Pre-stroke dementia and in-hospital outcomes in the Chinese Stroke Center Alliance

Chelsea Liu; Hong-Qiu Gu; Xin Yang; Chun-Juan Wang; Xia Meng; Kai-Xuan Yang; Yun-Yun Xiong; Xing-Quan Zhao; Yi-Long Wang; Li-Ping Liu; Yong-Jun Wang; Zi-Xiao Li

doi:10.21037/atm-22-723

Pre-stroke dementia and in-hospital outcomes in the Chinese Stroke Center Alliance

Ann Transl Med. 2022 Oct;10(19):1050. doi: 10.21037/atm-22-723.

Authors

Chelsea Liu^#¹, Hong-Qiu Gu^#^{2

3}, Xin Yang^{2

3}, Chun-Juan Wang^{2

3}, Xia Meng^{2

3}, Kai-Xuan Yang^{2

3}, Yun-Yun Xiong^{2

3}, Xing-Quan Zhao⁴, Yi-Long Wang⁴, Li-Ping Liu⁵, Yong-Jun Wang^{2

3

4}, Zi-Xiao Li^{2

3

4

6}

Affiliations

¹ Harvard T. H. Chan School of Public Health, Boston, MA, USA.
² China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
³ National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
⁴ Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
⁵ Neuro-Intensive Care Unit, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
⁶ Chinese Institute for Brain Research, Beijing, China.

^# Contributed equally.

Abstract

Background: Little is known about the impact of prevalent dementia on in-hospital outcomes of patients with incident stroke in China. Using data from the Chinese Stroke Center Alliance (CSCA), we aim to quantify the prevalence of pre-stroke dementia and whether this group is at higher risk of adverse in-hospital outcomes compared to those without pre-stroke dementia.

Methods: We used multivariable logistic regression models to assess the associations between pre-stroke dementia and ambulation by day 2, in-hospital mortality, in-hospital complications, and being discharged home. Covariates included age, sex, comorbidities [dyslipidemia, atrial fibrillation, peripheral vascular disease (PVD), smoking, and alcohol use], medication history (antiplatelet drugs or lipid-lowering drugs), stroke severity [measured by the National Institute of Health Stroke Scale (NIHSS)], administration of intravenous tissue plasminogen activator (IV tPA) within 4.5 hours of stroke onset, and receipt of deep vein thrombosis (DVT) prophylaxis if indicated.

Results: In the final analytic sample of 559,070 ischemic stroke patients with no prior stroke history enrolled across 1,476 hospitals, those with pre-stroke dementia (n=1,511; 0.3%) were older and more likely to be female. Despite having received similar treatment, patients with pre-stroke dementia had lower odds of ambulating by day 2 [odds ratio (OR) =0.69; 95% confidence interval (CI): 0.62-0.78], higher odds of in-hospital mortality (OR =2.01; 95% CI: 1.35-2.99) or complications (OR =2.17; 95% CI: 1.93-2.44), and lower odds of being discharged home compared to those without pre-stroke dementia (OR =0.71; 95% CI: 0.62-0.83).

Conclusions: Worse in-hospital outcomes among patients with pre-stroke dementia may be explained by pre-existing cognitive impairment that limited their ability to advocate for care needs. Further research is needed to determine whether a different care pathway or additional attention from clinicians is necessary for patients with pre-stroke dementia.

Keywords: China; dementia; inpatients; registries; stroke.