Thrombolysis in acute ischemic stroke in patients with dementia: A Swedish registry study

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Abstract

OBJECTIVE: To compare access to intravenous thrombolysis (IVT) for acute ischemic stroke (AIS) and its outcomes in patients with and without dementia.

METHODS: This was a longitudinal cohort study of the Swedish dementia and stroke registries. Patients with preexisting dementia who had AIS from 2010 to 2014 (n = 1,356) were compared with matched patients without dementia (n = 6,755). We examined access to thrombolysis and its outcomes at 3 months (death, residency, and modified Rankin Scale [mRS] score). Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated with logistic and ordinal logistic regression.

RESULTS: The median age at stroke onset was 83 years in both groups. IVT was administered to 94 (7.0%) patients with dementia and 639 (9.5%) patients without dementia. The OR of receiving IVT was 0.68 (95% CI 0.54-0.86) for patients with dementia. When the analysis was repeated exclusively among patients independent in everyday activities, dementia status was no longer significant (OR 0.79, 95% CI 0.60-1.06). However, differences persisted in patients ≤80 years of age (OR 0.58, 95% CI 0.36-0.94). In patients who received thrombolysis, the incidence of symptomatic intracerebral hemorrhage (sICH; 7.4% vs 7.3%) and death at 3 months (22.0% vs 18.8%) did not differ significantly between the 2 groups. However, mRS score and accommodation status were worse among patients with dementia after 3 months in adjusted analyses (both p < 0.001). Unfavorable outcomes with an mRS score of 5 to 6 were doubled in patients with dementia (56.1% vs 28.1%).

CONCLUSIONS: Younger patients with dementia and AIS are less likely to receive IVT. Among patients receiving thrombolysis, there are no differences in sICH or death, although patients with dementia have worse accommodation and functional outcomes at 3 months.

Detaljer

Författare
  • Eva Zupanic
  • Mia von Euler
  • Ingemar Kåreholt
  • Beatriz Contreras Escamez
  • Johan Fastbom
  • Bo Norrving
  • Dorota Religa
  • Milica G. Kramberger
  • Bengt Winblad
  • Kristina Johnell
  • Maria Eriksdotter
  • Sara Garcia-Ptacek
Enheter & grupper
Externa organisationer
  • Karolinska University Hospital
  • Karolinska Institute
  • University Medical Centre Ljubljana
  • Södersjukhuset
  • Stockholms universitet
  • Jönköping University
  • Getafe University Hospital
  • Skåne University Hospital
Forskningsområden

Ämnesklassifikation (UKÄ) – OBLIGATORISK

  • Neurologi
Originalspråkengelska
Sidor (från-till)1860-1868
Antal sidor9
TidskriftNeurology
Volym89
Utgåva nummer18
StatusPublished - 2017 okt 31
PublikationskategoriForskning
Peer review utfördJa