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Thrombolysis in acute ischemic stroke in patients with dementia : A Swedish registry study

Zupanic, Eva; von Euler, Mia; Kåreholt, Ingemar; Contreras Escamez, Beatriz; Fastbom, Johan; Norrving, Bo LU ; Religa, Dorota; Kramberger, Milica G.; Winblad, Bengt and Johnell, Kristina LU , et al. (2017) In Neurology 89(18). p.1860-1868
Abstract

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%)... (More)

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.

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published
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Neurology
volume
89
issue
18
pages
9 pages
publisher
American Academy of Neurology
external identifiers
  • scopus:85032826460
  • wos:000417674500011
ISSN
1526-632X
DOI
10.1212/WNL.0000000000004598
language
English
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yes
id
536bf067-7ccf-431b-afd0-30c06b473dc8
date added to LUP
2017-11-23 08:56:58
date last changed
2018-01-16 13:26:25
@article{536bf067-7ccf-431b-afd0-30c06b473dc8,
  abstract     = {<p>OBJECTIVE: To compare access to intravenous thrombolysis (IVT) for acute ischemic stroke (AIS) and its outcomes in patients with and without dementia.</p><p>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.</p><p>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 &lt; 0.001). Unfavorable outcomes with an mRS score of 5 to 6 were doubled in patients with dementia (56.1% vs 28.1%).</p><p>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.</p>},
  author       = {Zupanic, Eva and von Euler, Mia and Kåreholt, Ingemar and Contreras Escamez, Beatriz and Fastbom, Johan and Norrving, Bo and Religa, Dorota and Kramberger, Milica G. and Winblad, Bengt and Johnell, Kristina and Eriksdotter, Maria and Garcia-Ptacek, Sara},
  issn         = {1526-632X},
  language     = {eng},
  month        = {10},
  number       = {18},
  pages        = {1860--1868},
  publisher    = {American Academy of Neurology},
  series       = {Neurology},
  title        = {Thrombolysis in acute ischemic stroke in patients with dementia : A Swedish registry study},
  url          = {http://dx.doi.org/10.1212/WNL.0000000000004598},
  volume       = {89},
  year         = {2017},
}