auriat, A. M., Neva, J. L., Peters, S., Ferris, J. K., Boyd, L. A. (2015). A review of transcranial magnetic stimulation and multimodal neuroimaging to characterize post-stroke neuroplasticity. Frontiers in Neurology, 6, 226. [https://doi.org/10.3389/fneur.2015.00226]
Beez, T., Munoz-Bendix, C., Steiger, H.-J., Beseoglu, K. (2019). Decompressive craniectomy for acute ischemic stroke. Critical Care, 23(1), 209. [https://doi.org/10.1186/s13054-019-2490-x]
Bernhardt, J., English, C., Johnson, L., Cumming, T. B. (2015). Early mobilization after stroke: Early adoption but limited evidence. Stroke, 46(4), 1141–1146. [https://doi.org/10.1161/STROKEAHA.114.007434]
Biesbroek, J. M., Biessels, G. J. (2023). Diagnosing vascular cognitive impairment: Current challenges and future perspectives. International Journal of Stroke, 18(1), 36–43. [https://doi.org/10.1177/17474930211073387]
Binning, L., Basquill, C., Tvrda, L., Quinn, T. (2025). Epidemiology and outcomes associated with cognitive frailty and reserve in a stroke population: Systematic review and meta-analysis. Cerebrovascular Diseases, 54(4), 536–547. [https://doi.org/10.1159/000541670]
Bonaz, B., Bazin, T., Pellissier, S. (2018). The vagus nerve at the interface of the microbiota-gut-brain axis. Frontiers in Neuroscience, 12, 49. [https://doi.org/10.3389/fnins.2018.00049]
Bonkhoff, A. K., Grefkes, C. (2022). Precision medicine in stroke: Towards personalized outcome predictions using artificial intelligence. Brain, 145(2), 457–475. [https://doi.org/10.1093/brain/awab439]
Booth, J., Connelly, L., Lawrence, M., Chalmers, C., Joice, S., Becker, C., Dougall, N. (2015). Evidence of perceived psychosocial stress as a risk factor for stroke in adults: A meta-analysis. BMC Neurology, 15(1), 233. [https://doi.org/10.1186/s12883-015-0456-4]
Braley, M., Pierce, J. S., Saxena, S., De Oliveira, E., Taraboanta, L., Anantha, V., et al. (2021). A virtual, randomized, control trial of a digital therapeutic for speech, language, and cognitive intervention in post-stroke persons with aphasia. Frontiers in Neurology, 12, 626780. [https://doi.org/10.3389/fneur.2021.626780]
Brinjikji, W., Mereuta, O. M., Dai, D., Kallmes, D. F., Savastano, L., Liu, Y.,et al. (2021). Mechanisms of fibrinolysis resistance and potential targets for thrombolysis in acute ischaemic stroke: Lessons from retrieved stroke emboli. Stroke and Vascular Neurology, 6(4), e001032. [https://doi.org/10.1136/svn-2021-001032]
Cavallini, A., Micieli, G., Marcheselli, S., Quaglini, S. (2003). Role of monitoring in management of acute ischemic stroke patients. Stroke, 34(11), 2637–2641. [https://doi.org/10.1161/01.STR.0000094423.34841.BB]
Chandra, I., Ketaren, R. J., Pardede, I. M. (2019). Patent foramen ovale pada stroke kriptogenik: Sebuah laporan kasus. Siloam Hospitals Lippo Village.
Chen, X., Zhao, X., Xu, F., Guo, M., Yang, Y., Zhong, L., et al. (2022). A systematic review and meta-analysis comparing FAST and BEFAST in acute stroke patients. Frontiers in Neurology, 12, 765069. [https://doi.org/10.3389/fneur.2021.765069]
Chen, Y., Shen, F., Liu, J., Yang, G. Y. (2017). Arterial stiffness and stroke: De-stiffening strategy, a therapeutic target for stroke. Stroke and Vascular Neurology, 2, e000045. [https://doi.org/10.1136/svn-2016-000045]
Cherian, L., Wang, Y., Fakuda, K., Leurgans, S., Aggarwal, N., Morris, M. (2019). Mediterranean-Dash Intervention for Neurodegenerative Delay (MIND) diet slows cognitive decline after stroke. The Journal of Prevention of Alzheimer's Disease, 6(4), 267–273. [https://doi.org/10.14283/jpad.2019.28]
Choi, M. J., Kim, H., Nah, H. W., Kang, D. W. (2019). Digital therapeutics: Emerging new therapy for neurologic deficits after stroke. Journal of Stroke, 21(3), 242–258. [https://doi.org/10.5853/jos.2019.01963]
Choi, S. E., Sagris, D., Hill, A., Lip, G. Y., Abdul-Rahim, A. H. (2023). Atrial fibrillation and stroke. Expert Review of Cardiovascular Therapy, 21(1), 35–56. [https://doi.org/10.1080/14779072.2023.2160319]
Ciccone, A., Celani, M. G., Chiaramonte, R., Rossi, C., Righetti, E. (2013). Continuous versus intermittent physiological monitoring for acute stroke. Cochrane Database of Systematic Reviews, 2013(5). [https://doi.org/10.1002/14651858.CD008444.pub2]
Craig, A. J., Housley, G. D. (2016). Evaluation of gene therapy as an intervention strategy to treat brain injury from stroke. Frontiers in Molecular Neuroscience, 9, 34. [https://doi.org/10.3389/fnmol.2016.00034]
Crayton, E., Fahey, M., Ashworth, M., Besser, S. J., Weinman, J., Wright, A. J. (2017). Psychological determinants of medication adherence in stroke survivors: A systematic review of observational studies. Annals of Behavioral Medicine, 51(6), 833–845. [https://doi.org/10.1007/s12160-017-9906-0]
Debette, S., Paré, G. (2024). Stroke genetics, genomics, and precision medicine. Stroke, 55(2), 331–341. [https://doi.org/10.1161/STROKEAHA.123.044212]
del Zoppo, G. J. (2010). The neurovascular unit in the setting of stroke. Journal of Internal Medicine, 267(2), 156–171. [https://doi.org/10.1111/j.1365-2796.2009.02199.x]
Demaerschalk, B. M., Kleindorfer, D. O., Adeoye, O. M., Demchuk, A. M., Fugate, J. E., Grotta, J. C., et al. (2016). Scientific rationale for the inclusion and exclusion criteria for intravenous alteplase in acute ischemic stroke: A statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 47(2), 581–641. [https://doi.org/10.1161/STR.0000000000000086]
Denno, P., Zhao, S., Husain, M., Hampshire, A. (2025). Defining brain fog across medical conditions. Trends in Neurosciences. Advance online publication. [https://doi.org/10.1016/j.tins.2025.01.003]
Desmond, D. W., Moroney, J. T., Lynch, T., Chan, S., Chin, S. S., Mohr, J. P. (1999). The natural history of CADASIL: A pooled analysis of previously published cases. Stroke, 30(6), 1230–1233. [https://doi.org/10.1161/01.STR.30.6.1230]
Dharmakulaseelan, L., Boulos, M. I. (2024). Sleep apnea and stroke: A narrative review. CHEST, 165(1), 211–221. [https://doi.org/10.1016/j.chest.2024.04.028]
Dina, N. A., Sharmin, S., Kamal, T., Sarker, S. (2022). Impact of constraint-induced movement therapy (CIMT) on upper limb motor functions of post stroke survivors. Journal of Orthopaedics and Sports Medicine, 5(1), 62–69. [https://doi.org/10.26502/josm.511500080]
Dorsch, S., Elkins, M. R. (2020). Repetitions and dose in stroke rehabilitation. Journal of Physiotherapy, 66(4), 211–212. [https://doi.org/10.1016/j.jphys.2020.04.001]
Douven, E., Köhler, S., Rodriguez, M. M. F., Staals, J., Verhey, F. R. J., Aalten, P. (2017). Imaging markers of post-stroke depression and apathy: A systematic review and meta-analysis. Neuropsychology Review, 27(3), 202–219. [https://doi.org/10.1007/s11065-017-9356-2]
Dromerick, A. W., Geed, S., Barth, J., Brady, K., Giannetti, M. L., Mitchell, A., et al. (2021). Critical Period After Stroke Study (CPASS): A phase II clinical trial testing an optimal time for motor recovery after stroke in humans. Proceedings of the National Academy of Sciences, 118(39), e2026676118. [https://doi.org/10.1073/pnas.2026676118]
Durgan, D. J., Lee, J., McCullough, L. D., & Bryan, R. M., Jr. (2019). Examining the role of the microbiota-gut-brain axis in stroke. Stroke, 50(9), 2270–2277. [https://doi.org/10.1161/STROKEAHA.119.025140]
Familah, A., Arifin, A. F., Muchsin, A. H., Rachman, M. E., Dahliah. (2024). Karakteristik penderita stroke iskemik dan stroke hemoragik. Fakumi Medical Journal, 4(6). [https://doi.org/10.33096/fmj.v4i6.468]
Faraco, G., Iadecola, C. (2013). Hypertension: A harbinger of stroke and dementia. Hypertension, 62(5), 810–817. [https://doi.org/10.1161/HYPERTENSIONAHA.113.01063]
Feigin, V. L. (2005). Stroke epidemiology in the developing world. The Lancet, 365(9478), 2160–2161. [https://doi.org/10.1016/S0140-6736(05)66755-4]
Filley, C. M. (2022). White matter dementia then… and now. Frontiers in Neurology, 13, 1043583. [https://doi.org/10.3389/fneur.2022.1043583]
Fisher, C. M. (1982). Pure sensory stroke and allied conditions. Stroke, 13(4), 434–447. [https://doi.org/10.1161/01.str.13.4.434]
Flamand, M. N., Tegowski, M., Meyer, K. D. (2023). The proteins of mRNA modification: Writers, readers, and erasers. Annual Review of Biochemistry, 92, 145–173. [https://doi.org/10.1146/annurev-biochem-052521-035330]
Ganti, L., Mirajkar, A., Banerjee, P., Stead, T., Hanna, A., Tsau, J., et al. (2023). Impact of emergency department arrival time on door-to-needle time in patients with acute stroke. Frontiers in Neurology, 14, 1126472. [https://doi.org/10.3389/fneur.2023.1126472]
Gorelick, P. B. (2004). Risk factors for vascular dementia and Alzheimer disease. Stroke, 35(Suppl 1), 2620–2622. [https://doi.org/10.1161/01.STR.0000143318.70292.47]
Grønberg, N. V., Johansen, F. F., Kristiansen, U., Hasseldam, H. (2013). Leukocyte infiltration in experimental stroke. Journal of Neuroinflammation, 10, 115. [https://doi.org/10.1186/1742-2094-10-115]
Haiga, Y., Yulson, Chaniago, R. S. (2024). Demensia. Scientific Journal, 3(5), 283–291. [https://doi.org/10.56260/sciena.v3i5.158]
Haller, S., Jäger, H. R., Vernooij, M. W., Barkhof, F. (2023). Neuroimaging in dementia: More than typical Alzheimer disease. Radiology, 307(5), e223234. [https://doi.org/10.1148/radiol.230173]
Hama, S., Yamashita, H., Yamawaki, S., Kurisu, K. (2011). Post-stroke depression and apathy: Interactions between functional recovery, lesion location, and emotional response. Psychogeriatrics, 11(2), 68–76. [https://doi.org/10.1111/j.1479-8301.2011.00358.x]
Heiss, W.-D., Zaro Weber, O. (2017). Validation of MRI determination of the penumbra by PET measurements in ischemic stroke. Journal of Nuclear Medicine, 58(12), 1871–1877. [https://doi.org/10.2967/jnumed.116.185975]
Hidayat, A., Liswati, E., Sari, N., Kurniawati, D. (2021). Stroke ischemic: Understanding the pathophysiology, preventive diagnosis, treatment, & future perspective. International Journal of Molecular Sciences, 21(20), 7609. [https://doi.org/10.3390/ijms21207609]
Hinman, J. D., Rost, N. S., Leung, T. W., Montaner, J., Muir, K. W., Brown, S., et al. (2017). Principles of precision medicine in stroke. Journal of Neurology, Neurosurgery & Psychiatry, 88(1), 54–61. [https://doi.org/10.1136/jnnp-2016-314587]
Hwang, Y. K., Oh, J. S. (2025). Interaction of the vagus nerve and serotonin in the gut-brain axis. International Journal of Molecular Sciences, 26(3), 1160. [https://doi.org/10.3390/ijms26031160]
Inoue, Y., Shue, F., Bu, G., Kanekiyo, T. (2023). Pathophysiology and probable etiology of cerebral small vessel disease in vascular dementia and Alzheimer's disease. Molecular Neurodegeneration, 18, 46. [https://doi.org/10.1186/s13024-023-00640-5]
Jadhav, A. P., Desai, S. M., Jovin, T. G. (2021). Indications for mechanical thrombectomy for acute ischemic stroke: Current guidelines and beyond. Neurology, 97(20, Suppl. 2), S126–S136. [https://doi.org/10.1212/WNL.0000000000012801]
Jankowska, A., Hadław-Klimaszewska, O., Rakoczy, J., Woldańska-Okońska, M., Irzmański, R. (2024). The impact of rehabilitation on the recovery of executive functions in stroke patients with different location of the ischemic focus. International Journal of Occupational Medicine and Environmental Health, 37(4), 452–467. [https://doi.org/10.13075/ijomeh.1896.02129]
Jiang, C. T., Wu, W. F., Deng, Y. H., Ge, J. W. (2020). Modulators of microglia activation and polarization in ischemic stroke (Review). Molecular Medicine Reports, 21(5), 2006–2018. [https://doi.org/10.3892/mmr.2020.11003]
Karatas, A., Yilmaz, H., Coban, G., Koker, M., Uz, A. (2015). The anatomy of circulus arteriosus cerebri (Circle of Willis): A study in Turkish population. Turkish Neurosurgery, 25(4), 545–550. [https://doi.org/10.5137/1019-5149.JTN.13281-14.1]
Kim, D., Gagolewicz, P., McQueen, S., Latour, H., Tresidder, K., Jarvis, C. R., Andrew, R. D. (2024). Simulated ischemia in live cerebral slices is mimicked by opening the Na⁺/K⁺ pump: Clues to the generation of spreading depolarization. Journal of Neurophysiology, 131(1), 1–15. [https://doi.org/10.1152/jn.00429.2024]
Kim, D. C., Park, J., Kim, M. W. (2025). Systematic review of the treatment of anosognosia for hemiplegia in stroke. Brain Sciences, 15(9), 906. [https://doi.org/10.3390/brainsci15090906]
Kim, J., Han, K. D., Lee, J. Y., Yang, Y. S., Cheon, D. Y., Lee, J. J., Lee, M. (2025). Diabetes status, duration, and risk of dementia among ischemic stroke patients. Alzheimer's Research & Therapy, 17(1), 58. [https://doi.org/10.1186/s13195-025-01708-8]
Kotlęga, D., Gołąb-Janowska, M., Masztalewicz, M., Ciećwież, S., Nowacki, P. (2016). The emotional stress and risk of ischemic stroke. Neurologia i Neurochirurgia Polska, 50(4), 265–270. [https://doi.org/10.1016/j.pjnns.2016.03.006]
Kuang, H., Menon, B. K., Qiu, W. (2019). Segmenting hemorrhagic and ischemic infarct simultaneously from follow-up non-contrast CT images in patients with acute ischemic stroke. IEEE Access, 7, 39842–39851. [https://doi.org/10.1109/ACCESS.2019.2906605]
Lacy, C. R., Suh, D. C., Bueno, M., Kostis, J. B. (2001). Delay in presentation and evaluation for acute stroke: Stroke Time Registry for Outcomes Knowledge and Epidemiology (S.T.R.O.K.E.). Stroke, 32(1), 63–69. [https://doi.org/10.1161/01.STR.32.1.63]
Langhorne, P., Coupar, F., Pollock, A. (2009). Motor recovery after stroke: A systematic review. The Lancet Neurology, 8(8), 741–754. [https://doi.org/10.1016/S1474-4422(09)70150-4]
Lapchak, P. A. (2015). Neuronal dysregulation in stroke-associated pseudobulbar affect (PBA): Diagnostic scales and current treatment options. Journal of Neurology and Neurophysiology, 6(5), Article 1000323. [https://doi.org/10.4172/2155-9562.1000323]
Lawes, C. M. M., Bennett, D. A., Feigin, V. L., Rodgers, A. (2004). Blood pressure and stroke: An overview of published reviews. Stroke, 35(4), 776–785. [https://doi.org/10.1161/01.STR.0000116869.64771.5A]
Lee, H. (2014). Isolated vascular vertigo. Journal of Stroke, 16(3), 124–130. [https://doi.org/10.5853/jos.2014.16.3.124]
Legg, L. A., Lewis, S. R., Schofield-Robinson, O. J., Drummond, A., Langhorne, P. (2023). Occupational therapy for adults with problems in activities of daily living after stroke. Cochrane Database of Systematic Reviews, 2023(7). [https://doi.org/10.1002/14651858.CD003585.pub3]
Li, H., Pan, R., Wang, H., Rong, X., Yin, Z., Milgrom, D. P., et al. (2012). Clipping versus coiling for ruptured intracranial aneurysms: A systematic review and meta-analysis. Stroke, 44(1), 29–37. [https://doi.org/10.1161/STROKEAHA.112.663559]
Lindvall, O., Kokaia, Z. (2011). Stem cell research in stroke: How far from the clinic? Stroke, 42(8), 2369–2375. [https://doi.org/10.1161/STROKEAHA.110.599654]
Liu, Y., Qi, A., Wang, X., Chen, C., Song, F. (2025). Longer door-to-needle time is associated with the risk of post-stroke cognitive impairment after acute ischemic stroke: A retrospective study. Medicine, 104(51), e46344. [https://doi.org/10.1097/MD.0000000000046344]
Longo, S., Rizza, S., Federici, M. (2023). Microbiota-gut-brain axis: Relationships among the vagus nerve, gut microbiota, obesity, and diabetes. Acta Diabetologica, 60(8), 1007–1017. [https://doi.org/10.1007/s00592-023-02088-x]
Love, M. F., Sharrief, A., Chaoul, A., Savitz, S., Beauchamp, J. E. S. (2019). Mind-body interventions, psychological stressors, and quality of life in stroke survivors: A systematic review. Stroke, 50(2), 434–440. [https://doi.org/10.1161/STROKEAHA.118.021150]
Macchi, C., Catini, C., Cerini, F., Gulisano, M., Pacini, P., Cecchi, F., Brizzi, E. (1996). Magnetic resonance angiographic evaluation of circulus arteriosus cerebri (Circle of Willis): A morphologic study in 100 human healthy subjects. Italian Journal of Anatomy and Embryology, 101(2), 115–123. [https://pubmed.ncbi.nlm.nih.gov/8997907/]
MacKay-Lyons, M., Billinger, S. A., Eng, J. J., Dromerick, A., Giacomantonio, N., Hafer-Macko, C., et al. (2020). Aerobic exercise recommendations to optimize best practices in care after stroke: AEROBICS 2019 update. Physical Therapy, 100(1), 149–165. [https://doi.org/10.1093/ptj/pzz153]
Makharia, A., Agarwal, A., Garg, D., Vishnu, V. Y., Srivastava, M. V. P. (2024). The pitfalls of NIHSS: Time for a new clinical acute stroke severity scoring system in the emergency? Annals of Indian Academy of Neurology, 27(4), 325–332. [https://doi.org/10.4103/aian.aian_842_23]
Mangalik, G., Laurensia, A. R., Ariestiningsih, A. D. (2023). Diet management with dysphagia condition in stroke patients: A literature review. Amerta Nutrition, 7(3), 468–477. [https://doi.org/10.20473/amnt.v7i3.2023.468-477]
Marei, H. E., Hasan, A., Rizzi, R., Althani, A., Afifi, N., Cenciarelli, C., et al. (2018). Potential of stem cell-based therapy for ischemic stroke. Frontiers in Neurology, 9, 34. [https://doi.org/10.3389/fneur.2018.00034]
Marselli, G., Favieri, F., Casagrande, M. (2023). Episodic and semantic autobiographical memory in mild cognitive impairment (MCI): A systematic review. Journal of Clinical Medicine, 12(8), 2856. [https://doi.org/10.3390/jcm12082856]
Mattace-Raso, F. U., van der Cammen, T. J., Hofman, A., van Popele, N. M., Bos, M. L., Schalekamp, M. A., et al. (2006). Arterial stiffness and risk of coronary heart disease and stroke: The Rotterdam Study. Circulation, 113(5), 657–663. [https://doi.org/10.1161/CIRCULATIONAHA.105.555235]
McDonald, J. S., McDonald, R. J., Fan, J., Kallmes, D. F., Lanzino, G., Cloft, H. J. (2013). Comparative effectiveness of unruptured cerebral aneurysm therapies: Propensity score analysis of clipping versus coiling. Stroke, 44(3), 719–725. [https://doi.org/10.1161/STROKEAHA.111.000196]
Merwick, Á., Werring, D. (2014). Posterior circulation ischaemic stroke. BMJ, 348, g3175. [https://doi.org/10.1136/bmj.g3175]
Montalvan, V., Ulrich, A. K., Tirschwell, D. L., Zunt, J. R. (2021). Assessing sexual dysfunction among stroke survivors and barriers to address this issue by physicians at a Latin American reference hospital. Clinical Neurology and Neurosurgery, 205, 106642. [https://doi.org/10.1016/j.clineuro.2021.106642]
Mörkl, S., Butler, M. I., Wagner-Skacel, J. (2023). Gut-brain-crosstalk - The vagus nerve and the microbiota-gut-brain axis in depression: A narrative review. Journal of Affective Disorders Reports, 13, 100607. [https://doi.org/10.1016/j.jadr.2023.100607]
Mozaffarian, D., Benjamin, E. J., Go, A. S., Arnett, D. K., Blaha, M. J., Cushman, M., et al. (2015). Heart disease and stroke statistics—2015 update: A report from the American Heart Association. Circulation, 131(4), e29–e322. [https://doi.org/10.1161/CIR.0000000000000152]
Mulder, M. J., Dippel, D. W.,Burke, J. F. (2025). Use of diagnostic subtraction angiography for ischemic stroke (US DUTCH study): Regional variation and time-trend among medicare beneficiaries. Journal of Stroke and Cerebrovascular Diseases, 34, 108108. [https://doi.org/10.1016/j.jstrokecerebrovasdis.2024.108108]
Nehme, A., Li, L. (2025). The rising incidence of stroke in the young: Epidemiology, causes, and global impact. International Journal of Stroke, 21(1), 14–23. [https://doi.org/10.1177/17474930251362583]
Ospel, J., Singh, N., Ganesh, A., Goyal, M. (2023). Sex and gender differences in stroke and their practical implications in acute care. Journal of Stroke, 25(1), 16–25. [https://doi.org/10.5853/jos.2022.04077]
Pallesen, L.-P., Barlinn, K., Puetz, V. (2019). Role of decompressive craniectomy in ischemic stroke. Frontiers in Neurology, 9, 1119. [https://doi.org/10.3389/fneur.2018.01119]
Parikh, N. S., Parasram, M., White, H., Merkler, A. E., Navi, B. B., Kamel, H. (2021). Smoking cessation in stroke survivors in the United States: A nationwide analysis. Stroke, 52(9), 2750–2755. [https://doi.org/10.1161/STROKEAHA.121.036941]
Pawluk, H., Kołodziejska, R., Grześk, G., Woźniak, A., Kozakiewicz, M., Kosińska, A., et al. (2022). Increased oxidative stress markers in acute ischemic stroke patients treated with thrombolytics. International Journal of Molecular Sciences, 23(24), 15625. [https://doi.org/10.3390/ijms232415625]
Pawluk, H., Woźniak, A., Grześk, G., Kołodziejska, R., Kozakiewicz, M., Kopkowska, E., et al. (2020). The role of selected pro-inflammatory cytokines in pathogenesis of ischemic stroke. Clinical Interventions in Aging, 15, 469–484. [https://doi.org/10.2147/CIA.S233909]
Petrea, R. E., Beiser, A. S., Seshadri, S., Kelly-Hayes, M., Kase, C. S., Wolf, P. A. (2009). Gender differences in stroke incidence and poststroke disability in the Framingham Heart Study. Stroke, 40(4), 1032–1037. [https://doi.org/10.1161/STROKEAHA.108.542894]
Poh, L., Sim, W. L., Jo, D. G., Dinh, Q. N., Drummond, G. R., Sobey, C. G., et al. (2022). The role of inflammasomes in vascular cognitive impairment. Molecular Neurodegeneration, 17, 4. [https://doi.org/10.1186/s13024-021-00506-8]
Powers, W. J., Rabinstein, A. A., Ackerson, T., Adeoye, O. M., Bambakidis, N. C., Becker, K., et al (2018). 2018 guidelines for the early management of patients with acute ischemic stroke: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 49(3), e46–e110. [https://doi.org/10.1161/STR.0000000000000211]
Rafsten, L., Danielsson, A., Sunnerhagen, K. S. (2018). Anxiety after stroke: A systematic review and meta-analysis. Journal of Rehabilitation Medicine, 50(9), 769–778. [https://doi.org/10.2340/16501977-2384]
Ren, K., Pei, J., Guo, Y., Jiao, Y., Xing, H., Xie, Y., et al. (2023). Regulated necrosis pathways: A potential target for ischemic stroke. Burns & Trauma, 11, tkad016. [https://doi.org/10.1093/burnst/tkad016]
Robinson, R. G., Jorge, R. E. (2015). Post-stroke depression: A review. The American Journal of Psychiatry, 173(3), 221–231. [https://doi.org/10.1176/appi.ajp.2015.15030363]
Rosenich, E., Hordacre, B., Paquet, C., Koblar, S. A., Hillier, S. L. (2020). Cognitive reserve as an emerging concept in stroke recovery. Neurorehabilitation and Neural Repair, 34(3), 187–199. [https://doi.org/10.1177/1545968320907071]
Rundek, T., Tolea, M., Ariko, T., Fagerli, E. A., Camargo, C. J. (2022). Vascular cognitive impairment (VCI). Neurotherapeutics, 19(1), 68–88. [https://doi.org/10.1007/s13311-021-01170-y]
Saifullah, Y. Y., Rachman, M. E., Ramlian, Limoa, L. T., Hamado, N. (2024). Literature review: Hubungan hipertensi dengan kejadian stroke iskemik dan stroke hemoragik. Fakumi Medical Journal, 4(10). [https://doi.org/10.33096/fmj.v4i10.477]
Saini, M., Ikram, K., Hilal, S., Qiu, A., Venketasubramanian, N., Chen, C. (2012). Silent stroke: Not listened to rather than silent. Stroke, 43(11), 3102–3104. [https://doi.org/10.1161/STROKEAHA.112.666461]
Saini, V., Guada, L., Yavagal, D. R. (2021). Global epidemiology of stroke and access to acute ischemic stroke interventions. Neurology, 97(20 Suppl 2), S6–S16. [https://doi.org/10.1212/WNL.0000000000012781]
Salaudeen, M. A., Bello, N., Danraka, R. N., Ammani, M. L. (2024). Understanding the pathophysiology of ischemic stroke: The basis of current therapies and opportunity for new ones. Biomolecules, 14(3), 305. [https://doi.org/10.3390/biom14030305]
Setiawan, P. A. (2021). Diagnosis dan tatalaksana stroke hemoragik. Jurnal Medika Hutama, 3(1). [https://www.jurnalmedikahutama.com/index.php/JMH/article/view/336]
Shen, Z., Xiang, M., Chen, C., Ding, F., Wang, Y., Shang, C., et al. (2022). Glutamate excitotoxicity: Potential therapeutic target for ischemic stroke. Biomedicine & Pharmacotherapy, 151, 113125. [https://doi.org/10.1016/j.biopha.2022.113125]
Venketasubramanian, N. (2025). Stroke epidemiology in Asia. Cerebrovascular Diseases Extra, 15(1). [https://doi.org/10.1159/000543399]
Venketasubramanian, N., Yoon, B. W., Pandian, J., Navarro, J. C. (2017). Stroke epidemiology in South, East, and South-East Asia: A review. Journal of Stroke, 19(3), 286–294. [https://doi.org/10.5853/jos.2017.00234]
Vikelis, M., Papatriantafyllou, J., Karageorgiou, C. E. (2007). A novel CADASIL-causing mutation in a stroke patient. Swiss Medical Weekly, 137, 323–325. [https://doi.org/10.4414/smw.2007.11816]
Worthley, L. I. G., Holt, A. W. (2000). Acute ischaemic stroke: Part II. The vertebrobasilar circulation. Critical Care and Resuscitation, 2(1), 22–29. [https://doi.org/10.1016/S1441-2772(23)01986-5]
Xing, C., Arai, K., Lo, E. H., Hommel, M. (2012). Pathophysiologic cascades in ischemic stroke. International Journal of Stroke, 7(5), 378–385. [https://doi.org/10.1111/j.1747-4949.2012.00839.x]
Xu, L., Zhang, C., Yin, H., Gong, S., Wu, N., Ren, Z., Zhang, Y. (2021). RNA modifications act as regulators of cell death. RNA Biology, 18(12), 2183–2193. [https://doi.org/10.1080/15476286.2021.1925460]
Yang, C. W., Carr, J. C., Futterer, S. F., Morasch, M. D., Yang, B. P., Shors, S. M., Finn, J. P. (2005). Contrast-enhanced MR angiography of the carotid and vertebrobasilar circulations. American Journal of Neuroradiology, 26(8), 2095–2101. [http://www.ajnr.org/cgi/pmidlookup?view=long&pmid=16155164]
Zhang, X., Xu, Y., Hu, H., Liao, Z., Lou, C., Zou, X. (2025). Multi-omics integration reveals the role of N6-methyladenosine in epilepsy, ischemic stroke, and vascular dementia. Molecular Brain, 18(1), 58. [https://doi.org/10.1186/s13041-025-01228-4]
Zheng, W. (2001). Neurotoxicology of the brain barrier system: New implications. Journal of Toxicology: Clinical Toxicology, 39(7), 711–719. [https://doi.org/10.1081/CLT-100108492]
Downloads
Published
License

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

