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Abstract
Objective: To describe clinical characteristics and evaluate processes of care and outcomes at discharge in patients with ischemic stroke with and without preexisting dementia.
Methods: Retrospective cohort study using the Registry of the Canadian Stroke Network including patients presenting with an acute ischemic stroke between 2003 and 2008. Preexisting dementia was defined as any type of dementia that was present prior to the index stroke case. Palliative patients were excluded. Demographic information, clinical presentation, selected process measures (e.g., thrombolysis, admission to stroke unit, carotid imaging, stroke prevention), pneumonia, death, disability, and disposition at discharge were analyzed.
Results: Among 9,304 eligible patients with an acute ischemic stroke, 702 (9.1%) had a history of dementia. Patients with dementia were older (mean age 81 vs 70 years; p < 0.001), had more severe strokes (Canadian Neurological Scale score <4, 20.7% vs 10.5%; p < 0.001), and were more likely to have atrial fibrillation (22.8% vs 15.3%; p < 0.001) than those without dementia. Patients with dementia were slightly less likely to be admitted to a stroke unit (63% vs 67.6%; odds ratio [OR] 0.82, 95% confidence interval [CI] 0.70–0.96) or to receive thrombolysis (10.5% vs 15.7%; OR 0.63, 95% CI 0.49–0.81). There were no differences in other performance measures. Patients with preexisting dementia had higher disability at discharge (OR 3.20, 95% CI 2.64–3.87) and were less likely to be discharged to their prestroke place of residence (24% vs 45%; p < 0.001).
Conclusions: In patients with stroke, preexisting dementia is associated with high rates of disability and institutionalization, representing an increasing challenge for the health care system.
GLOSSARY
- CI=
- confidence interval;
- DAD=
- Discharge Abstract Database;
- mRS=
- modified Rankin Scale;
- OR=
- odds ratio;
- RCSN=
- Registry of the Canadian Stroke Network.
Footnotes
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Study funding: This work was funded by an operating grant from the Canadian Stroke Network. The Registry of the Canadian Stroke Network is funded by an operating grant from the Ontario Ministry of Health and Long-Term Care. The Institute for Clinical Evaluative Sciences is supported by an operating grant from the Ontario Ministry of Health and Long-Term Care. The results and conclusions are those of the authors, and should not be attributed to any of the sponsoring or funding agencies. The funding agencies had no role in the design or conduct of the study or the collection, management, analysis, or interpretation of the data. The manuscript was reviewed and approved by the publications committee of the Registry of the Canadian Stroke Network.
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Supplemental data at www.neurology.org
- Received March 22, 2011.
- Accepted July 18, 2011.
- Copyright © 2011 by AAN Enterprises, Inc.
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