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Many stroke patients who fulfilled diagnostic criteria for dementia three months after stroke had a mental deterioration before stroke, implying an underlying neurodegenerative process. The goal of this study was to determine the factors associated with pre-stroke dementia in hospitalised-based population.Pre-stroke cognitive decline was evaluated in 250 stroke patients using the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). Patients with IQCODE score ≥104 were classified as having pre-stroke dementia. Clinical, radiological, and biochemical data of patients with and without pre-stroke dementia were compared.Pre-stroke dementia was found in 12% of 250 stroke patients. Patients with pre-stroke dementia were older, suffered more frequently from ischemic heart disease and diabetes, and had more frequently prior cerebrovascular disease. These patients had significantly more brain atrophy and number of old infarcts on CT than patients without pre-stroke dementia. Serum γ-globulins levels at admission were significantly higher in patients with pre-stroke dementia. In logistic regression analysis female gender (OR 3.47, CI 95% 1.25-9.64), history of previous stroke (OR 3.46, CI 95 % 1.26-9.51), the number of old infarcts on CT (OR 1.58, CI 95 % 1.08-2.33) and serum γ-globulins level (OR 1.19, CI 95 % 1.02-1.40) were independently associated with pre-stroke dementia.Female gender and previous ischemic stroke are the most important determinants of pre-stroke cognitive decline.