Dysbiosis is one of the risk factor for stroke and cognitive impairment and potential target for treatment.

Abstract Above 50 millions people have different forms of cognitive impairment basically caused by neurodegenerative diseases, such as Alzheimer disease, Parkinson disease, and cerebrovascular diseases, mostly stroke. Often these coexistence and exacerbate one another. The damaged area in the post-stroke dementia may lead to the additional neurodegenerative lesions. Gut microbiome functions like an endocrine organ by generating bioactive metabolites, can directly or indirectly impact human physiology. An alteration in the composition and function of intestinal flora, i.e. gut dysbiosis, is involved in neurodegenerative and cerebrovascular diseases. Additionally, gut dysbiosis may accelerate the progression of the cognitive impairment in the course of these diseases. Dysbiosis may result from obesity; metabolic, cardiovascular, and sleep disorders; or lack of physical activity. They may coexist in various patterns in older people, enhancing the risk, incidence, and progression of cerebrovascular lesions, neurodegenerative disorders, and cognitive impairment, creating a vicious circle. Recently, several metabolites produced by gut microbiota from dietary metabolism, e.g. trimethylamine,/trimethylamine N-oxide, short-chain fatty acids, secondary bile acids have been linked to neurodegenerative and cerebrovascular diseases. New treatment modalities, including prebiotic and probiotics, may normalize the gut microbiota composition, change the brain-gut barrier and decrease the risk of the pathology development. Fecal microbiota transplantation, sometimes with combination with other methods, is used for remodeling and replenishing the symbiotic gut microbiome. The promising field of research is associated with basic findings of bidirectional communication between body organs and gut microbiota that open the possibilities of pharmacological treatments of many clinical situations. The authors present the role of gut microbiota in physiology, and the novel therapeutic targets in modulation of intestinal microbiota Personalized therapies based on their personal genome make up could offer benefits by modulating microbiota cross-talk with brain and cardiovascular system. A healthy lifestyle, including pre and probiotic nutrition is generally recommended. Prevention may also be enhanced by correcting gut dysbiosis resulting a reduced risk of post-stroke cognitive impairment including dementia.