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Influence of cognitive impairment on the institutionalisation rate 3 years after a stroke
  1. M Pasquini1,3,
  2. D Leys1,
  3. M Rousseaux2,
  4. F Pasquier1,
  5. H Hénon1
  1. 1Department of Neurology (Stroke and Memory Units), Lille University Hospital, Lille, France
  2. 2Department of Neurological Rehabilitation, Lille University Hospital
  3. 3Vth Chair of Neurological Sciences, University “La Sapienza”, Rome, Italy
  1. Correspondence to:
 D Leys
 Department of Neurology (Stroke Department), University of Lille, Roger Salengro Hospital, Lille F-59037, France; dleys{at}chru-lille.fr

Abstract

Background and purpose: Pre-existing cognitive decline and new-onset dementia are common in patients with stroke, but their influence on institutionalisation rates is unknown.

Objective: To evaluate the influence of cognitive impairment on the institutionalisation rate 3 years after a stroke.

Design: (1) The previous cognitive state of 192 consecutive patients with stroke living at home before the stroke (with the Informant Questionnaire on COgnitive Decline in the Elderly (IQCODE)), (2) new-onset dementia occurring within 3 years and (3) institutionalisation rates within 3 years in the 165 patients who were discharged alive after the acute stage were prospectively evaluated.

Results: Independent predictors of institutionalisation over a 3-year period that were available at admission were age (adjusted odds ratio (adjOR) for 1-year increase  = 1.08; 95% confidence interval (CI) 1.03 to 1.15), severity of the neurological deficit (adjOR for 1-point increase in Orgogozo score = 0.97; 95% CI 0.96 to 0.99) and severity of cognitive impairment (adjOR for 1-point increase in IQCODE score = 1.03; 95% CI 1 to 1.06). Factors associated with institutionalisation at 3 years that were present at admission or occurred during the follow-up were age (adjOR for 1-year increase = 1.17; 95% CI 1.07 to 1.27) and any (pre-existing or new) dementia (adjOR = 5.85; 95% CI 1.59 to 21.59), but not the severity of the deficit of the neurological deficit.

Conclusion: Age and cognitive impairment are more important predictors of institutionalisation 3 years after a stroke than the severity of the physical disability.

  • adjOR, adjusted odds ratio
  • IQCODE, Informant Questionnaire on COgnitive Decline in the Elderly
  • mRS, modified Rankin Scale
  • PSD, post-stroke dementia

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Footnotes

  • Published Online First 4 September 2006

  • Fundings: This study was supported by the CH&U de Lille (grant 9306), and a grant from the French Ministry of Education, Research and Technology (Research group on Cognition in Degenerative and Vascular Disorders, EA2691).

  • Competing interests: D L is the associate editor of the Journal of Neurology, Neurosurgery and Psychiatry, but he did not interfere at any stage of the review process.

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