Background and Purpose-The incidence of falls among noninstitutionalized individuals with long-standing stroke has not been examined previously, although fractures are more common and the consequences more severe for stroke patients than for elderly people in general. Methods-For 4 months (September to December 1998), we followed 111 home-living patients who had suffered a stroke a mean of 10 years previously and 143 control subjects randomly selected from the same municipality, matched with respect to age and sex. Falls were registered daily by use of "fall calendars." Before the fall registration period, information about morbidity, use of medication, and activities of daily living had been registered. Height, weight, vision, blood pressure, motor function, and body sway had been measured, and depressive symptoms as well as cognitive function had been assessed. Results-During follow-up, 23% of the patients and 11% of the control subjects fell once or more, and the risk of falling at least once was more than twice as high for the patients with stroke, when controlled for potential confounders (relative riskϭ2.2; 95% CI, 1.1 to 4.3). Among the stroke patients, depressive symptomatology predicted falls, and the relative risk for falling increased by 1.5 per standard deviation increase in the depression score. Conclusions-We conclude that falls are more frequent among noninstitutionalized long-term stroke survivors than among community control subjects and that the risk of falling and depressive symptoms are related in stroke patients. (Stroke. 2002;33:542-547.)
Background and Purpose-The aim of this study was to validate the diagnosis of self-reported stroke. Methods- During 1994During -1995 159 people attended a population health survey in the community of Tromsø, Norway, a response rate of 77%. A total of 418 attenders reported a history of stroke. In 1997, all individuals with a self-reported stroke who were still living in the community (nϭ362) were invited to a clinical reexamination. For each of the 269 people who were reexamined, a person who reported no history of stroke was selected and was reexamined in the same way. Results-On the basis of the reexamination, 213 (79.2%) of the self-reported strokes were confirmed. Thirteen individuals (4.8%) had a possible stroke. The remaining 43 individuals had either transient ischemic attack (TIA; nϭ18), traumatic head injuries (nϭ16), or perinatal cerebral damage, complicated migraine, syncope, possible TIA, or cerebral aneurysm without bleeding (nϭ9). Among the confirmed strokes, 30 (14.1%) were hemorrhagic and 118 (55.4%) were thromboembolic. Of the 30 hemorrhages, 16 were subarachnoidal bleedings, 10 due to ruptured aneurysms. The histories of stroke, including both the symptoms and the signs, often had a paucity of details and precision, making it impossible to classify 65 stroke victims (30.5%) into stroke subtypes. The positive predictive value (PPV) of a self-reported stroke was 0.79. The PPV was significantly (Pϭ0.016) greater in men (0.88) than in women (0.73). Individuals older than 60 years had a significantly greater PPV than those younger than 60 years (PPV 0.83 and 0.73, respectively; Pϭ0.05). Hypertension was associated with a greater PPV, whereas a history of either ischemic heart disease, diabetes mellitus, lung disease, or depression had no impact on the PPV. The estimated sensitivity of self-reported stroke in the survey population was Ϸ80% and the specificity was 99%. Conclusions-We conclude that a self-administered questionnaire can be used to assess the prevalence of stroke in epidemiological research. (Stroke. 2000;31:1602-1607.)
BackgroundInappropriate medical treatment of co-morbidities in Alzheimer's disease (AD) is an increasing concern in geriatric medicine. The objective of this study was to compare current drug use related to co-morbidity between individuals with a recent diagnosis of AD and a cognitively healthy control group in a population based clinical trial in Northern Norway.MethodsSetting: Nine rural municipalities with 70 000 inhabitants in Northern Norway.Participants: Participants with and without AD recruited in general practice and by population based screening.187 participants with a recent diagnosis of AD were recruited among community dwellers. Of 791 respondents without cognitive symptoms, 500 were randomly selected and invited to further clinical and cognitive testing. The final control group consisted of 200 cognitively healthy individuals from the same municipalities. Demographic characteristics, data on medical history and current medication were included, and a physical and cognitive examination was performed. The statistical analyses were carried out by independent sample t-test, chi-square, ANCOVA and logistic regression.ResultsA co-morbidity score was significantly higher in AD participants compared to controls. The mean number of drugs was higher for AD participants compared to controls (5.1 ± 3.6 and 2.9 ± 2.4 respectively, p < 0.001 age and gender adjusted), also when adjusted for co-morbidity. AD participants used significantly more anticholinergic, sedative and antidepressant drugs. For nursing home residents with AD the mean number of drugs was significantly higher compared to AD participants living at home (6.9 ± 3.9 and 4.5 ± 3.3, respectively, p < 0.001).ConclusionsAD participants were treated with a significantly higher number of drugs as compared to cognitively healthy controls, even after adjustment for co-morbidity. An inappropriate use of anticholinergic and sedative drugs was identified, especially among nursing home residents with AD. The drug burden and the increased risk of adverse reactions among individuals suffering from AD need more attention from prescribing doctors.
Background and Purpose-Osteoporosis and stroke share several risk factors, including age, smoking, low physical activity, and hypertension. Thus, low bone mineral density (BMD) and high stroke risk may be related. We examined the relationship between BMD and acute stroke in noninstitutionalized men and women aged Ն60 years. Methods-Sixty-three stroke patients (33 women and 30 men) and 188 control subjects from the general population were included. BMD was measured by using dual-energy x-ray absorptiometry at both proximal femurs. The measurements of the stroke patients were performed 6 days after the onset of stroke. Results-The BMD at the femoral neck in the female stroke patients was 8% lower than in the control subjects (Pϭ0.007).In men, no difference in BMD between the stroke patients and their controls was found. Women with BMD values in the lowest quartile had a higher risk of stroke than women with BMD values in the highest quartile (OR 4.8), and the probability value for linear trend over the quartiles was statistically significant (Pϭ0.003). The OR for stroke increased 1.9 per SD (0.13 g/cm 2 ) reduction in BMD, and the association between low BMD and stroke in women remained significant when the analysis was adjusted for potential confounders. Conclusions
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