and Stroke initiated the Stroke Data Bank, which is a multicenter project to prospectively collect data on the clinical course and sequelae of stroke. Additional objectives were to provide information that would enable a standard diagnostic clinical evaluation, to identify prognostic factors, and to provide planning data for future studies. A brief description of the structure and methods precede the baseline characterization of 1,805 patients enrolled in the Stroke Data Bank between July 1983 and June 1986. Two thirds of these patients were admitted within 24 hours after stroke onset. Medical history, neurologic history, and hospitalization summaries are presented separately for the following stroke subtypes: infarction, unknown cause; embolism from cardiac source; infarction due to atherosclerosis; lacune; parenchymatous or intracerebral hemorrhage; subarachnoid hemorrhage; and other. The utility and limitations of these data are discussed. (Stroke 1988;19:547-554) S troke is the third leading cause of death in the United States; only coronary heart disease and cancer are more prevalent causes of death. In 1985, there were 153,050 deaths attributed to cerebrovascular diseases and a crude death rate of 64.1 per 100,000 resident population.1 Cerebrovascular diseases are also a major cause of chronic disability, affecting millions of Americans. In 1978, the National Institute of Neurological and Communicative Disorders and Stroke (NINCDS) initiated a data bank project to provide prospectively and consistently recorded information on stroke to address some of the many unresolved research issues in cerebrovascular disease. The Stroke Data Bank (SDB) had four major objec- Received August 10, 1987; accepted November 17, 1987. tives: 1) to obtain information on the clinical course and outcome of stroke, 2) to provide information that would enable a standard diagnostic clinical evaluation, 3) to identify factors predictive of outcome following stroke, and 4) to provide planning data for future controlled, randomized, clinical trials in the treatment of stroke patients. The purpose of our report is to provide a comprehensive description of the project background, design, and methods and a description of the patients enrolled. Additional details (including copies of the data collection forms) are available in the SDB Manual of Operations.2 Previous communications have reported on the pilot phase, 3 reliability studies, 4 -5 and nursing implications 6 of this project. The primary analytic publications from the main phase of the SDB are now in preparation. Design and Methods Project OrganizationCooperative clinical projects require an organizational structure that will both facilitate efficient operation and at the same time provide a mechanism to ensure participation of all collaborators in the decisionmaking process. Toward these goals, the organizational structure developed for the SDB fostered careful and uniform adherence to the procedures for data collection and effective communication and cooperation among the va...

In a prospective study of 1,805 hospitalized patients in the Stroke Data Bank of the National Institute of Neurological and Communicative Disorders and Stroke, the 1,273 with infarction were classified into diagnostic subtypes. Diagnosis was based on the clinical history, examination, and laboratory tests including computed tomography, noninvasive vascular imaging, and where safe and relevant, angiography. Five hundred and eight cases (fully 40%) were labeled as infarcts of undetermined cause (IUC), of which 138 (27%) were evaluated with both computed tomography and angiography. The clinical syndrome and computed tomographic and angiographic findings in 91 (65.9%) of these 138 IUC cases were clearly not attributable to large-artery thrombosis and could permit reclassification of the infarct as due to some form of embolism. Failure to define a source of embolus kept them in the category of IUC. Thirty-one cases (22.5%) could be reclassified as due to stenosis or thrombosis of a large artery, and 16 (11.6%) as lacunar infarction. To determine if those selected for angiography among the IUC patients differed from those with other final diagnoses, a stepwise multiple logistic model was used. The most important characteristics were young age, presence of a superficial infarct, prior transient ischemic attack, low weakness score, and presentation with a nonlacunar syndrome. The results of the model suggest that angiography use was determined by clinical characteristics uniformly across centers and not by final diagnosis. Continued use of the category IUC may help clarify risk factors and stroke subtypes, allow new mechanisms of ischemic stroke to be uncovered, and prevent classification categories of stroke used in clinical trials from becoming too broad.

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The time of onset of ischemic stroke was determined for 1,167 of 1,273 patients during the collection of data by four academic hospital centers between June 30, 1983, and June 30, 1986. More strokes occurred in awake patients from 10:00 AM to noon than during any other 2-hour interval. The incidence of stroke onset declined steadily during the remainder of the day and early evening. The onset of stroke is least likely to occur in the late evening, before midnight.

We determined the prevalence of dementia in 927 patients with acute ischemic stroke aged years in the Stroke Data Bank cohort based on the examining neurologist's best judgment Diagnostic agreement among examiners was 68% (K=034). Of 726 testable patients, 116 (16%) were demented. Prevalence of dementia was related to age but not to sex, race, handedness, educational level, or employment status before the stroke. Previous stroke and previous myocardial infarction were related to prevalence of dementia although hypertension, diabetes mellitus, atrial fibrillation, and previous use of antithrombotic drugs were not Prevalence of dementia was most frequent in patients with infarcts due to large-artery atherosclerosis and in those with infarcts of unknown cause. Computed tomographic findings related to prevalence of dementia included infarct number, infarct site, and cortical atrophy. Among 610 patients who were not demented at stroke onset, we used methods of survival analysis to determine the incidence of dementia occurring during the 2-year follow-up. Incidence of dementia was related to age but not sex. Based on logistic regression analysis, the probability of new-onset dementia at 1 year was 5.4% for a patient aged 60 years and 10.4% for a patient aged 90 years. With a multivariate proportional hazards model, the most important predictors of incidence of dementia were a previous stroke and the presence of cortical atrophy at stroke onset (Stroke 1990-^1:858-866) C erebrovascular disease is considered to be the second most common cause of dementia; 20%-25% of cases of dementia are due to stroke, and another 10%-15% are attributed to a combination of vascular and Alzheimer's disease.