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J Neurol Neurosurg Psychiatry doi:10.1136/jnnp-2012-304084
  • Cerebrovascular disease
  • Research paper

Poststroke dementia is associated with recurrent ischaemic stroke

  1. Timo Erkinjuntti1,2
  1. 1Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
  2. 2Department of Neurological Sciences, University of Helsinki, Helsinki, Finland
  3. 3Forensic Medicine, School of Medicine, University of Tampere, Tampere, Finland
  4. 4The Laboratory Centre Research Unit, Tampere University Hospital, Tampere, Finland
  5. 5Division of Vascular Surgery, Department of Surgery, Tampere University Hospital, Tampere, Finland
  1. Correspondence to Dr Gerli Sibolt,  Department of Neurology, Helsinki University Central Hospital, P.O. Box 340 (Haartmaninkatu 4), Helsinki 00029 HUS, Finland; gerli.sibolt{at}hus.fi
  • Received 18 September 2012
  • Revised 15 January 2013
  • Accepted 20 January 2013
  • Published Online First 16 February 2013

Abstract

Objective To investigate whether poststroke dementia (PSD) diagnosed after ischaemic stroke predicts recurrent ischaemic stroke in long-term follow-up.

Methods We included 486 consecutive patients with ischaemic stroke (388 with first-ever stroke) admitted to Helsinki University Central Hospital who were followed-up for 12 years. Dementia was diagnosed in 115 patients using the Diagnostic and Statistical Manual of Mental Disorders, 3rd edition (DSM-III) criteria. The effects of risk factors and  PSD on survival free of recurrent stroke were estimated using Kaplan–Meier log-rank analyses, and the HRs for stroke recurrence were calculated using Cox proportional hazards models.

Results In the entire cohort, patients with PSD had a shorter mean time to recurrent stroke (7.13 years, 95% CI 6.20 to 8.06) than patients without dementia (9.41 years, 8.89 to 9.92; log rank p<0.001). This finding was replicated in patients with first-ever stroke (6.89 years, 5.85 to 7.93 vs 9.68 years, 9.12 to 10.24; p<0.001). In Cox univariate analysis, PSD was associated with increased risk for recurrent stroke both in the entire cohort (HR 2.02; 95% CI 1.47 to 2.77) and in those with first-ever stroke (2.40; 1.68 to 3.42). After adjustment for the significant covariates of age, atrial fibrillation, peripheral arterial disease and hypertension, PSD was associated with increased risk for recurrent stroke both in the entire cohort (1.84; 1.34 to 2.54) and in those with first-ever stroke (2.16; 1.51 to 3.10).

Conclusions Poststroke dementia predicts recurrence of ischaemic stroke in long-term follow-up and should be considered when estimating prognosis.