Care and outcomes in patients with ischemic stroke with and without preexisting dementia
Care and outcomes in patients with ischemic stroke with and without preexisting dementia
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DOI：
10.1212/wnl.0b013e31823648f1
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发表时间：
2011-11-01
期刊：
影响因子：
9.9
通讯作者：
Black, S. E.
中科院分区：
文献类型：
--
作者：
Saposnik, G.;Cote, R.;Black, S. E.
目的：描述临床特征和评估过程中的护理和结果在出院时与缺血性中风患者和不预先存在的dementia.Methods：回顾性队列研究，使用注册表的加拿大中风网络，包括2003年和2008年之间的急性缺血性中风的患者。既存痴呆定义为在索引卒中病例之前存在的任何类型的痴呆。姑息性患者被排除。人口统计学信息、临床表现、选定的过程测量（e.例如，在一个实施例中，结果：在9，304例符合条件的急性缺血性卒中患者中，702例（9.1%）有痴呆病史。与非痴呆患者相比，痴呆患者年龄更大（平均年龄81岁vs 70岁; p < 0.001），中风更严重（加拿大神经量表评分< 4，20.7% vs 10.5%; p < 0.001），更容易发生房颤（22.8% vs 15.3%; p < 0.001）。痴呆患者入住卒中单元（63% vs 67.6%;比值比[OR] 0.82，95%置信区间[CI] 0.70-0.96）或接受溶栓治疗（10.5% vs 15.7%; OR 0.63，95% CI 0.49-0.81）的可能性略低。其他业绩指标没有差异。有痴呆病史的患者出院时残疾程度较高（OR 3.20，95% CI 2.64-3.87），并且不太可能出院到卒中前的居住地（24%对45%; p < 0.001）。在中风患者中，既存痴呆与高残疾率和机构化相关，这对卫生保健系统来说是一个越来越大的挑战。神经病学（R）2011;77：1664-1673
Objective: To describe clinical characteristics and evaluate processes of care and outcomes at discharge in patients with ischemic stroke with and without preexisting dementia.Methods: Retrospective cohort study using the Registry of the Canadian Stroke Network including patients presenting with an acute ischemic stroke between 2003 and 2008. Preexisting dementia was defined as any type of dementia that was present prior to the index stroke case. Palliative patients were excluded. Demographic information, clinical presentation, selected process measures (e. g., thrombolysis, admission to stroke unit, carotid imaging, stroke prevention), pneumonia, death, disability, and disposition at discharge were analyzed.Results: Among 9,304 eligible patients with an acute ischemic stroke, 702 (9.1%) had a history of dementia. Patients with dementia were older (mean age 81 vs 70 years; p < 0.001), had more severe strokes (Canadian Neurological Scale score < 4, 20.7% vs 10.5%; p < 0.001), and were more likely to have atrial fibrillation (22.8% vs 15.3%; p < 0.001) than those without dementia. Patients with dementia were slightly less likely to be admitted to a stroke unit (63% vs 67.6%; odds ratio [OR] 0.82, 95% confidence interval [CI] 0.70-0.96) or to receive thrombolysis (10.5% vs 15.7%; OR 0.63, 95% CI 0.49-0.81). There were no differences in other performance measures. Patients with preexisting dementia had higher disability at discharge (OR 3.20, 95% CI 2.64-3.87) and were less likely to be discharged to their prestroke place of residence (24% vs 45%; p < 0.001).Conclusions: In patients with stroke, preexisting dementia is associated with high rates of disability and institutionalization, representing an increasing challenge for the health care system. Neurology(R) 2011;77:1664-1673