Mortality and institutionalization in early survivors of stroke: the effects of cognition, vascular mild cognitive impairment, and vascular dementia.
We explored th effects of vascular mild cognitive impairment (VaMCI), vascular dementia (VaD), and other predictors on mortality and institutionalization in early survivors of ischemic stroke without previous dementia who had been admitted to a stroke unit. A total of 202 consecutive consenting eligible ischemic stroke survivors and a matched sample of 97 community controls were followed for up to 10 years. Data for 167 patients who underwent detailed assessment 3-6 months after stroke were analyzed to determine predictors of outcomes. Cumulative mortality rates for patients (and controls) were 27% (4%) for the first 5 years and rose to 83% (10%) by 10 years. Predictors of mortality were older age, any cognitive impairment, less independent function, and less education. Nursing home admission rates were 24% at 5 years and 32% at 10 years for patients and 0 for controls over 8.9 years. Predictors of institutionalization were less independent function and older age. Patients with ischemic stroke who survive the first week have moderate, lower-than-expected mortality rates in the first 5 years that increase thereafter. VaMCI, VaD, and functional decline are predictors of mortality, while functional decline and older age predict institutionalization.
School of Psychiatry, Primary Dementia Collaborative Research Centre, University of New South Wales, Sydney, Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Randwick, Sydney, New South Wales, Australia.
Henry
H
Brodaty
Annette
A
Altendorf
Adrienne
A
Withall
Perminder S
PS
Sachdev
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D003071:Cognition; D003072:Cognition Disorders / Q000175:diagnosis / Q000401:mortality* / Q000523:psychology*; D015140:Dementia, Vascular / Q000175:diagnosis / Q000401:mortality* / Q000523:psychology*; D004185:Disability Evaluation; D005260:Female; D006707:Homes for the Aged / Q000706:statistics & numerical data; D006801:Humans; D007326:Institutionalization / Q000706:statistics & numerical data*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D009517:New South Wales; D009735:Nursing Homes / Q000706:statistics & numerical data; D011379:Prognosis; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000175:diagnosis / Q000401:mortality* / Q000523:psychology*; D015996:Survival Rate; D013997:Time Factors