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Poststroke dementia predicts poor survival in long-term follow-up: influence of prestroke cognitive decline and previous stroke
  1. S Melkas1,
  2. N K J Oksala2,
  3. H Jokinen1,4,
  4. T Pohjasvaara1,
  5. R Vataja1,
  6. A Oksala3,
  7. M Kaste1,
  8. P J Karhunen3,
  9. T Erkinjuntti1
  1. 1
    Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
  2. 2
    Division of Vascular Surgery, Department of Surgery, Tampere University Hospital and School of Medicine, Tampere University Hospital, Tampere, Finland
  3. 3
    Department of Forensic Medicine, School of Medicine, University of Tampere and the Laboratory Centre Research Unit, Tampere University Hospital, Tampere, Finland
  4. 4
    Department of Psychology, University of Helsinki, Helsinki, Finland
  1. Dr S Melkas, Department of Neurology, Helsinki University Central Hospital, POB 300, 00029 HUS, Finland; susanna.melkas{at}


Background: The aim of this study was to investigate the influence of poststroke dementia on long-term survival after acute stroke and also to assess the possible influence of prestroke cognitive decline and previous stroke on this relationship.

Methods: A total of 451 consecutive patients with acute ischaemic stroke admitted to hospital were included in the study and followed up for 12 years. Dementia was diagnosed 3 months after stroke in 115 patients (25.5%).

Results: In Kaplan–Meier analysis, poststroke dementia predicted poor long-term survival (5.1 years vs 8.8 years in patients who did not have poststroke dementia; p<0.001). Prestroke cognitive decline had a negative influence on survival in patients with poststroke dementia (3.8 years vs 5.8 years; p<0.001); however, previous stroke did not affect survival in these patients (p = 0.676). In stepwise Cox regression proportional hazards analysis adjusted for significant covariates, poststroke dementia (hazard ratio (HR) 1.53; p = 0.003), advanced age (HR 1.07; p<0.001), severity of stroke (HR 1.91; p<0.001), smoking (HR 1.35; p = 0.035), cardiac failure (HR 1.61; p = 0.003) and atrial fibrillation (HR 1.89; p = 0.035) were all independent predictors of poor long-term survival. Poststroke dementia (HR 2.33; p<0.001), advanced age (HR 1.07; p<0.001) and poor Rankin score (HR 2.15; p = 0.001) were associated with death from brain-related causes, including infarction, haemorrhage and dementia.

Conclusions: Long-term follow-up of our large well-defined poststroke cohort indicated that in patients with acute stroke, dementia is a significant predictor of poor long-term survival and death from brain-associated causes. Prestroke cognitive decline seems to have an additional negative influence on survival, but previous stroke does not seem to affect survival.

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  • Competing interests: None.