Outcomes in Hospitalized Ischemic Stroke Patients with Dementia on Admission: A Population-Based Cohort Study

Abstract

During the observed period, 313,138 people were admitted to a hospital in Canada for an ischemic stroke. Of those, 21,788 (7.0%) had a concurrent diagnosis of dementia. People with dementia had older median age (84 vs. 76 years; p<0.0001), were more often female (59.6% vs. 48.4%; p<0.0001) and more often had Charlson-Deyo Comorbidity Index ≥2 (64.5% vs. 43.5%; p<0.0001). Patients with dementia were less likely to be discharged to a rehabilitation facility (adjusted risk ratio [RR] 3.089, 95% confidence interval [CI] 2.992-3.188, p<0.0001) or home independently (adjusted RR 0.756, 95% CI 0.737-0.776, p<0.0001).InterpretationApproximately 1 in 13 hospitalized ischemic stroke patients has coded dementia. Patients with ischemic stroke and concurrent dementia have higher mortality, face significantly more dependence after stroke and utilize greater healthcare resources than stroke patients without dementia. Causative conclusions are limited by the administrative data source. Early care planning and coordination could potentially optimize outcomes.

Recent Trends in Hospitalizations for Cardiovascular Disease, Stroke, and Vascular Cognitive Impairment in Canada

“…The diagnostic codes used to identify hospitalizations for VCI included a range of codes which included vascular dementia, mild cognitive impairment, and Alzheimer disease-related diagnostic codes to capture dementia of possible or probable vascular contribution. 22,23 This is in line with recent coding standards 23 and with research supporting cognitive impairment and dementia as frequently a combination of Alzheimer pathology and microvascular damage. 24…”

Imperfect Patients: Disparities in Treatment of Stroke Patients with Premorbid Disability

“…7,25,35 Throughout the sources reviewed, patients with a higher mRS were typically older, had more comorbidities, had had more severe strokes, had had previous strokes, had diabetes mellitus, experienced atrial fibrillation, and were more likely to catch pneumonia. 16,22,33…”

“…7,25,35 Throughout the sources reviewed, patients with a higher mRS were typically older, had more comorbidities, had had more severe strokes, had had previous strokes, had diabetes mellitus, experienced atrial fibrillation, and were more likely to catch pneumonia. 16,22,33 Busl et al 16 found that patients ≥80 with AIS treated with IVT had a decreased likelihood of death, illustrating that age as a single variable does not limit the benefit of intervention for individuals. The finding of age not predicting stroke outcome was replicated by Murao et al, 35 who additionally found that cognitive impairment, no dementia (CIND), and onset to needle time were not associated with a positive outcome.…”

Augmented Reality Education Experience (AREduX): An Augmented Reality Experience and Experiential Education Medium to Teach Empathy to Healthcare Providers and Caregivers of Persons Living With Dementia

“…While the evolution of healthcare has contributed to increasing the population's life expectancy, the number of individuals living with noncommunicable diseases such as dementia is on the rise. In 2015, the World Health Organization reported 47.5 million people living with dementia (PLWD) and postulated that this will increase to 75.6 million by 2030 [1]. Challenges that PLWD encounter include memory loss, depression, anxiety, isolation, inability to live independently, and loss of a sense of self [2].…”