Pre-stroke dementia does not affect the post-acute care functional outcome of old patients with ischemic stroke.
OBJECTIVE
The purpose of the present study was to evaluate whether a diagnosis of dementia before stroke onset (pre-stroke dementia [PSD]) affects the short-term functional outcome of elderly ischemic stroke patients.


METHODS
This was a retrospective case-control study comprising of consecutive elderly ischemic stroke patients. Functional outcome was assessed by the Functional Independence Measure scale (FIM) at admission and discharge. Data was analyzed by t-test, χ(2) -test, multiple linear regression analysis and logistic regression.


RESULTS
There were 919 patients with acute ischemic stroke, out of whom 11.5% were diagnosed with PSD on index day. Compared with non-PSD patients, those with pre-stroke dementia had a shorter length of stay (P < 0.001), higher rate of female patients (P < 0.001) and lower Mini-Mental State Examination scores (P < 0.001). Both total and motor FIM scores at admission and discharge, and their respective FIM gain scores at discharge were higher in non-PSD compared with PSD patients (P < 0.001). In logistic regression analysis to identify factors predicting successful outcome (defined as total FIM at discharge ≥80), PSD remained as significantly associated with increased risk for adverse outcome on discharge (OR 2.449, CI 1.207-4.970, P = 0.013).


CONCLUSIONS
The present findings suggest that a diagnosis of pre-stroke dementia is associated with lower FIM scores at admission and discharge in patients with ischemic stroke. Yet, daily motor FIM gains were similar in PSD and non-PSD patients, suggesting that these patients should not be deprived of a post-acute rehabilitation, based on a diagnosis of dementia before stroke onset. Geriatr Gerontol Int 2016; 16: 928-933.
Department of Geriatric Medicine and Rehabilitation, Shmuel Harofe Hospital, Beer-Yaakov, Israel.|The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Eliyahu-Hayim
EH
Mizrahi
The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.|Department of Geriatric Medicine and Rehabilitation, Sheba Medical Center, Tel-Hashomer, Israel.
Marina
M
Arad
The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.|Department of Geriatric Medicine and Rehabilitation, Sheba Medical Center, Tel-Hashomer, Israel.
Abraham
A
Adunsky
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000175:diagnosis / Q000453:epidemiology* / Q000534:rehabilitation; D016022:Case-Control Studies; D003704:Dementia / Q000175:diagnosis / Q000453:epidemiology* / Q000534:rehabilitation; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D007902:Length of Stay; D016014:Linear Models; D008297:Male; D015999:Multivariate Analysis; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology*; D000071939:Stroke Rehabilitation / Q000379:methods*; D019467:Subacute Care; D013997:Time Factors
ischemic stroke; outcome; pre-stroke dementia; rehabilitation