Skip to main content Accessibility help
×
Hostname: page-component-7479d7b7d-767nl Total loading time: 0 Render date: 2024-07-12T16:56:42.613Z Has data issue: false hasContentIssue false

Chapter 6 - The Stroke Patient and Cognition

Published online by Cambridge University Press:  16 June 2018

Vladimir Hachinski
Affiliation:
University of Western Ontario
Get access

Summary

Image of the first page of this content. For PDF version, please use the ‘Save PDF’ preceeding this image.'
Type
Chapter
Information
Publisher: Cambridge University Press
Print publication year: 2018

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

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;8:10061018.CrossRefGoogle ScholarPubMed
Hénon, H, Pasquier, F, Leys, D. Poststroke dementia. Cerebrovasc Dis. 2006;22:6170.CrossRefGoogle ScholarPubMed
Godefroy, O, Fickl, A, Roussel, M, et al. Is the Montreal Cognitive Assessment superior to the Mini-Mental State Examination to detect poststroke cognitive impairment? A study with neuropsychological evaluation. Stroke. 2011;42:17121716.CrossRefGoogle Scholar
Hurford, R, Charidimou, A, Fox, Z, Cipolotti, L, Werring, DJ. Domain-specific trends in cognitive impairment after acute ischaemic stroke. J Neurol. 2013;260:237241.Google Scholar
Leśniak, M, Bak, T, Czepiel, W, Seniów, J, Członkowska, A. Frequency and prognostic value of cognitive disorders in stroke patients. Dement Geriatr Cogn Disord. 2008;26:356363.CrossRefGoogle ScholarPubMed
Nys, GMS, van Zandvoort, MJE, de Kort, PLM, Jansen, BPW, de Haan, EHF, Kappelle, LJ. Cognitive disorders in acute stroke: prevalence and clinical determinants. Cerebrovasc Dis. 2007;23:408416.Google Scholar
Douiri, A, Rudd, AG, Wolfe, CDA. Prevalence of poststroke cognitive impairment: South London Stroke Register 1995–2010. Stroke. 2013;44:138145.CrossRefGoogle ScholarPubMed
Popović, IM, Serić, V, Demarin, V. Mild cognitive impairment in symptomatic and asymptomatic cerebrovascular disease. J Neurol Sci. 2007;257:185193.CrossRefGoogle ScholarPubMed
Salvadori, E, Pasi, M, Poggesi, A, Chiti, G, Inzitari, D, Pantoni, L. Predictive value of MoCA in the acute phase of stroke on the diagnosis of mid-term cognitive impairment. J Neurol. 2013;260:22202227.Google Scholar
Srikanth, VK, Anderson, JFI, Donnan, GA, et al. Progressive dementia after first-ever stroke: a community-based follow-up study. Neurology. 2004;63:785792.Google Scholar
Qu, Y, Zhuo, L, Li, N, et al. Prevalence of post-stroke cognitive impairment in China: a community-based, cross-sectional study. PloS One. 2015;10:e0122864.CrossRefGoogle Scholar
Demeyere, N, Riddoch, MJ, Slavkova, ED, et al. Domain-specific versus generalized cognitive screening in acute stroke. J Neurol. 2016;263:306315.Google Scholar
Dacosta-Aguayo, R, Graña, M, Iturria-Medina, Y, et al. Impairment of functional integration of the default mode network correlates with cognitive outcome at three months after stroke. Hum Brain Mapp. 2015;36:577590.CrossRefGoogle ScholarPubMed
Zhu, Y, Bai, L, Liang, P, Kang, S, Gao, H, Yang, H. Disrupted brain connectivity networks in acute ischemic stroke patients. Brain Imaging Behav. 2017;11:444453.Google Scholar
Ballard, C, Rowan, E, Stephens, S, Kalaria, R, Kenny, RA. Prospective follow-up study between 3 and 15 months after stroke: improvements and decline in cognitive function among dementia-free stroke survivors>75 years of age. Stroke. 2003;34:24402444.Google Scholar
Rasquin, SMC, Verhey, FRJ, Lousberg, R, Winkens, I, Lodder, J. Vascular cognitive disorders: memory, mental speed and cognitive flexibility after stroke. J Neurol Sci. 2002;203,204:115119.Google Scholar
Rasquin, SMC, Lodder, J, Verhey, FRJ. Predictors of reversible mild cognitive impairment after stroke: a 2-year follow-up study. J Neurol Sci. 2005;229,230:2125.CrossRefGoogle ScholarPubMed
Pendlebury, ST, Wadling, S, Silver, LE, Mehta, Z, Rothwell, PM. Transient cognitive impairment in TIA and minor stroke. Stroke. 2011;42:31163121.CrossRefGoogle ScholarPubMed
Appelros, P, Andersson, AG. Changes in Mini Mental State Examination score after stroke: lacunar infarction predicts cognitive decline. Eur J Neurol. 2006;13:491495.Google Scholar
van Zandvoort, MJE, Kessels, RPC, Nys, GMS, de Haan, EHF, Kappelle, LJ. Early neuropsychological evaluation in patients with ischaemic stroke provides valid information. Clin Neurol Neurosurg. 2005;107:385392.Google Scholar
Levine, DA, Galecki, AT, Langa, KM, et al. Trajectory of cognitive decline after incident stroke. JAMA. 2015;314:4151.CrossRefGoogle ScholarPubMed
Pasquier, F, Leys, D. Why are stroke patients prone to develop dementia? J Neurol. 1997;244:135142.Google Scholar
Kalaria, RN, Akinyemi, R, Ihara, M. Stroke injury, cognitive impairment and vascular dementia. Biochim Biophys Acta. 2016;1862:915925.Google Scholar
Mok, VCT, Lam, BYK, Wang, Z, et al. Delayed-onset dementia after stroke or transient ischemic attack. Alzheimers Dement. 2016;12:11671176.Google Scholar
Wang, Z, Wong, A, Liu, W, et al. Cerebral microbleeds and cognitive function in ischemic stroke or transient ischemic attack patients. Dement Geriatr Cogn Disord. 2015;40:130136.Google Scholar
Arba, F, Quinn, T, Hankey, GJ, et al. Cerebral small vessel disease, medial temporal lobe atrophy and cognitive status in patients with ischaemic stroke and transient ischaemic attack. Eur J Neurol. 2017;24:276282.Google Scholar
Corraini, P, Henderson, VW, Ording, AG, Pedersen, L, Horváth-Puhó, E, Sørensen, HT. Long-term risk of dementia among survivors of ischemic or hemorrhagic stroke. Stroke. 2017;48:180186.CrossRefGoogle ScholarPubMed
Tay, SY, Ampil, ER, Chen, CPLH, Auchus, AP. The relationship between homocysteine, cognition and stroke subtypes in acute stroke. J Neurol Sci. 2006;250:5861.CrossRefGoogle ScholarPubMed
Munsch, F, Sagnier, S, Asselineau, J, et al. Stroke location is an independent predictor of cognitive outcome. Stroke. 2016;47:6673.Google Scholar
Lawrence, AJ, Brookes, RL, Zeestraten, EA, Barrick, TR, Morris, RG, Markus, HS. Pattern and rate of cognitive decline in cerebral small vessel disease: a prospective study. PloS One. 2015;10:e0135523.CrossRefGoogle ScholarPubMed
Makin, SDJ, Turpin, S, Dennis, MS, Wardlaw, JM. Cognitive impairment after lacunar stroke: systematic review and meta-analysis of incidence, prevalence and comparison with other stroke subtypes. J Neurol Neurosurg Psychiatry. 2013;84:893900.Google Scholar
Reijmer, YD, Freeze, WM, Leemans, A, Biessels, GJ, Utrecht vascular cognitive impairment study group. The effect of lacunar infarcts on white matter tract integrity. Stroke. 2013;44:20192021.Google Scholar
Tang, J, Zhong, S, Chen, Y, et al. Aberrant white matter networks mediate cognitive impairment in patients with silent lacunar infarcts in basal ganglia territory. J Cereb Blood Flow Metab. 2015;35:14261434.CrossRefGoogle ScholarPubMed
Pannese, E. Morphological changes in nerve cells during normal aging. Brain Struct Funct. 2011;216:8589.Google Scholar
Schaapsmeerders, P, Maaijwee, NAM, van Dijk, EJ, et al. Long-term cognitive impairment after first-ever ischemic stroke in young adults. Stroke. 2013;44:16211628.Google Scholar
Kivipelto, M, Ngandu, T, Fratiglioni, L, et al. Obesity and vascular risk factors at midlife and the risk of dementia and Alzheimer disease. Arch Neurol. 2005;62:15561560.Google Scholar
Beydoun, MA, Beydoun, HA, Gamaldo, AA, Teel, A, Zonderman, AB, Wang, Y. Epidemiologic studies of modifiable factors associated with cognition and dementia: systematic review and meta-analysis. BMC Public Health. 2014;14:643.CrossRefGoogle ScholarPubMed
Eskelinen, MH, Ngandu, T, Tuomilehto, J, Soininen, H, Kivipelto, M. Midlife healthy-diet index and late-life dementia and Alzheimer’s disease. Dement Geriatr Cogn Disord Extra. 2011;1:103112.CrossRefGoogle ScholarPubMed
Kalantarian, S, Stern, TA, Mansour, M, Ruskin, JN. Cognitive impairment associated with atrial fibrillation: a meta-analysis. Ann Intern Med. 2013;158:338346.Google Scholar
Elias, MF, Sullivan, LM, D’Agostino, RB, et al. Framingham Stroke Risk Profile and lowered cognitive performance. Stroke. 2004;35:404409.Google Scholar
Llewellyn, DJ, Lang, IA, Xie, J, Huppert, FA, Melzer, D, Langa, KM. Framingham Stroke Risk Profile and poor cognitive function: a population-based study. BMC Neurol. 2008;8:12.Google Scholar
Beason-Held, LL, Thambisetty, M, Deib, G, et al. Baseline cardiovascular risk predicts subsequent changes in resting brain function. Stroke. 2012;43:15421547.Google Scholar
Lu, D, Ren, S, Zhang, J, Sun, D. Vascular risk factors aggravate cognitive impairment in first-ever young ischaemic stroke patients. Eur J Neurol. 2016;23:940947.Google Scholar
Giau, VV, Bagyinszky, E, An, SSA, Kim, SY. Role of apolipoprotein E in neurodegenerative diseases. Neuropsychiatr Dis Treat. 2015;11:17231737.Google Scholar
Narasimhalu, K, Lee, J, Leong, YL, et al. Inflammatory markers and their association with post stroke cognitive decline. Int J Stroke. 2015;10:513518.Google Scholar
Kliper, E, Bashat, DB, Bornstein, NM, et al. Cognitive decline after stroke: relation to inflammatory biomarkers and hippocampal volume. Stroke. 2013;44:14331435.Google Scholar
Rothenburg, LS, Herrmann, N, Swardfager, W, et al. The relationship between inflammatory markers and post stroke cognitive impairment. J Geriatr Psychiatry Neurol. 2010;23:199205.Google Scholar
Wang, Q, Capistrant, BD, Ehntholt, A, Glymour, MM. Long-term rate of change in memory functioning before and after stroke onset. Stroke. 2012;43:25612566.Google Scholar
Rostamian, S, Mahinrad, S, Stijnen, T, Sabayan, B, de Craen, AJM. Cognitive impairment and risk of stroke: a systematic review and meta-analysis of prospective cohort studies. Stroke. 2014;45:13421348.Google Scholar
DeFries, T, Avendaño, M, Glymour, MM. Level and change in cognitive test scores predict risk of first stroke. J Am Geriatr Soc. 2009;57:499505.Google Scholar
Stern, Y. Cognitive reserve in ageing and Alzheimer’s disease. Lancet Neurol. 2012;11:10061012.Google Scholar
Boyle, PA, Wilson, RS, Yu, L, et al. Much of late life cognitive decline is not due to common neurodegenerative pathologies. Ann Neurol. 2013;74:478489.Google Scholar
Wang, H-X, Jin, Y, Hendrie, HC, et al. Late life leisure activities and risk of cognitive decline. J Gerontol A Biol Sci Med Sci. 2013;68:205213.Google Scholar
Nunnari, D, Bramanti, P, Marino, S. Cognitive reserve in stroke and traumatic brain injury patients. Neurol Sci. 2014;35:15131518.Google Scholar
Wong, A, Lau, AYL, Lo, E, et al. Relations between recent past leisure activities with risks of dementia and cognitive functions after stroke. PloS One. 2016;11:e0159952.CrossRefGoogle ScholarPubMed
Alladi, S, Bak, TH, Mekala, S, et al. Impact of bilingualism on cognitive outcome after stroke. Stroke. 2016;47:258261.Google Scholar
Pendlebury, ST, Mariz, J, Bull, L, Mehta, Z, Rothwell, PM. MoCA, ACE-R, and MMSE versus the National Institute of Neurological Disorders and Stroke–Canadian Stroke Network Vascular Cognitive Impairment Harmonization Standards Neuropsychological Battery after TIA and stroke. Stroke. 2012;43:464469.Google Scholar
Srikanth, VK, Quinn, SJ, Donnan, GA, Saling, MM, Thrift, AG. Long-term cognitive transitions, rates of cognitive change, and predictors of incident dementia in a population-based first-ever stroke cohort. Stroke J Cereb Circ. 2006;37:24792483.Google Scholar
Hachinski, V, Iadecola, C, Petersen, RC, et al. National Institute of Neurological Disorders and Stroke⎼Canadian Stroke Network vascular cognitive impairment harmonization standards. Stroke. 2006;37:22202241.Google Scholar
Maruta, C, Guerreiro, M, de Mendonça, A, Hort, J, Scheltens, P. The use of neuropsychological tests across Europe: the need for a consensus in the use of assessment tools for dementia. Eur J Neurol. 2011;18:279285.Google Scholar
Eskes, GA, Lanctôt, KL, Herrmann, N, et al. Canadian Stroke Best Practice Recommendations: Mood, Cognition and Fatigue Following Stroke practice guidelines, update 2015. Int J Stroke. 2015;10:11301140.Google Scholar
Lees, R, Selvarajah, J, Fenton, C, et al. Test accuracy of cognitive screening tests for diagnosis of dementia and multidomain cognitive impairment in stroke. Stroke. 2014;45:30083018.Google Scholar
van Rijsbergen, MWA, Mark, RE, de Kort, PLM, Sitskoorn, MM. Subjective cognitive complaints after stroke: a systematic review. J Stroke Cerebrovasc Dis. 2014;23:408420.Google Scholar
van Rijsbergen, MWA, Mark, RE, Kop, WJ, de Kort, PLM, Sitskoorn, MM. The role of objective cognitive dysfunction in subjective cognitive complaints after stroke. Eur J Neurol. 2017;24:475482.Google Scholar
Harrison, JK, Fearon, P, Noel-Storr, AH, McShane, R, Stott, DJ, Quinn, TJ. Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) for the diagnosis of dementia within a secondary care setting. Cochrane Database Syst Rev. 2015;3:CD010772.Google Scholar
Leys, D, Hénon, H, Mackowiak-Cordoliani, M-A, Pasquier, F. Poststroke dementia. Lancet Neurol. 2005;4:752759.Google Scholar
Grysiewicz, R, Gorelick, PB. Key neuroanatomical structures for post-stroke cognitive impairment. Curr Neurol Neurosci Rep. 2012;12:703708.Google Scholar
Kliper, E, Ben Assayag, E, Tarrasch, R, et al. Cognitive state following stroke: the predominant role of preexisting white matter lesions. PloS One. 2014;9:e105461.CrossRefGoogle ScholarPubMed
Kooistra, M, Geerlings, MI, van der Graaf, Y, et al. Vascular brain lesions, brain atrophy, and cognitive decline: The Second Manifestations of ARTerial disease–Magnetic Resonance (SMART-MR) study. Neurobiol Aging. 2014;35:3541.Google Scholar
Brainin, M, Tuomilehto, J, Heiss, W-D, et al. Post-stroke cognitive decline: an update and perspectives for clinical research. Eur J Neurol. 2015;22:229238, e1316.Google Scholar
Dichgans, M, Zietemann, V. Prevention of vascular cognitive impairment. Stroke. 2012;43:31373146.Google Scholar
Cicerone, KD, Langenbahn, DM, Braden, C, et al. Evidence-based cognitive rehabilitation: updated review of the literature from 2003 through 2008. Arch Phys Med Rehabil. 2011;92:519530.CrossRefGoogle ScholarPubMed
Rohling, ML, Faust, ME, Beverly, B, Demakis, G. Effectiveness of cognitive rehabilitation following acquired brain injury: a meta-analytic re-examination of Cicerone et al.’s (2000, 2005) systematic reviews. Neuropsychology. 2009;23: 2039.CrossRefGoogle ScholarPubMed
das Nair, R, Cogger, H, Worthington, E, Lincoln, NB. Cognitive rehabilitation for memory deficits after stroke. Cochrane Database Syst Rev. 2016;9:CD002293.Google Scholar
Loetscher, T, Lincoln, NB. Cognitive rehabilitation for attention deficits following stroke. Cochrane Database Syst Rev. 2013;5:CD002842.Google Scholar
Chung, CSY, Pollock, A, Campbell, T, Durward, BR, Hagen, S. Cognitive rehabilitation for executive dysfunction in adults with stroke or other adult non-progressive acquired brain damage. Cochrane Database Syst Rev. 2013;4:CD008391.Google Scholar
Bath, PM, Wardlaw, JM. Pharmacological treatment and prevention of cerebral small vessel disease: a review of potential interventions. Int J Stroke. 2015;10:469478.CrossRefGoogle ScholarPubMed
Hackett, ML, Pickles, K. Part I: frequency of depression after stroke: an updated systematic review and meta-analysis of observational studies. Int J Stroke. 2014;9:10171025.Google Scholar
Hackett, ML, Anderson, CS, House, A, Xia, J. Interventions for treating depression after stroke. Cochrane Database Syst Rev. 2008;4:CD003437.Google Scholar
Mead, GE, Hsieh, C-F, Lee, R, et al. Selective serotonin reuptake inhibitors (SSRIs) for stroke recovery. Cochrane Database Syst Rev. 2012;11:CD009286.Google Scholar
Ngandu, T, Lehtisalo, J, Solomon, A, et al. A 2 year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER): a randomised controlled trial. Lancet. 2015;385:22552263.Google Scholar
Moll van Charante, EP, Richard, E, Eurelings, LS, et al. Effectiveness of a 6-year multidomain vascular care intervention to prevent dementia (preDIVA): a cluster-randomised controlled trial. Lancet. 2016;388:797805.Google Scholar
Matz, K, Teuschl, Y, Firlinger, B, et al. Multidomain lifestyle interventions for the prevention of cognitive decline after ischemic stroke: randomized trial. Stroke. 2015;46:28742880.Google Scholar
Ihle-Hansen, H, Thommessen, B, Fagerland, MW, et al. Multifactorial vascular risk factor intervention to prevent cognitive impairment after stroke and TIA: a 12-month randomized controlled trial. Int J Stroke. 2014;9:932938.Google Scholar
Ihle-Hansen, H, Thommessen, B, Fagerland, MW, et al. Effect on anxiety and depression of a multifactorial risk factor intervention program after stroke and TIA: a randomized controlled trial. Aging Ment Health. 2014;18:540546.Google Scholar
Douiri, A, McKevitt, C, Emmett, ES, Rudd, AG, Wolfe, CDA. Long-term effects of secondary prevention on cognitive function in stroke patients. Circulation. 2013;128:13411348.CrossRefGoogle ScholarPubMed
Bath, PM, Scutt, P, Blackburn, DJ, et al. Intensive versus guideline blood pressure and lipid lowering in patients with previous stroke: main results from the Pilot “Prevention of Decline in Cognition after Stroke Trial” (PODCAST) randomised controlled trial. PloS One. 2017;12:e0164608.Google Scholar
Valls-Pedret, C, Sala-Vila, A, Serra-Mir, M, et al. Mediterranean diet and age-related cognitive decline: a randomized clinical trial. JAMA Intern Med. 2015;175:10941103.Google Scholar
Ursin, MH, Bergland, A, Fure, B, Tørstad, A, Tveit, A, Ihle-Hansen, H. Balance and mobility as predictors of post-stroke cognitive impairment. Dement Geriatr Cogn Disord Extra. 2015;5:203211.Google Scholar
Constans, A, Pin-Barre, C, Temprado, J-J, Decherchi, P, Laurin, J. Influence of aerobic training and combinations of interventions on cognition and neuroplasticity after stroke. Front Aging Neurosci. 2016;8:164.Google Scholar
Tiozzo, E, Youbi, M, Dave, K, et al. Aerobic, resistance, and cognitive exercise training poststroke. Stroke. 2015;46:20122016.Google Scholar
Jones, F, Riazi, A. Self-efficacy and self-management after stroke: a systematic review. Disabil Rehabil. 2011;33:797810.Google Scholar
Visser, MM, Aben, L, Heijenbrok-Kal, MH, Busschbach, JJV, Ribbers, GM. The relative effect of coping strategy and depression on health-related quality of life in patients in the chronic phase after stroke. J Rehabil Med. 2014;46:514519.Google Scholar
Marzolini, S, Balitsky, A, Jagroop, D, et al. Factors affecting attendance at an adapted cardiac rehabilitation exercise program for individuals with mobility deficits poststroke. J Stroke Cerebrovasc Dis. Epub. 2015 Sep. 28.Google Scholar
Banks, G, Bernhardt, J, Churilov, L, Cumming, TB. Exercise preferences are different after stroke. Stroke Res Treat. 2012;2012:890946.Google Scholar
Prout, EC, Brooks, D, Mansfield, A, Bayley, M, McIlroy, WE. Patient characteristics that influence enrollment and attendance in aerobic exercise early after stroke. Arch Phys Med Rehabil. 2015;96:823830.CrossRefGoogle ScholarPubMed
Pfaeffli Dale, L, Dobson, R, Whittaker, R, Maddison, R. The effectiveness of mobile-health behaviour change interventions for cardiovascular disease self-management: a systematic review. Eur J Prev Cardiol. 2016; 23:801-817.Google Scholar
Pal, K, Eastwood, SV, Michie, S, et al. Computer-based diabetes self-management interventions for adults with type 2 diabetes mellitus. Cochrane Database Syst Rev. 2013;3:CD008776.Google Scholar
Corbett, D, Nguemeni, C, Gomez-Smith, M. How can you mend a broken brain? Neurorestorative approaches to stroke recovery. Cerebrovasc Dis. 2014;38:233239.Google Scholar
Steiber, N. Population aging at cross-roads: diverging secular trends in average cognitive functioning and physical health in the older population of Germany. PloS One. 2015;10:e0136583.Google Scholar
Kueider, AM, Parisi, JM, Gross, AL, Rebok, GW. Computerized cognitive training with older adults: a systematic review. PloS One. 2012;7:e40588.Google Scholar
Woods, B, Aguirre, E, Spector, AE, Orrell, M. Cognitive stimulation to improve cognitive functioning in people with dementia. Cochrane Database Syst Rev. 2012;2:CD005562.Google Scholar
Särkämö, T, Tervaniemi, M, Laitinen, S, et al. Music listening enhances cognitive recovery and mood after middle cerebral artery stroke. Brain J Neurol. 2008;131:866876.CrossRefGoogle ScholarPubMed
Särkämö, T, Ripollés, P, Vepsäläinen, H, et al. Structural changes induced by daily music listening in the recovering brain after middle cerebral artery stroke: a voxel-based morphometry study. Front Hum Neurosci. 2014;8:245.Google Scholar
Friedler, B, Crapser, J, McCullough, L. One is the deadliest number: the detrimental effects of social isolation on cerebrovascular diseases and cognition. Acta Neuropathol. 2015;129:493509.Google Scholar
Glymour, MM, Weuve, J, Fay, ME, Glass, T, Berkman, LF. Social ties and cognitive recovery after stroke: does social integration promote cognitive resilience? Neuroepidemiology. 2008;31:1020.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×