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31-10-2011 | Stroke | Article

Poor outlook for stroke patients with dementia

Abstract

Free abstract

MedWire News: Ischemic stroke is highly likely to leave patients with dementia disabled and needing ongoing nursing care, a study shows.

"How to best manage stroke patients with pre-existing dementia is under debate and raises several diagnostic, management, and ethical issues, as some facilities may limit access to specialized stroke care for dementia patients unless the care is likely to improve outcomes," said lead researcher Gustavo Saposnik (University of Toronto, Ontario, Canada), in a press statement.

"The lack of established guidelines for the management and treatment of stroke patients with dementia contributes to this uncertainty."

The present study, involving 9304 stroke patients, shows significant reductions in the likelihood for dementia patients being admitted to a stroke unit or undergoing thrombolysis in the event of a stroke. The stroke unit admission rate was 63.0% among the 702 patients with a history of dementia, compared with 67.6% among those without, while a respective 10.5% versus 15.7% of eligible patients received thrombolysis.

Compared with patients without dementia, those with the condition were also less likely to undergo carotid imaging before discharge and to receive a statin prescription at discharge. But differences in other performance measures, including receipt of swallowing assessment, stroke team management, and physiotherapy, were "not meaningful," with unadjusted standardized differences generally at about 0.1 or less.

Patients with dementia were frailer and at greater risk for poor outcomes at the outset, the team reports in the journal Neurology. They were significantly older than other patients, at 81 versus 70 years, more frequently had severe strokes, with 20.7% versus 10.5% having Canadian Neurological Scale scores lower than 4, and more often had atrial fibrillation, at 22.8% versus 15.3%.

Thus, at discharge, patients with dementia were significantly more often disabled than those without, with 80.6% versus 56.6% having modified Rankin Scale scores of at least 3. They were also less likely to be discharged to their prestroke place of residence, at 24.1% versus 45.0%; among those who had previously lived at home, 36.5% versus 47.3% returned there after stroke.

"Given the present demographic trends toward aging of the population, governments, policy-makers, healthcare providers, and health insurance representatives will need to work together to discuss achievable goals and priorities to reduce the impact of stroke in this population," conclude Saposnik et al.

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By Eleanor McDermid