Original ArticlePrestroke Dementia is Associated With Poor Outcomes After Reperfusion Therapy Among Elderly Stroke Patients
Section snippets
Methods
We retrospectively identified all AIS patients ≥80 years of age who received IV or IAT in our institutional prospective Get With the Guidelines Stroke (GWTG-S) database between February 2002 and December 2009. All aspects of this study were approved by the local institutional review board.
At our institution, IV tPA is administered to all appropriately selected AIS patients based on the current thrombolysis guidelines, regardless of age. The thrombolysis guideline with regard to the blood
Results
We identified 153 patients with AIS ≥80 years of age who received acute reperfusion therapy between February 2002 and December 2009. Of these, 72% received IV tPA (n = 110), 35% IAT (n = 54), and 7% both (n = 11). Baseline clinical data and demographics of the cohort are summarized in Table 1. The mean age was 85.8 ± 4.6 years (range 80-103), 30.7% were men, 88.2% were white, 98.3% were ambulatory before admission, and 10 lived in a nursing home before admission Twenty-one patients (13.7%) had
Discussion
Among the elderly treated with reperfusion therapy for acute stroke at our large tertiary care center, prestroke dementia was a powerful independent predictor of in-hospital mortality and unfavorable discharge. These novel data emphasize the importance of patient selection and consideration of outcomes when establishing the efficacy of AIS treatment options. The notion that functional outcomes are poor in most elderly despite treatment16 could be re-evaluated based on the newly discovered role
Acknowledgment
Dr Rost is supported by the National Institute of Neurological Disorders and Stroke (NINDS) (K23NS064052). Dr Nogueira is a member of the Physician Advisory Board for Concentric Medical, ev3 Neurovascular, Coaxia, Rapid Medical, and Neurointervention, and the site PI for the TREVO-2 Trial. He does not receive any consulting fees. Dr Yoo receives research funding from Penumbra, Inc. Dr Schwamm serves as chair of the AHA GWTG National Steering Committee (unpaid), a member of the international
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Impact of dementia status on intravenous thrombolysis and endovascular treatment for acute ischemic stroke: Retrospective study
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2018, Journal of the Neurological SciencesCitation Excerpt :Third, we lacked reliable information on the presence and severity of premorbid dementia or psychiatric disorders which may have affected LOC scores (especially LOC-Q). Indeed, dementia itself likely poses an increased risk of unfavorable outcome after ischemic stroke [16,17], and may be challenging to disentangle from stroke symptoms and superimposed processes like delirium [18,19]. However, the lack of a significant association between baseline LOC scores and outcome in the model we used in our sensitivity analysis suggests that LOC at discharge may be more important in determining outcomes.
Multisociety Consensus Quality Improvement Revised Consensus Statement for Endovascular Therapy of Acute Ischemic Stroke: From the American Association of Neurological Surgeons (AANS), American Society of Neuroradiology (ASNR), Cardiovascular and Interventional Radiology Society of Europe (CIRSE), Canadian Interventional Radiology Association (CIRA), Congress of Neurological Surgeons (CNS), European Society of Minimally Invasive Neurological Therapy (ESMINT), European Society of Neuroradiology (ESNR), European Stroke Organization (ESO), Society for Cardiovascular Angiography and Interventions (SCAI), Society of Interventional Radiology (SIR), Society of NeuroInterventional Surgery (SNIS), and World Stroke Organization (WSO)
2018, Journal of Vascular and Interventional RadiologyCitation Excerpt :Importantly, the trials included only patients with independent premorbid function, regardless of age, and the potential quality-of-life benefit for patients with significant comorbidities needs to be weighed in clinical practice. Prestroke dementia before endovascular reperfusion has been linked with a low probability of achieving a good clinical outcome (72). Some trials have therefore excluded patients aged > 80 years (73).
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