1
|
Ganesh A, Volny O, Kovacova I, Tomek A, Bar M, Pádr R, Cihlar F, Nevsimalova M, Jurak L, Havlicek R, Kovar M, Sevcik P, Rohan V, Fiksa J, Cerník D, Jura R, Vaclavik D, Hill MD, Mikulík R. Utilization, Workflow, and Outcomes of Endovascular Thrombectomy in Patients With vs Without Premorbid Disability in a National Registry. Neurol Clin Pract 2024; 14:e200341. [PMID: 39185095 PMCID: PMC11341008 DOI: 10.1212/cpj.0000000000200341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 04/17/2024] [Indexed: 08/27/2024]
Abstract
Background and Objectives Given the paucity of high-quality safety/efficacy data on acute stroke therapies in patients with premorbid disability, they risk being routinely excluded from such therapies. We examined utilization of endovascular thrombectomy (EVT), associated workflow, and poststroke outcomes among patients with vs without premorbid disability. Methods We used national registry data on thrombolysis/EVT for the Czech Republic from 1 January 2016 to 31 December 2020. Premorbid disability was defined as prestroke modified Rankin Scale score (mRS) ≥3. We compared proportions of patients with vs without premorbid disability who received EVT and examined workflow times. We compared ΔmRS-change in mRS from prestroke to 3 months-in patients with vs without premorbid disability, in addition to intracerebral hemorrhage (ICH), mortality, and discharge NIHSS (National Institutes of Health Stroke Scale score), adjusting for age, sex, baseline NIHSS, and comorbidities, and verified using propensity score weighting (PSW) and matching for differences in treatment assignment. We stratified by age group (<65, 65-74, 75-84, ≥85 years) to explore outcome heterogeneity with vs without premorbid disability. Results Among 22,405 patients with ischemic stroke who received thrombolysis/EVT/both, 1,712 (7.6%) had prestroke mRS ≥ 3. Patients with prestroke disability were less likely to receive EVT vs those without (10.1% vs 20.7%, aOR: 0.30, 95% CI 0.24-0.36). When treated, they had longer door-to-arterial puncture times (median: 75 minutes, IQR: 58-100 vs 54, IQR: 27-77, adjusted difference: 12.5, 95% CI 2.68-22.3). Patients with prestroke disability receiving thrombolysis/EVT/both had worse ΔmRS (adjusted rate ratio, aIRR on PSW: 1.57, 95% CI 1.43-1.72), rates of 3-month mRS 5-6, discharge NIHSS, and mortality (aOR-PSW [mortality]: 2.54, 95% CI 1.92-3.34), while ICH did not significantly differ. 32.1% of patients with prestroke disability receiving thrombolysis/EVT/both successfully returned to prestroke state, but this proportion ranged from 19.6% for those older than 85 years to 66.0% for those younger than 65 years. Regardless of premorbid disability, EVT was associated with better outcomes including lower ΔmRS (aIRR-PSW: 0.87, 95% CI 0.83-0.91) and mortality, with no interaction of treatment effect by premorbid disability status (e.g., mortality pinteraction = 0.73). EVT recipients with premorbid disability did not differ significantly for several outcomes including ΔmRS (aIRR: 0.99, 95% CI 0.84-1.17) but were more likely to have 3-month mRS 5-6 (70.1% vs 39.5% without premorbid disability, aOR: 1.85, 95% CI 1.12-3.04). Discussion Patients with premorbid disability were less likely to receive EVT, had slower treatment times, and had worse outcomes compared with patients without premorbid disability. However, regardless of premorbid disability, patients fared better with EVT vs medical management and one-third with prestroke disability returned to their prestroke status.
Collapse
Affiliation(s)
- Aravind Ganesh
- Calgary Stroke Program (AG, MDH), Departments of Clinical Neurosciences and Community Health Sciences, the Hotchkiss Brain Institute, and the O'Brien Institute for Public Health, University of Calgary Cumming School of Medicine, Canada; Department of Neurology (OV, MB), University Hospital Ostrava, Ostrava; International Clinical Research Centre (OV, IK, RM), Stroke Research Program, St. Anne's University Hospital, Brno; Faculty of Medicine (OV, MB), University Ostrava; Department of Neurology (OV), Charles University, 2nd Medical Faculty; Institute of Health Information and Statistics of the Czech Republic (AT), Prague; Department of Radiology (RP), 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital; Department of Radiology (FC), Masaryk Hospital, Usti nad Labem; Department of Neurology (MN), Hospital Ceske Budejovice; Neurocenter (LJ), Regional Hospital Liberec; Department of Neurology (RH), Military University Hospital; Department of Neurology (MK), Na Homolce Hospital, Prague; Department of Neurology (PS, VR), Faculty of Medicine in Pilsen, Charles University in Prague; Department of Neurology (JF), Charles University, First Faculty of Medicine and General University Hospital, Prague; Masaryk Hospital Usti nad Labem - KZ a.s. (DC), Department of Neurology-Comprehensive Stroke Center; Department of Neurology (RJ), University Hospital Brno and Faculty of Medicine Masaryk University, Brno; Department of Neurology (DV), AGEL Research and Training Institute, Ostrava Vitkovice Hospital, Czech Republic; Departments of Radiology and Medicine (MDH), University of Calgary Cumming School of Medicine, Alberta, Canada; and Department of Neurology (RM), Tomas Bata Regional Hospital Zlin, Czech Republic
| | - Ondrej Volny
- Calgary Stroke Program (AG, MDH), Departments of Clinical Neurosciences and Community Health Sciences, the Hotchkiss Brain Institute, and the O'Brien Institute for Public Health, University of Calgary Cumming School of Medicine, Canada; Department of Neurology (OV, MB), University Hospital Ostrava, Ostrava; International Clinical Research Centre (OV, IK, RM), Stroke Research Program, St. Anne's University Hospital, Brno; Faculty of Medicine (OV, MB), University Ostrava; Department of Neurology (OV), Charles University, 2nd Medical Faculty; Institute of Health Information and Statistics of the Czech Republic (AT), Prague; Department of Radiology (RP), 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital; Department of Radiology (FC), Masaryk Hospital, Usti nad Labem; Department of Neurology (MN), Hospital Ceske Budejovice; Neurocenter (LJ), Regional Hospital Liberec; Department of Neurology (RH), Military University Hospital; Department of Neurology (MK), Na Homolce Hospital, Prague; Department of Neurology (PS, VR), Faculty of Medicine in Pilsen, Charles University in Prague; Department of Neurology (JF), Charles University, First Faculty of Medicine and General University Hospital, Prague; Masaryk Hospital Usti nad Labem - KZ a.s. (DC), Department of Neurology-Comprehensive Stroke Center; Department of Neurology (RJ), University Hospital Brno and Faculty of Medicine Masaryk University, Brno; Department of Neurology (DV), AGEL Research and Training Institute, Ostrava Vitkovice Hospital, Czech Republic; Departments of Radiology and Medicine (MDH), University of Calgary Cumming School of Medicine, Alberta, Canada; and Department of Neurology (RM), Tomas Bata Regional Hospital Zlin, Czech Republic
| | - Ingrid Kovacova
- Calgary Stroke Program (AG, MDH), Departments of Clinical Neurosciences and Community Health Sciences, the Hotchkiss Brain Institute, and the O'Brien Institute for Public Health, University of Calgary Cumming School of Medicine, Canada; Department of Neurology (OV, MB), University Hospital Ostrava, Ostrava; International Clinical Research Centre (OV, IK, RM), Stroke Research Program, St. Anne's University Hospital, Brno; Faculty of Medicine (OV, MB), University Ostrava; Department of Neurology (OV), Charles University, 2nd Medical Faculty; Institute of Health Information and Statistics of the Czech Republic (AT), Prague; Department of Radiology (RP), 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital; Department of Radiology (FC), Masaryk Hospital, Usti nad Labem; Department of Neurology (MN), Hospital Ceske Budejovice; Neurocenter (LJ), Regional Hospital Liberec; Department of Neurology (RH), Military University Hospital; Department of Neurology (MK), Na Homolce Hospital, Prague; Department of Neurology (PS, VR), Faculty of Medicine in Pilsen, Charles University in Prague; Department of Neurology (JF), Charles University, First Faculty of Medicine and General University Hospital, Prague; Masaryk Hospital Usti nad Labem - KZ a.s. (DC), Department of Neurology-Comprehensive Stroke Center; Department of Neurology (RJ), University Hospital Brno and Faculty of Medicine Masaryk University, Brno; Department of Neurology (DV), AGEL Research and Training Institute, Ostrava Vitkovice Hospital, Czech Republic; Departments of Radiology and Medicine (MDH), University of Calgary Cumming School of Medicine, Alberta, Canada; and Department of Neurology (RM), Tomas Bata Regional Hospital Zlin, Czech Republic
| | - Aleš Tomek
- Calgary Stroke Program (AG, MDH), Departments of Clinical Neurosciences and Community Health Sciences, the Hotchkiss Brain Institute, and the O'Brien Institute for Public Health, University of Calgary Cumming School of Medicine, Canada; Department of Neurology (OV, MB), University Hospital Ostrava, Ostrava; International Clinical Research Centre (OV, IK, RM), Stroke Research Program, St. Anne's University Hospital, Brno; Faculty of Medicine (OV, MB), University Ostrava; Department of Neurology (OV), Charles University, 2nd Medical Faculty; Institute of Health Information and Statistics of the Czech Republic (AT), Prague; Department of Radiology (RP), 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital; Department of Radiology (FC), Masaryk Hospital, Usti nad Labem; Department of Neurology (MN), Hospital Ceske Budejovice; Neurocenter (LJ), Regional Hospital Liberec; Department of Neurology (RH), Military University Hospital; Department of Neurology (MK), Na Homolce Hospital, Prague; Department of Neurology (PS, VR), Faculty of Medicine in Pilsen, Charles University in Prague; Department of Neurology (JF), Charles University, First Faculty of Medicine and General University Hospital, Prague; Masaryk Hospital Usti nad Labem - KZ a.s. (DC), Department of Neurology-Comprehensive Stroke Center; Department of Neurology (RJ), University Hospital Brno and Faculty of Medicine Masaryk University, Brno; Department of Neurology (DV), AGEL Research and Training Institute, Ostrava Vitkovice Hospital, Czech Republic; Departments of Radiology and Medicine (MDH), University of Calgary Cumming School of Medicine, Alberta, Canada; and Department of Neurology (RM), Tomas Bata Regional Hospital Zlin, Czech Republic
| | - Michal Bar
- Calgary Stroke Program (AG, MDH), Departments of Clinical Neurosciences and Community Health Sciences, the Hotchkiss Brain Institute, and the O'Brien Institute for Public Health, University of Calgary Cumming School of Medicine, Canada; Department of Neurology (OV, MB), University Hospital Ostrava, Ostrava; International Clinical Research Centre (OV, IK, RM), Stroke Research Program, St. Anne's University Hospital, Brno; Faculty of Medicine (OV, MB), University Ostrava; Department of Neurology (OV), Charles University, 2nd Medical Faculty; Institute of Health Information and Statistics of the Czech Republic (AT), Prague; Department of Radiology (RP), 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital; Department of Radiology (FC), Masaryk Hospital, Usti nad Labem; Department of Neurology (MN), Hospital Ceske Budejovice; Neurocenter (LJ), Regional Hospital Liberec; Department of Neurology (RH), Military University Hospital; Department of Neurology (MK), Na Homolce Hospital, Prague; Department of Neurology (PS, VR), Faculty of Medicine in Pilsen, Charles University in Prague; Department of Neurology (JF), Charles University, First Faculty of Medicine and General University Hospital, Prague; Masaryk Hospital Usti nad Labem - KZ a.s. (DC), Department of Neurology-Comprehensive Stroke Center; Department of Neurology (RJ), University Hospital Brno and Faculty of Medicine Masaryk University, Brno; Department of Neurology (DV), AGEL Research and Training Institute, Ostrava Vitkovice Hospital, Czech Republic; Departments of Radiology and Medicine (MDH), University of Calgary Cumming School of Medicine, Alberta, Canada; and Department of Neurology (RM), Tomas Bata Regional Hospital Zlin, Czech Republic
| | - Radek Pádr
- Calgary Stroke Program (AG, MDH), Departments of Clinical Neurosciences and Community Health Sciences, the Hotchkiss Brain Institute, and the O'Brien Institute for Public Health, University of Calgary Cumming School of Medicine, Canada; Department of Neurology (OV, MB), University Hospital Ostrava, Ostrava; International Clinical Research Centre (OV, IK, RM), Stroke Research Program, St. Anne's University Hospital, Brno; Faculty of Medicine (OV, MB), University Ostrava; Department of Neurology (OV), Charles University, 2nd Medical Faculty; Institute of Health Information and Statistics of the Czech Republic (AT), Prague; Department of Radiology (RP), 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital; Department of Radiology (FC), Masaryk Hospital, Usti nad Labem; Department of Neurology (MN), Hospital Ceske Budejovice; Neurocenter (LJ), Regional Hospital Liberec; Department of Neurology (RH), Military University Hospital; Department of Neurology (MK), Na Homolce Hospital, Prague; Department of Neurology (PS, VR), Faculty of Medicine in Pilsen, Charles University in Prague; Department of Neurology (JF), Charles University, First Faculty of Medicine and General University Hospital, Prague; Masaryk Hospital Usti nad Labem - KZ a.s. (DC), Department of Neurology-Comprehensive Stroke Center; Department of Neurology (RJ), University Hospital Brno and Faculty of Medicine Masaryk University, Brno; Department of Neurology (DV), AGEL Research and Training Institute, Ostrava Vitkovice Hospital, Czech Republic; Departments of Radiology and Medicine (MDH), University of Calgary Cumming School of Medicine, Alberta, Canada; and Department of Neurology (RM), Tomas Bata Regional Hospital Zlin, Czech Republic
| | - Filip Cihlar
- Calgary Stroke Program (AG, MDH), Departments of Clinical Neurosciences and Community Health Sciences, the Hotchkiss Brain Institute, and the O'Brien Institute for Public Health, University of Calgary Cumming School of Medicine, Canada; Department of Neurology (OV, MB), University Hospital Ostrava, Ostrava; International Clinical Research Centre (OV, IK, RM), Stroke Research Program, St. Anne's University Hospital, Brno; Faculty of Medicine (OV, MB), University Ostrava; Department of Neurology (OV), Charles University, 2nd Medical Faculty; Institute of Health Information and Statistics of the Czech Republic (AT), Prague; Department of Radiology (RP), 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital; Department of Radiology (FC), Masaryk Hospital, Usti nad Labem; Department of Neurology (MN), Hospital Ceske Budejovice; Neurocenter (LJ), Regional Hospital Liberec; Department of Neurology (RH), Military University Hospital; Department of Neurology (MK), Na Homolce Hospital, Prague; Department of Neurology (PS, VR), Faculty of Medicine in Pilsen, Charles University in Prague; Department of Neurology (JF), Charles University, First Faculty of Medicine and General University Hospital, Prague; Masaryk Hospital Usti nad Labem - KZ a.s. (DC), Department of Neurology-Comprehensive Stroke Center; Department of Neurology (RJ), University Hospital Brno and Faculty of Medicine Masaryk University, Brno; Department of Neurology (DV), AGEL Research and Training Institute, Ostrava Vitkovice Hospital, Czech Republic; Departments of Radiology and Medicine (MDH), University of Calgary Cumming School of Medicine, Alberta, Canada; and Department of Neurology (RM), Tomas Bata Regional Hospital Zlin, Czech Republic
| | - Miroslava Nevsimalova
- Calgary Stroke Program (AG, MDH), Departments of Clinical Neurosciences and Community Health Sciences, the Hotchkiss Brain Institute, and the O'Brien Institute for Public Health, University of Calgary Cumming School of Medicine, Canada; Department of Neurology (OV, MB), University Hospital Ostrava, Ostrava; International Clinical Research Centre (OV, IK, RM), Stroke Research Program, St. Anne's University Hospital, Brno; Faculty of Medicine (OV, MB), University Ostrava; Department of Neurology (OV), Charles University, 2nd Medical Faculty; Institute of Health Information and Statistics of the Czech Republic (AT), Prague; Department of Radiology (RP), 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital; Department of Radiology (FC), Masaryk Hospital, Usti nad Labem; Department of Neurology (MN), Hospital Ceske Budejovice; Neurocenter (LJ), Regional Hospital Liberec; Department of Neurology (RH), Military University Hospital; Department of Neurology (MK), Na Homolce Hospital, Prague; Department of Neurology (PS, VR), Faculty of Medicine in Pilsen, Charles University in Prague; Department of Neurology (JF), Charles University, First Faculty of Medicine and General University Hospital, Prague; Masaryk Hospital Usti nad Labem - KZ a.s. (DC), Department of Neurology-Comprehensive Stroke Center; Department of Neurology (RJ), University Hospital Brno and Faculty of Medicine Masaryk University, Brno; Department of Neurology (DV), AGEL Research and Training Institute, Ostrava Vitkovice Hospital, Czech Republic; Departments of Radiology and Medicine (MDH), University of Calgary Cumming School of Medicine, Alberta, Canada; and Department of Neurology (RM), Tomas Bata Regional Hospital Zlin, Czech Republic
| | - Lubomir Jurak
- Calgary Stroke Program (AG, MDH), Departments of Clinical Neurosciences and Community Health Sciences, the Hotchkiss Brain Institute, and the O'Brien Institute for Public Health, University of Calgary Cumming School of Medicine, Canada; Department of Neurology (OV, MB), University Hospital Ostrava, Ostrava; International Clinical Research Centre (OV, IK, RM), Stroke Research Program, St. Anne's University Hospital, Brno; Faculty of Medicine (OV, MB), University Ostrava; Department of Neurology (OV), Charles University, 2nd Medical Faculty; Institute of Health Information and Statistics of the Czech Republic (AT), Prague; Department of Radiology (RP), 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital; Department of Radiology (FC), Masaryk Hospital, Usti nad Labem; Department of Neurology (MN), Hospital Ceske Budejovice; Neurocenter (LJ), Regional Hospital Liberec; Department of Neurology (RH), Military University Hospital; Department of Neurology (MK), Na Homolce Hospital, Prague; Department of Neurology (PS, VR), Faculty of Medicine in Pilsen, Charles University in Prague; Department of Neurology (JF), Charles University, First Faculty of Medicine and General University Hospital, Prague; Masaryk Hospital Usti nad Labem - KZ a.s. (DC), Department of Neurology-Comprehensive Stroke Center; Department of Neurology (RJ), University Hospital Brno and Faculty of Medicine Masaryk University, Brno; Department of Neurology (DV), AGEL Research and Training Institute, Ostrava Vitkovice Hospital, Czech Republic; Departments of Radiology and Medicine (MDH), University of Calgary Cumming School of Medicine, Alberta, Canada; and Department of Neurology (RM), Tomas Bata Regional Hospital Zlin, Czech Republic
| | - Roman Havlicek
- Calgary Stroke Program (AG, MDH), Departments of Clinical Neurosciences and Community Health Sciences, the Hotchkiss Brain Institute, and the O'Brien Institute for Public Health, University of Calgary Cumming School of Medicine, Canada; Department of Neurology (OV, MB), University Hospital Ostrava, Ostrava; International Clinical Research Centre (OV, IK, RM), Stroke Research Program, St. Anne's University Hospital, Brno; Faculty of Medicine (OV, MB), University Ostrava; Department of Neurology (OV), Charles University, 2nd Medical Faculty; Institute of Health Information and Statistics of the Czech Republic (AT), Prague; Department of Radiology (RP), 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital; Department of Radiology (FC), Masaryk Hospital, Usti nad Labem; Department of Neurology (MN), Hospital Ceske Budejovice; Neurocenter (LJ), Regional Hospital Liberec; Department of Neurology (RH), Military University Hospital; Department of Neurology (MK), Na Homolce Hospital, Prague; Department of Neurology (PS, VR), Faculty of Medicine in Pilsen, Charles University in Prague; Department of Neurology (JF), Charles University, First Faculty of Medicine and General University Hospital, Prague; Masaryk Hospital Usti nad Labem - KZ a.s. (DC), Department of Neurology-Comprehensive Stroke Center; Department of Neurology (RJ), University Hospital Brno and Faculty of Medicine Masaryk University, Brno; Department of Neurology (DV), AGEL Research and Training Institute, Ostrava Vitkovice Hospital, Czech Republic; Departments of Radiology and Medicine (MDH), University of Calgary Cumming School of Medicine, Alberta, Canada; and Department of Neurology (RM), Tomas Bata Regional Hospital Zlin, Czech Republic
| | - Martin Kovar
- Calgary Stroke Program (AG, MDH), Departments of Clinical Neurosciences and Community Health Sciences, the Hotchkiss Brain Institute, and the O'Brien Institute for Public Health, University of Calgary Cumming School of Medicine, Canada; Department of Neurology (OV, MB), University Hospital Ostrava, Ostrava; International Clinical Research Centre (OV, IK, RM), Stroke Research Program, St. Anne's University Hospital, Brno; Faculty of Medicine (OV, MB), University Ostrava; Department of Neurology (OV), Charles University, 2nd Medical Faculty; Institute of Health Information and Statistics of the Czech Republic (AT), Prague; Department of Radiology (RP), 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital; Department of Radiology (FC), Masaryk Hospital, Usti nad Labem; Department of Neurology (MN), Hospital Ceske Budejovice; Neurocenter (LJ), Regional Hospital Liberec; Department of Neurology (RH), Military University Hospital; Department of Neurology (MK), Na Homolce Hospital, Prague; Department of Neurology (PS, VR), Faculty of Medicine in Pilsen, Charles University in Prague; Department of Neurology (JF), Charles University, First Faculty of Medicine and General University Hospital, Prague; Masaryk Hospital Usti nad Labem - KZ a.s. (DC), Department of Neurology-Comprehensive Stroke Center; Department of Neurology (RJ), University Hospital Brno and Faculty of Medicine Masaryk University, Brno; Department of Neurology (DV), AGEL Research and Training Institute, Ostrava Vitkovice Hospital, Czech Republic; Departments of Radiology and Medicine (MDH), University of Calgary Cumming School of Medicine, Alberta, Canada; and Department of Neurology (RM), Tomas Bata Regional Hospital Zlin, Czech Republic
| | - Petr Sevcik
- Calgary Stroke Program (AG, MDH), Departments of Clinical Neurosciences and Community Health Sciences, the Hotchkiss Brain Institute, and the O'Brien Institute for Public Health, University of Calgary Cumming School of Medicine, Canada; Department of Neurology (OV, MB), University Hospital Ostrava, Ostrava; International Clinical Research Centre (OV, IK, RM), Stroke Research Program, St. Anne's University Hospital, Brno; Faculty of Medicine (OV, MB), University Ostrava; Department of Neurology (OV), Charles University, 2nd Medical Faculty; Institute of Health Information and Statistics of the Czech Republic (AT), Prague; Department of Radiology (RP), 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital; Department of Radiology (FC), Masaryk Hospital, Usti nad Labem; Department of Neurology (MN), Hospital Ceske Budejovice; Neurocenter (LJ), Regional Hospital Liberec; Department of Neurology (RH), Military University Hospital; Department of Neurology (MK), Na Homolce Hospital, Prague; Department of Neurology (PS, VR), Faculty of Medicine in Pilsen, Charles University in Prague; Department of Neurology (JF), Charles University, First Faculty of Medicine and General University Hospital, Prague; Masaryk Hospital Usti nad Labem - KZ a.s. (DC), Department of Neurology-Comprehensive Stroke Center; Department of Neurology (RJ), University Hospital Brno and Faculty of Medicine Masaryk University, Brno; Department of Neurology (DV), AGEL Research and Training Institute, Ostrava Vitkovice Hospital, Czech Republic; Departments of Radiology and Medicine (MDH), University of Calgary Cumming School of Medicine, Alberta, Canada; and Department of Neurology (RM), Tomas Bata Regional Hospital Zlin, Czech Republic
| | - Vladimír Rohan
- Calgary Stroke Program (AG, MDH), Departments of Clinical Neurosciences and Community Health Sciences, the Hotchkiss Brain Institute, and the O'Brien Institute for Public Health, University of Calgary Cumming School of Medicine, Canada; Department of Neurology (OV, MB), University Hospital Ostrava, Ostrava; International Clinical Research Centre (OV, IK, RM), Stroke Research Program, St. Anne's University Hospital, Brno; Faculty of Medicine (OV, MB), University Ostrava; Department of Neurology (OV), Charles University, 2nd Medical Faculty; Institute of Health Information and Statistics of the Czech Republic (AT), Prague; Department of Radiology (RP), 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital; Department of Radiology (FC), Masaryk Hospital, Usti nad Labem; Department of Neurology (MN), Hospital Ceske Budejovice; Neurocenter (LJ), Regional Hospital Liberec; Department of Neurology (RH), Military University Hospital; Department of Neurology (MK), Na Homolce Hospital, Prague; Department of Neurology (PS, VR), Faculty of Medicine in Pilsen, Charles University in Prague; Department of Neurology (JF), Charles University, First Faculty of Medicine and General University Hospital, Prague; Masaryk Hospital Usti nad Labem - KZ a.s. (DC), Department of Neurology-Comprehensive Stroke Center; Department of Neurology (RJ), University Hospital Brno and Faculty of Medicine Masaryk University, Brno; Department of Neurology (DV), AGEL Research and Training Institute, Ostrava Vitkovice Hospital, Czech Republic; Departments of Radiology and Medicine (MDH), University of Calgary Cumming School of Medicine, Alberta, Canada; and Department of Neurology (RM), Tomas Bata Regional Hospital Zlin, Czech Republic
| | - Jan Fiksa
- Calgary Stroke Program (AG, MDH), Departments of Clinical Neurosciences and Community Health Sciences, the Hotchkiss Brain Institute, and the O'Brien Institute for Public Health, University of Calgary Cumming School of Medicine, Canada; Department of Neurology (OV, MB), University Hospital Ostrava, Ostrava; International Clinical Research Centre (OV, IK, RM), Stroke Research Program, St. Anne's University Hospital, Brno; Faculty of Medicine (OV, MB), University Ostrava; Department of Neurology (OV), Charles University, 2nd Medical Faculty; Institute of Health Information and Statistics of the Czech Republic (AT), Prague; Department of Radiology (RP), 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital; Department of Radiology (FC), Masaryk Hospital, Usti nad Labem; Department of Neurology (MN), Hospital Ceske Budejovice; Neurocenter (LJ), Regional Hospital Liberec; Department of Neurology (RH), Military University Hospital; Department of Neurology (MK), Na Homolce Hospital, Prague; Department of Neurology (PS, VR), Faculty of Medicine in Pilsen, Charles University in Prague; Department of Neurology (JF), Charles University, First Faculty of Medicine and General University Hospital, Prague; Masaryk Hospital Usti nad Labem - KZ a.s. (DC), Department of Neurology-Comprehensive Stroke Center; Department of Neurology (RJ), University Hospital Brno and Faculty of Medicine Masaryk University, Brno; Department of Neurology (DV), AGEL Research and Training Institute, Ostrava Vitkovice Hospital, Czech Republic; Departments of Radiology and Medicine (MDH), University of Calgary Cumming School of Medicine, Alberta, Canada; and Department of Neurology (RM), Tomas Bata Regional Hospital Zlin, Czech Republic
| | - David Cerník
- Calgary Stroke Program (AG, MDH), Departments of Clinical Neurosciences and Community Health Sciences, the Hotchkiss Brain Institute, and the O'Brien Institute for Public Health, University of Calgary Cumming School of Medicine, Canada; Department of Neurology (OV, MB), University Hospital Ostrava, Ostrava; International Clinical Research Centre (OV, IK, RM), Stroke Research Program, St. Anne's University Hospital, Brno; Faculty of Medicine (OV, MB), University Ostrava; Department of Neurology (OV), Charles University, 2nd Medical Faculty; Institute of Health Information and Statistics of the Czech Republic (AT), Prague; Department of Radiology (RP), 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital; Department of Radiology (FC), Masaryk Hospital, Usti nad Labem; Department of Neurology (MN), Hospital Ceske Budejovice; Neurocenter (LJ), Regional Hospital Liberec; Department of Neurology (RH), Military University Hospital; Department of Neurology (MK), Na Homolce Hospital, Prague; Department of Neurology (PS, VR), Faculty of Medicine in Pilsen, Charles University in Prague; Department of Neurology (JF), Charles University, First Faculty of Medicine and General University Hospital, Prague; Masaryk Hospital Usti nad Labem - KZ a.s. (DC), Department of Neurology-Comprehensive Stroke Center; Department of Neurology (RJ), University Hospital Brno and Faculty of Medicine Masaryk University, Brno; Department of Neurology (DV), AGEL Research and Training Institute, Ostrava Vitkovice Hospital, Czech Republic; Departments of Radiology and Medicine (MDH), University of Calgary Cumming School of Medicine, Alberta, Canada; and Department of Neurology (RM), Tomas Bata Regional Hospital Zlin, Czech Republic
| | - Rene Jura
- Calgary Stroke Program (AG, MDH), Departments of Clinical Neurosciences and Community Health Sciences, the Hotchkiss Brain Institute, and the O'Brien Institute for Public Health, University of Calgary Cumming School of Medicine, Canada; Department of Neurology (OV, MB), University Hospital Ostrava, Ostrava; International Clinical Research Centre (OV, IK, RM), Stroke Research Program, St. Anne's University Hospital, Brno; Faculty of Medicine (OV, MB), University Ostrava; Department of Neurology (OV), Charles University, 2nd Medical Faculty; Institute of Health Information and Statistics of the Czech Republic (AT), Prague; Department of Radiology (RP), 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital; Department of Radiology (FC), Masaryk Hospital, Usti nad Labem; Department of Neurology (MN), Hospital Ceske Budejovice; Neurocenter (LJ), Regional Hospital Liberec; Department of Neurology (RH), Military University Hospital; Department of Neurology (MK), Na Homolce Hospital, Prague; Department of Neurology (PS, VR), Faculty of Medicine in Pilsen, Charles University in Prague; Department of Neurology (JF), Charles University, First Faculty of Medicine and General University Hospital, Prague; Masaryk Hospital Usti nad Labem - KZ a.s. (DC), Department of Neurology-Comprehensive Stroke Center; Department of Neurology (RJ), University Hospital Brno and Faculty of Medicine Masaryk University, Brno; Department of Neurology (DV), AGEL Research and Training Institute, Ostrava Vitkovice Hospital, Czech Republic; Departments of Radiology and Medicine (MDH), University of Calgary Cumming School of Medicine, Alberta, Canada; and Department of Neurology (RM), Tomas Bata Regional Hospital Zlin, Czech Republic
| | - Daniel Vaclavik
- Calgary Stroke Program (AG, MDH), Departments of Clinical Neurosciences and Community Health Sciences, the Hotchkiss Brain Institute, and the O'Brien Institute for Public Health, University of Calgary Cumming School of Medicine, Canada; Department of Neurology (OV, MB), University Hospital Ostrava, Ostrava; International Clinical Research Centre (OV, IK, RM), Stroke Research Program, St. Anne's University Hospital, Brno; Faculty of Medicine (OV, MB), University Ostrava; Department of Neurology (OV), Charles University, 2nd Medical Faculty; Institute of Health Information and Statistics of the Czech Republic (AT), Prague; Department of Radiology (RP), 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital; Department of Radiology (FC), Masaryk Hospital, Usti nad Labem; Department of Neurology (MN), Hospital Ceske Budejovice; Neurocenter (LJ), Regional Hospital Liberec; Department of Neurology (RH), Military University Hospital; Department of Neurology (MK), Na Homolce Hospital, Prague; Department of Neurology (PS, VR), Faculty of Medicine in Pilsen, Charles University in Prague; Department of Neurology (JF), Charles University, First Faculty of Medicine and General University Hospital, Prague; Masaryk Hospital Usti nad Labem - KZ a.s. (DC), Department of Neurology-Comprehensive Stroke Center; Department of Neurology (RJ), University Hospital Brno and Faculty of Medicine Masaryk University, Brno; Department of Neurology (DV), AGEL Research and Training Institute, Ostrava Vitkovice Hospital, Czech Republic; Departments of Radiology and Medicine (MDH), University of Calgary Cumming School of Medicine, Alberta, Canada; and Department of Neurology (RM), Tomas Bata Regional Hospital Zlin, Czech Republic
| | - Michael D Hill
- Calgary Stroke Program (AG, MDH), Departments of Clinical Neurosciences and Community Health Sciences, the Hotchkiss Brain Institute, and the O'Brien Institute for Public Health, University of Calgary Cumming School of Medicine, Canada; Department of Neurology (OV, MB), University Hospital Ostrava, Ostrava; International Clinical Research Centre (OV, IK, RM), Stroke Research Program, St. Anne's University Hospital, Brno; Faculty of Medicine (OV, MB), University Ostrava; Department of Neurology (OV), Charles University, 2nd Medical Faculty; Institute of Health Information and Statistics of the Czech Republic (AT), Prague; Department of Radiology (RP), 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital; Department of Radiology (FC), Masaryk Hospital, Usti nad Labem; Department of Neurology (MN), Hospital Ceske Budejovice; Neurocenter (LJ), Regional Hospital Liberec; Department of Neurology (RH), Military University Hospital; Department of Neurology (MK), Na Homolce Hospital, Prague; Department of Neurology (PS, VR), Faculty of Medicine in Pilsen, Charles University in Prague; Department of Neurology (JF), Charles University, First Faculty of Medicine and General University Hospital, Prague; Masaryk Hospital Usti nad Labem - KZ a.s. (DC), Department of Neurology-Comprehensive Stroke Center; Department of Neurology (RJ), University Hospital Brno and Faculty of Medicine Masaryk University, Brno; Department of Neurology (DV), AGEL Research and Training Institute, Ostrava Vitkovice Hospital, Czech Republic; Departments of Radiology and Medicine (MDH), University of Calgary Cumming School of Medicine, Alberta, Canada; and Department of Neurology (RM), Tomas Bata Regional Hospital Zlin, Czech Republic
| | - Robert Mikulík
- Calgary Stroke Program (AG, MDH), Departments of Clinical Neurosciences and Community Health Sciences, the Hotchkiss Brain Institute, and the O'Brien Institute for Public Health, University of Calgary Cumming School of Medicine, Canada; Department of Neurology (OV, MB), University Hospital Ostrava, Ostrava; International Clinical Research Centre (OV, IK, RM), Stroke Research Program, St. Anne's University Hospital, Brno; Faculty of Medicine (OV, MB), University Ostrava; Department of Neurology (OV), Charles University, 2nd Medical Faculty; Institute of Health Information and Statistics of the Czech Republic (AT), Prague; Department of Radiology (RP), 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital; Department of Radiology (FC), Masaryk Hospital, Usti nad Labem; Department of Neurology (MN), Hospital Ceske Budejovice; Neurocenter (LJ), Regional Hospital Liberec; Department of Neurology (RH), Military University Hospital; Department of Neurology (MK), Na Homolce Hospital, Prague; Department of Neurology (PS, VR), Faculty of Medicine in Pilsen, Charles University in Prague; Department of Neurology (JF), Charles University, First Faculty of Medicine and General University Hospital, Prague; Masaryk Hospital Usti nad Labem - KZ a.s. (DC), Department of Neurology-Comprehensive Stroke Center; Department of Neurology (RJ), University Hospital Brno and Faculty of Medicine Masaryk University, Brno; Department of Neurology (DV), AGEL Research and Training Institute, Ostrava Vitkovice Hospital, Czech Republic; Departments of Radiology and Medicine (MDH), University of Calgary Cumming School of Medicine, Alberta, Canada; and Department of Neurology (RM), Tomas Bata Regional Hospital Zlin, Czech Republic
| |
Collapse
|
2
|
Li H, Liu J, Liang Q, Yu Y, Sun G. Effect of Vascular Senescence on the Efficacy and Safety of Warfarin: Insights from Rat Models and a Prospective Cohort Study. J Pharmacol Exp Ther 2024; 391:39-50. [PMID: 39095206 DOI: 10.1124/jpet.124.002265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 07/03/2024] [Accepted: 07/12/2024] [Indexed: 08/04/2024] Open
Abstract
Warfarin, with its narrow therapeutic range, requires the understanding of various influencing factors for personalized medication. Vascular senescence, marked by vascular stiffening and endothelial dysfunction, has an unclear effect on the efficacy and safety of warfarin. Based on previous studies, we hypothesized that vascular senescence increases the risk of bleeding during warfarin therapy. This study aimed to explore these effects using animal models and clinical cohorts. We established rat models of vascular senescence and calcification using d-galactose, vitamin D, and nicotine. After validating the models, we examined changes in the international normalized ratio (INR) at fixed warfarin doses (0.20 and 0.35 mg/kg). We found that vascular senescence caused significantly elevated INR values and increased bleeding risk. In the prospective clinical cohort study (NCT06428110), hospitalized warfarin patients with standard dose adjustments were divided into vascular senescence and control groups based on ultrasound and computed tomography diagnosis. Using propensity score matching to exclude the influence of confounding factors, we found that the vascular senescence group had lower steady-state warfarin doses and larger dose adjustments, with a higher probability of INR exceeding the therapeutic range. The vascular senescence group tended to experience more bleeding or thromboembolic/ischemic events during 1 year of follow-up, while there was no statistical difference. In conclusion, vascular senescence leads to unstable INR values and increases higher bleeding risk during warfarin therapy, highlighting the importance of considering vascular senescence in future precision warfarin therapies. SIGNIFICANCE STATEMENT: Many factors influence warfarin efficacy; however, the effect of vascular senescence remains unclear. This study aimed to investigate the effects of vascular senescence on the efficacy and safety of warfarin. Through both rat models and clinical cohort studies, our findings indicated that vascular senescence may compromise the stability of warfarin, presenting challenges in maintaining its efficacy and safety.
Collapse
Affiliation(s)
- Haobin Li
- Department of Pharmacy, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
| | - Jing Liu
- Department of Pharmacy, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
| | - Qing Liang
- Department of Pharmacy, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
| | - Yan Yu
- Department of Pharmacy, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
| | - Guangchun Sun
- Department of Pharmacy, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
| |
Collapse
|
3
|
Behl T, Kaur I, Sehgal A, Khandige PS, Imran M, Gulati M, Khalid Anwer M, Elossaily GM, Ali N, Wal P, Gasmi A. The link between Alzheimer's disease and stroke: A detrimental synergism. Ageing Res Rev 2024; 99:102388. [PMID: 38914265 DOI: 10.1016/j.arr.2024.102388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 05/05/2024] [Accepted: 05/06/2024] [Indexed: 06/26/2024]
Abstract
Being age-related disorders, both Alzheimer's disease (AD) and stroke share multiple risk factors, such as hypertension, smoking, diabetes, and apolipoprotein E (APOE) Ɛ4 genotype, and coexist in patients. Accumulation of amyloid-β plaques and neurofibrillary tangled impair cognitive potential, leading to AD. Blocked blood flow in the neuronal tissues, causes neurodegeneration and cell death in stroke. AD is commonly characterized by cerebral amyloid angiopathy, which significantly elevates the risk of hemorrhagic stroke. Patients with AD and stroke have been both reported to exhibit greater cognitive impairment, followed by multiple pathophysiological mechanisms shared between the two. The manuscript aims to elucidate the relationship between AD and stroke, as well as the common pathways and risk factors while understanding the preventive therapies that might limit the negative impacts of this correlation, with diagnostic modalities and current AD treatments. The authors provide a comprehensive review of the link and aid the healthcare professionals to identify suitable targets and risk factors, that may retard cognitive decline and neurodegeneration in patients. However, more intricate research is required in this regard and an interdisciplinary approach that would target both the vascular and neurodegenerative factors would improve the quality of life in AD patients.
Collapse
Affiliation(s)
- Tapan Behl
- Amity School of Pharmaceutical Sciences, Amity University, Mohali, Punjab, India.
| | - Ishnoor Kaur
- University of Glasgow, College of Medical, Veterinary and Life Sciences, Glasgow, United Kingdom
| | - Aayush Sehgal
- GHG Khalsa College of Pharmacy, Gurusar Sadhar, Ludhiana, Punjab, India
| | - Prasanna Shama Khandige
- NITTE (Deemed to be University), NGSM Institute of Pharmaceutical Sciences, Department of Pharmacology, Mangaluru, Karnataka, India
| | - Mohd Imran
- Department of Pharmaceutical Chemistry, College of Pharmacy, Northern Border University, Rafha 91911, Saudi Arabia
| | - Monica Gulati
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab 1444411, India; ARCCIM, Faculty of Health, University of Technology Sydney, Ultimo, NSW 20227, Australia
| | - Md Khalid Anwer
- Department of Pharmaceutics, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia
| | - Gehan M Elossaily
- Department of Baisc Medical Sciences, College of Medicine, AlMaarefa University, P.O. Box 71666, Riyadh 11597, Saudi Arabia
| | - Nemat Ali
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, P.O. Box 2457, Riyadh 11451, Saudi Arabia
| | - Pranay Wal
- PSIT Kanpur, Department of Pharmacy, Uttar Pradesh, India
| | - Amin Gasmi
- Societe Francophone de Nutritherapie et de Nutrigenetique Appliquee, Villeurbanne, France; International Institute of Nutrition and Micronutrition Sciences, Saint Etienne, France
| |
Collapse
|
4
|
Kyaw KLS, Pana TA, Bettencourt-Silva JH, Metcalf AK, Myint PK, Potter JF. The individual and combined impacts of pre-existing diabetes and dementia on ischemic stroke outcomes: a registry-based cohort study. BMC Cardiovasc Disord 2024; 24:396. [PMID: 39080558 PMCID: PMC11290225 DOI: 10.1186/s12872-024-04050-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 07/15/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Individually, diabetes mellitus and dementia are associated with poorer outcomes after stroke. However, the combined impact of these pre-existing factors on acute ischemic stroke (AIS) outcomes has not been examined. METHODS All consecutive patients with AIS admitted to Norfolk and Norwich University Hospitals between 2003 and 2016 (catchment population ~ 900,000) were divided into four groups: those with neither diabetes nor dementia (reference), with diabetes without dementia, with dementia without diabetes, and with both co-morbidities. In-hospital mortality, length of hospital stay (LoS), and disability outcomes were analysed using logistic regressions. Post-discharge mortality and recurrence were assessed using Cox regressions. Additionally, interaction terms were added to the models for the short-term outcomes and long-term mortality to test for synergistic effects of diabetes and dementia. Models were adjusted for age, sex, Oxfordshire Community Stroke Project classification, comorbidities, hematological and biochemical measures, and antithrombotic medications. RESULTS The cohort was 10,812 patients with 52% females and a median age of 80. The median follow-up was 3.8 years for stroke recurrence and 5.5 years for mortality. No significant differences between the four groups existed for in-hospital mortality and post-stroke disability. Patients with dementia had significantly longer LoS (OR 2.25 [95% CI: 1.34-3.77] and 1.31 [1.02-1.68] with and without diabetes, respectively). Patients with both comorbidities had the highest risk of stroke recurrence (HR 2.06 [1.12-3.77]), followed by those with only dementia (1.59 [1.15-2.20]) and only diabetes (1.25 [1.06-1.49]). Similarly, the patient group with both diabetes and dementia had the highest long-term mortality risk (1.76 [1.33-2.37]). The hazard ratios for patients with only dementia and only diabetes were 1.71 [1.46-2.01] and 1.19 [1.08-1.32], respectively. No significant interactions were seen between diabetes and dementia with regards to their effects on the outcomes. CONCLUSION Individual and cumulative impacts of the two conditions on long-term mortality and stroke recurrence were notable. However, no synergistic impact of the two comorbidities were seen on the stroke outcomes tested in our study. Therefore, tailoring the management of stroke patients based on additional requirements associated with each pre-existing condition will be more impactful towards improving outcomes.
Collapse
Affiliation(s)
- Kyi Lae Shune Kyaw
- Edinburgh Medical School, University of Edinburgh, Edinburgh, Scotland, UK
| | - Tiberiu A Pana
- Aberdeen Cardiovascular & Diabetes Centre, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, Scotland, UK
- Ageing Clinical and Experimental Research Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, UK
| | - Joao H Bettencourt-Silva
- Norfolk & Norwich University Hospitals NHS Foundation Trust, Norwich, UK
- Healthcare and Life Sciences, IBM Research, Norwich, UK
| | - Anthony K Metcalf
- Norfolk & Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Phyo K Myint
- Aberdeen Cardiovascular & Diabetes Centre, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, Scotland, UK
- Ageing Clinical and Experimental Research Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, UK
- Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, Scotland, UK
| | - John F Potter
- Norwich Medical School, University of East Anglia, Norwich, UK.
| |
Collapse
|
5
|
Luo X, Chaves J, Dhamane AD, Dai F, Latremouille-Viau D, Wang A. Delayed treatment initiation of oral anticoagulants among Medicare patients with atrial fibrillation. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2024; 39:100369. [PMID: 38510996 PMCID: PMC10945966 DOI: 10.1016/j.ahjo.2024.100369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 01/31/2024] [Accepted: 02/01/2024] [Indexed: 03/22/2024]
Abstract
Study objective This study aimed to identify factors associated with delayed oral anticoagulant (OAC) treatment initiation among atrial fibrillation (AF) patients in United States (US) clinical practice. Participants Medicare beneficiaries newly diagnosed with AF without moderate-to-severe mitral stenosis or a mechanical heart valve, were aged ≥65 years and prescribed OAC on or after 10/1/2015 through 2019 were included. Delayed and early OAC initiation were defined as >3 months and 0-3 months initiation from first AF diagnosis, respectively. Main outcome measures Association between delayed OAC initiation and patient demographics, clinical and index OAC coverage and formulary characteristics was examined using multivariable logistic regression. Results A total of 446,441 patients met the inclusion criteria; 30.0 % (N = 131,969) were identified as delayed and 70.0 % (N = 314,472) as early OAC initiation. Median age for both cohorts was 78 years. In the early and delayed OAC cohorts, 47.1 % and 47.6 % were male and 88.8 % and 86.6 %, were White, respectively. Factors associated with delayed OAC initiation (odds ratio; 95 % confidence interval) included Black race (1.29; 1.25 to 1.33), west region (1.29; 1.26 to 1.32), comorbidities such as dementia (1.27; 1.23 to 1.30), recent bleeding hospitalization (1.22; 1.18 to 1.27), prior authorization (1.69; 1.66 to 1.71), tier 4 formulary for index OAC at AF diagnosis (1.26; 1.22 to 1.30). Conclusion Our study revealed that nearly one-third of Medicare patients with AF experienced delayed OAC initiation. Key patient characteristics found to be associated with delayed OAC initiation included race and ethnicity, comorbidities, and formulary restrictions.
Collapse
Affiliation(s)
- Xuemei Luo
- Pfizer, Inc., Health Economics and Outcomes Research, Groton, CT, USA
| | - Jose Chaves
- Pfizer SLU, Internal Medicine, Global Medical Affairs, Madrid, Spain
| | | | - Feng Dai
- Pfizer, Inc., Global Product Development, Groton, CT, USA
| | | | | |
Collapse
|
6
|
Matsugaki R, Muramatsu K, Fushimi K, Matsuda S. Dementia and acute care of ischemic stroke in Japan: A retrospective observational study using the Japanese Diagnosis Procedure Combination database. Geriatr Gerontol Int 2023; 23:270-274. [PMID: 36807503 DOI: 10.1111/ggi.14560] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 01/17/2023] [Accepted: 01/27/2023] [Indexed: 02/23/2023]
Abstract
AIM This study aimed to determine the impact of dementia on the implementation of intravenous thrombolysis and early rehabilitation as acute care for patients with acute ischemic stroke in Japan. METHODS This retrospective observational study used the Japanese Diagnosis Procedure Combination database. Patients aged ≥75 years with acute ischemic stroke (ICD-10 code: I63) were enrolled (n = 464 710). In this study, dementia was identified using the ICD-10 codes (F00, F01, F02, F03, G30, and G31) for comorbidity. A mixed-effects logistic regression analysis nested at the hospital level was conducted to examine the impact of dementia on the implementation of intravenous thrombolysis and early rehabilitation. RESULTS Overall, 57 905 patients with ischemic stroke had dementia. The group with dementia was less likely to receive intravenous thrombolysis (5.2% vs. 6.9%) and more likely to undergo early rehabilitation than the group without dementia (76.1% vs. 73.0%). In the mixed-effects logistic regression analysis, dementia was significantly associated with a lower probability of undergoing intravenous thrombolysis (adjusted odds ratio: 0.79, 95% confidence interval: 0.76-0.82, P < 0.001) and a higher probability of early rehabilitation (adjusted odds ratio: 1.06, 95% confidence interval: 1.04-1.09, P < 0.001). CONCLUSIONS We found that while dementia was associated with fewer opportunities for aggressive treatment, such as intravenous thrombolysis, it was also associated with increased opportunities to receive rehabilitation. It is necessary to examine the reasons why patients with dementia do not receive aggressive treatment and to establish a system that allows older adults with and without dementia to receive equal access to medical care. Geriatr Gerontol Int 2023; ••: ••-••.
Collapse
Affiliation(s)
- Ryutaro Matsugaki
- Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Keiji Muramatsu
- Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medical and Dental Sciences, Tokyo, Japan
| | - Shinya Matsuda
- Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| |
Collapse
|
7
|
Ganesh A, Fladt J, Singh N, Goyal M. Efficacy and safety of mechanical thrombectomy in acute stroke patients with pre-morbid disability. Expert Rev Med Devices 2022; 19:641-648. [PMID: 36093630 DOI: 10.1080/17434440.2022.2124109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION – Patients with pre-morbid disability have been generally excluded from randomized controlled trials of mechanical thrombectomy for acute ischemic stroke. However, stroke physicians commonly encounter such patients in practice, and face challenging treatment decisions when caring for them. AREAS COVERED – We review the literature on the safety and efficacy of thrombectomy in patients with pre-morbid disability. Recent clinical-epidemiological studies have highlighted the adverse outcomes that come with each increment of additional post-stroke disability in these patients. Several observational studies - both case series and registry-based studies - have helped demonstrate the comparable safety of thrombectomy in patients with pre-morbid disability as in those without, complementing similar data on thrombolysis. These data also suggest similar rates of successful recanalization, symptomatic intracerebral hemorrhage, and return to pre-stroke level of disability when treated with mechanical thrombectomy, although they have higher mortality. EXPERT OPINION – In the absence of high-quality evidence, we recommend pursuing shared decision-making with patients or family members and being upfront about the uncertain evidence. Available observational data underline the potential for a substantial proportion of these patients to return to their pre-morbid state, do not indicate a greater rate of treatment-related complications, and do not support routinely excluding these patients from thrombectomy.
Collapse
Affiliation(s)
- Aravind Ganesh
- Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada.,Hotchkiss Brain Institute and the Mathison Centre for Mental Health Research and Education, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Joachim Fladt
- Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada.,Stroke Center and Department of Neurology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Nishita Singh
- Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Mayank Goyal
- Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada.,Hotchkiss Brain Institute and the Mathison Centre for Mental Health Research and Education, University of Calgary, Calgary, Alberta, Canada.,Department of Radiology, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| |
Collapse
|
8
|
Campbell A, Gustafsson L, Gullo H, Summers M, Rosbergen I, Grimley R. Uncharted territory: The feasibility of serial computerised cognitive assessment the first week post-stroke. J Stroke Cerebrovasc Dis 2022; 31:106614. [PMID: 35858514 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 06/05/2022] [Accepted: 06/20/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Cognitive impairment is common and problematic post-stroke, yet vital information to understand early cognitive recovery is lacking. To examine early cognitive recovery, it is first necessary to establish the feasibility of repeat cognitive assessment during the acute post-stroke phase. OBJECTIVE To determine if serial computerised testing is feasible for cognitive assessment in an acute post-stroke phase, measured by assessment completion rates. METHOD An observational cohort study recruited consecutive stroke patients admitted to an acute stroke unit within 48 hours of onset. Daily assessment with the Cambridge Neuropsychological Test Automated Battery (CANTAB) was performed for seven days, and single Montreal Cognitive Assessment (MoCA). RESULTS Seventy-one participants were recruited, mean age 74 years, with 67 completing daily testing. Participants had predominantly mild (85%; NIHSS ≤6), ischemic (90%) stroke, 32% demonstrated clinical delirium. The first day of testing, 76% of participants completed CANTAB batteries. Eighty-seven percent of participants completed MoCA a mean of 3.4 days post-stroke. The proportion of CANTAB batteries completed improved significantly from day 2 to day 3 post-stroke with test completion rates stabilizing ≥ 92% by day 4. Participants with incomplete CANTAB were older, with persisting delirium, and longer stay in acute care. CONCLUSION Serial computerised cognitive assessments are feasible the first week post-stroke and provide a novel approach to measuring cognitive change for both clinical and research purposes. Maximum completion rates by day four have clinical implications for optimal timing of cognitive testing.
Collapse
Affiliation(s)
- Alana Campbell
- Brisbane, Queensland, Australia; and Queensland Health (Sunshine Coast Hospital and Health Service), The University of Queensland (School of Health and Rehabilitation Sciences), Sunshine Coast, QLD, Australia.
| | - Louise Gustafsson
- Griffith University (School of Health Sciences and Social Work), Brisbane, QLD, Australia
| | - Hannah Gullo
- The University of Queensland (School of Health and Rehabilitation Sciences), Brisbane, QLD, Australia
| | - Mathew Summers
- University of the Sunshine Coast (School of Health and Behavioural Sciences), Sunshine Coast, QLD, Australia
| | - Ingrid Rosbergen
- Surgical Treatment and Rehabilitation Service (STARS), The University of Queensland and Metro North Health, Brisbane, QLD, Australia
| | - Rohan Grimley
- Griffith University and Queensland Health (Sunshine Coast Hospital and Health Service), Sunshine Coast, Queensland, Australia
| |
Collapse
|
9
|
Gupta A, Uthayaseelan K, Uthayaseelan K, Kadari M, Subhan M, Saji Parel N, Krishna PV, Sange I. Alzheimer's Disease and Stroke: A Tangled Neurological Conundrum. Cureus 2022; 14:e25005. [PMID: 35712342 PMCID: PMC9194877 DOI: 10.7759/cureus.25005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2022] [Indexed: 11/05/2022] Open
|
10
|
Ganesh A, Fraser JF, Gordon Perue GL, Amin-Hanjani S, Leslie-Mazwi TM, Greenberg SM, Couillard P, Asdaghi N, Goyal M. Endovascular Treatment and Thrombolysis for Acute Ischemic Stroke in Patients With Premorbid Disability or Dementia: A Scientific Statement From the American Heart Association/American Stroke Association. Stroke 2022; 53:e204-e217. [PMID: 35343235 DOI: 10.1161/str.0000000000000406] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Patients with premorbid disability or dementia have generally been excluded from randomized controlled trials of reperfusion therapies such as thrombolysis and endovascular therapy for acute ischemic stroke. Consequently, stroke physicians face treatment dilemmas in caring for such patients. In this scientific statement, we review the literature on acute ischemic stroke in patients with premorbid disability or dementia and propose principles to guide clinicians, clinician-scientists, and policymakers on the use of acute stroke therapies in these populations. Recent clinical-epidemiological studies have demonstrated challenges in our concept and measurement of premorbid disability or dementia while highlighting the significant proportion of the general stroke population that falls under this umbrella, risking exclusion from therapies. Such studies have also helped clarify the adverse long-term clinical and health economic consequences with each increment of additional poststroke disability in these patients, underscoring the importance of finding strategies to mitigate such additional disability. Several observational studies, both case series and registry-based studies, have helped demonstrate the comparable safety of endovascular therapy in patients with premorbid disability or dementia and in those without, complementing similar data on thrombolysis. These data also suggest that such patients have a substantial potential to retain their prestroke level of disability when treated, despite their generally worse prognosis overall, although this remains to be validated in higher-quality registries and clinical trials. By pairing pragmatic and transparent decision-making in clinical practice with an active pursuit of high-quality research, we can work toward a more inclusive paradigm of patient-centered care for this often-neglected patient population.
Collapse
|
11
|
Heikal SA, Salama M, Richard Y, Moustafa AA, Lawlor B. The Impact of Disease Registries on Advancing Knowledge and Understanding of Dementia Globally. Front Aging Neurosci 2022; 14:774005. [PMID: 35197840 PMCID: PMC8859161 DOI: 10.3389/fnagi.2022.774005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 01/14/2022] [Indexed: 12/01/2022] Open
Abstract
To help address the increasing challenges related to the provision of dementia care, dementia registries have emerged around the world as important tools to gain insights and a better understanding of the disease process. Dementia registries provide a valuable source of standardized data collected from a large number of patients. This review explores the published research relating to different dementia registries around the world and discusses how these registries have improved our knowledge and understanding of the incidence, prevalence, risk factors, mortality, diagnosis, and management of dementia. A number of the best-known dementia registries with high research output including SveDem, NACC, ReDeGi, CREDOS and PRODEM were selected to study the publication output based on their data, investigate the key findings of these registry-based studies. Registries data contributed to understanding many aspects of the disease including disease prevalence in specific areas, patient characteristics and how they differ in populations, mortality risks, as well as the disease risk factors. Registries data impacted the quality of patients’ lives through determining the best treatment strategy for a patient based on previous patient outcomes. In conclusion, registries have significantly advanced scientific knowledge and understanding of dementia and impacted policy, clinical practice care delivery.
Collapse
Affiliation(s)
- Shimaa A. Heikal
- Institute of Global Health and Human Ecology (IGHHE), The American University in Cairo (AUC), New Cairo, Egypt
- *Correspondence: Shimaa A. Heikal,
| | - Mohamed Salama
- Institute of Global Health and Human Ecology (IGHHE), The American University in Cairo (AUC), New Cairo, Egypt
- Medical Experimental Research Center (MERC), Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Yuliya Richard
- Blue Horizon Counseling Services, Sydney, NSW, Australia
| | - Ahmed A. Moustafa
- School of Psychology, Faculty of Society and Design, Bond University, Gold Coast, QLD, Australia
- Department of Human Anatomy and Physiology, The Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
| | - Brian Lawlor
- Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland
| |
Collapse
|
12
|
Hoang MT, Kåreholt I, von Koch L, Xu H, Secnik J, Religa D, Tan ECK, Johnell K, Garcia-Ptacek S. Influence of Education and Income on Receipt of Dementia Care in Sweden. J Am Med Dir Assoc 2021; 22:2100-2107. [PMID: 34280361 DOI: 10.1016/j.jamda.2021.06.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/07/2021] [Accepted: 06/10/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To explore the dementia diagnostic process and drug prescription for persons with dementia (PWD) with different socioeconomic status (SES). DESIGN Register-based cohort study. SETTING AND PARTICIPANTS This study included 74,414 PWD aged ≥65 years from the Swedish Dementia Register (2007-2018). Their data were linked with the Swedish Longitudinal Integrated Database for Health Insurance and Labor Market Studies (2006-2017) to acquire the SES information 1 year before dementia diagnosis. METHODS Education and income-2 traditional SES indicators-were divided into 5 levels. Outcomes comprised the dementia diagnostic examinations, types of dementia diagnosis, diagnostic unit, and prescription of antidementia drugs. Binary logistic regression was performed to evaluate socioeconomic inequalities. RESULTS Compared to PWD with the lowest educational level, PWD with the highest educational level had a higher probability of receiving the basic diagnostic workup [odds ratio (OR) 1.19, 95% confidence interval (CI) 1.10-1.29], clock test (OR 1.12, 95% CI 1.02-1.24) and neuroimaging (OR 1.23, 95% CI 1.09-1.39). Compared with PWD in the lowest income quintile, PWD in the highest income quintile presented a higher chance of receiving the basic diagnostic workup (OR 1.35, 95% CI 1.26-1.46), clock test (OR 1.40, 95% CI 1.28-1.52), blood analysis (OR 1.21, 95% CI 1.06-1.39), Mini-Mental State Examination (OR 1.47, 95% CI 1.26-1.70), and neuroimaging (OR 1.30, 95% CI 1.18-1.44). PWD with higher education or income had a higher likelihood of obtaining a specified dementia diagnosis or being diagnosed at a memory clinic. SES presented no association with prescription of antidementia medication, except for the association between education and the use of memantine. CONCLUSIONS AND IMPLICATIONS Higher education or income was significantly associated with higher chance of receiving dementia diagnostic examinations, a specified dementia diagnosis, being diagnosed at a memory clinic, and using memantine. Socioeconomic inequalities in dementia diagnostic process and prescription of memantine occurred among PWD with different education or income levels.
Collapse
Affiliation(s)
- Minh Tuan Hoang
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
| | - Ingemar Kåreholt
- Aging Research Center (ARC), Karolinska Institutet and Stockholm University, Stockholm, Sweden; Institute of Gerontology, School of Health Welfare, Aging Research Network-Jönköping (ARN-J), Jönköping University, Jönköping, Sweden
| | - Lena von Koch
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Neuro Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Hong Xu
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Juraj Secnik
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Dorota Religa
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Aging Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Edwin C K Tan
- Aging Research Center (ARC), Karolinska Institutet and Stockholm University, Stockholm, Sweden; Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, New South Wales, Australia
| | - Kristina Johnell
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Sara Garcia-Ptacek
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Aging Theme, Karolinska University Hospital, Stockholm, Sweden.
| |
Collapse
|
13
|
Zupanic E, Kramberger MG, von Euler M, Norrving B, Winblad B, Secnik J, Fastbom J, Eriksdotter M, Garcia-Ptacek S. Secondary Stroke Prevention After Ischemic Stroke in Patients with Alzheimer's Disease and Other Dementia Disorders. J Alzheimers Dis 2021; 73:1013-1021. [PMID: 31884483 PMCID: PMC7081091 DOI: 10.3233/jad-191011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background: Recurrent ischemic stroke (IS) increases the risk of cognitive decline. To lower the risk of recurrent IS, secondary prevention is essential. Objective: Our aim was to compare post-discharge secondary IS prevention and its maintenance up to 3 years after first IS in patients with and without Alzheimer’s disease and other dementia disorders. Methods: Prospective open-cohort study 2007–2014 from the Swedish national dementia registry (SveDem) and the Swedish national stroke registry (Riksstroke). Patients with dementia who experienced an IS (n = 1410; 332 [23.5%] with Alzheimer’s disease) were compared with matched non-dementia IS patients (n = 7150). We analyzed antiplatelet, anticoagulant, blood pressure lowering, and statin treatment as planned medication initiation at discharge and actual dispensation of medications at first, second, and third year post-stroke. Results: At discharge, planned initiation of medication was higher in patients with dementia compared to non-dementia patients for antiplatelets (OR with 95% CI for fully adjusted models 1.23 [1.02–1.48]) and lower for blood pressure lowering medication (BPLM; 0.57 [0.49–0.67]), statins (0.57 [0.50–0.66]), and anticoagulants (in patients with atrial fibrillation – AF; 0.41 [0.32–0.53]). When analysis for antiplatelets was stratified according to the presence of AF, ORs for receiving antiplatelets remained significant only in the presence of AF (in the presence of AF 1.56 [1.21–2.01], in patients without AF 0.99 [0.75–1.33]). Similar trends were observed in 1st, 2nd, and 3rd year post-stroke. Conclusions: Dementia was a predictor of lower statin and BPLM use. Patients with dementia and AF were more likely to be prescribed antiplatelets and less likely to receive anticoagulants.
Collapse
Affiliation(s)
- Eva Zupanic
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Neurogeriatrics, Solna, Sweden.,Department of Neurology, University Medical Centre, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Milica G Kramberger
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Neurogeriatrics, Solna, Sweden.,Department of Neurology, University Medical Centre, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Mia von Euler
- Karolinska Institutet, Department of Clinical Science and Education, Södersjukhuset and Department of Medicine, Solna, Stockholm, Sweden.,Department of Clinical Pharmacology, Karolinska University Hospital, Stockholm, Sweden
| | - Bo Norrving
- Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Neurology, Lund, Sweden
| | - Bengt Winblad
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Neurogeriatrics, Solna, Sweden.,Karolinska University Hospital, Theme Aging, Stockholm, Sweden
| | - Juraj Secnik
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Clinical Geriatrics, Huddinge, Sweden
| | - Johan Fastbom
- Karolinska Institutet and Stockholm University, Department of Neurobiology, Care Sciences and Society, Aging Research Center (ARC), Stockholm, Sweden
| | - Maria Eriksdotter
- Karolinska University Hospital, Theme Aging, Stockholm, Sweden.,Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Clinical Geriatrics, Huddinge, Sweden
| | - Sara Garcia-Ptacek
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Clinical Geriatrics, Huddinge, Sweden.,Department of Internal Medicine Section for Neurology, Södersjukhuset, Stockholm, Sweden
| |
Collapse
|
14
|
Hoang MT, Kåreholt I, von Euler M, Jönsson L, von Koch L, Eriksdotter M, Garcia-Ptacek S. Costs of Inpatient Rehabilitation for Ischemic Stroke in Patients with Dementia: A Cohort Swedish Register-Based Study. J Alzheimers Dis 2021; 73:967-979. [PMID: 31884465 PMCID: PMC7081100 DOI: 10.3233/jad-190749] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Stroke and dementia are frequent comorbidities. Dementia possibly increases total costs of stroke care, especially cost of institutionalization and informal medical care. However, stroke rehabilitation costs in dementia patients are understudied. OBJECTIVE To estimate inpatient stroke rehabilitation costs for Swedish dementia patients in comparison with non-dementia patients. METHODS A longitudinal cohort study with linked data from the Swedish Dementia Register and the Swedish Stroke Register was conducted. Patients diagnosed with dementia who suffered a first ischemic stroke between 2010 and 2014 (n = 138) were compared with non-dementia patients (n = 935). Cost analyses were conducted from a Swedish health care perspective. The difference of rehabilitation costs between the two groups was examined via simple linear regression (before and after matching by propensity scores of dementia) and multiple linear regression. RESULTS Mean inpatient rehabilitation costs for dementia and non-dementia patients were SEK 103,693/$11,932 and SEK 130,057/$14,966, respectively (median SEK 92,183/$10,607 and SEK 106,365/$12,239) (p = 0.001). Dementia patients suffered from more comorbidities and experienced lower functioning, compared to non-dementia patients. The inpatient rehabilitation cost for patients with known dementia was 0.84 times the cost in non-dementia individuals. CONCLUSION Dementia diagnosis was significantly associated with lower inpatient stroke rehabilitation costs. This might be explained by physicians' beliefs on the limited effectiveness of rehabilitation in dementia patients. Further research on cost-effectiveness of stroke rehabilitation and patients' satisfaction with stroke rehabilitation is necessary.
Collapse
Affiliation(s)
- Minh Tuan Hoang
- Center for Alzheimer Research, Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Ingemar Kåreholt
- Aging Research Center (ARC), Karolinska Institutet and Stockholm University, Stockholm, Sweden.,Institute of Gerontology, School of Health and Welfare, Aging Research Network - Jönköping (ARN-J), Jönköping University, Jönköping, Sweden
| | - Mia von Euler
- Karolinska Institutet, Departments of Clinical Science and Education, Södersjukhuset, and Medicine, Solna, Stockholm, Sweden.,Department of Clinical Pharmacology, Karolinska University Laboratory, Karolinska University Hospital, Stockholm, Sweden
| | - Linus Jönsson
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Lena von Koch
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.,Neuro Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Maria Eriksdotter
- Center for Alzheimer Research, Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.,Aging Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Sara Garcia-Ptacek
- Center for Alzheimer Research, Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.,Section for Neurology, Department of Internal Medicine, Södersjukhuset, Stockholm, Sweden
| |
Collapse
|
15
|
Levine DA, Galecki AT, Morgenstern LB, Zahuranec DB, Langa KM, Kabeto MU, Okullo D, Nallamothu BK, Giordani B, Reale BK, Campbell M, Lisabeth LD. Preexisting Mild Cognitive Impairment, Dementia, and Receipt of Treatments for Acute Ischemic Stroke. Stroke 2021; 52:2134-2142. [PMID: 33902296 DOI: 10.1161/strokeaha.120.032258] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Differences in acute ischemic stroke (AIS) treatment by cognitive status are unclear, but some studies have found patients with preexisting dementia get less treatment. We compared AIS care by preexisting cognitive status. METHODS Cross-sectional analysis of prospectively obtained data on 836 adults ≥45 with AIS from the population-based Brain Attack Surveillance in Corpus Christi project from 2008 to 2013. We compared receipt of a composite quality measure representing the percentage of 7 treatments/procedures received (ordinal scale; values, <0.75, 0.75-0.99, and 1.0), a binary defect-free quality score, and individual treatments after AIS between patients with preexisting dementia (Informant Questionnaire on Cognitive Decline in the Elderly score ≥3.44), mild cognitive impairment (MCI, score 3.1-3.43), and normal cognition (score ≤3). RESULTS Among patients with AIS, 42% had normal cognition (47% women; median age [interquartile range], 65 [56-76]), 32% had MCI (54% women; median age, 70 [60-78]), 26% had dementia (56% women; median age, 78 [64-85]). After AIS, 44% of patients with preexisting dementia and 55% of patients with preexisting MCI or normal cognition received defect-free care. Compared with cognitively normal patients, patients with preexisting MCI had similar cumulative odds (unadjusted cumulative odds ratio =0.99, P=0.92), and patients with preexisting dementia had 36% lower cumulative odds of receiving the composite quality measure (unadjusted cumulative odds ratio [OR]=0.64, P=0.005). However, the dementia-quality association became nonsignificant after adjusting for patient factors, namely sex, comorbidity, and body mass index (adjusted cumulative OR [acOR]=0.79, P=0.19). Independent of patient factors, preexisting MCI was negatively associated with receipt of IV tPA (intravenous tissue-type plasminogen activator; acOR=0.36, P=0.04), rehabilitation assessment (acOR=0.28, P=0.016), and echocardiogram (acOR=0.48, P<0.001). Preexisting dementia was negatively associated with receipt of antithrombotic by day 2 (acOR=0.39, P=0.04) and echocardiogram (acOR=0.42, P<0.001). CONCLUSIONS Patients with preexisting MCI and dementia, compared with cognitively normal patients, may receive less frequently some treatments and procedures, but not the composite quality measure, after AIS.
Collapse
Affiliation(s)
- Deborah A Levine
- Department of Internal Medicine and Cognitive Health Services Research Program (D.A.L., A.T.G., K.M.L., M.U.K., D.O., B.K.N., B.K.R.), University of Michigan, Ann Arbor.,Department of Neurology and Stroke Program (D.A.L., L.B.M., D.B.Z., L.D.L.), University of Michigan, Ann Arbor.,Institute for Healthcare Policy and Innovation (D.A.L., L.B.M., K.M.L., B.K.N.), University of Michigan, Ann Arbor
| | - Andrzej T Galecki
- Department of Internal Medicine and Cognitive Health Services Research Program (D.A.L., A.T.G., K.M.L., M.U.K., D.O., B.K.N., B.K.R.), University of Michigan, Ann Arbor.,Department of Biostatistics (A.T.G.), University of Michigan, Ann Arbor
| | - Lewis B Morgenstern
- Department of Neurology and Stroke Program (D.A.L., L.B.M., D.B.Z., L.D.L.), University of Michigan, Ann Arbor.,Institute for Healthcare Policy and Innovation (D.A.L., L.B.M., K.M.L., B.K.N.), University of Michigan, Ann Arbor.,Department of Epidemiology (L.B.M., L.D.L.), University of Michigan, Ann Arbor
| | - Darin B Zahuranec
- Department of Neurology and Stroke Program (D.A.L., L.B.M., D.B.Z., L.D.L.), University of Michigan, Ann Arbor
| | - Kenneth M Langa
- Department of Internal Medicine and Cognitive Health Services Research Program (D.A.L., A.T.G., K.M.L., M.U.K., D.O., B.K.N., B.K.R.), University of Michigan, Ann Arbor.,Institute for Healthcare Policy and Innovation (D.A.L., L.B.M., K.M.L., B.K.N.), University of Michigan, Ann Arbor.,VA Ann Arbor Healthcare System, MI (K.M.L., B.K.N.)
| | - Mohammed U Kabeto
- Department of Internal Medicine and Cognitive Health Services Research Program (D.A.L., A.T.G., K.M.L., M.U.K., D.O., B.K.N., B.K.R.), University of Michigan, Ann Arbor
| | - Dolorence Okullo
- Department of Internal Medicine and Cognitive Health Services Research Program (D.A.L., A.T.G., K.M.L., M.U.K., D.O., B.K.N., B.K.R.), University of Michigan, Ann Arbor
| | - Brahmajee K Nallamothu
- Department of Internal Medicine and Cognitive Health Services Research Program (D.A.L., A.T.G., K.M.L., M.U.K., D.O., B.K.N., B.K.R.), University of Michigan, Ann Arbor.,Institute for Healthcare Policy and Innovation (D.A.L., L.B.M., K.M.L., B.K.N.), University of Michigan, Ann Arbor.,VA Ann Arbor Healthcare System, MI (K.M.L., B.K.N.)
| | - Bruno Giordani
- Department of Psychiatry and Michigan Alzheimer's Disease Center (B.G.), University of Michigan, Ann Arbor
| | - Bailey K Reale
- Department of Internal Medicine and Cognitive Health Services Research Program (D.A.L., A.T.G., K.M.L., M.U.K., D.O., B.K.N., B.K.R.), University of Michigan, Ann Arbor
| | - Morgan Campbell
- Neuroscience Institute and Stroke Program Medical Director, Christus Spohn Shoreline, Corpus Christi, TX (M.C.)
| | - Lynda D Lisabeth
- Department of Neurology and Stroke Program (D.A.L., L.B.M., D.B.Z., L.D.L.), University of Michigan, Ann Arbor.,Department of Epidemiology (L.B.M., L.D.L.), University of Michigan, Ann Arbor
| |
Collapse
|
16
|
Kalar I, Xu H, Secnik J, Schwertner E, Kramberger MG, Winblad B, von Euler M, Eriksdotter M, Garcia‐Ptacek S. Calcium channel blockers, survival and ischaemic stroke in patients with dementia: a Swedish registry study. J Intern Med 2021; 289:508-522. [PMID: 32854138 PMCID: PMC8049076 DOI: 10.1111/joim.13170] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 07/27/2020] [Accepted: 08/19/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The effect of calcium channel blockers (CCB) on mortality and ischaemic stroke risk in dementia patients is understudied. OBJECTIVES To calculate the risk of death and ischaemic stroke in dementia patients treated with CCBs, considering individual agents and dose response. METHODS Longitudinal cohort study with 18 906 hypertensive dementia patients from the Swedish Dementia Registry (SveDem), 2008-2014. Other Swedish national registries contributed information on comorbidities, dispensed medication and outcomes. Individual CCB agents and cumulative defined daily doses (cDDD) were considered. RESULTS In patients with hypertension and dementia, nifedipine was associated with increased mortality risk (aHR 1.32; CI 1.01-1.73; P < 0.05) compared to non-CCB users. Patients diagnosed with Alzheimer's dementia (AD) or dementia with Lewy bodies/Parkinson's disease dementia (DLB-PDD) taking amlodipine had lower mortality risk (aHR, 0.89; CI, 0.80-0.98; P < 0.05 and aHR 0.58; CI, 0.38-0.86; P < 0.01, respectively), than those taking other CCBs. Amlodipine was associated with lower stroke risk in patients with Alzheimer's dementia compared to other CCBs (aHR 0.63; CI, 0.44-0.89; P < 0.05). Sensitivity analyses with propensity score-matched cohorts repeated the results for nifedipine (aHR 1.35; 95% CI, 1.02-1.78; P < 0.05) and amlodipine in AD (aHR, 0.87; CI, 0.78-0.97; P < 0.05) and DLB-PDD (aHR, 0.56, 95%CI, 0.37-0.85; P < 0.05). CONCLUSION Amlodipine was associated with reduced mortality risk in dementia patients diagnosed with AD and DLB-PDD. AD patients using amlodipine had a lower risk of ischaemic stroke compared to other CCB users.
Collapse
Affiliation(s)
- I. Kalar
- From theDivision of NeurogeriatricsDepartment of Neurobiology, Care Sciences and SocietyKarolinska InstitutetStockholmSweden
- Department of NeurologyUniversity Medical Centre LjubljanaLjubljanaSlovenia
- University of LjubljanaLjubljanaSlovenia
| | - H. Xu
- Division of Clinical GeriatricsDepartment of Neurobiology, Care Sciences and SocietyKarolinska InstitutetStockholmSweden
| | - J. Secnik
- Division of Clinical GeriatricsDepartment of Neurobiology, Care Sciences and SocietyKarolinska InstitutetStockholmSweden
| | - E. Schwertner
- Division of Clinical GeriatricsDepartment of Neurobiology, Care Sciences and SocietyKarolinska InstitutetStockholmSweden
| | - M. G. Kramberger
- From theDivision of NeurogeriatricsDepartment of Neurobiology, Care Sciences and SocietyKarolinska InstitutetStockholmSweden
- Department of NeurologyUniversity Medical Centre LjubljanaLjubljanaSlovenia
- University of LjubljanaLjubljanaSlovenia
| | - B. Winblad
- From theDivision of NeurogeriatricsDepartment of Neurobiology, Care Sciences and SocietyKarolinska InstitutetStockholmSweden
- Theme AgingKarolinska University HospitalStockholmSweden
| | - M. von Euler
- Department of Clinical Research and EducationSödersjukhuset (KI SÖS)Karolinska InstitutetStockholmSweden
| | - M. Eriksdotter
- Division of Clinical GeriatricsDepartment of Neurobiology, Care Sciences and SocietyKarolinska InstitutetStockholmSweden
- Theme AgingKarolinska University HospitalStockholmSweden
| | - S. Garcia‐Ptacek
- Division of Clinical GeriatricsDepartment of Neurobiology, Care Sciences and SocietyKarolinska InstitutetStockholmSweden
- Theme AgingKarolinska University HospitalStockholmSweden
- Department of Internal MedicineNeurology SectionSödersjukhusetStockholmSweden
| |
Collapse
|
17
|
Xu H, Garcia-Ptacek S, Jönsson L, Wimo A, Nordström P, Eriksdotter M. Long-term Effects of Cholinesterase Inhibitors on Cognitive Decline and Mortality. Neurology 2021; 96:e2220-e2230. [PMID: 33741639 PMCID: PMC8166426 DOI: 10.1212/wnl.0000000000011832] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 01/04/2021] [Indexed: 12/20/2022] Open
Abstract
Objective To investigate whether cholinesterase inhibitors (ChEIs) are associated with slower cognitive decline in Alzheimer dementia and decreased risk of severe dementia or death. Methods Patients with Alzheimer dementia from the Swedish Dementia Registry starting on ChEIs within 3 months of the dementia diagnosis were included and compared to nontreated patients with Alzheimer dementia. In a propensity score–matched cohort, the association between ChEI use and cognitive trajectories assessed by Mini-Mental State Examination (MMSE) scores was examined with a mixed model, and severe dementia (MMSE score <10) or death as an outcome was assessed with Cox proportional hazards models. Results The matched cohort included 11,652 ChEI users and 5,826 nonusers. During an average of 5 years of follow-up, 255 cases developed severe dementia, and 6,055 (35%) died. ChEI use was associated with higher MMSE score at each visit (0.13 MMSE points per year; 95% confidence interval [CI] 0.06–0.20). ChEI users had a 27% lower risk of death (0.73, 95% CI 0.69–0.77) compared with nonusers. Galantamine was associated with lower risk of death (0.71, 95% CI 0.65–0.76) and lower risk of severe dementia (0.69, 95% CI 0.47–1.00) and had the strongest effect on cognitive decline of all the ChEIs (0.18 MMSE points per year, 95% CI 0.07–0.28). Conclusions ChEIs are associated with cognitive benefits that are modest but persist over time and with reduced mortality risk, which could be explained partly by their cognitive effects. Galantamine was the only ChEI demonstrating a significant reduction in the risk of developing severe dementia. Classification of Evidence This study provides Class III evidence that for patients with Alzheimer dementia ChEIs decrease long-term cognitive decline and risk of death and that galantamine decreases the risk of severe dementia.
Collapse
Affiliation(s)
- Hong Xu
- From the Division of Clinical Geriatrics (H.X., S.G.-P., M.E.), Division of Neurogeriatrics (L.J., A.W.), Department of Neurobiology, Care Sciences and Society, and Department of Medical Epidemiology and Biostatistics (H.X.), Karolinska Institutet; Department of Internal Medicine (S.G.-P.), Neurology Section, Södersjukhuset, Stockholm, Sweden; H. Lundbeck A/S (L.J.), Copenhagen, Denmark; Department of Community Medicine and Rehabilitation (P.N.), Geriatric Medicine, Umeå University; and Theme Aging (S.G.-P., M.A.), Karolinska University Hospital, Stockholm, Sweden.
| | - Sara Garcia-Ptacek
- From the Division of Clinical Geriatrics (H.X., S.G.-P., M.E.), Division of Neurogeriatrics (L.J., A.W.), Department of Neurobiology, Care Sciences and Society, and Department of Medical Epidemiology and Biostatistics (H.X.), Karolinska Institutet; Department of Internal Medicine (S.G.-P.), Neurology Section, Södersjukhuset, Stockholm, Sweden; H. Lundbeck A/S (L.J.), Copenhagen, Denmark; Department of Community Medicine and Rehabilitation (P.N.), Geriatric Medicine, Umeå University; and Theme Aging (S.G.-P., M.A.), Karolinska University Hospital, Stockholm, Sweden
| | - Linus Jönsson
- From the Division of Clinical Geriatrics (H.X., S.G.-P., M.E.), Division of Neurogeriatrics (L.J., A.W.), Department of Neurobiology, Care Sciences and Society, and Department of Medical Epidemiology and Biostatistics (H.X.), Karolinska Institutet; Department of Internal Medicine (S.G.-P.), Neurology Section, Södersjukhuset, Stockholm, Sweden; H. Lundbeck A/S (L.J.), Copenhagen, Denmark; Department of Community Medicine and Rehabilitation (P.N.), Geriatric Medicine, Umeå University; and Theme Aging (S.G.-P., M.A.), Karolinska University Hospital, Stockholm, Sweden
| | - Anders Wimo
- From the Division of Clinical Geriatrics (H.X., S.G.-P., M.E.), Division of Neurogeriatrics (L.J., A.W.), Department of Neurobiology, Care Sciences and Society, and Department of Medical Epidemiology and Biostatistics (H.X.), Karolinska Institutet; Department of Internal Medicine (S.G.-P.), Neurology Section, Södersjukhuset, Stockholm, Sweden; H. Lundbeck A/S (L.J.), Copenhagen, Denmark; Department of Community Medicine and Rehabilitation (P.N.), Geriatric Medicine, Umeå University; and Theme Aging (S.G.-P., M.A.), Karolinska University Hospital, Stockholm, Sweden
| | - Peter Nordström
- From the Division of Clinical Geriatrics (H.X., S.G.-P., M.E.), Division of Neurogeriatrics (L.J., A.W.), Department of Neurobiology, Care Sciences and Society, and Department of Medical Epidemiology and Biostatistics (H.X.), Karolinska Institutet; Department of Internal Medicine (S.G.-P.), Neurology Section, Södersjukhuset, Stockholm, Sweden; H. Lundbeck A/S (L.J.), Copenhagen, Denmark; Department of Community Medicine and Rehabilitation (P.N.), Geriatric Medicine, Umeå University; and Theme Aging (S.G.-P., M.A.), Karolinska University Hospital, Stockholm, Sweden
| | - Maria Eriksdotter
- From the Division of Clinical Geriatrics (H.X., S.G.-P., M.E.), Division of Neurogeriatrics (L.J., A.W.), Department of Neurobiology, Care Sciences and Society, and Department of Medical Epidemiology and Biostatistics (H.X.), Karolinska Institutet; Department of Internal Medicine (S.G.-P.), Neurology Section, Södersjukhuset, Stockholm, Sweden; H. Lundbeck A/S (L.J.), Copenhagen, Denmark; Department of Community Medicine and Rehabilitation (P.N.), Geriatric Medicine, Umeå University; and Theme Aging (S.G.-P., M.A.), Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
18
|
D'Souza CE, Greenway MRF, Graff-Radford J, Meschia JF. Cognitive Impairment in Patients with Stroke. Semin Neurol 2021; 41:75-84. [PMID: 33418591 DOI: 10.1055/s-0040-1722217] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Despite substantial advances in stroke care, vascular cognitive impairment remains a prominent source of disability. Unlike sensorimotor impairments, cognition often continues to decline after stroke. An aging population will increase the prevalence of vascular cognitive impairment, with stroke playing an important role. Ten percent of patients presenting with stroke have pre-stroke dementia; an additional 10% will develop incident dementia with a first stroke, and 30% with a recurrent stroke. While stroke increases the risk of cognitive impairment, the presence of cognitive impairment also impacts acute stroke treatment and increases risk of poor outcome by nearly twofold. There is substantial overlap in the clinical and pathological aspects of vascular and degenerative dementias in many patients. How they relate to one another is controversial. The treatment of vascular cognitive impairment remains supportive, focusing on treating vascular risk factors. Cognitive rehabilitation after stroke is an area of active research, and existing pharmacologic treatments have limited benefit. Heightened awareness of cognitive impairment in the setting of stroke is imperative for prognostication and management, impetus for research and, ultimately, the discovery of efficacious treatments.
Collapse
Affiliation(s)
- Caitlin E D'Souza
- Department of Neurology, Mayo Clinic Florida, Jacksonville, Florida.,Department of Neurology, Baptist Health, Jacksonville, Florida
| | | | | | - James F Meschia
- Department of Neurology, Mayo Clinic Florida, Jacksonville, Florida
| |
Collapse
|
19
|
Hoang MT, Kåreholt I, von Euler M, von Koch L, Eriksdotter M, Garcia-Ptacek S. Satisfaction with Stroke Care Among Patients with Alzheimer's and Other Dementias: A Swedish Register-Based Study. J Alzheimers Dis 2020; 79:905-916. [PMID: 33361596 PMCID: PMC7902943 DOI: 10.3233/jad-200976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Patient dissatisfaction with stroke care is associated with poor self-rated health and unmet care needs. Dementia patients’ satisfaction with stroke care is understudied. Objective: To compare satisfaction with stroke care in patients with and without dementia. Methods: This longitudinal cohort study included 5,932 dementia patients (2007–2017) who suffered a first stroke after dementia diagnosis and 39,457 non-dementia stroke patients (2007–2017). Data were retrieved by linking the Swedish Stroke Register, the Swedish Dementia Register, the Swedish National Patient Register, and the Swedish Prescribed Drug Register. The association between dementia and satisfaction was analyzed with ordinal logistic regression. Results: When dementia patients answered themselves, they reported significantly lower odds of satisfaction with acute stroke care (OR: 0.71; 95% CI: 0.60–0.85), healthcare staff’s attitude (OR: 0.79; 95% CI: 0.66–0.96), communication with doctors (OR: 0.78; 95% CI: 0.66–0.92), stroke information (OR: 0.62; 95% CI: 0.52–0.74); but not regarding inpatient rehabilitation (OR: 0.93; 95% CI: 0.75–1.16), or outpatient rehabilitation (OR: 0.93; 95% CI: 0.73–1.18). When patients answered with caregivers’ help, the association between dementia status and satisfaction remained significant in all items. Subgroup analyses showed that patients with Alzheimer’s disease and mixed dementia reported lower odds of satisfaction with acute care and healthcare staff’s attitude when they answered themselves. Conclusion: Patients with dementia reported lower satisfaction with stroke care, revealing unfulfilled care needs among dementia patients, which are possibly due to different (or less) care, or because dementia patients require adaptations to standard care.
Collapse
Affiliation(s)
- Minh Tuan Hoang
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Ingemar Kåreholt
- Aging Research Center (ARC), Karolinska Institutet and Stockholm University, Stockholm, Sweden.,Institute of Gerontology, School of Health and Welfare, Aging Research Network Jönköping (ARN-J), Jönköping University, Jönköping, Sweden
| | - Mia von Euler
- Department of Medical Sciences, School of Medicine, Örebro University, Örebro, Sweden
| | - Lena von Koch
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Neuro Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Maria Eriksdotter
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Aging Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Sara Garcia-Ptacek
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Aging Theme, Karolinska University Hospital, Stockholm, Sweden.,Section for Neurology, Department of Internal Medicine, Södersjukhuset, Stockholm, Sweden
| |
Collapse
|
20
|
Seblova D, Brayne C, Machů V, Kuklová M, Kopecek M, Cermakova P. Changes in Cognitive Impairment in the Czech Republic. J Alzheimers Dis 2020; 72:693-701. [PMID: 31609688 DOI: 10.3233/jad-190688] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Studies from North America and Western Europe suggest stable or declining trends in impaired cognition across birth cohorts. OBJECTIVE We aimed to examine changes in the age-specific prevalence of cognitive impairment in the Czech Republic. METHODS The study used two samples from the population-based Czech Survey on Health, Ageing and Retirement in Europe. Age-specific prevalence of cognitive impairment (defined based on scores in verbal fluency, immediate recall, delayed recall, and temporal orientation) was compared between participants in wave 2 (2006/2007; n = 1,107) and wave 6 (2015; n = 3,104). Logistic regression was used to estimate the association between the wave and cognitive impairment, step-wise adjusting for sociodemographic and clinical characteristics. Multiple sensitivity analyses, focusing on alternative operationalizations of relative cognitive impairment, impact of missing cognitive data, and survival bias, were carried out. RESULTS The most conservative estimate suggested that the age-specific prevalence of cognitive impairment declined by one fifth, from 11% in 2006/2007 to 9% in 2015. Decline was observed in all sensitivity analyses. The change was associated with differences in physical inactivity, management of high blood cholesterol, and increases in length education. CONCLUSION Older adults in the Czech Republic, a country situated in the Central and Eastern European region, have achieved positive developments in cognitive aging. Longer education, better management of cardiovascular factors, and reduced physical inactivity seem to be of key importance.
Collapse
Affiliation(s)
- Dominika Seblova
- Aging Research Center, Karolinska Institutet & Stockholm University, Stockholm, Sweden.,Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Neurology, Columbia University College of Physicians and Surgeons, New York City, NY, USA
| | - Carol Brayne
- Department of Public Health and Primary Care, Cambridge Institute of Public Health, University of Cambridge, Cambridge, United Kingdom
| | - Vendula Machů
- National Institute of Mental Health, Klecany, Czech Republic.,Charles University Prague, Faculty of Science, Prague, Czech Republic.,University of Groningen, Faculty of Medical Sciences, Groningen, Netherlands
| | - Marie Kuklová
- National Institute of Mental Health, Klecany, Czech Republic.,Charles University Prague, Faculty of Science, Prague, Czech Republic
| | - Miloslav Kopecek
- National Institute of Mental Health, Klecany, Czech Republic.,Charles University Prague, Third Faculty of Medicine, Prague, Czech Republic
| | - Pavla Cermakova
- National Institute of Mental Health, Klecany, Czech Republic.,Charles University Prague, Third Faculty of Medicine, Prague, Czech Republic
| |
Collapse
|
21
|
Cognitive impairment in patients with atrial fibrillation: Implications for outcome in a cohort study. Int J Cardiol 2020; 323:83-89. [PMID: 32800908 DOI: 10.1016/j.ijcard.2020.08.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/20/2020] [Accepted: 08/07/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND The impact of cognitive status on outcomes of patients with atrial fibrillation (AF) is not well defined. AIMS To assess the prevalence of cognitive impairment in AF patients and evaluate its association with: i) all-cause mortality; ii) a composite endpoint of death, stroke/systemic embolism, hemorrhages, acute coronary syndrome, pulmonary embolism, new/worsening heart failure. METHODS In a cohort study, cognitive status was assessed at baseline by the Mini Mental State examination adjusted for age and education (aMMSE). aMMSE <24 was considered indicative of cognitive impairment. RESULTS The cohort included 437 patients (61.3% male, mean age 73.4 ± 11.7 years). Sixty-three patients (14.4%) had cognitive impairment at baseline aMMSE. Permanent AF (odds ratio [OR] 1.750; 95%CI 1.012-3.025; p = .045), haemoglobin levels (OR 0.827; 95%CI 0.707-0.967; p = .017) and previous treatment with antiplatelet drugs only, without oral anticoagulation, (OR 4.352; 95%CI 1.583-11.963; p = .004) were independently associated with cognitive impairment at baseline. After a median follow-up of 887 days (interquartile range 731-958) 30 patients died (7.1%), and 97 (22.9%) reached the composite endpoint. After adjustment for Elixhauser Comorbidy Measure, aMMSE <24 was significantly associated with all-cause mortality (hazard ratio [HR] 2.473, 95%CI 1.062-5.756, p = .036) and with the composite endpoint (HR 1.852, 95%CI 1.106-3.102, p = .019). CONCLUSIONS In patients with AF, cognitive impairment (aMMSE <24) is associated with worse outcomes, and the association of adverse outcomes with previous treatment with antiplatelet drugs only, without oral anticoagulation, highlights the potential role of appropriate antithrombotic treatment for improving patient prognosis.
Collapse
|
22
|
Levine DA, Galecki A, Kabeto M, Nallamothu BK, Zahuranec DB, Morgenstern LB, Lisabeth LD, Giordani B, Langa KM. Mild cognitive impairment and receipt of procedures for acute ischemic stroke in older adults. J Stroke Cerebrovasc Dis 2020; 29:105083. [PMID: 32912555 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 06/21/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND AND PURPOSE Older patients with pre-existing mild cognitive impairment (MCI) receive less evidence-based care after acute myocardial infarction, however, whether they receive less care after acute ischemic stroke (AIS) is unknown. We compared receipt of guideline-concordant procedures after AIS between older adults with pre-existing MCI and normal cognition. METHODS Prospective study of 591 adults ≥65 hospitalized for AIS between 2000 and 2014, and followed through 2015 using data from the nationally representative Health and Retirement Study, Medicare and American Hospital Association. We assessed pre-existing MCI (modified Telephone Interview for Cognitive Status score of 7-11) and normal cognition (score of 12-27). Primary outcome was a composite quality measure representing the number of 4 procedures (carotid imaging, cardiac monitoring, echocardiogram, and rehabilitation assessment) received within 30 days after AIS (ordinal scale with values of 0, 1, 2, 3-4). RESULTS Among survivors of AIS, 26.9% had pre-existing MCI (62.9% were women, with a mean [SD] age of 82.4 [7.7] years), and 73.1% had normal cognition (51.4% were women, with a mean age of 78.4 [7.2] years). Patients with pre-existing MCI, compared to cognitively normal patients, had 39% lower cumulative odds of receiving the composite quality measure (unadjusted cumulative odds ratio, OR, 0.61 [95% CI, 0.43-0.87]; P=0.006). However, this association became non-significant after adjusting for patient and hospital factors (adjusted cumulative OR, 0.83 [95% CI, 0.56-1.24]; P=0.37). Lower cumulative odds of receiving the composite quality measure were associated with older patient age (adjusted cumulative OR per 1-year older age, 0.97 [95% CI, 0.95-0.99]; P=0.01) and Southern hospitals (adjusted cumulative OR for South vs North, 0.54 [95% CI, 0.31-0.94]; P=0.03). CONCLUSIONS Differences in receipt of guideline-concordant procedures after AIS exist between patients with pre-existing MCI and normal cognition. These differences were largely explained by patient and regional factors associated with receiving less AIS care.
Collapse
Affiliation(s)
- Deborah A Levine
- Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan, NCRC 16-430W, 2800 Plymouth Road, Ann Arbor, MI 48109-2800, United States; Department of Neurology and Stroke Program, University of Michigan, Ann Arbor, MI, United States; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, United States.
| | - Andrzej Galecki
- Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan, NCRC 16-430W, 2800 Plymouth Road, Ann Arbor, MI 48109-2800, United States; Department of Biostatistics, University of Michigan, Ann Arbor, MI, United States.
| | - Mohammed Kabeto
- Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan, NCRC 16-430W, 2800 Plymouth Road, Ann Arbor, MI 48109-2800, United States.
| | - Brahmajee K Nallamothu
- Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan, NCRC 16-430W, 2800 Plymouth Road, Ann Arbor, MI 48109-2800, United States; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, United States; VA Ann Arbor Healthcare System, University of Michigan, Ann Arbor, MI, United States.
| | - Darin B Zahuranec
- Department of Neurology and Stroke Program, University of Michigan, Ann Arbor, MI, United States.
| | - Lewis B Morgenstern
- Department of Neurology and Stroke Program, University of Michigan, Ann Arbor, MI, United States; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, United States; Department of Epidemiology, University of Michigan, Ann Arbor, MI, United States.
| | - Lynda D Lisabeth
- Department of Neurology and Stroke Program, University of Michigan, Ann Arbor, MI, United States; Department of Epidemiology, University of Michigan, Ann Arbor, MI, United States.
| | - Bruno Giordani
- Department of Psychiatry and Michigan Alzheimer's Disease Center, University of Michigan, Ann Arbor, MI, United States.
| | - Kenneth M Langa
- Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan, NCRC 16-430W, 2800 Plymouth Road, Ann Arbor, MI 48109-2800, United States; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, United States; VA Ann Arbor Healthcare System, University of Michigan, Ann Arbor, MI, United States; Institute for Social Research, University of Michigan, Ann Arbor, MI, United States.
| |
Collapse
|
23
|
Viticchi G, Falsetti L, Burattini M, Zaccone V, Buratti L, Bartolini M, Moroncini G, Silvestrini M. Atrial Fibrillation on Patients with Vascular Dementia: A Fundamental Target for Correct Management. Brain Sci 2020; 10:brainsci10070420. [PMID: 32630627 PMCID: PMC7407398 DOI: 10.3390/brainsci10070420] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 06/26/2020] [Accepted: 06/28/2020] [Indexed: 12/19/2022] Open
Abstract
Background: Atrial fibrillation (AF) is a risk factor for cerebrovascular diseases and vascular dementia (VAD). The aim of this study was to evaluate the effect of the adherence to anticoagulant therapy guidelines in patients with dementia and AF on the risk of stroke/TIA or major bleeding (MB). Methods: In a cohort of 1705 hospitalized patients with pre-existent AF, we observed 193 patients with vascular dementia (VAD). Non-demented AF patients were included as controls. For each subject, we calculated CHA2DS2-VASc, CHADS2, and HAS-BLED scores, and collected information regarding anticoagulant therapy, in-hospital therapeutic failure (TF) occurrence, stroke/TIA, and MB. Results: According to CHA2DS2-VASc and CHADS2 scores, 99.5% of VAD patients had the indication to anticoagulant treatment, but only 69.9% were correctly treated. During hospitalization, MB occurred in 4.66% of VAD and 8.9% of non-demented patients (p = 0.048). In-hospital stroke/TIA were observed in 24.3% of VAD and 0.8% of non-demented patients (p = 0.0001). A similar proportion of TF among patients with VAD and with normal cognition (12.9% vs. 11.2%) was observed. Conclusion: In our cohort, we observed that VAD patients with pre-existent AF were undertreated despite a higher risk of stroke/TIA with respect to non-demented patients.
Collapse
Affiliation(s)
- Giovanna Viticchi
- Neurological Clinic, Marche Polytechnic University, 60020 Ancona, Italy; (M.B.); (L.B.); (M.B.); (M.S.)
- Correspondence: ; Tel.: +39-071-596-4463; Fax: +39-071-887-262
| | - Lorenzo Falsetti
- Internal and Subintensive Medicine, Ospedali Riuniti Ancona, 60020 Ancona, Italy; (L.F.); (V.Z.)
| | - Marco Burattini
- Neurological Clinic, Marche Polytechnic University, 60020 Ancona, Italy; (M.B.); (L.B.); (M.B.); (M.S.)
| | - Vincenzo Zaccone
- Internal and Subintensive Medicine, Ospedali Riuniti Ancona, 60020 Ancona, Italy; (L.F.); (V.Z.)
| | - Laura Buratti
- Neurological Clinic, Marche Polytechnic University, 60020 Ancona, Italy; (M.B.); (L.B.); (M.B.); (M.S.)
| | - Marco Bartolini
- Neurological Clinic, Marche Polytechnic University, 60020 Ancona, Italy; (M.B.); (L.B.); (M.B.); (M.S.)
| | - Gianluca Moroncini
- Department of Clinical and Molecular Sciences, Marche Polytechnic University, 60020 Ancona, Italy;
| | - Mauro Silvestrini
- Neurological Clinic, Marche Polytechnic University, 60020 Ancona, Italy; (M.B.); (L.B.); (M.B.); (M.S.)
| |
Collapse
|
24
|
Callisaya ML, Purvis T, Lawler K, Brodtmann A, Cadilhac DA, Kilkenny MF. Dementia is Associated With Poorer Quality of Care and Outcomes After Stroke: An Observational Study. J Gerontol A Biol Sci Med Sci 2020; 76:851-858. [DOI: 10.1093/gerona/glaa139] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
To determine whether preexisting dementia is associated with poorer quality of care and outcomes after stroke in the acute hospital phase.
Method
This was a retrospective analysis of pooled data from the Australian Stroke Foundation national audit conducted in 2015 and 2017. Dementia status was obtained from the medical records. Processes of care to assess quality included: stroke unit care, time-dependent therapy, nursing/allied health assessments, and preparation for discharge. Outcomes included in-hospital complications, independence on discharge, and destination. Logistic regression was used to examine associations between dementia status and processes of care. Multilevel random effects logistic regression, with level defined as hospital, was used to examine associations between dementia status and outcomes.
Results
There were 683/7,070 (9.7%) audited patients with dementia included. Patients with dementia were less likely to be treated in stroke units (58.3% vs 70.6%), receive thrombolysis if an ischemic stroke (5.8% vs 11.1%), have access within 48 hours to physiotherapy (56.4% vs 69.7%) or occupational therapy (46.8% vs 55.6%), see a dietitian if problems with nutrition (64.4% vs 75.9%), or have mood assessed (2.6% vs 12.3%). Patients with dementia were more likely to receive no rehabilitation (adjusted odds ratio 1.88, 95% confidence interval 1.25, 2.83) and be discharged to residential care (adjusted odds ratio 2.36, 95% confidence interval 1.50, 3.72).
Conclusion
People with dementia received poorer quality of care and had worse outcomes after stroke. Our findings raise questions regarding equity and the need for better understanding of why the quality of care differs after stroke for people with dementia.
Collapse
Affiliation(s)
- Michele L Callisaya
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Tara Purvis
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Katherine Lawler
- Wicking Dementia Research and Education Centre, College of Health and Medicine, University of Tasmania, Hobart, Australia
| | - Amy Brodtmann
- Florey Institute of Neuroscience and Mental Health, Heidelberg, University of Melbourne, Victoria, Australia
| | - Dominique A Cadilhac
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- Florey Institute of Neuroscience and Mental Health, Heidelberg, University of Melbourne, Victoria, Australia
| | - Monique F Kilkenny
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- Florey Institute of Neuroscience and Mental Health, Heidelberg, University of Melbourne, Victoria, Australia
| |
Collapse
|
25
|
Waziry R, Chibnik LB, Bos D, Ikram MK, Hofman A. Risk of hemorrhagic and ischemic stroke in patients with Alzheimer disease: A synthesis of the literature. Neurology 2020; 94:265-272. [PMID: 31949087 PMCID: PMC7136067 DOI: 10.1212/wnl.0000000000008924] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 11/14/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To assess the risk of hemorrhagic and ischemic stroke in patients with Alzheimer disease (AD) compared with non-AD controls with similar risk profiles. METHODS A search was conducted on EMBASE and MEDLINE for reports published up to September 26, 2018. Studies were included if they (1) assessed the incidence of stroke in patients diagnosed with AD; (2) included patients with no history of stroke; and (3) reported outcomes by stroke subtype. The main outcome was relative risk of ischemic or hemorrhagic stroke. Furthermore, the rate of stroke occurrence per 1,000 person-years was assessed. A random-effects meta-analysis was undertaken. The risk of bias in included studies was assessed in terms of selection, comparability, and outcome. RESULTS A total of 3,605 studies were screened in the title and abstract phase after removing duplicates, and 88 eligible studies were screened for full text. Eight studies met the inclusion criteria representing 121,719 individuals (AD = 73,044; non-AD = 48,675). Five studies were included in the relative risk analysis, among which 4 studies applied formal matching criteria of 44,544 AD and 44,660 non-AD controls. The included studies were based on nationwide registries from Finland, Sweden, Taiwan (2), United Kingdom (2), 1 clinic-based study from the Netherlands, and 1 US population-based cohort. Among patients with AD, the incidence rate of hemorrhagic stroke was 3.41/1000 person-years (95% CI 2.70-4.32) and 2.23 (95% CI 1.72-2.88) among AD cases and non-AD controls, respectively. This is in contrast to 13.98 (95% CI 9.86-19.81) and 12.12 (95% CI 7.55-19.46) for ischemic stroke among AD cases and non-AD controls, respectively. Compared with non-AD controls with similar risk profiles, patients with AD had a relative risk of 1.42 (95% CI 1.23-1.64) for hemorrhagic stroke and 1.15 (95% CI 0.89-1.48) for ischemic stroke. CONCLUSION Compared with non-AD controls with similar risk profiles, patients with AD are likely at a higher risk of hemorrhagic but not ischemic stroke.
Collapse
Affiliation(s)
- Reem Waziry
- From the Department of Epidemiology (R.W., L.B.C., D.B., A.H.), Harvard T.H. Chan School of Public Health, Boston, MA; Department of Epidemiology (R.W., D.B., M.K.I., A.H.), Department of Radiology and Nuclear Medicine (D.B.), and Department of Neurology (M.K.I.), Erasmus Medical Center, Rotterdam, The Netherlands.
| | - Lori B Chibnik
- From the Department of Epidemiology (R.W., L.B.C., D.B., A.H.), Harvard T.H. Chan School of Public Health, Boston, MA; Department of Epidemiology (R.W., D.B., M.K.I., A.H.), Department of Radiology and Nuclear Medicine (D.B.), and Department of Neurology (M.K.I.), Erasmus Medical Center, Rotterdam, The Netherlands
| | - Daniel Bos
- From the Department of Epidemiology (R.W., L.B.C., D.B., A.H.), Harvard T.H. Chan School of Public Health, Boston, MA; Department of Epidemiology (R.W., D.B., M.K.I., A.H.), Department of Radiology and Nuclear Medicine (D.B.), and Department of Neurology (M.K.I.), Erasmus Medical Center, Rotterdam, The Netherlands
| | - M Kamran Ikram
- From the Department of Epidemiology (R.W., L.B.C., D.B., A.H.), Harvard T.H. Chan School of Public Health, Boston, MA; Department of Epidemiology (R.W., D.B., M.K.I., A.H.), Department of Radiology and Nuclear Medicine (D.B.), and Department of Neurology (M.K.I.), Erasmus Medical Center, Rotterdam, The Netherlands
| | - Albert Hofman
- From the Department of Epidemiology (R.W., L.B.C., D.B., A.H.), Harvard T.H. Chan School of Public Health, Boston, MA; Department of Epidemiology (R.W., D.B., M.K.I., A.H.), Department of Radiology and Nuclear Medicine (D.B.), and Department of Neurology (M.K.I.), Erasmus Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
26
|
Evaluation of Respiratory Muscular Strength Compared to Predicted Values in Patients with Stroke. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17031091. [PMID: 32050421 PMCID: PMC7036931 DOI: 10.3390/ijerph17031091] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 02/06/2020] [Accepted: 02/07/2020] [Indexed: 12/16/2022]
Abstract
The purpose of this study was to evaluate the inspiratory and expiratory muscle strength of individuals affected by stroke and to compare it with the predicted values in the literature considering their corresponding age. Respiratory muscle strength was evaluated in 22 elderly people who had sequels of stroke, four with right hemiparesis, 16 with left hemiparesis and two with bilateral, of ages ranging from 34 to 82 years. The collected data were submitted to statistical analysis using a Mann–Whitney test to evaluate if there was a significant difference in the average data collected when compared with a mean of the predicted data in the literature. Fourteen men and eight women were evaluated, who obtained mean values of 71.85 cmH2O and 57.75 cmH2O, respectively, for a maximal inspiratory pressure (MIP), and when compared to the predicted values for men and women, 105.41 cmH2O (p-value 0.0019) and 80.57 cmH2O (p-value 0.00464) were significantly lower. For a maximal expiratory pressure (MEP), the mean value obtained for men was 62.28 cmH2O and 49.5 cmH2O for women, whereas the predicted values in the literature were 114.79 cmH2O (p-value < 0.0001) and 78, 46 cmH2O (p-value 0.0059), respectively. In the statistical analysis, it was possible to notice that the studied population did not reach the predicted age indexes and that there was a significant difference between the median columns. In conclusion, there is a weakness in the respiratory muscles of hemiparetic men and women due to stroke.
Collapse
|
27
|
Cermakova P. Changing utilization of cardiovascular drugs during the course of Alzheimer's disease. Int J Cardiol 2020; 300:226-227. [DOI: 10.1016/j.ijcard.2019.11.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 11/13/2019] [Accepted: 11/25/2019] [Indexed: 11/28/2022]
|
28
|
Rau CS, Wu SC, Hsu SY, Liu HT, Huang CY, Hsieh TM, Chou SE, Su WT, Liu YW, Hsieh CH. Concurrent Types of Intracranial Hemorrhage are Associated with a Higher Mortality Rate in Adult Patients with Traumatic Subarachnoid Hemorrhage: A Cross-Sectional Retrospective Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16234787. [PMID: 31795322 PMCID: PMC6926691 DOI: 10.3390/ijerph16234787] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 11/25/2019] [Accepted: 11/26/2019] [Indexed: 11/30/2022]
Abstract
Traumatic subarachnoid hemorrhage (SAH) is the second most frequent intracranial hemorrhage and a common radiologic finding in computed tomography. This study aimed to estimate the risk of mortality in adult trauma patients with traumatic SAH concurrent with other types of intracranial hemorrhage, such as subdural hematoma (SDH), epidural hematoma (EDH), and intracerebral hemorrhage (ICH), compared to the risk in patients with isolated traumatic SAH. We searched our hospital’s trauma database from 1 January, 2009 to 31 December, 2018 to identify hospitalized adult patients ≥20 years old who presented with a trauma abbreviated injury scale (AIS) of ≥3 in the head region. Polytrauma patients with an AIS of ≥3 in any other region of the body were excluded. A total of 1856 patients who had SAH were allocated into four exclusive groups: (Group I) isolated traumatic SAH, n = 788; (Group II) SAH and one diagnosis, n = 509; (Group III) SAH and two diagnoses, n = 493; and (Group IV) SAH and three diagnoses, n = 66. One, two, and three diagnoses indicated occurrences of one, two, or three other types of intracranial hemorrhage (SDH, EDH, or ICH). The adjusted odds ratio with a 95% confidence interval (CI) of the level of mortality was calculated with logistic regression, controlling for sex, age, and pre-existing comorbidities. Patients with isolated traumatic SAH had a lower rate of mortality (1.8%) compared to the other three groups (Group II: 7.9%, Group III: 12.4%, and Group IV: 27.3%, all p < 0.001). When controlling for sex, age, and pre-existing comorbidities, we found that Group II, Group III, and Group IV patients had a 4.0 (95% CI 2.4–6.5), 8.9 (95% CI 4.8–16.5), and 21.1 (95% CI 9.4–47.7) times higher adjusted odds ratio for mortality, respectively, than the patients with isolated traumatic SAH. In this study, we demonstrated that compared to patients with isolated traumatic SAH, traumatic SAH patients with concurrent types of intracranial hemorrhage have a higher adjusted odds ratio for mortality.
Collapse
Affiliation(s)
- Cheng-Shyuan Rau
- Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University and College of Medicine, Kaohsiung 83301, Taiwan;
| | - Shao-Chun Wu
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University and College of Medicine, Kaohsiung 83301, Taiwan;
| | - Shiun-Yuan Hsu
- Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University and College of Medicine, Kaohsiung 83301, Taiwan; (S.-Y.H.); (H.-T.L.); (C.-Y.H.); (T.-M.H.); (S.-E.C.); (W.-T.S.)
| | - Hang-Tsung Liu
- Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University and College of Medicine, Kaohsiung 83301, Taiwan; (S.-Y.H.); (H.-T.L.); (C.-Y.H.); (T.-M.H.); (S.-E.C.); (W.-T.S.)
| | - Chun-Ying Huang
- Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University and College of Medicine, Kaohsiung 83301, Taiwan; (S.-Y.H.); (H.-T.L.); (C.-Y.H.); (T.-M.H.); (S.-E.C.); (W.-T.S.)
| | - Ting-Min Hsieh
- Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University and College of Medicine, Kaohsiung 83301, Taiwan; (S.-Y.H.); (H.-T.L.); (C.-Y.H.); (T.-M.H.); (S.-E.C.); (W.-T.S.)
| | - Sheng-En Chou
- Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University and College of Medicine, Kaohsiung 83301, Taiwan; (S.-Y.H.); (H.-T.L.); (C.-Y.H.); (T.-M.H.); (S.-E.C.); (W.-T.S.)
| | - Wei-Ti Su
- Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University and College of Medicine, Kaohsiung 83301, Taiwan; (S.-Y.H.); (H.-T.L.); (C.-Y.H.); (T.-M.H.); (S.-E.C.); (W.-T.S.)
| | - Yueh-Wei Liu
- Department of General Gurgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University and College of Medicine, Kaohsiung 83301, Taiwan
- Correspondence: (Y.-W.L.); (C.-H.H.); Tel.: +886-7-345-4746 (C.-H.H.)
| | - Ching-Hua Hsieh
- Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University and College of Medicine, Kaohsiung 83301, Taiwan
- Correspondence: (Y.-W.L.); (C.-H.H.); Tel.: +886-7-345-4746 (C.-H.H.)
| |
Collapse
|
29
|
Voellger B, Rupa R, Arndt C, Carl B, Nimsky C. Outcome after Interdisciplinary Treatment for Aneurysmal Subarachnoid Hemorrhage-A Single Center Experience. MEDICINA-LITHUANIA 2019; 55:medicina55110724. [PMID: 31683909 PMCID: PMC6915558 DOI: 10.3390/medicina55110724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 10/22/2019] [Accepted: 10/28/2019] [Indexed: 11/21/2022]
Abstract
Background and Objectives: To identify predictors of outcome after aneurysmal subarachnoid hemorrhage (aSAH) in our interdisciplinary setting. Materials and Methods: 176 patients who had been treated for aSAH by a team of neurosurgeons and neuroradiologists between 2009 and 2017 were analyzed retrospectively. Age, gender, clinical presentation according to the Hunt and Hess (H&H) grading on admission, overall clot burden, aneurysm localization, modality of aneurysm obliteration, early deterioration (ED), occurrence of vasospasm in transcranial Doppler ultrasonography, delayed cerebral ischemia (DCI), spasmolysis, decompressive craniectomy (DC), cerebrospinal fluid (CSF) shunt placement, deep vein thrombosis (DVT), pulmonary embolism (PE), severe cardiac events (SCE), mortality on Days 14, and 30 after admission, and outcome at one year after the hemorrhage according to the Glasgow Outcome Scale (GOS) were recorded. Chi square, Fisher’s exact, Welch’s t, and Wilcoxon rank sum served as statistical tests. Generalized linear models were fitted, and ordered logistic regression was performed. Results: SCE (p = 0.049) were a significant predictor of mortality at 14 days after aSAH, but not later during the first year after the hemorrhage. Clipping as opposed to coiling (p = 0.049) of ruptured aneurysms was a significant predictor of survival on Day 30 after aSAH, but not later during the first year after the hemorrhage, while coiling as opposed to clipping of ruptured aneurysms was significantly related to a lower frequency of DVT during hospitalization (p = 0.024). Aneurysms of the anterior circulation were significantly more often clipped, while aneurysms of the posterior circulation were significantly more often coiled (p < 0.001). Age over 70 years (p = 0.049), H&H grade on admission (p = 0.022), overall clot burden (p = 0.035), ED (p = 0.009), DCI (p = 0.013), DC (p = 0.0005), and CSF shunt placement (p = 0.038) proved to be predictive of long-term outcome after aSAH. Conclusion: Long-term results after clipping and coiling of ruptured aneurysms appear equal in an interdisciplinary setting that takes aneurysm localization, available staff, and equipment into account.
Collapse
Affiliation(s)
- Benjamin Voellger
- Department of Neurosurgery, University Hospital Marburg, 35033 Marburg, Germany.
| | - Rosita Rupa
- Department of Neurosurgery, University Hospital Marburg, 35033 Marburg, Germany.
| | - Christian Arndt
- Department of Anaesthesiology, University Hospital Marburg, 35033 Marburg, Germany.
| | - Barbara Carl
- Department of Neurosurgery, University Hospital Marburg, 35033 Marburg, Germany.
| | - Christopher Nimsky
- Department of Neurosurgery, University Hospital Marburg, 35033 Marburg, Germany.
| |
Collapse
|
30
|
Subic A, Zupanic E, von Euler M, Norrving B, Cermakova P, Religa D, Winblad B, Kramberger MG, Eriksdotter M, Garcia-Ptacek S. Stroke as a Cause of Death in Death Certificates of Patients with Dementia: A Cohort Study from the Swedish Dementia Registry. Curr Alzheimer Res 2019; 15:1322-1330. [PMID: 30280666 PMCID: PMC6635398 DOI: 10.2174/1567205015666181002134155] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 09/09/2018] [Accepted: 09/26/2018] [Indexed: 12/17/2022]
Abstract
Introduction: Patients with dementia may be at a higher risk for death from stroke. We aimed to describe characteristics of dementia patients that died from ischemic stroke (IS) in Sweden. Methods: A retrospective longitudinal analysis of prospectively collected data of patients registered into the Swedish Dementia Registry was conducted. Data on causes of death, drugs and comorbidities were acquired from the Swedish nationwide health registers. Deaths were attributed to stroke if the death certificate contained stroke as a cause of death and the patient had a stroke registered in Riksstroke, the Swedish Stroke Register, in the year preceding death. Demographic data at the time of dementia diagnosis was compared between patients dying from IS and registered in Riksstroke, patients dying from IS without being registered in Riksstroke and those dying from other causes. Results: Out of 49823 patients diagnosed with dementia between 2007 and 2014 in primary care or specialist clinics, 14170 (28.4%) had died by the end of 2014. Of these 1180 (8.3%) had IS in their death certificate, of which 459 (38.9%) had been registered in Riksstroke. In patients who died of IS the most common type of dementia was vascular dementia while those died from other causes were most often diagnosed with Alzheimer’s dementia (AD). Patients who died from IS and were registered in Riksstroke had higher MMSE score compared to other groups. Patients who died from IS took more cardiovascular medications. There were no differences in the use of antipsychotics, antidepressants, acetylcholinesterase inhibitors, memantine, anxiolytics, or hypnotics between the groups. Conclusions: There was a relatively high number of patients who died from IS as shown in their death certificate but had not been registered in Riksstroke in the year before death. This creates concerns on the accuracy of death certificate stroke diagnoses, particularly for deaths taking place outside hospitals.
Collapse
Affiliation(s)
- Ana Subic
- Department of Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, Karolinska Institutet, Stockholm, Sweden.,Department of Neurology, University Medical Center, Ljubljana, Slovenia.,Medical faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Eva Zupanic
- Department of Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, Karolinska Institutet, Stockholm, Sweden.,Department of Neurology, University Medical Center, Ljubljana, Slovenia.,Medical faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Mia von Euler
- Departments of Medicine Solna and Clinical Research and Education, Karolinska Institutet, Södersjukhuset.,Department and Clinical Pharmacology, Karolinska University Hospital, Stockholm, Sweden
| | - Bo Norrving
- Department of Clinical Sciences, Lund University, Lund ,Sweden.,Department of Neurology Lund, Skåne University Hospital, Lund, Sweden
| | - Pavla Cermakova
- Department of Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, Karolinska Institutet, Stockholm, Sweden.,National Institute of Mental Health, Klecany, Czech Republic
| | - Dorota Religa
- Department of Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, Karolinska Institutet, Stockholm, Sweden.,Department of Geriatric Medicine, Huddinge, Karolinska University Hospital, Stockholm, Sweden.,Mossakowski Medical Research Center, Polish Academy of Sciences, Warsaw, Poland
| | - Bengt Winblad
- Department of Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, Karolinska Institutet, Stockholm, Sweden.,Department of Geriatric Medicine, Huddinge, Karolinska University Hospital, Stockholm, Sweden
| | - Milica G Kramberger
- Department of Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, Karolinska Institutet, Stockholm, Sweden.,Department of Neurology, University Medical Center, Ljubljana, Slovenia.,Medical faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Maria Eriksdotter
- Department of Geriatric Medicine, Huddinge, Karolinska University Hospital, Stockholm, Sweden.,Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden
| | - Sara Garcia-Ptacek
- Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden.,Department of Internal Medicine, Neurology Section, Södersjukhuset, Stockholm, Sweden
| |
Collapse
|
31
|
Ilomäki J, Fanning L, Keen C, Sluggett JK, Page AT, Korhonen MJ, Meretoja A, Mc Namara KP, Bell JS. Trends and Predictors of Oral Anticoagulant Use in People with Alzheimer’s Disease and the General Population in Australia. J Alzheimers Dis 2019; 70:733-745. [DOI: 10.3233/jad-190094] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Jenni Ilomäki
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Laura Fanning
- Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Claire Keen
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
| | - Janet K. Sluggett
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, Australia
| | - Amy T. Page
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
- Pharmacy Department, Alfred Health, Melbourne, Australia
| | - Maarit J. Korhonen
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
- Institute of Biomedicine, University of Turku, Turku, Finland
| | - Atte Meretoja
- Neurocenter, Helsinki University Hospital, Helsinki, Finland
- Department of Medicine at the Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia
| | - Kevin P. Mc Namara
- Deakin Rural Health, School of Medicine and Centre for Population Health, Deakin University, Melbourne, Australia
| | - J. Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, Australia
| |
Collapse
|
32
|
Kozyolkin O, Kuznietsov A, Novikova L. Prediction of the Lethal Outcome of Acute Recurrent Cerebral Ischemic Hemispheric Stroke. MEDICINA-LITHUANIA 2019; 55:medicina55060311. [PMID: 31242700 PMCID: PMC6631068 DOI: 10.3390/medicina55060311] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 06/17/2019] [Accepted: 06/20/2019] [Indexed: 01/04/2023]
Abstract
Background and objectives. Stroke-induced mortality is the third most common cause of death in developed countries. Intense interest has focused on the recurrent ischemic stroke, which rate makes up 30% during first 5 years after first-ever stroke. This work aims to develop criteria for the prediction of acute recurrent cerebral ischemic hemispheric stroke (RCIHS) outcome on the basis of comprehensive baseline clinical, laboratory, and neuroimaging examinations. Materials and Methods. One hundred thirty-six patients (71 males and 65 females, median age 74 (65; 78)) with acute RCIHS were enrolled in the study. All patients underwent a detailed clinical and neurological examination using National Institutes of Health Stroke Scale (NIHSS), computed tomography of the brain, hematological, and biochemical investigations. In order to detect the dependent and independent risk factors of the lethal outcome of the acute period of RCIHS, univariable and multivariable regression analysis were conducted. A receiver operating characteristic (ROC) analysis with the calculation of sensitivity and specificity was performed to determine the prediction variables. Results. Twenty-five patients died. The independent predictors of the lethal outcome of acute RCIHS were: Baseline NIHSS score (OR 95% CІ 1.33 (1.08-1.64), p = 0.0003), septum pellucidum displacement (OR 95% CI 1.53 (1.17-2.00), p = 0.0021), glucose serum level (OR 95% CI 1.28 (1.09-1.50), p = 0.0022), neutrophil-to-lymphocyte ratio (OR 95% CI 1.11 (1.00-1.21), p = 0.0303). The mathematical model, which included these variables was developed and it could determine the prognosis of lethal outcome of the acute RCIHS with an accuracy of 86.8% (AUC = 0.88 ± 0.04 (0.88-0.93), p < 0.0001).
Collapse
Affiliation(s)
- Olexandr Kozyolkin
- Department of Nervous Disease Zaporizhzhia State Medical University, 69035 Zaporizhzhia, Ukraine.
| | - Anton Kuznietsov
- Department of Nervous Disease Zaporizhzhia State Medical University, 69035 Zaporizhzhia, Ukraine.
| | - Liubov Novikova
- Department of Nervous Disease Zaporizhzhia State Medical University, 69035 Zaporizhzhia, Ukraine.
| |
Collapse
|
33
|
Subic A, Cermakova P, Religa D, Han S, von Euler M, Kåreholt I, Johnell K, Fastbom J, Bognandi L, Winblad B, Kramberger MG, Eriksdotter M, Garcia-Ptacek S. Treatment of Atrial Fibrillation in Patients with Dementia: A Cohort Study from the Swedish Dementia Registry. J Alzheimers Dis 2019; 61:1119-1128. [PMID: 29286925 PMCID: PMC5798527 DOI: 10.3233/jad-170575] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Background: Patients with dementia might have higher risk for hemorrhagic complications with anticoagulant therapy prescribed for atrial fibrillation (AF). Objective: This study assesses the risks and benefits of warfarin, antiplatelets, and no treatment in patients with dementia and AF. Methods: Of 49,792 patients registered in the Swedish Dementia Registry 2007–2014, 8,096 (16%) had a previous diagnosis of AF. Cox proportional hazards models were used to calculate the risk for ischemic stroke (IS), nontraumatic intracranial hemorrhage, any-cause hemorrhage, and death. Results: Out of the 8,096 dementia patients with AF, 2,143 (26%) received warfarin treatment, 2,975 (37%) antiplatelet treatment, and 2,978 (37%) had no antithrombotic treatment at the time of dementia diagnosis. Patients on warfarin had fewer IS than those without treatment (5.2% versus 8.7%; p < 0.001) with no differences compared to antiplatelets. In adjusted analyses, warfarin was associated with a lower risk for IS (HR 0.76, CI 0.59–0.98), while antiplatelets were associated with increased risk (HR 1.25, CI 1.01–1.54) compared to no treatment. For any-cause hemorrhage, there was a higher risk with warfarin (HR 1.28, CI 1.03–1.59) compared to antiplatelets. Warfarin and antiplatelets were associated with a lower risk for death compared to no treatment. Conclusions: Warfarin treatment in Swedish patients with dementia is associated with lower risk of IS and mortality, and a small increase in any-cause hemorrhage. This study supports the use of warfarin in appropriate cases in patients with dementia. The low percentage of patients on warfarin treatment indicates that further gains in stroke prevention are possible.
Collapse
Affiliation(s)
- Ana Subic
- Department of Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, Karolinska Institutet, Stockholm, Sweden.,Department of Neurology, University Medical Center, Ljubljana, Slovenia.,Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Pavla Cermakova
- Department of Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, Karolinska Institutet, Stockholm, Sweden.,National Institute of Mental Health, Klecany, Czech Republic
| | - Dorota Religa
- Department of Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, Karolinska Institutet, Stockholm, Sweden.,Department of Geriatric Medicine, Karolinska University Hospital, Stockholm, Sweden.,Polish Academy of Sciences, Mossakowski Medical Research Center, Warsaw, Poland
| | - Shuang Han
- Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden.,Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Mia von Euler
- Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden.,Department of Clinical Pharmacology, Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine-Solna, Karolinska Institutet, Stockholm, Sweden
| | - Ingemar Kåreholt
- Institute of Gerontology, School of Health and Welfare, Aging Research Network (ARN-J), Jönköping University, Jönköping, Sweden.,Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Kristina Johnell
- Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Johan Fastbom
- Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Liselia Bognandi
- Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden
| | - Bengt Winblad
- Department of Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, Karolinska Institutet, Stockholm, Sweden.,Department of Geriatric Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Milica G Kramberger
- Department of Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, Karolinska Institutet, Stockholm, Sweden.,Department of Neurology, University Medical Center, Ljubljana, Slovenia.,Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Maria Eriksdotter
- Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden.,Department of Geriatric Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Sara Garcia-Ptacek
- Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden.,Department of Geriatric Medicine, Karolinska University Hospital, Stockholm, Sweden.,Department of Internal Medicine, Neurology Section, Södersjukhuset, Stockholm, Sweden
| |
Collapse
|
34
|
Management of acute ischaemic stroke in patients with dementia. J Intern Med 2018; 283:332. [PMID: 29460454 DOI: 10.1111/joim.12733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
35
|
Prestroke Mobility and Dementia as Predictors of Stroke Outcomes in Patients Over 65 Years of Age: A Cohort Study From The Swedish Dementia and Stroke Registries. J Am Med Dir Assoc 2018; 19:154-161. [DOI: 10.1016/j.jamda.2017.08.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 08/19/2017] [Accepted: 08/21/2017] [Indexed: 11/30/2022]
|
36
|
Zupanic E, Kåreholt I, Norrving B, Secnik J, von Euler M, Winblad B, Religa D, Kramberger MG, Johnell K, Eriksdotter M, Garcia-Ptacek S. Acute Stroke Care in Dementia: A Cohort Study from the Swedish Dementia and Stroke Registries. J Alzheimers Dis 2018; 66:185-194. [PMID: 30248059 PMCID: PMC6294591 DOI: 10.3233/jad-180653] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Previous studies have shown that patients with dementia receive less testing and treatment for stroke. OBJECTIVES Our aim was to investigate hospital management of acute ischemic stroke in patients with and without dementia. METHODS Retrospective analysis of prospectively collected data 2010-2014 from the Swedish national dementia registry (SveDem) and the Swedish national stroke registry (Riksstroke). Patients with dementia who suffered an acute ischemic stroke (AIS) (n = 1,356) were compared with matched non-dementia AIS patients (n = 6,755). Outcomes included length of stay in a stroke unit, total length of hospitalization, and utilization of diagnostic tests and assessments. RESULTS The median age at stroke onset was 83 years. While patients with dementia were equally likely to be directly admitted to a stroke unit as their non-dementia counterparts, their stroke unit and total hospitalization length were shorter (10.5 versus 11.2 days and 11.6 versus 13.5, respectively, p < 0.001). Dementia patients were less likely to receive carotid ultrasound (OR 0.36, 95% CI [0.30-0.42]) or undergo assessments by the interdisciplinary team members (physiotherapists, speech therapists, occupational therapists; p < 0.05 for all adjusted models). However, a similar proportion of patients received CT imaging (97.4% versus 98.6%, p = 0.001) and a swallowing assessment (90.7% versus 91.8%, p = 0.218). CONCLUSIONS Patients with dementia who suffer an ischemic stroke have equal access to direct stroke unit care compared to non-dementia patients; however, on average, their stay in a stroke unit and total hospitalization are shorter. Dementia patients are also less likely to receive specific diagnostic tests and assessments by the interdisciplinary stroke team.
Collapse
Affiliation(s)
- Eva Zupanic
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, Huddinge, Sweden
- Department of Neurology, University Medical Centre, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Ingemar Kåreholt
- Jönköping University, Institute of Gerontology, School of Health and Welfare, Aging Research network - Jönköping (ARN-J), Jönköping, Sweden
- Aging Research Center (ARC), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Bo Norrving
- Department of Clinical Sciences Lund, Neurology, Lund University, Skane University Hospital, Lund, Sweden
| | - Juraj Secnik
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, Huddinge, Sweden
| | - Mia von Euler
- Department of Clinical Science and Education, Södersjukhuset and Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Pharmacology, Karolinska University Hospital, Stockholm, Sweden
| | - Bengt Winblad
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, Huddinge, Sweden
- Theme Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Dorota Religa
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, Huddinge, Sweden
- Theme Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Milica Gregoric Kramberger
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, Huddinge, Sweden
- Department of Neurology, University Medical Centre, Ljubljana, Slovenia
| | - Kristina Johnell
- Aging Research Center (ARC), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Maria Eriksdotter
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer research, Karolinska Institutet, Huddinge, Sweden
- Theme Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Sara Garcia-Ptacek
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer research, Karolinska Institutet, Huddinge, Sweden
- Theme Aging, Karolinska University Hospital, Stockholm, Sweden
- Department of Internal Medicine, Section for Neurology, Södersjukhuset, Stockholm, Sweden
| |
Collapse
|
37
|
Zupanic E, von Euler M, Kåreholt I, Contreras Escamez B, Fastbom J, Norrving B, Religa D, Kramberger MG, Winblad B, Johnell K, Eriksdotter M, Garcia-Ptacek S. Thrombolysis in acute ischemic stroke in patients with dementia: A Swedish registry study. Neurology 2017; 89:1860-1868. [PMID: 28986410 PMCID: PMC5664294 DOI: 10.1212/wnl.0000000000004598] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 08/11/2017] [Indexed: 11/15/2022] Open
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.
Collapse
Affiliation(s)
- Eva Zupanic
- From the Karolinska Institutet (E.Z., D.R., B.W.), Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Neurogeriatrics, Huddinge, Sweden; Department of Neurology (E.Z., M.G.K.), University Medical Centre, Ljubljana, Slovenia; Karolinska Institutet (M.v.E.), Department of Clinical Science and Education, Södersjukhuset, and Department of Medicine, Solna; Karolinska University Hospital (M.v.E.), Department of Clinical Pharmacology; Karolinska Institutet and Stockholm University (I.K., J.F., K.J.), Aging Research Center, Stockholm, Sweden; Jönköping University (I.K.), Institute of Gerontology, School of Health and Welfare, Aging Research Network-Jönköping; Karolinska Institutet (B.C.E., M.E., S.G.-P.), Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Clinical Geriatrics, Huddinge, Sweden; Department of Geriatrics (B.C.E.), Hospital Universitario de Getafe, Madrid, Spain; Lund University (B.N.), Skane University Hospital, Department of Clinical Sciences Lund, Neurology; Karolinska University Hospital, Department of Geriatric Medicine (D.R., M.E., S.G.-P.); and Södersjukhuset (S.G.-P.), Department of Internal Medicine, Section for Neurology, Stockholm, Sweden
| | - Mia von Euler
- From the Karolinska Institutet (E.Z., D.R., B.W.), Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Neurogeriatrics, Huddinge, Sweden; Department of Neurology (E.Z., M.G.K.), University Medical Centre, Ljubljana, Slovenia; Karolinska Institutet (M.v.E.), Department of Clinical Science and Education, Södersjukhuset, and Department of Medicine, Solna; Karolinska University Hospital (M.v.E.), Department of Clinical Pharmacology; Karolinska Institutet and Stockholm University (I.K., J.F., K.J.), Aging Research Center, Stockholm, Sweden; Jönköping University (I.K.), Institute of Gerontology, School of Health and Welfare, Aging Research Network-Jönköping; Karolinska Institutet (B.C.E., M.E., S.G.-P.), Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Clinical Geriatrics, Huddinge, Sweden; Department of Geriatrics (B.C.E.), Hospital Universitario de Getafe, Madrid, Spain; Lund University (B.N.), Skane University Hospital, Department of Clinical Sciences Lund, Neurology; Karolinska University Hospital, Department of Geriatric Medicine (D.R., M.E., S.G.-P.); and Södersjukhuset (S.G.-P.), Department of Internal Medicine, Section for Neurology, Stockholm, Sweden
| | - Ingemar Kåreholt
- From the Karolinska Institutet (E.Z., D.R., B.W.), Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Neurogeriatrics, Huddinge, Sweden; Department of Neurology (E.Z., M.G.K.), University Medical Centre, Ljubljana, Slovenia; Karolinska Institutet (M.v.E.), Department of Clinical Science and Education, Södersjukhuset, and Department of Medicine, Solna; Karolinska University Hospital (M.v.E.), Department of Clinical Pharmacology; Karolinska Institutet and Stockholm University (I.K., J.F., K.J.), Aging Research Center, Stockholm, Sweden; Jönköping University (I.K.), Institute of Gerontology, School of Health and Welfare, Aging Research Network-Jönköping; Karolinska Institutet (B.C.E., M.E., S.G.-P.), Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Clinical Geriatrics, Huddinge, Sweden; Department of Geriatrics (B.C.E.), Hospital Universitario de Getafe, Madrid, Spain; Lund University (B.N.), Skane University Hospital, Department of Clinical Sciences Lund, Neurology; Karolinska University Hospital, Department of Geriatric Medicine (D.R., M.E., S.G.-P.); and Södersjukhuset (S.G.-P.), Department of Internal Medicine, Section for Neurology, Stockholm, Sweden
| | - Beatriz Contreras Escamez
- From the Karolinska Institutet (E.Z., D.R., B.W.), Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Neurogeriatrics, Huddinge, Sweden; Department of Neurology (E.Z., M.G.K.), University Medical Centre, Ljubljana, Slovenia; Karolinska Institutet (M.v.E.), Department of Clinical Science and Education, Södersjukhuset, and Department of Medicine, Solna; Karolinska University Hospital (M.v.E.), Department of Clinical Pharmacology; Karolinska Institutet and Stockholm University (I.K., J.F., K.J.), Aging Research Center, Stockholm, Sweden; Jönköping University (I.K.), Institute of Gerontology, School of Health and Welfare, Aging Research Network-Jönköping; Karolinska Institutet (B.C.E., M.E., S.G.-P.), Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Clinical Geriatrics, Huddinge, Sweden; Department of Geriatrics (B.C.E.), Hospital Universitario de Getafe, Madrid, Spain; Lund University (B.N.), Skane University Hospital, Department of Clinical Sciences Lund, Neurology; Karolinska University Hospital, Department of Geriatric Medicine (D.R., M.E., S.G.-P.); and Södersjukhuset (S.G.-P.), Department of Internal Medicine, Section for Neurology, Stockholm, Sweden
| | - Johan Fastbom
- From the Karolinska Institutet (E.Z., D.R., B.W.), Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Neurogeriatrics, Huddinge, Sweden; Department of Neurology (E.Z., M.G.K.), University Medical Centre, Ljubljana, Slovenia; Karolinska Institutet (M.v.E.), Department of Clinical Science and Education, Södersjukhuset, and Department of Medicine, Solna; Karolinska University Hospital (M.v.E.), Department of Clinical Pharmacology; Karolinska Institutet and Stockholm University (I.K., J.F., K.J.), Aging Research Center, Stockholm, Sweden; Jönköping University (I.K.), Institute of Gerontology, School of Health and Welfare, Aging Research Network-Jönköping; Karolinska Institutet (B.C.E., M.E., S.G.-P.), Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Clinical Geriatrics, Huddinge, Sweden; Department of Geriatrics (B.C.E.), Hospital Universitario de Getafe, Madrid, Spain; Lund University (B.N.), Skane University Hospital, Department of Clinical Sciences Lund, Neurology; Karolinska University Hospital, Department of Geriatric Medicine (D.R., M.E., S.G.-P.); and Södersjukhuset (S.G.-P.), Department of Internal Medicine, Section for Neurology, Stockholm, Sweden
| | - Bo Norrving
- From the Karolinska Institutet (E.Z., D.R., B.W.), Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Neurogeriatrics, Huddinge, Sweden; Department of Neurology (E.Z., M.G.K.), University Medical Centre, Ljubljana, Slovenia; Karolinska Institutet (M.v.E.), Department of Clinical Science and Education, Södersjukhuset, and Department of Medicine, Solna; Karolinska University Hospital (M.v.E.), Department of Clinical Pharmacology; Karolinska Institutet and Stockholm University (I.K., J.F., K.J.), Aging Research Center, Stockholm, Sweden; Jönköping University (I.K.), Institute of Gerontology, School of Health and Welfare, Aging Research Network-Jönköping; Karolinska Institutet (B.C.E., M.E., S.G.-P.), Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Clinical Geriatrics, Huddinge, Sweden; Department of Geriatrics (B.C.E.), Hospital Universitario de Getafe, Madrid, Spain; Lund University (B.N.), Skane University Hospital, Department of Clinical Sciences Lund, Neurology; Karolinska University Hospital, Department of Geriatric Medicine (D.R., M.E., S.G.-P.); and Södersjukhuset (S.G.-P.), Department of Internal Medicine, Section for Neurology, Stockholm, Sweden
| | - Dorota Religa
- From the Karolinska Institutet (E.Z., D.R., B.W.), Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Neurogeriatrics, Huddinge, Sweden; Department of Neurology (E.Z., M.G.K.), University Medical Centre, Ljubljana, Slovenia; Karolinska Institutet (M.v.E.), Department of Clinical Science and Education, Södersjukhuset, and Department of Medicine, Solna; Karolinska University Hospital (M.v.E.), Department of Clinical Pharmacology; Karolinska Institutet and Stockholm University (I.K., J.F., K.J.), Aging Research Center, Stockholm, Sweden; Jönköping University (I.K.), Institute of Gerontology, School of Health and Welfare, Aging Research Network-Jönköping; Karolinska Institutet (B.C.E., M.E., S.G.-P.), Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Clinical Geriatrics, Huddinge, Sweden; Department of Geriatrics (B.C.E.), Hospital Universitario de Getafe, Madrid, Spain; Lund University (B.N.), Skane University Hospital, Department of Clinical Sciences Lund, Neurology; Karolinska University Hospital, Department of Geriatric Medicine (D.R., M.E., S.G.-P.); and Södersjukhuset (S.G.-P.), Department of Internal Medicine, Section for Neurology, Stockholm, Sweden
| | - Milica G Kramberger
- From the Karolinska Institutet (E.Z., D.R., B.W.), Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Neurogeriatrics, Huddinge, Sweden; Department of Neurology (E.Z., M.G.K.), University Medical Centre, Ljubljana, Slovenia; Karolinska Institutet (M.v.E.), Department of Clinical Science and Education, Södersjukhuset, and Department of Medicine, Solna; Karolinska University Hospital (M.v.E.), Department of Clinical Pharmacology; Karolinska Institutet and Stockholm University (I.K., J.F., K.J.), Aging Research Center, Stockholm, Sweden; Jönköping University (I.K.), Institute of Gerontology, School of Health and Welfare, Aging Research Network-Jönköping; Karolinska Institutet (B.C.E., M.E., S.G.-P.), Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Clinical Geriatrics, Huddinge, Sweden; Department of Geriatrics (B.C.E.), Hospital Universitario de Getafe, Madrid, Spain; Lund University (B.N.), Skane University Hospital, Department of Clinical Sciences Lund, Neurology; Karolinska University Hospital, Department of Geriatric Medicine (D.R., M.E., S.G.-P.); and Södersjukhuset (S.G.-P.), Department of Internal Medicine, Section for Neurology, Stockholm, Sweden
| | - Bengt Winblad
- From the Karolinska Institutet (E.Z., D.R., B.W.), Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Neurogeriatrics, Huddinge, Sweden; Department of Neurology (E.Z., M.G.K.), University Medical Centre, Ljubljana, Slovenia; Karolinska Institutet (M.v.E.), Department of Clinical Science and Education, Södersjukhuset, and Department of Medicine, Solna; Karolinska University Hospital (M.v.E.), Department of Clinical Pharmacology; Karolinska Institutet and Stockholm University (I.K., J.F., K.J.), Aging Research Center, Stockholm, Sweden; Jönköping University (I.K.), Institute of Gerontology, School of Health and Welfare, Aging Research Network-Jönköping; Karolinska Institutet (B.C.E., M.E., S.G.-P.), Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Clinical Geriatrics, Huddinge, Sweden; Department of Geriatrics (B.C.E.), Hospital Universitario de Getafe, Madrid, Spain; Lund University (B.N.), Skane University Hospital, Department of Clinical Sciences Lund, Neurology; Karolinska University Hospital, Department of Geriatric Medicine (D.R., M.E., S.G.-P.); and Södersjukhuset (S.G.-P.), Department of Internal Medicine, Section for Neurology, Stockholm, Sweden
| | - Kristina Johnell
- From the Karolinska Institutet (E.Z., D.R., B.W.), Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Neurogeriatrics, Huddinge, Sweden; Department of Neurology (E.Z., M.G.K.), University Medical Centre, Ljubljana, Slovenia; Karolinska Institutet (M.v.E.), Department of Clinical Science and Education, Södersjukhuset, and Department of Medicine, Solna; Karolinska University Hospital (M.v.E.), Department of Clinical Pharmacology; Karolinska Institutet and Stockholm University (I.K., J.F., K.J.), Aging Research Center, Stockholm, Sweden; Jönköping University (I.K.), Institute of Gerontology, School of Health and Welfare, Aging Research Network-Jönköping; Karolinska Institutet (B.C.E., M.E., S.G.-P.), Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Clinical Geriatrics, Huddinge, Sweden; Department of Geriatrics (B.C.E.), Hospital Universitario de Getafe, Madrid, Spain; Lund University (B.N.), Skane University Hospital, Department of Clinical Sciences Lund, Neurology; Karolinska University Hospital, Department of Geriatric Medicine (D.R., M.E., S.G.-P.); and Södersjukhuset (S.G.-P.), Department of Internal Medicine, Section for Neurology, Stockholm, Sweden
| | - Maria Eriksdotter
- From the Karolinska Institutet (E.Z., D.R., B.W.), Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Neurogeriatrics, Huddinge, Sweden; Department of Neurology (E.Z., M.G.K.), University Medical Centre, Ljubljana, Slovenia; Karolinska Institutet (M.v.E.), Department of Clinical Science and Education, Södersjukhuset, and Department of Medicine, Solna; Karolinska University Hospital (M.v.E.), Department of Clinical Pharmacology; Karolinska Institutet and Stockholm University (I.K., J.F., K.J.), Aging Research Center, Stockholm, Sweden; Jönköping University (I.K.), Institute of Gerontology, School of Health and Welfare, Aging Research Network-Jönköping; Karolinska Institutet (B.C.E., M.E., S.G.-P.), Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Clinical Geriatrics, Huddinge, Sweden; Department of Geriatrics (B.C.E.), Hospital Universitario de Getafe, Madrid, Spain; Lund University (B.N.), Skane University Hospital, Department of Clinical Sciences Lund, Neurology; Karolinska University Hospital, Department of Geriatric Medicine (D.R., M.E., S.G.-P.); and Södersjukhuset (S.G.-P.), Department of Internal Medicine, Section for Neurology, Stockholm, Sweden
| | - Sara Garcia-Ptacek
- From the Karolinska Institutet (E.Z., D.R., B.W.), Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Neurogeriatrics, Huddinge, Sweden; Department of Neurology (E.Z., M.G.K.), University Medical Centre, Ljubljana, Slovenia; Karolinska Institutet (M.v.E.), Department of Clinical Science and Education, Södersjukhuset, and Department of Medicine, Solna; Karolinska University Hospital (M.v.E.), Department of Clinical Pharmacology; Karolinska Institutet and Stockholm University (I.K., J.F., K.J.), Aging Research Center, Stockholm, Sweden; Jönköping University (I.K.), Institute of Gerontology, School of Health and Welfare, Aging Research Network-Jönköping; Karolinska Institutet (B.C.E., M.E., S.G.-P.), Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Clinical Geriatrics, Huddinge, Sweden; Department of Geriatrics (B.C.E.), Hospital Universitario de Getafe, Madrid, Spain; Lund University (B.N.), Skane University Hospital, Department of Clinical Sciences Lund, Neurology; Karolinska University Hospital, Department of Geriatric Medicine (D.R., M.E., S.G.-P.); and Södersjukhuset (S.G.-P.), Department of Internal Medicine, Section for Neurology, Stockholm, Sweden.
| |
Collapse
|