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Stroke, Vol 25, 1915-1919, Copyright © 1994 by American Heart Association
TK Tatemichi, M Paik, E Bagiella, DW Desmond, M Pirro and LK Hanzawa
BACKGROUND AND PURPOSE: The aim of this study was to determine whether
dementia after stroke adversely influences long-term survival. METHODS:
Subjects were 251 patients > or = 60 years of age with ischemic stroke
who were given neurological, neuropsychological, and functional
examinations 3 months after hospitalization and were followed up
prospectively. Using criteria modified from the Diagnostic and Statistical
Manual of Mental Disorders-III-R, dementia was found in 66 (26.3%) patients
at the 3-month baseline examination. Life-table methods were used to
estimate mortality rates in the groups with and without dementia after 1 to
5 years of follow-up, Kaplan-Meier curves to estimate the cumulative
proportion surviving with and without dementia, and Cox
proportional-hazards analysis to compute the relative risk of mortality
associated with dementia at baseline, after adjusting for other potential
predictors of stroke mortality. RESULTS: The mortality rate was 19.8 deaths
per 100 person-years with dementia compared with 6.9 deaths per 100
person-years without dementia. The cumulative proportion surviving after a
median follow-up of 58.6 months was 38.9 +/- 0.08% for those with dementia
and 74.5 +/- 0.04% for those without dementia. The relative risk associated
with dementia was 3.11 (95% confidence interval, 1.79 to 5.41) after
adjusting for the effects of demographic factors, cardiac disease, severity
of stroke (Barthel Index), stroke type (lacunar versus nonlacunar), and
recurrent stroke (examined as a time-dependent variable). When the
Mini-Mental State Examination score at baseline was examined instead of the
diagnosis of dementia, the results of the model were similar. CONCLUSION:
Our study is the first to demonstrate that dementia or cognitive impairment
adversely influences long-term survival after stroke, even after adjusting
for other commonly accepted predictors of stroke mortality. Impairment in
intellectual function after stroke, independent of physical disability, has
a significant impact on prognosis. Both cognitive and physical functions
should be assessed in clinical studies of stroke outcome.
ARTICLES
Dementia after stroke is a predictor of long-term survival
Department of Neurology (Stroke and Aging Research Project), Columbia University, College of Physicians and Surgeons, New York, NY.
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