Thrombolysis in acute ischemic stroke in patients with dementia: A Swedish registry study
Eva Zupanic1, Mia von Euler1, Ingemar Kåreholt1
1From 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.
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.
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