Thromboxane biosynthesis in stroke and post-stroke dementia

With 25 to 30 thousand new patients per year and an incidence of 170/100.000, stroke is a major health problem in the Netherlands, as it is in other western countries. It accounts for almost I 0% of the annual death in the Netherlands. Approximately 80% of stroke is of ischemic origin, and 20% cerebral hemorrhage. For the individual patient, the consequences of stroke are often devastating. Approximately 20% of the patients do not survive the first weeks and case fatality at I year is approximately 35%1 However, mortality strongly depends on type of stroke, and is higher in hemorrhagic than in ischemic cases. Of the survivors, only 65% is discharged home directly. Approximately 15% is discharged to a nursery home, and 20% to a stroke recovery or a rehabilitation center2 Even patients who are discharged to their own home are often not able to live fully independently, partly due to their physical handicap, but often also due to cognitive impairment. In approximately 25% of the cases, cognitive dysfunction is severe enough to the extent that patients fulfill all criteria of dementia. Although the highest incidence of ischemic stroke is between the 6'h and 7'h decade oflife, it is a disease of all ages. In subjects between 15 and 4 5 years of age, the incidence of ischemic stroke is between 6 and 15/1OO.OOO/year. The mortality in this group of relatively young adults, is about 20% in the first 6 years after stroke and only less than half of the survivors is eventually able to perform a job. Although the consequences of stroke are often dramatic for the individual patient, these figures also indicate the large burden of stroke on the community and the health care system. As a result of the high incidence of stroke, a relatively small reduction of a few percent of stroke or stroke recurrence would mean a large reduction in number of patients appealing to the health care system in absolute terms. Obviously, this makes every effort reducing the incidence or recurrence of stroke, even with only a few percent, more than worthwhile