BACKGROUND AND PURPOSE: The aim of this study was to determine whether dementia after stroke adversely influences long-term survival. METHODS: Subjects were 251 patients > or = 60 years of age with ischemic stroke who were given neurological, neuropsychological, and functional examinations 3 months after hospitalization and were followed up prospectively. Using criteria modified from the Diagnostic and Statistical Manual of Mental Disorders-III-R, dementia was found in 66 (26.3%) patients at the 3-month baseline examination. Life-table methods were used to estimate mortality rates in the groups with and without dementia after 1 to 5 years of follow-up, Kaplan-Meier curves to estimate the cumulative proportion surviving with and without dementia, and Cox proportional-hazards analysis to compute the relative risk of mortality associated with dementia at baseline, after adjusting for other potential predictors of stroke mortality. RESULTS: The mortality rate was 19.8 deaths per 100 person-years with dementia compared with 6.9 deaths per 100 person-years without dementia. The cumulative proportion surviving after a median follow-up of 58.6 months was 38.9 +/- 0.08% for those with dementia and 74.5 +/- 0.04% for those without dementia. The relative risk associated with dementia was 3.11 (95% confidence interval, 1.79 to 5.41) after adjusting for the effects of demographic factors, cardiac disease, severity of stroke (Barthel Index), stroke type (lacunar versus nonlacunar), and recurrent stroke (examined as a time-dependent variable). When the Mini-Mental State Examination score at baseline was examined instead of the diagnosis of dementia, the results of the model were similar. CONCLUSION: Our study is the first to demonstrate that dementia or cognitive impairment adversely influences long-term survival after stroke, even after adjusting for other commonly accepted predictors of stroke mortality. Impairment in intellectual function after stroke, independent of physical disability, has a significant impact on prognosis. Both cognitive and physical functions should be assessed in clinical studies of stroke outcome.
BACKGROUND AND PURPOSE: The aim of this study was to determine whether dementia after stroke adversely influences long-term survival. METHODS: Subjects were 251 patients > or = 60 years of age with ischemic stroke who were given neurological, neuropsychological, and functional examinations 3 months after hospitalization and were followed up prospectively. Using criteria modified from the Diagnostic and Statistical Manual of Mental Disorders-III-R, dementia was found in 66 (26.3%) patients at the 3-month baseline examination. Life-table methods were used to estimate mortality rates in the groups with and without dementia after 1 to 5 years of follow-up, Kaplan-Meier curves to estimate the cumulative proportion surviving with and without dementia, and Cox proportional-hazards analysis to compute the relative risk of mortality associated with dementia at baseline, after adjusting for other potential predictors of stroke mortality. RESULTS: The mortality rate was 19.8 deaths per 100 person-years with dementia compared with 6.9 deaths per 100 person-years without dementia. The cumulative proportion surviving after a median follow-up of 58.6 months was 38.9 +/- 0.08% for those with dementia and 74.5 +/- 0.04% for those without dementia. The relative risk associated with dementia was 3.11 (95% confidence interval, 1.79 to 5.41) after adjusting for the effects of demographic factors, cardiac disease, severity of stroke (Barthel Index), stroke type (lacunar versus nonlacunar), and recurrent stroke (examined as a time-dependent variable). When the Mini-Mental State Examination score at baseline was examined instead of the diagnosis of dementia, the results of the model were similar. CONCLUSION: Our study is the first to demonstrate that dementia or cognitive impairment adversely influences long-term survival after stroke, even after adjusting for other commonly accepted predictors of stroke mortality. Impairment in intellectual function after stroke, independent of physical disability, has a significant impact on prognosis. Both cognitive and physical functions should be assessed in clinical studies of stroke outcome.
Authors: Deborah A Levine; Andrzej T Galecki; Kenneth M Langa; Frederick W Unverzagt; Mohammed U Kabeto; Bruno Giordani; Virginia G Wadley Journal: JAMA Date: 2015-07-07 Impact factor: 56.272
Authors: Mark B Snowden; Lesley E Steinman; Lucinda L Bryant; Monique M Cherrier; Kurt J Greenlund; Katherine H Leith; Cari Levy; Rebecca G Logsdon; Catherine Copeland; Mia Vogel; Lynda A Anderson; David C Atkins; Janice F Bell; Annette L Fitzpatrick Journal: Int J Geriatr Psychiatry Date: 2017-02-01 Impact factor: 3.485
Authors: Alexandra J Lansky; Steven R Messé; Adam M Brickman; Michael Dwyer; H Bart van der Worp; Ronald M Lazar; Cody G Pietras; Kevin J Abrams; Eugene McFadden; Nils H Petersen; Jeffrey Browndyke; Bernard Prendergast; Vivian G Ng; Donald E Cutlip; Samir Kapadia; Mitchell W Krucoff; Axel Linke; Claudia Scala Moy; Joachim Schofer; Gerrit-Anne van Es; Renu Virmani; Jeffrey Popma; Michael K Parides; Susheel Kodali; Michel Bilello; Robert Zivadinov; Joseph Akar; Karen L Furie; Daryl Gress; Szilard Voros; Jeffrey Moses; David Greer; John K Forrest; David Holmes; Arie P Kappetein; Michael Mack; Andreas Baumbach Journal: Eur Heart J Date: 2018-05-14 Impact factor: 29.983