Stroke as a Cause of Death in Death Certificates of Patients with Dementia: A Cohort Study from the Swedish Dementia Registry

Abstract

Introduction: Patients with dementia may be at a higher risk for death from stroke. We aimed to describe characteristics of dementia patients that died from ischemic stroke (IS) in Sweden. Methods: A retrospective longitudinal analysis of prospectively collected data of patients registered into the Swedish Dementia Registry was conducted. Data on causes of death, drugs and comorbidities were acquired from the Swedish nationwide health registers. Deaths were attributed to stroke if the death certificate contained stroke as a cause of death and the patient had a stroke registered in Riksstroke, the Swedish Stroke Register, in the year preceding death. Demographic data at the time of dementia diagnosis was compared between patients dying from IS and registered in Riksstroke, patients dying from IS without being registered in Riksstroke and those dying from other causes. Results: Out of 49823 patients diagnosed with dementia between 2007 and 2014 in primary care or specialist clinics, 14170 (28.4%) had died by the end of 2014. Of these 1180 (8.3%) had IS in their death certificate, of which 459 (38.9%) had been registered in Riksstroke. In patients who died of IS the most common type of dementia was vascular dementia while those died from other causes were most often diagnosed with Alzheimer’s dementia (AD). Patients who died from IS and were registered in Riksstroke had higher MMSE score compared to other groups. Patients who died from IS took more cardiovascular medications. There were no differences in the use of antipsychotics, antidepressants, acetylcholinesterase inhibitors, memantine, anxiolytics, or hypnotics between the groups. Conclusions: There was a relatively high number of patients who died from IS as shown in their death certificate but had not been registered in Riksstroke in the year before death. This creates concerns on the accuracy of death certificate stroke diagnoses, particularly for deaths taking place outside hospitals.

Long-term Effects of Cholinesterase Inhibitors on Cognitive Decline and Mortality

“…Better cognition may in itself be protective for mortality but ChEIs may also have beneficial systemic effects 27,28 . Stroke and mortality prevention in mild-to-moderate dementia stages are desirable, and stroke prevention could theoretically prolong independent functioning in dementia [41][42][43][44] . Meanwhile, a recent study showed that initiation of antipsychotic treatment was reduced in those treated with ChEIs 45 .…”

Hospitalizations and Mortality of Individuals with Dementia: Evidence from Czech National Registers

“…The models were adjusted for age, sex, and CCI (Model 1) and also for type of facility, civil status, reason for admission, planned care, and region (Model 2). These covariates were chosen based on literature as sociodemographic and clinical characteristics associated with mortality in people with dementia [23][24][25][26][27]. The individuals in the hospitalized cohort were followed from the discharge from their first hospitalization for dementia until 31 December 2014 or death, whichever came first.…”

“…The individuals in the hospitalized cohort were followed from the discharge from their first hospitalization for dementia until 31 December 2014 or death, whichever came first. We used the date of discharge rather than date of admission to be in line with international registerbased studies on this topic [23][24][25][26][27] and because it is a more reliable information with no missing values.…”

3-<em>n</em>-butylphthalide exerts neuroprotective effects by enhancing anti-oxidation and attenuating mitochondrial dysfunction in an in vitro model of ischemic stroke

“…Ischemic stroke is a major risk factor for vascular dementia and Alzheimer's disease, and it is associated with high neurological disability and mortality. [1][2][3] Within a few minutes, the cascade of reactions caused by ischemic stroke can lead to irreversible functional impairment of nerve tissue in the ischemic core. Ischemic stroke is thought to occur when cerebral artery stenosis and reduction or interruption of regional cerebral blood flow decrease the supply of oxygen and energy to brain tissue, triggering secondary vascular endothelial damage and autonomic nervous dysfunction.…”