Thrombolysis in acute ischemic stroke in patients with dementia: A Swedish registry study
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 t...
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| Veröffentlicht in: | Neurology 2017-10, Vol.89 (18), p.1860-1868 |
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| creator | Zupanic, Eva von Euler, Mia Kåreholt, Ingemar Contreras Escamez, Beatriz Fastbom, Johan Norrving, Bo Religa, Dorota Kramberger, Milica G Winblad, Bengt Johnell, Kristina Eriksdotter, Maria Garcia-Ptacek, Sara |
| description | 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.This is an open access article distributed under the terms of the Creative Commons Attribution License 4.0 (CC BY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
| doi_str_mv | 10.1212/WNL.0000000000004598 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_swepu</sourceid><recordid>TN_cdi_swepub_primary_oai_swepub_ki_se_493532</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1948760035</sourcerecordid><originalsourceid>FETCH-LOGICAL-c5418-2d474270f05ae7b808529a084a8032ccb735ef17bc0a8453aac69bb1aea49e3b3</originalsourceid><addsrcrecordid>eNqNkluLEzEUx4Mobq1-A5F59MFZc51kfBDKeoWiD663p5BkznRiZ5qazFj67U1pXXaFFQOHXM7v_084OQg9JvicUEKff_2wPMfXBhe1uoNmRNCqrBj9dhfNMKaqZEqqM_QgpR8Y56Ss76MzqmpVcYJn6PtlF8NgQ79PPhV-Uxg3jVD45DoYvCvSGMMaDomtGT1sxlTs_NgVDQx5482LYlF82kHjU1dEWPnM77NoavYP0b3W9AkeneY5-vzm9eXFu3L58e37i8WydIITVdKGS04lbrEwIK3CStDaYMWNwow6ZyUT0BJpHTaKC2aMq2priQHDa2CWzVF59E072E5Wb6MfTNzrYLw-Ha3zCjSvmWA088tb-X7a5rA5DgLBKtviSmrpXKs5I1abtsGaYYcryyVrnMp2z261e-W_LHSIK50mTQTJ3_F_eIiTVliSOuMvj3hmB2hcrnk0_Q3VzczGd3oVfmlRVZzWPBs8PRnE8HOCNOoh_y30vdlAmJImNVeywjiXZo74EXUxpBShvbqGYH1oOZ1bTv_dcln25PoTr0R_eiwD6gjsQj9CTOt-2kHUHZh-7P7t_RujJOXI</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1948760035</pqid></control><display><type>article</type><title>Thrombolysis in acute ischemic stroke in patients with dementia: A Swedish registry study</title><source>MEDLINE</source><source>Alma/SFX Local Collection</source><source>SWEPUB Freely available online</source><source>Journals@Ovid Complete</source><creator>Zupanic, Eva ; von Euler, Mia ; Kåreholt, Ingemar ; Contreras Escamez, Beatriz ; Fastbom, Johan ; Norrving, Bo ; Religa, Dorota ; Kramberger, Milica G ; Winblad, Bengt ; Johnell, Kristina ; Eriksdotter, Maria ; Garcia-Ptacek, Sara</creator><creatorcontrib>Zupanic, Eva ; von Euler, Mia ; Kåreholt, Ingemar ; Contreras Escamez, Beatriz ; Fastbom, Johan ; Norrving, Bo ; Religa, Dorota ; Kramberger, Milica G ; Winblad, Bengt ; Johnell, Kristina ; Eriksdotter, Maria ; Garcia-Ptacek, Sara</creatorcontrib><description>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.This is an open access article distributed under the terms of the Creative Commons Attribution License 4.0 (CC BY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</description><identifier>ISSN: 0028-3878</identifier><identifier>ISSN: 1526-632X</identifier><identifier>EISSN: 1526-632X</identifier><identifier>DOI: 10.1212/WNL.0000000000004598</identifier><identifier>PMID: 28986410</identifier><language>eng</language><publisher>United States: American Academy of Neurology</publisher><subject>Age Factors ; Aged, 80 and over ; Brain Ischemia - complications ; Case-Control Studies ; Clinical Medicine ; Cohort Studies ; Dementia - complications ; Female ; Fibrinolytic Agents - therapeutic use ; Humans ; Klinisk medicin ; Male ; Medical and Health Sciences ; Medicin och hälsovetenskap ; Neurologi ; Neurology ; Registries ; Statistics, Nonparametric ; Stroke - complications ; Stroke - drug therapy ; Stroke - etiology ; Sweden - epidemiology ; Treatment Outcome</subject><ispartof>Neurology, 2017-10, Vol.89 (18), p.1860-1868</ispartof><rights>2017 American Academy of Neurology</rights><rights>Copyright © 2017 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.</rights><rights>Copyright © 2017 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology 2017 American Academy of Neurology</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c5418-2d474270f05ae7b808529a084a8032ccb735ef17bc0a8453aac69bb1aea49e3b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,550,776,780,881,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28986410$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-80719$$DView record from Swedish Publication Index$$Hfree_for_read</backlink><backlink>$$Uhttps://urn.kb.se/resolve?urn=urn:nbn:se:su:diva-151002$$DView record from Swedish Publication Index$$Hfree_for_read</backlink><backlink>$$Uhttps://lup.lub.lu.se/record/536bf067-7ccf-431b-afd0-30c06b473dc8$$DView record from Swedish Publication Index$$Hfree_for_read</backlink><backlink>$$Uhttp://kipublications.ki.se/Default.aspx?queryparsed=id:137282407$$DView record from Swedish Publication Index$$Hfree_for_read</backlink></links><search><creatorcontrib>Zupanic, Eva</creatorcontrib><creatorcontrib>von Euler, Mia</creatorcontrib><creatorcontrib>Kåreholt, Ingemar</creatorcontrib><creatorcontrib>Contreras Escamez, Beatriz</creatorcontrib><creatorcontrib>Fastbom, Johan</creatorcontrib><creatorcontrib>Norrving, Bo</creatorcontrib><creatorcontrib>Religa, Dorota</creatorcontrib><creatorcontrib>Kramberger, Milica G</creatorcontrib><creatorcontrib>Winblad, Bengt</creatorcontrib><creatorcontrib>Johnell, Kristina</creatorcontrib><creatorcontrib>Eriksdotter, Maria</creatorcontrib><creatorcontrib>Garcia-Ptacek, Sara</creatorcontrib><title>Thrombolysis in acute ischemic stroke in patients with dementia: A Swedish registry study</title><title>Neurology</title><addtitle>Neurology</addtitle><description>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.This is an open access article distributed under the terms of the Creative Commons Attribution License 4.0 (CC BY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</description><subject>Age Factors</subject><subject>Aged, 80 and over</subject><subject>Brain Ischemia - complications</subject><subject>Case-Control Studies</subject><subject>Clinical Medicine</subject><subject>Cohort Studies</subject><subject>Dementia - complications</subject><subject>Female</subject><subject>Fibrinolytic Agents - therapeutic use</subject><subject>Humans</subject><subject>Klinisk medicin</subject><subject>Male</subject><subject>Medical and Health Sciences</subject><subject>Medicin och hälsovetenskap</subject><subject>Neurologi</subject><subject>Neurology</subject><subject>Registries</subject><subject>Statistics, Nonparametric</subject><subject>Stroke - complications</subject><subject>Stroke - drug therapy</subject><subject>Stroke - etiology</subject><subject>Sweden - epidemiology</subject><subject>Treatment Outcome</subject><issn>0028-3878</issn><issn>1526-632X</issn><issn>1526-632X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>D8T</sourceid><recordid>eNqNkluLEzEUx4Mobq1-A5F59MFZc51kfBDKeoWiD663p5BkznRiZ5qazFj67U1pXXaFFQOHXM7v_084OQg9JvicUEKff_2wPMfXBhe1uoNmRNCqrBj9dhfNMKaqZEqqM_QgpR8Y56Ss76MzqmpVcYJn6PtlF8NgQ79PPhV-Uxg3jVD45DoYvCvSGMMaDomtGT1sxlTs_NgVDQx5482LYlF82kHjU1dEWPnM77NoavYP0b3W9AkeneY5-vzm9eXFu3L58e37i8WydIITVdKGS04lbrEwIK3CStDaYMWNwow6ZyUT0BJpHTaKC2aMq2priQHDa2CWzVF59E072E5Wb6MfTNzrYLw-Ha3zCjSvmWA088tb-X7a5rA5DgLBKtviSmrpXKs5I1abtsGaYYcryyVrnMp2z261e-W_LHSIK50mTQTJ3_F_eIiTVliSOuMvj3hmB2hcrnk0_Q3VzczGd3oVfmlRVZzWPBs8PRnE8HOCNOoh_y30vdlAmJImNVeywjiXZo74EXUxpBShvbqGYH1oOZ1bTv_dcln25PoTr0R_eiwD6gjsQj9CTOt-2kHUHZh-7P7t_RujJOXI</recordid><startdate>20171031</startdate><enddate>20171031</enddate><creator>Zupanic, Eva</creator><creator>von Euler, Mia</creator><creator>Kåreholt, Ingemar</creator><creator>Contreras Escamez, Beatriz</creator><creator>Fastbom, Johan</creator><creator>Norrving, Bo</creator><creator>Religa, Dorota</creator><creator>Kramberger, Milica G</creator><creator>Winblad, Bengt</creator><creator>Johnell, Kristina</creator><creator>Eriksdotter, Maria</creator><creator>Garcia-Ptacek, Sara</creator><general>American Academy of Neurology</general><general>Lippincott Williams & Wilkins</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><scope>AABEP</scope><scope>ADTPV</scope><scope>AOWAS</scope><scope>D8T</scope><scope>D91</scope><scope>ZZAVC</scope><scope>ABAVF</scope><scope>DG7</scope><scope>D95</scope></search><sort><creationdate>20171031</creationdate><title>Thrombolysis in acute ischemic stroke in patients with dementia: A Swedish registry study</title><author>Zupanic, Eva ; von Euler, Mia ; Kåreholt, Ingemar ; Contreras Escamez, Beatriz ; Fastbom, Johan ; Norrving, Bo ; Religa, Dorota ; Kramberger, Milica G ; Winblad, Bengt ; Johnell, Kristina ; Eriksdotter, Maria ; Garcia-Ptacek, Sara</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5418-2d474270f05ae7b808529a084a8032ccb735ef17bc0a8453aac69bb1aea49e3b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Age Factors</topic><topic>Aged, 80 and over</topic><topic>Brain Ischemia - complications</topic><topic>Case-Control Studies</topic><topic>Clinical Medicine</topic><topic>Cohort Studies</topic><topic>Dementia - complications</topic><topic>Female</topic><topic>Fibrinolytic Agents - therapeutic use</topic><topic>Humans</topic><topic>Klinisk medicin</topic><topic>Male</topic><topic>Medical and Health Sciences</topic><topic>Medicin och hälsovetenskap</topic><topic>Neurologi</topic><topic>Neurology</topic><topic>Registries</topic><topic>Statistics, Nonparametric</topic><topic>Stroke - complications</topic><topic>Stroke - drug therapy</topic><topic>Stroke - etiology</topic><topic>Sweden - epidemiology</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Zupanic, Eva</creatorcontrib><creatorcontrib>von Euler, Mia</creatorcontrib><creatorcontrib>Kåreholt, Ingemar</creatorcontrib><creatorcontrib>Contreras Escamez, Beatriz</creatorcontrib><creatorcontrib>Fastbom, Johan</creatorcontrib><creatorcontrib>Norrving, Bo</creatorcontrib><creatorcontrib>Religa, Dorota</creatorcontrib><creatorcontrib>Kramberger, Milica G</creatorcontrib><creatorcontrib>Winblad, Bengt</creatorcontrib><creatorcontrib>Johnell, Kristina</creatorcontrib><creatorcontrib>Eriksdotter, Maria</creatorcontrib><creatorcontrib>Garcia-Ptacek, Sara</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>SWEPUB Örebro universitet full text</collection><collection>SwePub</collection><collection>SwePub Articles</collection><collection>SWEPUB Freely available online</collection><collection>SWEPUB Örebro universitet</collection><collection>SwePub Articles full text</collection><collection>SWEPUB Stockholms universitet full text</collection><collection>SWEPUB Stockholms universitet</collection><collection>SWEPUB Lunds universitet</collection><jtitle>Neurology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Zupanic, Eva</au><au>von Euler, Mia</au><au>Kåreholt, Ingemar</au><au>Contreras Escamez, Beatriz</au><au>Fastbom, Johan</au><au>Norrving, Bo</au><au>Religa, Dorota</au><au>Kramberger, Milica G</au><au>Winblad, Bengt</au><au>Johnell, Kristina</au><au>Eriksdotter, Maria</au><au>Garcia-Ptacek, Sara</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Thrombolysis in acute ischemic stroke in patients with dementia: A Swedish registry study</atitle><jtitle>Neurology</jtitle><addtitle>Neurology</addtitle><date>2017-10-31</date><risdate>2017</risdate><volume>89</volume><issue>18</issue><spage>1860</spage><epage>1868</epage><pages>1860-1868</pages><issn>0028-3878</issn><issn>1526-632X</issn><eissn>1526-632X</eissn><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.This is an open access article distributed under the terms of the Creative Commons Attribution License 4.0 (CC BY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</abstract><cop>United States</cop><pub>American Academy of Neurology</pub><pmid>28986410</pmid><doi>10.1212/WNL.0000000000004598</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Age Factors Aged, 80 and over Brain Ischemia - complications Case-Control Studies Clinical Medicine Cohort Studies Dementia - complications Female Fibrinolytic Agents - therapeutic use Humans Klinisk medicin Male Medical and Health Sciences Medicin och hälsovetenskap Neurologi Neurology Registries Statistics, Nonparametric Stroke - complications Stroke - drug therapy Stroke - etiology Sweden - epidemiology Treatment Outcome |
| title | Thrombolysis in acute ischemic stroke in patients with dementia: A Swedish registry study |
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