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[ACUTE KIDNEY INJURY AND IN-HOSPITAL MORTALITY IN PATIENTS WITH STROKE].

https://arctichealth.org/en/permalink/ahliterature270161
Source
Klin Med (Mosk). 2015;93(7):50-5
Publication Type
Article
Date
2015
Author
A M Gerdt
A M Shutov
M V Menzorov
V V Naydenova
Source
Klin Med (Mosk). 2015;93(7):50-5
Date
2015
Language
Russian
Publication Type
Article
Keywords
Acute Kidney Injury - diagnosis - etiology - mortality - physiopathology
Aged
Creatinine - blood
Female
Hospital Mortality
Humans
Kidney Function Tests - methods
Male
Middle Aged
Prognosis
Risk factors
Russia - epidemiology
Severity of Illness Index
Stroke - complications - mortality
Abstract
to estimate the frequency and severity of acute kidney injury (AKI) in patients with stroke and the influence of AKI on intra-hospital lethality.
180 patients with stroke. 8 (4.4%) of them died within 24 hr after admission. It was impossible to diagnose AKI in these patients from serum creatinine dynamics. The development of AKI was followed up in the remaining 80 (47.1%) men and 91 (52.9%) women (mean age 66.6 ± 11.2 yr). AKI was diagnosed and classified as recommended by KDIGO (2012).
AKI was documented in 47 (27.3%) patients including 13 (41.9%) and 34 (24.1%) with hemorrhagic and ischemic stroke respectively. Logistic regressive analysis revealed association of in-hospital lethality with AKI (relative risk 2.5; 95%, CI 1.7-3.8) regardless of sex, age, stroke type, duration of the disease prior to hospitalisation, arterial hypertension, and diabetes.
stroke is complicated by AKI in every fourth patient; in combination, they significantly increase intra-hospital lethality.
PubMed ID
26596060 View in PubMed
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Age disparities in stroke quality of care and delivery of health services.

https://arctichealth.org/en/permalink/ahliterature149008
Source
Stroke. 2009 Oct;40(10):3328-35
Publication Type
Article
Date
Oct-2009
Author
Gustavo Saposnik
Sandra E Black
Antoine Hakim
Jiming Fang
Jack V Tu
Moira K Kapral
Author Affiliation
Stroke Research Unit, Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. saposnikg@smh.toronto.on.ca
Source
Stroke. 2009 Oct;40(10):3328-35
Date
Oct-2009
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Aged
Aged, 80 and over
Aging - physiology - psychology
Atrial Fibrillation - drug therapy - prevention & control
Cohort Studies
Cost of Illness
Deglutition Disorders - diagnosis - prevention & control - therapy
Emergency Medical Services - standards - statistics & numerical data - trends
Female
Health Policy
Health Services - economics
Hospital Units - standards - statistics & numerical data - trends
Hospitalization - economics
Humans
Longevity
Male
Middle Aged
Mortality - trends
Ontario
Outcome Assessment (Health Care) - economics
Patient Discharge - economics
Pneumonia - epidemiology
Prospective Studies
Quality of Health Care - statistics & numerical data - trends
Quality of Life
Severity of Illness Index
Stroke - complications - mortality - therapy
Thrombolytic Therapy - statistics & numerical data - trends
Warfarin - therapeutic use
Abstract
Limited information is available on the effect of age on stroke management and care delivery. Our aim was to determine whether access to stroke care, delivery of health services, and clinical outcomes after stroke are affected by age.
This was a prospective cohort study of patients with acute ischemic stroke in the province of Ontario, Canada, admitted to stroke centers participating in the Registry of the Canadian Stroke Network between July 1, 2003 and March 31, 2005. Primary outcomes were the following selected indicators of quality stroke care: (1) use of thrombolysis; (2) dysphagia screening; (3) admission to a stroke unit; (4) carotid imaging; (5) antithrombotic therapy; and (6) warfarin for atrial fibrillation at discharge. Secondary outcomes were risk-adjusted stroke fatality, discharge disposition, pneumonia, and length of hospital stay.
Among 3631 patients with ischemic stroke, 1219 (33.6%) were older than 80 years. There were no significant differences in stroke care delivery by age group. Stroke fatality increased with age, with a 30-day risk adjusted fatality of 7.1%, 6.5%, 8.8%, and 14.8% for those aged 59 or younger, 60 to 69, 70 to 79, and 80 years or older, respectively. Those aged older than 80 years had a longer length of hospitalization, increased risk of pneumonia, and higher disability at discharge compared to those younger than 80. This group was also less likely to be discharged home.
In the context of a province-wide coordinated stroke care system, stroke care delivery was similar across all age groups with the exception of slightly lower rates of investigations in the very elderly. Increasing age was associated with stroke severity and stroke case-fatality.
PubMed ID
19696418 View in PubMed
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Aphasia in acute stroke and relation to outcome.

https://arctichealth.org/en/permalink/ahliterature194692
Source
J Intern Med. 2001 May;249(5):413-22
Publication Type
Article
Date
May-2001
Author
A C Laska
A. Hellblom
V. Murray
T. Kahan
M. Von Arbin
Author Affiliation
Division of Internal Medicine, Karolinska Institutet, Danderyd Hospital, Sweden. ann-charlotte.laska@med.ds.sll.se
Source
J Intern Med. 2001 May;249(5):413-22
Date
May-2001
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Aphasia - etiology - physiopathology - radiography
Follow-Up Studies
Humans
Middle Aged
Prognosis
Stroke - complications - mortality
Sweden - epidemiology
Tomography, X-Ray Computed
Abstract
The natural course of aphasia in unselected, consecutive stroke patients is not well established. We investigated morbidity, mortality and recovery for different types of aphasia in consecutive unselected aphasic patients with acute stroke. Setting and subjects. In 119 aphasic patients, the type and degree of aphasia were assessed acutely and at 3, 6 and 18 months after stroke onset, using Reinvang's 'Grunntest for afasi' and Amsterdam-Nijmegen-Everyday-Language-Test.
About one-third of patients with acute stroke had presented with aphasia. Mortality among the aphasic patients during the 18-month follow-up was twice that in non-aphasics (36 vs. 16%). Presence of atrial fibrillation was associated with poorer prognosis. At 18 months, 24% of the 119 aphasic patients had recovered completely, 43% still had significant aphasia, and 21% had died. The proportion with global aphasia decreased from almost 25% acutely to a few per cent after 18 months, that with Wernicke's aphasia from 25% to less than 10%, whereas conduction aphasia increased from 13 to 23% during follow-up. Among those with initial mild aphasia, 70% recovered completely. Great improvement was observed in patients with initial low degree of speech function. Younger patients recovered to a greater extent than older patients.
The high long-term mortality among aphasics may be seen as an indirect sign of advanced cardiovascular disease. A combination of different and adjusted aphasia tests provided the possibility to assess almost all acute aphasic patients. Irrespective of type and degree of aphasia, great improvements were seen in almost all aphasic patients. Even patients with severe speech impairment have a considerable potential for recovery, particularly in the first 3 months after stroke.
PubMed ID
11350565 View in PubMed
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Cause of death in patients with poststroke epilepsy: Results from a nationwide cohort study.

https://arctichealth.org/en/permalink/ahliterature285358
Source
PLoS One. 2017;12(4):e0174659
Publication Type
Article
Date
2017
Author
Julia Hansen
Signild Åsberg
Eva Kumlien
Johan Zelano
Source
PLoS One. 2017;12(4):e0174659
Date
2017
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Cardiovascular Diseases - complications - mortality
Cause of Death
Cohort Studies
Epilepsy - complications - mortality
Female
Humans
Male
Middle Aged
Neoplasms - complications - mortality
Nervous System Diseases - complications - mortality
Registries
Status Epilepticus - complications - mortality
Stroke - complications - mortality
Sweden - epidemiology
Young Adult
Abstract
The risk of death is increased for persons with epilepsy. The literature on causes of death in epilepsy is based mainly on cohorts with epilepsy of mixed aetiologies. For clinical purposes and improved understanding of mortality in different epilepsies, more information is needed on mortality in epilepsies of specific causes. In poststroke epilepsy (PSE), seizures occur in a setting of vascular disease and high mortality rates. The extent to which epilepsy contributes to mortality in this patient group is poorly understood. We therefore aimed to describe causes of death (COD) in PSE on a national scale. A previously identified cohort of 7740 patients with epilepsy or seizures after a stroke in 2005-2010 was investigated. A total of 4167 deaths occurred before the end of 2014. The standardized mortality ratio for the study cohort was 3.56 (95% CI: 3.45-3.67). The main underlying causes of death were disorders of the circulatory system (60%) followed by neoplasms (12%). Diseases of the nervous system were the sixth leading underlying COD (3%), and epilepsy or status epilepticus was considered the underlying COD in approximately a similar proportion of cases as neurodegenerative disorders (0.9% and 1.1%, respectively). Epilepsy was considered a contributing COD in 14% of cases. Our findings highlight the importance of optimal management of vascular morbidity in patients with PSE. The large proportion of patients with epilepsy as a contributing COD indicate the need of high ambitions also regarding the management of seizures in patients with PSE.
Notes
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Cites: BMC Public Health. 2011 Jun 09;11:45021658213
Cites: Epilepsia. 1997 Oct;38(10):1062-89579951
Cites: Stroke. 2013 Mar;44(3):605-1123370202
Cites: Epilepsia. 1999 Oct;40(10):1388-9210528934
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Cites: Epilepsy Res. 2005 Jun;65(1-2):101-1516005188
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Cites: Epilepsy Behav. 2008 Oct;13(3):542-418539085
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Cites: Epilepsia. 2005;46 Suppl 11:18-2716393174
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Cites: Brain Behav. 2015 Sep;5(9):e0036626445704
Cites: Clin Neuropharmacol. 2007 Jul-Aug;30(4):189-9517762314
Cites: Epilepsia. 2013 Mar;54(3):495-50123167828
Cites: Neurology. 2010 Jan 26;74(4):295-30120101034
PubMed ID
28380003 View in PubMed
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The disparity in long-term survival after a first stroke in patients with and without diabetes persists: the Northern Sweden MONICA study.

https://arctichealth.org/en/permalink/ahliterature121448
Source
Cerebrovasc Dis. 2012;34(2):153-60
Publication Type
Article
Date
2012
Author
Marie Eriksson
Bo Carlberg
Mats Eliasson
Author Affiliation
Department of Statistics, USBE, Umeå University, Umeå, Sweden. marie.eriksson@stat.umu.se
Source
Cerebrovasc Dis. 2012;34(2):153-60
Date
2012
Language
English
Publication Type
Article
Keywords
Adult
Age Factors
Aged
Antihypertensive Agents - therapeutic use
Atrial Fibrillation - epidemiology
Cohort Studies
Diabetes Complications - mortality
Diabetes Mellitus - epidemiology
Female
Fibrinolytic Agents - therapeutic use
Follow-Up Studies
Humans
Hypertension - epidemiology
Male
Middle Aged
Mortality - trends
Myocardial Infarction - epidemiology
Prevalence
Proportional Hazards Models
Registries - statistics & numerical data
Risk factors
Sex Factors
Smoking - epidemiology
Stroke - complications - mortality
Survival Analysis
Sweden - epidemiology
Abstract
Diabetes is an established risk factor for stroke. Compared to nondiabetic patients, diabetic patients also have an increased risk of new vascular events and death after stroke. We analyzed how differences in long-term survival between diabetic and nondiabetic stroke patients have changed over time, and if differences varied with respect to sex and age.
This population-based study included 12,375 first-ever stroke patients, 25-74 years old, who were registered in the Northern Sweden MONICA Stroke Registry 1985-2005. Uniform diagnostic criteria for stroke case ascertainment were used throughout the study period. The diagnosis of diabetes was based on medical records or diabetes diagnosed during the acute stroke event. Patients were separated into four cohorts according to year of stroke and followed for survival until August 30, 2008.
The diabetes prevalence at stroke onset was 21%, similar in men and women, and remained stable throughout the study period. The diabetic patients were an average of 2 years older, more often nonsmokers and more likely to have antihypertensive treatment, antithrombotics, atrial fibrillation, and a history of myocardial infarction or transient ischemic attack than the nondiabetic patients. The total follow-up time was 86,086 patient-years during which a total of 1,930 (75.7%) of the diabetic patients and 5,744 (58.5%) of the nondiabetic patients died (p
PubMed ID
22907276 View in PubMed
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Incidence and predictors of post-stroke epilepsy.

https://arctichealth.org/en/permalink/ahliterature116439
Source
Acta Neurol Scand. 2013 Jun;127(6):427-30
Publication Type
Article
Date
Jun-2013
Author
Gerhard J Jungehulsing
Peter U Heuschmann
Martin Holtkamp
Stefan Schwab
Peter L Kolominsky-Rabas
Author Affiliation
Center for Stroke Research Berlin (CSB), Berlin, Germany. jan.jungehuelsing@charite.de
Source
Acta Neurol Scand. 2013 Jun;127(6):427-30
Date
Jun-2013
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Cohort Studies
Epilepsy - diagnosis - epidemiology
Female
Humans
Incidence
Male
Middle Aged
Risk factors
Scandinavia
Severity of Illness Index
Stroke - complications - mortality
Time Factors
Abstract
Stroke is the leading cause of seizures and epilepsy in the elderly. The aim of this study was to assess the incidence of post-stroke epilepsy (PSE) based on the revised epilepsy definition of the International League Against Epilepsy (ILAE) in a population-based study and to describe possible predictors.
Data from the prospective population-based Erlangen Stroke Project (ESPro) were collected to describe the frequency of PSE. Patients were followed up 3, 12, and 24 months after stroke. Stroke was diagnosed according to the WHO and PSE according to the new ILAE criteria. Multivariable analysis was performed to identify predictors of PSE including age, sex, stroke type, stroke severity, and comorbidities.
From 1998 to 2006, 1815 patients with first-ever stroke were included (55.7% women; mean age 72.7 years, SD 13). Patients with known (n = 52) or unknown (n = 331) prior-to-stroke epilepsy or no available information on post-stroke seizures (n = 412) were excluded. From the remaining 1020 patients, 84 (8.2%) developed PSE within 2 years after stroke. Univariate analysis demonstrated stroke severity (P
PubMed ID
23398544 View in PubMed
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Long-term survival after stroke: 30 years of follow-up in a cohort, the Copenhagen City Heart Study.

https://arctichealth.org/en/permalink/ahliterature98959
Source
Neuroepidemiology. 2009;33(3):254-60
Publication Type
Article
Date
2009
Author
Gudrun Boysen
Jacob Louis Marott
Morten Grønbaek
Houry Hassanpour
Thomas Truelsen
Author Affiliation
Department of Neurology, Bispebjerg Hospital, University of Copenhagen, DK-2400 Copenhagen, Denmark. gb01@bbh.regionh.dk
Source
Neuroepidemiology. 2009;33(3):254-60
Date
2009
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Cohort Studies
Denmark - epidemiology
Female
Follow-Up Studies
Heart Diseases - complications - mortality
Humans
Male
Middle Aged
Stroke - complications - mortality
Survival Rate - trends
Time Factors
Abstract
BACKGROUND AND PURPOSE: Only few have studied long-term survival after stroke. Such knowledge is essential for the evaluation of the current and future burden of stroke. The present study presents up to 30 years of follow-up of patients after a first-ever stroke. METHODS: Participants in the Copenhagen City Heart Study who experienced a first-ever stroke from 1978 to the end of 2001 were followed to the end of 2007. Stroke events were validated using the World Health Organization's definition of stroke. Linkage to the Danish Civil Registration System enabled identification of participants who died before the end of 2007. The National Register of Causes of Death provided cause of death. Survival in stroke patients was compared with survival in participants in the Copenhagen City Heart Study who did not suffer a stroke, and with survival in the general Danish population. Cox regression analyses adjusting for age and gender were used to compare survival in six consecutive 4-year periods starting with 1978-1982. RESULTS: Of 2,051 patients with first-ever stroke 1,801 died during follow-up. Causes of death were cerebrovascular disease in 37%, other cardiovascular diseases in 28%, cancer in 12%, and other causes in 23%. The most important determinant for long-term survival was age at time of stroke. In the 65- to 72-year age group 11% survived 15 years after stroke. In the age group
PubMed ID
19641331 View in PubMed
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Number of teeth as a predictor of cardiovascular mortality in a cohort of 7,674 subjects followed for 12 years.

https://arctichealth.org/en/permalink/ahliterature144607
Source
J Periodontol. 2010 Jun;81(6):870-6
Publication Type
Article
Date
Jun-2010
Author
Anders Holmlund
Gunnar Holm
Lars Lind
Author Affiliation
Department of Periodontology, County Hospital of Gävle-Sandviken, 801 87 Gävle, Sweden. anders.holmlund@lg.se
Source
J Periodontol. 2010 Jun;81(6):870-6
Date
Jun-2010
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Alveolar Bone Loss - complications - epidemiology
Cardiovascular Diseases - complications - mortality
Cause of Death
Coronary Disease - complications - mortality
Female
Follow-Up Studies
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Periodontal Index
Proportional Hazards Models
Prospective Studies
Questionnaires
Stroke - complications - mortality
Sweden - epidemiology
Tooth Loss - complications - epidemiology
Young Adult
Abstract
That oral health is related to the development of different cardiovascular disorders is reported in a number of studies. This study investigates if different parameters of oral health are associated with future mortality in different cardiovascular disorders in a dose-dependent manner.
A total of 7,674 subjects (3,300 males and 4,374 females; age range 20 to 89 years) received a dental examination by specialists in periodontology between the years 1976 and 2002. Number of remaining teeth, severity of periodontal disease, number of deepened periodontal pockets, and bleeding on probing were evaluated in relation to cause of death.
During a median follow-up period of 12 years, 629 of the subjects died. For 299 subjects the cause of mortality was cardiovascular disease (CVD); 167 of these subjects died from coronary heart disease (CHD); 83 died from stroke; and 49 died from aortic aneurysm or congestive heart failure. The causes of death for the remaining 330 subjects were other than CVD. After adjustment for age, gender, and smoking, number of remaining teeth predicted in a dose-dependent manner all-cause mortality and mortality in CVD and in CHD (P 25 teeth. Severity of periodontal disease, number of deepened periodontal pockets, and bleeding on probing were not related to mortality in a dose-dependent manner after adjustment for confounders.
This fairly large, prospective study with a long follow-up period presents for the first time a dose-dependent relationship between number of teeth and both all-cause and CVD mortality, indicating a link between oral health and CVD, and that the number of teeth is a proper indicator for oral health in this respect.
PubMed ID
20350152 View in PubMed
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Obstructive sleep apnea is a risk factor for death in patients with stroke: a 10-year follow-up.

https://arctichealth.org/en/permalink/ahliterature158864
Source
Arch Intern Med. 2008 Feb 11;168(3):297-301
Publication Type
Article
Date
Feb-11-2008
Author
Carin Sahlin
Olov Sandberg
Yngve Gustafson
Gösta Bucht
Bo Carlberg
Hans Stenlund
Karl A Franklin
Author Affiliation
Department of Respiratory Medicine, Umeå University Hospital, SE-901 85 Umeå, Sweden.
Source
Arch Intern Med. 2008 Feb 11;168(3):297-301
Date
Feb-11-2008
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Female
Follow-Up Studies
Humans
Male
Risk factors
Sleep Apnea, Obstructive - etiology - mortality
Stroke - complications - mortality
Survival Analysis
Abstract
Sleep apnea occurs frequently among patients with stroke, but it is still unknown whether a diagnosis of sleep apnea is an independent risk factor for mortality. We aimed to investigate whether obstructive or central sleep apnea was related to reduced long-term survival among patients with stroke.
Of 151 patients admitted for in-hospital stroke rehabilitation in the catchment area of Umeå from April 1, 1995, to May 1, 1997, 132 underwent overnight sleep apnea recordings at a mean (SD) of 23 (8) days after the onset of stroke. All patients were followed up prospectively for a mean (SD) of 10.0 (0.6) years, with death as the primary outcome; no one was lost to follow-up. Obstructive sleep apnea was defined when the obstructive apnea-hypopnea index was 15 or greater, and central sleep apnea was defined when the central apnea-hypopnea index was 15 or greater. Patients with obstructive and central apnea-hypopnea indexes of less than 15 served as control subjects.
Of 132 enrolled patients, 116 had died at follow-up. The risk of death was higher among the 23 patients with obstructive sleep apnea than controls (adjusted hazard ratio, 1.76; 95% confidence interval, 1.05-2.95; P = .03), independent of age, sex, body mass index, smoking, hypertension, diabetes mellitus, atrial fibrillation, Mini-Mental State Examination score, and Barthel index of activities of daily living. There was no difference in mortality between the 28 patients with central sleep apnea and controls (adjusted hazard ratio, 1.07; 95% confidence interval, 0.65-1.76; P = .80).
Patients with stroke and obstructive sleep apnea have an increased risk of early death. Central sleep apnea was not related to early death among the present patients.
PubMed ID
18268171 View in PubMed
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Post-stroke delirium in relation to dementia and long-term mortality.

https://arctichealth.org/en/permalink/ahliterature134607
Source
Int J Geriatr Psychiatry. 2012 Apr;27(4):401-8
Publication Type
Article
Date
Apr-2012
Author
Susanna Melkas
Jouko V Laurila
Risto Vataja
Niku Oksala
Hanna Jokinen
Tarja Pohjasvaara
Antero Leppävuori
Markku Kaste
Pekka J Karhunen
Timo Erkinjuntti
Author Affiliation
Department of Neurology, Helsinki University Central Hospital and Department of Neurological Sciences, University of Helsinki, Helsinki, Finland. susanna.melkas@hus.fi
Source
Int J Geriatr Psychiatry. 2012 Apr;27(4):401-8
Date
Apr-2012
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Cohort Studies
Delirium - epidemiology - etiology
Dementia - etiology
Educational Status
Female
Finland - epidemiology
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Proportional Hazards Models
Risk factors
Stroke - complications - mortality
Abstract
Delirium is a frequent post-stroke complication that compromises effective rehabilitation and has been associated with poor outcome. We aimed to investigate whether delirium is associated with increased risk of post-stroke dementia and long-term mortality once confounding is taken into account.
The study comprised 263 consecutive acute ischemic stroke patients aged 55-85 years admitted to the emergency department of a university hospital. The cohort included three-month survivors followed up for 10 years. The diagnosis of post-stroke delirium during the first 7 days after stroke was based on the DSM-IV criteria.
Of all the patients, 50 (19.0%) were diagnosed with delirium. Low education, pre-stroke cognitive decline, and severe stroke indicated by a Modified Rankin score between 3 and 5 were risk factors for post-stroke delirium, which was also associated with diagnosis of dementia at 3 months post-stroke. In the Kaplan-Meier analysis, delirium was associated with poor long-term survival (6.1 versus 9.1 years). In the stepwise Cox regression proportional hazards analysis adjusted for demographic factors and risk factors, advanced age (hazard ratio [HR] 1.08) and stroke severity (HR 1.83), but not post-stroke delirium, were associated with poor survival.
In our well-defined cohort of post-stroke patients, acute stage delirium was diagnosed in one in five patients and associated with dementia at 3 months. Advanced age and stroke severity were related to the higher long-term mortality among patients with post-stroke delirium.
PubMed ID
21560162 View in PubMed
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15 records – page 1 of 2.