From the Stockholm Gerontology Research Center and Department of
Geriatric Medicine, Karolinska Institute, Stockholm, Sweden.
Background and Purpose—Stroke is
a major cause of disability in the elderly and is also related to the
development of dementia, which is another important source of
disability in old age. The aim of the present study was to examine
the potential impact of stroke on cognitive and functional status in a
community-based cohort of individuals aged 75 years and older.
Methods—The data were derived from a cross-sectional survey on
aging and dementia that included all inhabitants of the Kungsholmen
district in central Stockholm who were aged
Results—The prevalence of stroke was 10.0% in men and 8.0% in
women. One third of stroke survivors were diagnosed as demented, which
was 3 times higher than those without stroke: adjusted odds ratio (OR)
was 3.6 (95% confidence interval, 2.5 to 5.8). Stroke was also
significantly related to cognitive impairment without dementia
(adjusted OR, 2.4 [95% confidence interval, 1.3 to 4.6]). The
population-attributable risks of dementia and cognitive impairment in
relation to stroke were 18.4% and 8.5%, respectively. Among the 49
stroke patients with dementia, 15 cases (30.6%) had missing
information on dementia onset, 22 (44.9%) had been reported by the
informant to have dementia-related symptoms after or close to the
occurrence of stroke, and 12 (24.5%) had symptoms before stroke
occurrence. The prevalence rates of disability in activities of daily
living were much higher among stroke patients than among stroke-free
subjects, even after adjustment for age, sex, heart disease, hip
fracture, and dementia: the corresponding adjusted ORs for bathing,
dressing, toileting, transfer, and continence were 3.5 (2.4 to 5.3),
2.2 (1.4 to 3.3), 3.0 (2.0 to 4.5), 3.3 (1.9 to 5.7), and 2.1 (1.3 to
3.3), respectively. After dementia and hip fracture, stroke was the
third largest contributor to disability in bathing, dressing, and
transfer. Stroke was the second contributor to disability in
toileting.
Conclusions—Stroke is strongly associated with dementia, although
it may relate to dementia in different ways: it can be the main cause
or a precipitating factor of dementia, or they may share common
etiological bases. Together with dementia and hip fracture, stroke is a
major contributor to disability in most aspects of activities of daily
living in very old people.
© 1998 American Heart Association, Inc.
Original Contributions
Association of Stroke With Dementia, Cognitive Impairment, and Functional Disability in the Very Old
A Population-Based Study
75 years. Cases of stroke
were identified through the computerized inpatient register system that
has been widely used to study stroke in Sweden. Dementia was defined
according to the Diagnostic and Statistical Manual
of Mental Disorders, Third Edition, Revised. Dementia onset was
considered the appearance, according to an informant, of the first
symptom. Cognitive impairment without dementia was defined as the
presence of a Mini-Mental State Examination score of <24 and the
absence of dementia. Functional disability was assessed according to
Katz Index of independence in activities of daily living.
Key Words: aging • cognitive impairment • dementia • disability • stroke
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