Background: Dementia prevalence is rising, and will double in the next 20 years. This study sought to understand the prevalence of dementia in hospitalized patients with stroke and TIA, differences in characteristics and impact on outcomes.
Methods: Using the Canadian Institute of Health Information (CIHI) Discharge Abstract Database (DAD), all acute stroke and TIA admissions from April 2003 to March 2015 in Canada (excluding Quebec) were analyzed. Concurrent dementia at time of admission was assessed based on hospital diagnostic codes. Characteristics and in-hospital outcomes were compared in patients with vs. without dementia using chi-square and logistic regression.
Results: During the observed period 464,741 patients were admitted to hospital for cerebrovascular syndromes (ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage (SAH) and TIA). Of those, 29,812 (6.4%) had a concurrent diagnosis of dementia, including 8.4% of patients ≥65 years. People with dementia had older median age (84 vs. 75 years; p<0.01), were more often female (59.6% vs. 49.3%; p<0.01) and more often had Charlson-Deyo comorbidity index ≥ 2 (62.1% v. 38.4%; p<0.01). They were less likely admitted with SAH (1.3% vs. 5.3%; p<0.01) and more likely coded as strokes with unidentified subtype (29.4% vs. 20.8%; p<0.01). Median length of stay (13 vs. 7 days; p<0.01) was longer. Patients with dementia were less likely discharged to another acute care facility (7.6% vs. 14.7%; p<0.01), rehabilitation facility (5.4% vs. 12.0%; p<0.01) or home independently (22.9% 48.9%; p<0.01); other outcomes are shown in the Table.
Conclusions: Approximately 1 in 10 hospitalized stroke and TIA patients age ≥65 has coded dementia. Patients with stroke or TIA and dementia have higher mortality, face significantly more dependence after stroke and utilize greater healthcare resources than stroke patients without dementia. Early care planning and coordination are essential to optimize outcomes.