Sara Garcia-Ptacek1, Beatriz Contreras Escamez2, Eva Zupanic3, Dorota Religa4, Lena von Koch5, Kristina Johnell6, Mia von Euler7, Ingemar Kåreholt8, Maria Eriksdotter9. 1. Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Clinical Geriatrics, Karolinska Institutet, Huddinge, Sweden; Department of Geriatric Medicine, Karolinska University Hospital, Stockholm, Sweden; Department of Internal Medicine, Section for Neurology, Södersjukhuset, Stockholm, Sweden. Electronic address: sara.garcia-ptacek@ki.se. 2. Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Clinical Geriatrics, Karolinska Institutet, Huddinge, Sweden; Department of Geriatrics, Hospital Universitario de Getafe, Madrid, Spain. 3. Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Neurogeriatrics, Karolinska Institutet, Huddinge, Sweden; Department of Neurology, University Medical Center, Ljubljana, Slovenia. 4. Department of Geriatric Medicine, Karolinska University Hospital, Stockholm, Sweden; Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Neurogeriatrics, Karolinska Institutet, Huddinge, Sweden. 5. Department of Neurobiology, Care Sciences and Society, Division of Occupational Therapy, Karolinska Institutet, Huddinge, Sweden; Department of Neurology, Karolinska University Hospital, Stockholm, Sweden. 6. Aging Research Center (ARC), Karolinska Institutet and Stockholm University, Stockholm, Sweden. 7. Department of Clinical Science and Education, Södersjukhuset and Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Pharmacology, Karolinska University Hospital, Stockholm, Sweden. 8. Aging Research Center (ARC), Karolinska Institutet and Stockholm University, Stockholm, Sweden; Institute of Gerontology, School of Health and Welfare, Aging Research Network -Jönköping (ARN-J), Jönköping University, Jönköping, Sweden. 9. Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Clinical Geriatrics, Karolinska Institutet, Huddinge, Sweden; Department of Geriatric Medicine, Karolinska University Hospital, Stockholm, Sweden.
Abstract
OBJECTIVES: To explore the association between prestroke mobility dependency and dementia on functioning and mortality outcomes after stroke in patients>65 years of age. DESIGN: Longitudinal cohort study based on SveDem, the Swedish Dementia Registry and Riksstroke, the Swedish Stroke Registry. PARTICIPANTS: A total of 1689 patients with dementia >65 years of age registered in SveDem and suffering a first stroke between 2007 and 2014 were matched with 7973 controls without dementia with stroke. MEASUREMENTS: Odds ratios (ORs) and 95% confidence intervals (CIs) for intrahospital mortality, and functioning and mortality outcomes at 3 months were calculated. Functioning included level of residential assistance (living at home without help, at home with help, or nursing home) and mobility dependency (independent, needing help to move outdoors, or needing help indoors and outdoors). RESULTS: Prestroke dependency in activities of daily living and mobility were worse in patients with dementia than controls without dementia. In unadjusted analyses, patients with dementia were more often discharged to nursing homes (51% vs 20%; P < .001). Mortality at 3 months was higher in patients with dementia (31% vs 23% P < .001) and fewer were living at home without help (21% vs 55%; P < .001). In adjusted analyses, prestroke dementia was associated with higher risk of 3-month mortality (OR 1.34; 95% CI 1.18-1.52), requiring a higher level of residential assistance (OR 4.07; 3.49-.75) and suffering from more dependency in relation to mobility (OR 2.57; 2.20-3.02). Patients with dementia who were independent for mobility prestroke were more likely to be discharged to a nursing home compared with patients without dementia with the same prestroke mobility (37% vs 16%; P < .001), but there were no differences in discharge to geriatric rehabilitation (19% for both; P = .976). Patients, who moved independently before stroke, were more often discharged home (60% vs 28%) and had lower mortality. In adjusted analyses, prestroke mobility limitations were associated with higher odds for poorer mobility, needing more residential assistance, and death. CONCLUSIONS: Patients with mobility impairments and/or dementia present a high burden of disability after a stroke. There is a need for research on stroke interventions among these populations.
OBJECTIVES: To explore the association between prestroke mobility dependency and dementia on functioning and mortality outcomes after stroke in patients>65 years of age. DESIGN: Longitudinal cohort study based on SveDem, the Swedish Dementia Registry and Riksstroke, the Swedish Stroke Registry. PARTICIPANTS: A total of 1689 patients with dementia >65 years of age registered in SveDem and suffering a first stroke between 2007 and 2014 were matched with 7973 controls without dementia with stroke. MEASUREMENTS: Odds ratios (ORs) and 95% confidence intervals (CIs) for intrahospital mortality, and functioning and mortality outcomes at 3 months were calculated. Functioning included level of residential assistance (living at home without help, at home with help, or nursing home) and mobility dependency (independent, needing help to move outdoors, or needing help indoors and outdoors). RESULTS:Prestroke dependency in activities of daily living and mobility were worse in patients with dementia than controls without dementia. In unadjusted analyses, patients with dementia were more often discharged to nursing homes (51% vs 20%; P < .001). Mortality at 3 months was higher in patients with dementia (31% vs 23% P < .001) and fewer were living at home without help (21% vs 55%; P < .001). In adjusted analyses, prestroke dementia was associated with higher risk of 3-month mortality (OR 1.34; 95% CI 1.18-1.52), requiring a higher level of residential assistance (OR 4.07; 3.49-.75) and suffering from more dependency in relation to mobility (OR 2.57; 2.20-3.02). Patients with dementia who were independent for mobility prestroke were more likely to be discharged to a nursing home compared with patients without dementia with the same prestroke mobility (37% vs 16%; P < .001), but there were no differences in discharge to geriatric rehabilitation (19% for both; P = .976). Patients, who moved independently before stroke, were more often discharged home (60% vs 28%) and had lower mortality. In adjusted analyses, prestroke mobility limitations were associated with higher odds for poorer mobility, needing more residential assistance, and death. CONCLUSIONS:Patients with mobility impairments and/or dementia present a high burden of disability after a stroke. There is a need for research on stroke interventions among these populations.
Authors: Henry de Berker; Archy de Berker; Htin Aung; Pedro Duarte; Salman Mohammed; Hamsaraj Shetty; Tom Hughes Journal: Clin Med (Lond) Date: 2021-03 Impact factor: 2.659
Authors: Eva Zupanic; Mia von Euler; Bengt Winblad; Hong Xu; Juraj Secnik; Milica Gregoric Kramberger; Dorota Religa; Bo Norrving; Sara Garcia-Ptacek Journal: J Alzheimers Dis Date: 2021 Impact factor: 4.472
Authors: Minh Tuan Hoang; Ingemar Kåreholt; Mia von Euler; Lena von Koch; Maria Eriksdotter; Sara Garcia-Ptacek Journal: J Alzheimers Dis Date: 2021 Impact factor: 4.472
Authors: Hong Xu; Sara Garcia-Ptacek; Linus Jönsson; Anders Wimo; Peter Nordström; Maria Eriksdotter Journal: Neurology Date: 2021-03-19 Impact factor: 9.910
Authors: Shimaa A Heikal; Mohamed Salama; Yuliya Richard; Ahmed A Moustafa; Brian Lawlor Journal: Front Aging Neurosci Date: 2022-02-07 Impact factor: 5.750
Authors: Eva Zupanic; Ingemar Kåreholt; Bo Norrving; Juraj Secnik; Mia von Euler; Bengt Winblad; Dorota Religa; Milica Gregoric Kramberger; Kristina Johnell; Maria Eriksdotter; Sara Garcia-Ptacek Journal: J Alzheimers Dis Date: 2018 Impact factor: 4.472
Authors: Minh Tuan Hoang; Ingemar Kåreholt; Mia von Euler; Linus Jönsson; Lena von Koch; Maria Eriksdotter; Sara Garcia-Ptacek Journal: J Alzheimers Dis Date: 2020 Impact factor: 4.472
Authors: Gargi Banerjee; Edgar Chan; Gareth Ambler; Duncan Wilson; Lisa Cipolotti; Clare Shakeshaft; Hannah Cohen; Tarek Yousry; Rustam Al-Shahi Salman; Gregory Y H Lip; Keith W Muir; Martin M Brown; Hans Rolf Jäger; David J Werring Journal: J Am Heart Assoc Date: 2020-01-04 Impact factor: 5.501