Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Clinical Geriatrics, Karolinska Institutet, Huddinge, Sweden; Department of Geriatric Medicine, Karolinska University Hospital, Stockholm, Sweden; Department of Internal Medicine, Section for Neurology, Södersjukhuset, Stockholm, Sweden.
Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Clinical Geriatrics, Karolinska Institutet, Huddinge, Sweden; Department of Geriatrics, Hospital Universitario de Getafe, Madrid, Spain.
J Am Med Dir Assoc. 2018 Feb;19(2):154-161. doi: 10.1016/j.jamda.2017.08.014. Epub 2017 Oct 6.
To explore the association between prestroke mobility dependency and dementia on functioning and mortality outcomes after stroke in patients>65 years of age.
Longitudinal cohort study based on SveDem, the Swedish Dementia Registry and Riksstroke, the Swedish Stroke Registry.
A total of 1689 patients with dementia >65 years of age registered in SveDem and suffering a first stroke between 2007 and 2014 were matched with 7973 controls without dementia with stroke.
Odds ratios (ORs) and 95% confidence intervals (CIs) for intrahospital mortality, and functioning and mortality outcomes at 3 months were calculated. Functioning included level of residential assistance (living at home without help, at home with help, or nursing home) and mobility dependency (independent, needing help to move outdoors, or needing help indoors and outdoors).
Prestroke dependency in activities of daily living and mobility were worse in patients with dementia than controls without dementia. In unadjusted analyses, patients with dementia were more often discharged to nursing homes (51% vs 20%; P < .001). Mortality at 3 months was higher in patients with dementia (31% vs 23% P < .001) and fewer were living at home without help (21% vs 55%; P < .001). In adjusted analyses, prestroke dementia was associated with higher risk of 3-month mortality (OR 1.34; 95% CI 1.18-1.52), requiring a higher level of residential assistance (OR 4.07; 3.49-.75) and suffering from more dependency in relation to mobility (OR 2.57; 2.20-3.02). Patients with dementia who were independent for mobility prestroke were more likely to be discharged to a nursing home compared with patients without dementia with the same prestroke mobility (37% vs 16%; P < .001), but there were no differences in discharge to geriatric rehabilitation (19% for both; P = .976). Patients, who moved independently before stroke, were more often discharged home (60% vs 28%) and had lower mortality. In adjusted analyses, prestroke mobility limitations were associated with higher odds for poorer mobility, needing more residential assistance, and death.
Patients with mobility impairments and/or dementia present a high burden of disability after a stroke. There is a need for research on stroke interventions among these populations.
探讨 65 岁以上患者中风前的移动能力依赖与痴呆症对中风后功能和死亡率结局的关系。
基于 SveDem、瑞典痴呆症登记处和 Riksstroke、瑞典中风登记处的纵向队列研究。
共有 1689 名年龄>65 岁且患有痴呆症并在 2007 年至 2014 年间首次中风的患者被登记在 SveDem 中，与 7973 名无痴呆症但患有中风的对照组相匹配。
计算院内死亡率和 3 个月时功能和死亡率结局的比值比 (OR) 和 95%置信区间 (CI)。功能包括居住援助水平（居家无帮助、居家有帮助或疗养院）和移动依赖（独立、需要帮助户外活动或需要室内外帮助）。
与无痴呆症的对照组相比，患有痴呆症的患者中风前的日常生活活动和移动能力依赖更差。在未调整的分析中，痴呆症患者更常被送往疗养院（51%比 20%；P<0.001）。3 个月时的死亡率更高（31%比 23%；P<0.001），居家无帮助的人数更少（21%比 55%；P<0.001）。在调整后的分析中，中风前的痴呆症与 3 个月时的死亡风险增加相关（OR 1.34；95%CI 1.18-1.52），需要更高水平的居住援助（OR 4.07；3.49-7.5），并且在移动方面的依赖性更高（OR 2.57；2.20-3.02）。与无痴呆症但具有相同中风前移动能力的患者相比，中风前独立移动的痴呆症患者更有可能被送往疗养院（37%比 16%；P<0.001），但送往老年康复的比例没有差异（两者均为 19%；P=0.976）。在中风前能够独立移动的患者中，更多的患者出院回家（60%比 28%），死亡率更低。在调整后的分析中，中风前的移动能力限制与更差的移动能力、需要更多的居住援助和死亡的可能性更高相关。
患有移动能力障碍和/或痴呆症的患者中风后残疾负担较高。需要对这些人群的中风干预措施进行研究。
