1. Influence of Pre-Existing Mild Cognitive Impairment and Dementia on Post-Stroke Mortality. The Dijon Stroke Registry
- Author
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Benoit Delpont, Lucie Garnier, Yannick Béjot, Maurice Giroud, Sophie Mohr, Catherine Vergely, Christelle Blanc-Labarre, Mathilde Graber, Physiopathologie et épidémiologie cérébro-cardiovasculaire [Dijon] (PEC2), and Université de Bourgogne (UB)-Université Bourgogne Franche-Comté [COMUE] (UBFC)
- Subjects
Male ,medicine.medical_specialty ,Epidemiology ,Population ,Comorbidity ,030501 epidemiology ,03 medical and health sciences ,0302 clinical medicine ,[SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system ,Risk Factors ,Internal medicine ,Case fatality rate ,medicine ,Dementia ,Humans ,Cognitive Dysfunction ,Prospective Studies ,Registries ,cardiovascular diseases ,Cognitive impairment ,education ,Stroke ,Aged ,Aged, 80 and over ,education.field_of_study ,Proportional hazards model ,business.industry ,Hazard ratio ,medicine.disease ,Female ,Neurology (clinical) ,France ,0305 other medical science ,business ,030217 neurology & neurosurgery - Abstract
Objective: We assessed the association between pre-stroke cognitive status and 90-day case-fatality. Methods: Patients with ischemic stroke (IS) or spontaneous intracerebral hemorrhage (ICH) were prospectively identified among residents of Dijon, France, between 2013 and 2015, using a population-based registry. Association between pre-stroke cognitive status and case-fatality at 90 days was evaluated using Cox regression. Results: Seven hundred sixty-two patients were identified, and information about pre-stroke cognitive status was obtained for 716 (92.6%) of them, including 603 IS (84.2%) and 113 ICH (15.8%). Before stroke, 99 (13.8%) patients had mild cognitive impairment (MCI) and 98 (13.7%) had dementia. Patients with cognitive impairment were older, had a higher prevalence of several risk factors, more severe stroke, more frequent ICH, and less admission to stroke unit. Case-fatality rate at 90 days was 11.7% in patients without cognitive impairment, 32.3% in MCI patients, and 55.1% in patients with dementia. In multivariable analyses, pre-existing MCI (hazard ratio [HR] 2.22, 95% CI 1.21–4.05, p = 0.009) and dementia (HR 4.35, 95% CI 2.49–7.61, p < 0.001) were both associated with 90-day case-fatality. Conclusion: Pre-stroke MCI and dementia were both associated with increased mortality. These associations were not fully explained by baseline characteristics, pre-stroke dependency, stroke severity or patient management, and underlying reasons need to be investigated.
- Published
- 2020