Influence of Pre-Existing Mild Cognitive Impairment and Dementia on Post-Stroke Mortality. The Dijon Stroke Registry

Abstract

Objective: We assessed the association between pre-stroke cognitive status and 90-day case-fatality. Methods: Patients with ischemic stroke (IS) or spontaneous intracerebral hemorrhage (ICH) were prospectively identified among residents of Dijon, France, between 2013 and 2015, using a population-based registry. Association between pre-stroke cognitive status and case-fatality at 90 days was evaluated using Cox regression. Results: Seven hundred sixty-two patients were identified, and information about pre-stroke cognitive status was obtained for 716 (92.6%) of them, including 603 IS (84.2%) and 113 ICH (15.8%). Before stroke, 99 (13.8%) patients had mild cognitive impairment (MCI) and 98 (13.7%) had dementia. Patients with cognitive impairment were older, had a higher prevalence of several risk factors, more severe stroke, more frequent ICH, and less admission to stroke unit. Case-fatality rate at 90 days was 11.7% in patients without cognitive impairment, 32.3% in MCI patients, and 55.1% in patients with dementia. In multivariable analyses, pre-existing MCI (hazard ratio [HR] 2.22, 95% CI 1.21-4.05, p = 0.009) and dementia (HR 4.35, 95% CI 2.49-7.61, p < 0.001) were both associated with 90-day case-fatality. Conclusion: Prestroke MCI and dementia were both associated with increased mortality. These associations were not fully explained by baseline characteristics, pre-stroke dependency, stroke severity or patient management, and underlying reasons need to be investigated.

Pre-stroke cognitive impairment is associated with vascular imaging pathology: a prospective observational study

“…Pre-stroke dementia is more widely studied than pre-stroke cognitive impairment and is found in around 9–14% of stroke patients [ 7 ]. Pre-stroke dementia is associated with older age at onset, greater prevalence of atrial fibrillation, a history of stroke, heart failure and premorbid use of anticoagulants and anti-hypertensive medication [ 8 ]. Additionally, female stroke survivors are more likely to suffer from pre-stroke dementia [ 3 ], which has been attributed to the fact that women generally are older than men at the time of their first stroke [ 9 ].…”

Social deprivation and 1‐year survival after stroke: a prospective cohort study

“…Furthermore, the lower cumulative risk of death could be partially explained by an age effect. Hence, patients included in our study were younger than those enrolled in population‐based registries from high‐income countries [25], mainly because of the hospital‐based nature of the recruitment, the fact that about 70% of patients were included in French Overseas Departments where mean age at stroke onset is lower than in mainland France [26], and a possible non‐inclusion of patients with pre‐stroke severe dementia, especially those living in an long‐term care institution, in whom social deprivation is difficult to assess, and who have a poorer vital prognosis [27]. Finally, the lower number of events than expected could have led to a lack of power, especially for intracerebral hemorrhage (10% power to detect the observed difference between the two groups in death proportions at 1 year).…”

Large Vessel Occlusion in Patients With Minor Ischemic Stroke in a Population-Based Study. The Dijon Stroke Registry

“…Data were obtained from the Dijon Stroke Registry (5-7), an ongoing prospective population-based study that complies with the criteria for conducting ideal incidence stroke studies (8), and the guidelines for the reporting of incidence and prevalence studies in neuroepidemiology according to Standards of Reporting of Neurological Disorders (9). The methodology of the Dijon Stroke Registry has been described extensively elsewhere (5)(6)(7). Briefly, case collection relies on multiple overlapping sources of information to identify hospitalized and not hospitalized cases of stroke among residents of the city of Dijon, France (156,000 inhabitants), including a review of medical records of all patients referred to the Dijon University Hospital where the only stroke unit in the country is located, a review of computerized hospital diagnostic codes using the International Classification of Diseases, Tenth Revision (ICD-10; I61; I62; I63; I64; G45; G46, and G81), a review of medical records from the departments of the private hospitals of the city and its suburbs, a cooperation with local general practitioners and private neurologists to identify stroke patients from home or nursing homes and Dijon residents who had a stroke when outside the city, a review of the medical records of patients identified from a computer-generated list of all requests for imaging to radiology centers in Dijon, and regular reviewing of death certificates to identify fatal strokes that occurred outside the hospital.…”

“…As previously described, vascular risk factors, past medical history, and pre-stroke treatments were collected (7). Prestroke cognitive function (no cognitive impairment, mild cognitive impairment, and dementia) and functional status based on the premorbid modified Rankin Scale score were assessed.…”