PT  - JOURNAL ARTICLE
AU  - Zupanic, Eva
AU  - von Euler, Mia
AU  - Kåreholt, Ingemar
AU  - Contreras Escamez, Beatriz
AU  - Fastbom, Johan
AU  - Norrving, Bo
AU  - Religa, Dorota
AU  - Kramberger, Milica G.
AU  - Winblad, Bengt
AU  - Johnell, Kristina
AU  - Eriksdotter, Maria
AU  - Garcia-Ptacek, Sara
TI  - Thrombolysis in acute ischemic stroke in patients with dementia
AID  - 10.1212/WNL.0000000000004598
DP  - 2017 Oct 31
TA  - Neurology
PG  - 1860--1868
VI  - 89
IP  - 18
4099  - http://n.neurology.org/content/89/18/1860.short
4100  - http://n.neurology.org/content/89/18/1860.full
SO  - Neurology2017 Oct 31; 89
AB  - Objective: To compare access to intravenous thrombolysis (IVT) for acute ischemic stroke (AIS) and its outcomes in patients with and without dementia.Methods: This was a longitudinal cohort study of the Swedish dementia and stroke registries. Patients with preexisting dementia who had AIS from 2010 to 2014 (n = 1,356) were compared with matched patients without dementia (n = 6,755). We examined access to thrombolysis and its outcomes at 3 months (death, residency, and modified Rankin Scale [mRS] score). Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated with logistic and ordinal logistic regression.Results: The median age at stroke onset was 83 years in both groups. IVT was administered to 94 (7.0%) patients with dementia and 639 (9.5%) patients without dementia. The OR of receiving IVT was 0.68 (95% CI 0.54–0.86) for patients with dementia. When the analysis was repeated exclusively among patients independent in everyday activities, dementia status was no longer significant (OR 0.79, 95% CI 0.60–1.06). However, differences persisted in patients ≤80 years of age (OR 0.58, 95% CI 0.36–0.94). In patients who received thrombolysis, the incidence of symptomatic intracerebral hemorrhage (sICH; 7.4% vs 7.3%) and death at 3 months (22.0% vs 18.8%) did not differ significantly between the 2 groups. However, mRS score and accommodation status were worse among patients with dementia after 3 months in adjusted analyses (both p < 0.001). Unfavorable outcomes with an mRS score of 5 to 6 were doubled in patients with dementia (56.1% vs 28.1%).Conclusions: Younger patients with dementia and AIS are less likely to receive IVT. Among patients receiving thrombolysis, there are no differences in sICH or death, although patients with dementia have worse accommodation and functional outcomes at 3 months.ADL=activities of daily living; AIS=acute ischemic stroke; ATC=Anatomical Therapeutic Chemical; CI=confidence interval; ICD-10=International Classification of Diseases, 10th revision; IVT=intravenous thrombolysis; MMSE=Mini-Mental State Examination; mRS=modified Rankin Scale; NIHSS=NIH Stroke Scale; OR=odds ratio; Riksstroke=Swedish national quality registry for acute vascular diseases of the brain; RLS=Reaction Level Scale; sICH=symptomatic intracranial hemorrhage; SveDem=Swedish Dementia Registry