Predictors of severe stroke: influence of preexisting dementia and cardiac disorders

There is little research into the impact of prestroke dementia on stroke severity and short-term mortality. We included prestroke dementia, along with other risk factors, to determine independent predictors of stroke severity and early death in a community-based stroke study.

All patients (n=377) with a first-ever stroke were evaluated in terms of risk factors. Registration took place over a 12-month period. Stroke severity was evaluated with the National Institutes of Health Stroke Scale. Predictors of severe stroke and early death were analyzed in logistic regression models. The following independent variables were used: age, sex, living alone, arterial hypertension, ischemic heart disease, heart failure, atrial fibrillation, diabetes mellitus, transient ischemic attack, cigarette smoking, peripheral atherosclerosis, and dementia.

Risk factors for stroke were found in 82% of the patients. Heart failure, atrial fibrillation, and dementia were associated with more severe strokes. Dementia, atrial fibrillation, heart failure, and living alone were associated with death within 28 days of the event.

These results raise the question of whether certain high-risk patients, ie, patients with atrial fibrillation, heart failure, and dementia, can benefit from more aggressive primary and secondary stroke prevention measures.