Adverse Influence of Pre-Stroke Dementia on Short-Term Functional Outcomes in Patients with Acute Ischemic Stroke: The Fukuoka Stroke Registry

Abstract

Background: Dementia and stroke are major causes of disability in the elderly. However, the association between pre-stroke dementia and functional outcome after stoke remains unresolved. We aimed to determine this association in patients with acute ischemic stroke. Methods: Among patients registered in the Fukuoka Stroke Registry from June 2007 to May 2015, 4,237 patients with ischemic stroke within 24 h of onset, who were functionally independent before the onset, were enrolled in this study. Pre-stroke dementia was defined as any type of dementia that was present prior to the index stroke. Primary and secondary study outcomes were poor functional outcome (modified Rankin Scale 3-6) at 3 months after the stroke onset and neurological deterioration (≥2-point increases on the National Institutes of Health Stroke Scale score during hospitalization), respectively. For propensity score (PS)-matched cohort study to control confounding variables for pre-stroke dementia, 318 pairs of patients with and without pre-stroke dementia were also selected on the basis of 1:1 matching. Multivariable logistic regression models and conditional logistic regression analysis were used to quantify associations between pre-stroke dementia and study outcomes. Results: Of all 4,237 participants, 347 (8.2%) had pre-stroke dementia. The frequencies of neurological deterioration and poor functional outcome were significantly higher in patients with pre-stroke dementia than in those without pre-stroke dementia (neurological deterioration, 16.1 vs. 7.1%, p < 0.01; poor functional outcome, 63.7 vs. 27.1%, p < 0.01). Multivariable analysis showed that pre-stroke dementia was significantly associated with neurological deterioration (OR 1.67; 95% CI 1.14-2.41; p < 0.01) and poor functional outcome (OR 2.91; 95% CI 2.17-3.91; p < 0.01). In the PS-matched cohort study, the same trends were observed between the pre-stroke dementia and neurological deterioration (OR 2.60; 95% CI 1.17-5.78; p < 0.01) and between the dementia and poor functional outcome (OR 3.62; 95% CI 1.89-6.95; p < 0.01). Conclusions: Pre-stroke dementia was significantly associated with higher risks for poor functional outcome at 3 months after stroke onset as well as for neurological deterioration during hospitalization in patients with acute ischemic stroke.

Selection of anterior circulation acute stroke patients for mechanical thrombectomy

“…These findings are in line with the results of a recent work reporting that patients with pre-existing disability are older and have higher risk of unfavorable outcome despite MT [23]. Noteworthy, the cutoff value of pre stroke mRS was 0, suggesting that even slight disability may affect outcome, especially in elderly and that all efforts should be done to trace accurately and definitely pre stroke cognitive and physical condition (preferably in the pre-hospital setting) [15,16,23]. Compared to the MR PREDICTS score [14] IVT was not included in our score since no association with outcome was found ( Table 4).…”

“…In particular, LVO strokes present with more severe neurological deficits and are at high risk of poor outcome (with increased mid and long-term economic burden) and mortality [12,14]. Currently, stroke physicians often face the dilemma of treating or not treating, especially for very elderly patients who may suffer from several comorbidities (beyond aging) such as pre stroke dementia and disability which potentially affect outcome [15,16].…”

“…The TVSS ROC curve shows a trend toward better diagnostic predictiveness than MR PREDICTS score evaluated in a dichotomous way (e.g., age > 80 = 2 points; age ≤ 80 = 0 points). The TVSS identifies three risk groups: low (0-5), moderate (6)(7)(8)(9)(10)(11), high (12)(13)(14)(15)(16)(17)(18). Notably, 100% of patients in the higher quartile of the score presented a poor outcome with a 70% prevalence of death.…”

Secondary Stroke Prevention After Ischemic Stroke in Patients with Alzheimer’s Disease and Other Dementia Disorders

“…After IS, patients with dementia receive less specific diagnostic tests and assessments by the interdisciplinary stroke team [36] and have worse functional status [37,38]. It is important to weigh possible therapeutic benefits after severe IS against a particular patient's limited life expectancy.…”

Editorial 2017

“…A paper from the FUKUOKA STROKE REGISTRY [2] reporting that pre-stroke dementia was significantly associated with higher risks for poor functional outcome at 3 months after stroke onset as well as for neurological deterioration during hospitalization in patients with acute ischemic stroke; …”