Post-stroke dementia and permanent institutionalization

Gerli Sibolt, Sami Curtze, Hanna Jokinen, Tarja Pohjasvaara, Markku Kaste, Pekka J. Karhunen, Timo Erkinjuntti, Susanna Melkas, Niku K.J. Oksala

Research output: Contribution to journalArticleScientificpeer-review

Abstract

Background: Dementia is among the most frequent causes of institutionalization. To serve the purpose of preventive strategies, there are no follow-up studies that have evaluated the actual impact of post-stroke dementia on institutionalization. We therefore compared the institutionalization rate and length of stay in an institutional care facility of patients with post-stroke dementia with stroke patients without dementia. Methods: We included 410 consecutive patients aged 55 to 85 years with ischemic stroke who were admitted to Helsinki University Hospital (The SAM cohort). Hospitalization and nursing home admissions were reviewed from national registries. Dementia was diagnosed using the Diagnostic and Statistical Manual of Mental Disorders 3rd edition (DSM-III) criteria using extensive clinical assessments performed 3 months post-stroke. The cohort had a follow-up 21 years later. Results: Compared to patients without dementia, post-stroke dementia was associated with shorter survival time (6.60 vs 10.10 years, p < 0.001), shorter time spent not institutionalized (5.40 vs 9.37 years, p < 0.001), but not with time spent permanently institutionalized (0.73 vs 1.10 years, p = 0.08). Post-stroke dementia was associated with higher rates and earlier permanent institutionalization compared to absence of post-stroke dementia (HR 1.53, 95% CI 1.07–2.18) in a Cox regression model adjusting for age, status of living alone at baseline, modified Rankin Scale at baseline, history of atrial fibrillation, and cardiac failure. Conclusions: Post-stroke dementia is associated with earlier permanent institutionalization. Due to significantly shorter survival, the time spent in nursing homes was not significantly longer in patients with post-stroke dementia compared with patients without post-stroke dementia.

Original languageEnglish
Article number117307
JournalJournal of the Neurological Sciences
Volume421
DOIs
Publication statusPublished - 2021
Publication typeA1 Journal article-refereed

Keywords

  • Institutionalization
  • Ischemic stroke
  • Post-stroke dementia

Publication forum classification

  • Publication forum level 1

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

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