Treatment for the secondary prevention of stroke in older patients: the influence of dementia status.
OBJECTIVE
To investigate the influence of dementia status on treatment for the secondary prevention of stroke in older patients.


METHODS
Based on patient examinations and medical record review, we investigated the frequency of aspirin and/or warfarin use at hospital discharge for the prevention of recurrent stroke in older patients hospitalized with acute ischemic stroke.


METHODS
A large academic medical center.


METHODS
A cohort of 272 patients, mean age 72.1 +/- 8.5 years.


METHODS
We performed neurologic examinations and reviewed medical records to investigate the effects of a clinical diagnosis of dementia and other potentially relevant factors on treatment with aspirin or warfarin at hospital discharge.


RESULTS
Thirty-one patients (11.4%) were not prescribed aspirin or warfarin at hospital discharge. Logistic regression determined that dementia (odds ratio (OR) = 2.57, 95% confidence interval (CI), 1.04-6.30) was a significant independent determinant of nontreatment with aspirin or warfarin, adjusting for abnormal gait (OR = 2.01, CI, .88-4.59); discharge to a nursing home or other institutional residence (OR = 2.55, CI, .83-7.81); cardiac disease (OR = .39, CI, .16-.95); cortical infarct location (OR = .45, CI, .18-1.10); male sex (OR = .47, CI, .20-1.15); age 80+ (OR = 1.14, CI, .46-2.82) and age 70-79 (OR = .96, CI, .32-2.88) versus age 60-69.


CONCLUSIONS
Our results suggest that dementia is a significant independent determinant of nontreatment with aspirin or warfarin when otherwise indicated for the prevention of recurrent stroke. The underutilization of aspirin and warfarin in older stroke patients with dementia may be a modifiable basis for their increased risk of recurrence and death.
Department of Neurology the Gertrude H. Sergievsky Center, Columbia University, College of Physicians and Surgeons, New York, New York, USA.
J T
JT
Moroney
C L
CL
Tseng
M C
MC
Paik
J P
JP
Mohr
D W
DW
Desmond
D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D001241:Aspirin / Q000627:therapeutic use*; D002561:Cerebrovascular Disorders / Q000150:complications* / Q000517:prevention & control*; D003704:Dementia / Q000150:complications* / Q000175:diagnosis; D004363:Drug Utilization; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D010351:Patient Discharge; D018579:Patient Selection; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D014859:Warfarin / Q000627:therapeutic use*
D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D014859:Warfarin; D001241:Aspirin