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Mortality after Ischemic Stroke in Patients with Alzheimer's Disease Dementia and Other Dementia Disorders

Zupanic, Eva ; Von Euler, Mia ; Winblad, Bengt ; Xu, Hong ; Secnik, Juraj ; Kramberger, Milica Gregoric ; Religa, Dorota ; Norrving, Bo LU and Garcia-Ptacek, Sara (2021) In Journal of Alzheimer's Disease 81(3). p.1253-1261
Abstract

Background: Stroke and dementia are interrelated diseases and risk for both increases with age. Even though stroke incidence and age-standardized death rates have decreased due to prevention of stroke risk factors, increased utilization of reperfusion therapies, and other changes in healthcare, the absolute numbers are increasing due to population growth and aging. Objective: To analyze predictors of death after stroke in patients with dementia and investigate possible time and treatment trends. Methods: A national longitudinal cohort study 2007-2017 using Swedish national registries. We compared 12,629 ischemic stroke events in patients with dementia with matched 57,954 stroke events in non-dementia controls in different aspects of... (More)

Background: Stroke and dementia are interrelated diseases and risk for both increases with age. Even though stroke incidence and age-standardized death rates have decreased due to prevention of stroke risk factors, increased utilization of reperfusion therapies, and other changes in healthcare, the absolute numbers are increasing due to population growth and aging. Objective: To analyze predictors of death after stroke in patients with dementia and investigate possible time and treatment trends. Methods: A national longitudinal cohort study 2007-2017 using Swedish national registries. We compared 12,629 ischemic stroke events in patients with dementia with matched 57,954 stroke events in non-dementia controls in different aspects of patient care and mortality. Relationship between dementia status and dementia type (Alzheimer's disease and mixed dementia, vascular dementia, other dementias) and death was analyzed using Cox regressions. Results: Differences in receiving intravenous thrombolysis between patients with and without dementia disappeared after the year 2015 (administered to 11.1% dementia versus 12.3% non-dementia patients, p = 0.117). One year after stroke, nearly 50% dementia and 30% non-dementia patients had died. After adjustment for demographics, mobility, nursing home placement, and comorbidity index, dementia was an independent predictor of death compared with non-dementia patients (HR 1.26 [1.23-1.29]). Conclusion: Dementia before ischemic stroke is an independent predictor of death. Over time, early and delayed mortality in patients with dementia remained increased, regardless of dementia type. Patients with≤80 years with prior Alzheimer's disease or mixed dementia had higher mortality rates after stroke compared to patients with prior vascular dementia.

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author
; ; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Alzheimer's disease, dementia, ischemic stroke, mixed dementia, mortality, vascular dementia
in
Journal of Alzheimer's Disease
volume
81
issue
3
pages
9 pages
publisher
IOS Press
external identifiers
  • scopus:85107755384
  • pmid:33935077
ISSN
1387-2877
DOI
10.3233/JAD-201459
language
English
LU publication?
yes
id
8b2c6e93-259c-4b1e-b43f-16cfb7b8f398
date added to LUP
2021-07-20 10:48:34
date last changed
2024-03-08 14:53:04
@article{8b2c6e93-259c-4b1e-b43f-16cfb7b8f398,
  abstract     = {{<p>Background: Stroke and dementia are interrelated diseases and risk for both increases with age. Even though stroke incidence and age-standardized death rates have decreased due to prevention of stroke risk factors, increased utilization of reperfusion therapies, and other changes in healthcare, the absolute numbers are increasing due to population growth and aging. Objective: To analyze predictors of death after stroke in patients with dementia and investigate possible time and treatment trends. Methods: A national longitudinal cohort study 2007-2017 using Swedish national registries. We compared 12,629 ischemic stroke events in patients with dementia with matched 57,954 stroke events in non-dementia controls in different aspects of patient care and mortality. Relationship between dementia status and dementia type (Alzheimer's disease and mixed dementia, vascular dementia, other dementias) and death was analyzed using Cox regressions. Results: Differences in receiving intravenous thrombolysis between patients with and without dementia disappeared after the year 2015 (administered to 11.1% dementia versus 12.3% non-dementia patients, p = 0.117). One year after stroke, nearly 50% dementia and 30% non-dementia patients had died. After adjustment for demographics, mobility, nursing home placement, and comorbidity index, dementia was an independent predictor of death compared with non-dementia patients (HR 1.26 [1.23-1.29]). Conclusion: Dementia before ischemic stroke is an independent predictor of death. Over time, early and delayed mortality in patients with dementia remained increased, regardless of dementia type. Patients with≤80 years with prior Alzheimer's disease or mixed dementia had higher mortality rates after stroke compared to patients with prior vascular dementia.</p>}},
  author       = {{Zupanic, Eva and Von Euler, Mia and Winblad, Bengt and Xu, Hong and Secnik, Juraj and Kramberger, Milica Gregoric and Religa, Dorota and Norrving, Bo and Garcia-Ptacek, Sara}},
  issn         = {{1387-2877}},
  keywords     = {{Alzheimer's disease; dementia; ischemic stroke; mixed dementia; mortality; vascular dementia}},
  language     = {{eng}},
  number       = {{3}},
  pages        = {{1253--1261}},
  publisher    = {{IOS Press}},
  series       = {{Journal of Alzheimer's Disease}},
  title        = {{Mortality after Ischemic Stroke in Patients with Alzheimer's Disease Dementia and Other Dementia Disorders}},
  url          = {{http://dx.doi.org/10.3233/JAD-201459}},
  doi          = {{10.3233/JAD-201459}},
  volume       = {{81}},
  year         = {{2021}},
}