title: Poststroke dementia is associated with recurrent ischaemic stroke.
abstract: OBJECTIVE
  To investigate whether poststroke dementia (PSD) diagnosed after ischaemic stroke predicts recurrent ischaemic stroke in long-term follow-up.
  
  
  METHODS
  We included 486 consecutive patients with ischaemic stroke (388 with first-ever stroke) admitted to Helsinki University Central Hospital who were followed-up for 12 years. Dementia was diagnosed in 115 patients using the Diagnostic and Statistical Manual of Mental Disorders, 3rd edition (DSM-III) criteria. The effects of risk factors and  PSD on survival free of recurrent stroke were estimated using Kaplan-Meier log-rank analyses, and the HRs for stroke recurrence were calculated using Cox proportional hazards models.
  
  
  RESULTS
  In the entire cohort, patients with PSD had a shorter mean time to recurrent stroke (7.13 years, 95% CI 6.20 to 8.06) than patients without dementia (9.41 years, 8.89 to 9.92; log rank p<0.001). This finding was replicated in patients with first-ever stroke (6.89 years, 5.85 to 7.93 vs 9.68 years, 9.12 to 10.24; p<0.001). In Cox univariate analysis, PSD was associated with increased risk for recurrent stroke both in the entire cohort (HR 2.02; 95% CI 1.47 to 2.77) and in those with first-ever stroke (2.40; 1.68 to 3.42). After adjustment for the significant covariates of age, atrial fibrillation, peripheral arterial disease and hypertension, PSD was associated with increased risk for recurrent stroke both in the entire cohort (1.84; 1.34 to 2.54) and in those with first-ever stroke (2.16; 1.51 to 3.10).
  
  
  CONCLUSIONS
  Poststroke dementia predicts recurrence of ischaemic stroke in long-term follow-up and should be considered when estimating prognosis.
authors: Department of Neurology, Helsinki University Central Hospital, P.O. Box 340 (Haartmaninkatu 4), , Helsinki 00029 HUS, Finland. gerli.sibolt@hus.fi
authors: Gerli
authors: G
authors: Sibolt
authors: Sami
authors: S
authors: Curtze
authors: Susanna
authors: S
authors: Melkas
authors: Jukka
authors: J
authors: Putaala
authors: Tarja
authors: T
authors: Pohjasvaara
authors: Markku
authors: M
authors: Kaste
authors: Pekka J
authors: PJ
authors: Karhunen
authors: Niku K J
authors: NK
authors: Oksala
authors: Timo
authors: T
authors: Erkinjuntti
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000150:complications* / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000150:complications / Q000453:epidemiology; D003072:Cognition Disorders / Q000209:etiology / Q000523:psychology; D015331:Cohort Studies; D003704:Dementia / Q000453:epidemiology / Q000209:etiology*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004522:Educational Status; D005260:Female; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008279:Magnetic Resonance Imaging; D008297:Male; D008568:Memory / Q000502:physiology; D008875:Middle Aged; D059906:Neuroimaging; D009483:Neuropsychological Tests; D012008:Recurrence; D012044:Regression Analysis; D012307:Risk Factors; D020521:Stroke / Q000150:complications* / Q000453:epidemiology / Q000209:etiology*; D014057:Tomography, X-Ray Computed
keywords: DEMENTIA; STROKE; VASCULAR DEMENTIA