Mortality after Ischemic Stroke in Patients with Alzheimer's Disease Dementia and Other Dementia Disorders

Research output: Contribution to journalArticle

Abstract

Background: Stroke and dementia are interrelated diseases and risk for both increases with age. Even though stroke incidence and age-standardized death rates have decreased due to prevention of stroke risk factors, increased utilization of reperfusion therapies, and other changes in healthcare, the absolute numbers are increasing due to population growth and aging. Objective: To analyze predictors of death after stroke in patients with dementia and investigate possible time and treatment trends. Methods: A national longitudinal cohort study 2007-2017 using Swedish national registries. We compared 12,629 ischemic stroke events in patients with dementia with matched 57,954 stroke events in non-dementia controls in different aspects of patient care and mortality. Relationship between dementia status and dementia type (Alzheimer's disease and mixed dementia, vascular dementia, other dementias) and death was analyzed using Cox regressions. Results: Differences in receiving intravenous thrombolysis between patients with and without dementia disappeared after the year 2015 (administered to 11.1% dementia versus 12.3% non-dementia patients, p = 0.117). One year after stroke, nearly 50% dementia and 30% non-dementia patients had died. After adjustment for demographics, mobility, nursing home placement, and comorbidity index, dementia was an independent predictor of death compared with non-dementia patients (HR 1.26 [1.23-1.29]). Conclusion: Dementia before ischemic stroke is an independent predictor of death. Over time, early and delayed mortality in patients with dementia remained increased, regardless of dementia type. Patients with≤80 years with prior Alzheimer's disease or mixed dementia had higher mortality rates after stroke compared to patients with prior vascular dementia.

Details

Authors
  • Eva Zupanic
  • Mia Von Euler
  • Bengt Winblad
  • Hong Xu
  • Juraj Secnik
  • Milica Gregoric Kramberger
  • Dorota Religa
  • Bo Norrving
  • Sara Garcia-Ptacek
Organisations
External organisations
  • Karolinska Institutet
  • University Medical Centre Ljubljana
  • University of Ljubljana
  • Örebro University Hospital
  • Örebro University
  • Karolinska University Hospital
  • Skåne University Hospital
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Cardiac and Cardiovascular Systems
  • Neurology

Keywords

  • Alzheimer's disease, dementia, ischemic stroke, mixed dementia, mortality, vascular dementia
Original languageEnglish
Pages (from-to)1253-1261
Number of pages9
JournalJournal of Alzheimer's Disease
Volume81
Issue number3
Publication statusPublished - 2021
Publication categoryResearch
Peer-reviewedYes