Dementia people with stroke more likely to become disabled and not return home

New research shows people with dementia who have a stroke are more likely to become disabled and not return home compared to people who didn't have dementia at the time they had a stroke. The study is published in the November 1, 2011, issue of Neurology®, the medical journal of the American Academy of Neurology.

"Our findings represent a growing challenge for the health care system as baby boomers age and their risk of stroke and dementia increases," said lead study author Gustavo Saposnik, MD, MSc, of the University of Toronto in Canada and member of the American Academy of Neurology.

The study involved 9,304 people who had a stroke between 2003 and 2008. Of the group, 702 people had dementia at the time they had a stroke.

Researchers found the people with dementia who had a stroke were three times more likely to have greater disability at discharge from the hospital compared to people without dementia who had a stroke, with 81 percent of those with dementia having moderate to severe disability compared to 57 percent of those without dementia. In addition, only 24 percent of the people in the dementia group returned to the place they lived prior to the stroke compared to 45 percent of people without dementia.

People with dementia were also more likely to have severe stroke and an abnormal heart rhythm and less likely to receive tPA, a clot-busting drug used to treat stroke.

"How to best manage stroke patients with pre-existing dementia is under debate and raises several diagnostic, management and ethical issues as some facilities may limit access to specialized stroke care for dementia patients unless the care is likely to improve outcomes," said Saposnik. "The lack of established guidelines for the management and treatment of stroke patients with dementia contributes to this uncertainty." Another study is underway to determine whether dementia or other comorbid conditions (e.g. hypertension, diabetes, atrial fibrillation, smoking) are responsible for the observed outcomes.