Joundi Raed A, Fang Jiming, Austin Peter C, Smith Eric E, Yu Amy Ying Xin, Hachinski Vladimir, Sposato Luciano A, Ganesh Aravind, Sharma Mukul, Kapral Moira K
From the Division of Neurology (R.A.J., M.S.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Hamilton; ICES (J.F., P.C.A., A.Y.X.Y.), Toronto, Ontario; Departments of Clinical Neurosciences and Community Health Sciences (E.E.S., A.G.), Cumming School of Medicine, University of Calgary, Alberta; Division of Neurology (A.Y.X.Y.), Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto; Robarts Research Institute (V.H., L.A.S.), Department of Clinical Neurological Sciences, and Department of Epidemiology and Biostatistics, University of Western Ontario, London; and Division of General Internal Medicine (M.K.K.), Department of Medicine, University of Toronto-University Health Network, Ontario, Canada.
Neurology. 2025 Jan 14;104(1):e210131. doi: 10.1212/WNL.0000000000210131. Epub 2024 Dec 4.
Survivors of stroke are at high risk of dementia, but it is unclear whether this elevated risk is due to other confounding factors. We sought to determine the magnitude and time course of dementia risk after stroke with robust comparison with matched nonstroke populations in an entire province.
We conducted a population-wide analysis of over 15 million people in Ontario, Canada, between 2002 and 2022. Using linked administrative databases, we identified adults hospitalized for ischemic stroke, intracerebral hemorrhage, or acute myocardial infarction (AMI). We performed 1:1 matching of people with stroke to all residents of Ontario (reference population) without stroke and separately to those with AMI, on age, sex, rural residence, neighborhood deprivation, and vascular comorbidities. We calculated the incident rate per 100 person-years and hazard ratios (HRs) for all-cause dementia between 90 days after stroke and 1 year, 5 years, 10 years, and total follow-up and evaluated time-varying HRs. In sensitivity analyses, we adjusted for new stroke in follow-up and the cumulative number of health care encounters.
Of 175,980 stroke survivors, 174,817 (99.3%) were successfully matched to people in the reference population and 151,673 (90%) were matched to those with AMI. Over a mean follow-up of 5.6 years (SD 4.71, maximum 20 years), a total of 32,621 (18.7%) were diagnosed with dementia after stroke compared with 21,929 (12.5%) in the Ontario reference population. The rate of dementia per 100 person-years over total follow-up time was higher after acute stroke compared with the reference population (3.34 vs 1.89) and the AMI cohort (3.19 vs 1.75). The HR of dementia was higher in those with stroke compared with the reference population (1.76, 95% CI 1.73-1.79) and the AMI cohort (1.82, 1.79-1.85). HRs varied across time, with over 2.5-fold increase in dementia risk within 1 year, decreasing to 1.5-fold at 5 years and 1.3-fold at 20 years after stroke. Estimates were similar in sensitivity analyses. Recurrent stroke was associated with 3-fold increased dementia risk.
In this population-wide study, almost one-fifth of stroke survivors were diagnosed with dementia, with an 80% higher risk of dementia after robust matching to those without stroke. Targeted dementia prevention efforts in acute and chronic survivors of stroke are needed.
中风幸存者患痴呆症的风险很高，但尚不清楚这种风险升高是否归因于其他混杂因素。我们试图通过与全省匹配的非中风人群进行有力比较，来确定中风后痴呆症风险的程度和时间进程。
我们对2002年至2022年期间加拿大安大略省超过1500万人进行了全人群分析。利用关联的行政数据库，我们识别出因缺血性中风、脑出血或急性心肌梗死（AMI）住院的成年人。我们将中风患者与安大略省所有无中风的居民（参照人群）以及与患有AMI的人群，按照年龄、性别、农村居住情况、邻里贫困程度和血管合并症进行1:1匹配。我们计算了中风后90天至1年、5年、10年及总随访期内全因痴呆症的每100人年发病率和风险比（HRs），并评估了随时间变化的HRs。在敏感性分析中，我们对随访期间的新发中风和医疗保健接触的累积次数进行了调整。
在175,980名中风幸存者中，174,817名（99.3%）成功与参照人群中的人匹配，151,673名（90%）与患有AMI的人群匹配。在平均5.6年（标准差4.71，最长20年）的随访中，共有32,621名（18.7%）中风幸存者被诊断为痴呆症，而安大略省参照人群中这一比例为21,929名（12.5%）。与参照人群（3.34对1.89）和AMI队列（3.19对1.75）相比，急性中风后全随访期内每100人年的痴呆症发病率更高。与参照人群（HR为1.76，95%可信区间1.73 - 1.79）和AMI队列（HR为1.82，1.79 - 1.85）相比，中风患者患痴呆症的HR更高。HR随时间变化，中风后1年内痴呆症风险增加超过2.5倍，5年后降至1.5倍，20年后降至1.3倍。敏感性分析中的估计结果相似。复发性中风与痴呆症风险增加3倍相关。
在这项全人群研究中，近五分之一的中风幸存者被诊断为痴呆症，在与无中风者进行有力匹配后，患痴呆症的风险高出80%。需要针对中风的急性和慢性幸存者开展有针对性的痴呆症预防工作。
