ArticleJournal of stroke and cerebrovascular diseases : the official journal of National Stroke Association2013
Prestroke dementia is associated with poor outcomes after reperfusion therapy among elderly stroke patients.
Article in Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers, 2 of them syntheses that pooled it.
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Who cites it
22 citing papers in PubMed, 2 syntheses or guidelines pooled it, 59 citations in OpenAlex.
- Reperfusion therapies for ischemic stroke in dementia and cognitive impairment: A systematic review and meta-analysis.International journal of stroke : official journal of the International Stroke Society · 2024Pooled it
- Pooled it
- Stroke-heart syndrome outcomes in pre-existing vs. new-onset dementia: a report from a global federated research network.Journal of thrombosis and thrombolysis · 2026Article
- Differences in In-Hospital and Post-Discharge Ischemic Stroke Care According to Prestroke Functional Status.Journal of the American Heart Association · 2025Article
- Preexisting cognitive impairment in patients with acute stroke.Frontiers in neurology · 2025Review
- Utilization, Workflow, and Outcomes of Endovascular Thrombectomy in Patients With vs Without Premorbid Disability in a National Registry.Neurology. Clinical practice · 2024Article
- Thrombolysis Outcomes in Acute Ischaemic Stroke Patients with Pre-Existing Cognitive Impairment.Life (Basel, Switzerland) · 2023Article
- Epigenetics and stroke: role of DNA methylation and effect of aging on blood-brain barrier recovery.Fluids and barriers of the CNS · 2023Article
- Epigenetics and stroke: role of DNA methylation and effect of aging on blood-brain barrier recovery.Research square · 2023Article
- Mechanical Thrombectomy for Acute Ischemic Stroke in Patients With Dementia.Stroke (Hoboken, N.J.) · 2022Article
- Pre-stroke cognitive impairment in acute ischemic stroke patients predicts poor functional outcome after mechanical thrombectomy.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2021Article
- White matter hyperintensity burden in patients with ischemic stroke treated with thrombectomy.Neurology · 2019Article
- Prevention and Treatment of Acute Stroke in the Nonagenarians and Beyond: Medical and Ethical Issues.Current treatment options in neurology · 2019Review
- Multisociety Consensus Quality Improvement Revised Consensus Statement for Endovascular Therapy of Acute Ischemic Stroke.AJNR. American journal of neuroradiology · 2018Article
- Thrombolysis in acute ischemic stroke in patients with dementia: A Swedish registry study.Neurology · 2017Article
- Stroke in Older Survivors of Ischemic Stroke: Standard Care or Something Different?Geriatrics (Basel, Switzerland) · 2017Article
- The American Heart Association's Get With the Guidelines (GWTG)-Stroke development and impact on stroke care.Stroke and vascular neurology · 2017Review
- Thrombolysis in dementia patients with acute stroke: is it justified?Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2017Review
- Absolute and Relative Contraindications to IV rt-PA for Acute Ischemic Stroke.The Neurohospitalist · 2015Review
- Cognitive profiles in patients with multi-infarct dementia: an omani study.Dementia and geriatric cognitive disorders extra · 2014Article
Corrections and comments
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Authors and funding
6 authors at 3 institutions in 1 country.
Funding
Abstract
backgroundIn elderly acute stroke patients, reperfusion therapy is often withheld. We sought to determine whether prestroke dementia contributed to poor outcomes after reperfusion therapy in these patients.
methodsAll consecutive patients ≥ 80 years of age who received intravenous (IV) or intra-arterial reperfusion therapy (IAT) were identified in our Get With the Guidelines Stroke (GWTG-S) database. Vascular risk factors, presence of dementia, and outcomes were abstracted from the medical record. Dementia was recorded when listed in the medical history or when under medical treatment. Primary outcome was in-hospital mortality. Secondary outcome was discharge destination, "favorable" (home or rehabilitation facility) versus "unfavorable" (skilled nursing facility, hospice, or death). Multivariate logistic regression models were used to assess outcomes.
resultsOf 153 patients, 72% received IV tissue plasminogen activator (tPA), 35% IAT, and 7% both. The mean age was 85.8 ± 4.6 years; 13.6% had prestroke dementia. The in-hospital mortality rate was 35%. The likelihood of death increased with National Institutes of Health Stroke Scale (NIHSS; odds ratio [OR] 1.14; 95% confidence interval [CI] 1.07-1.21), IAT (OR 3.43; 95% CI 1.70-6.92), and dementia (OR 3.61; 95% CI 1.39-9.37), and decreased with IV tPA (OR 0.34; 95% CI 0.17-0.71). Increasing NIHSS (OR 0.90; 95% CI 0.85-0.95), symptomatic intracranial hemorrhage (OR 0.08; 95% CI 0.01-0.67), IAT (OR 0.43; 95% CI 0.22-0.84), and dementia (OR 0.37; 95% CI 0.14-0.97) decreased the likelihood of favorable discharge. In multivariate analysis, only NIHSS (OR 1.13; 95% CI 1.06-1.22) and dementia (OR 5.64; 95% CI 1.88-16.89) independently predicted death and unfavorable discharge destination.
conclusionsAmong the elderly, prestroke dementia is a powerful independent predictor of in-hospital mortality after acute reperfusion therapy for stroke. Future investigations of thrombolysis outcomes in the elderly are warranted.
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