Abstract TP208: Pre-Existing Dementia Should Not Be Independently Associated Short-Term Functional Outcome in Patients With Acute Ischemic Stroke: A Sub-Analysis of the PASTA Registry Study

Abstract

Background: The aging of the population is associated with an increasing number of stroke patients with pre-existing dementia. However, the association between pre-stroke dementia and functional outcome after acute ischemic stroke (AIS) has not been fully investigated. We aimed to investigate the association between PED and functional outcome in patients with AIS. Methods: We conducted a sub-analysis of the PASTA registry, an observational, multicenter registry of 1,043 patients with stroke receiving oral anticoagulants in Japan, by including patients with AIS with atrial fibrillation (AF). PED was defined as any type of dementia that was present prior to the index stroke. Poor outcome was defined as a modified Rankin Scale (mRS) score of 3-5 or death (mRS score 6). We compared the clinical characteristics and the rate of recanalization therapy between PED and non-PED and determined the effect of PED on stroke outcome. Results: Of all 493 participants (median age, 80 years; 212, 43.0% women), 86 (17.4%) had PED. PED were older (P<0.001), had a higher prevalence of congestive heart failure (P<0.001), a greater severity at onset and upon discharge compared to those with non-PED (P=0.0015 and P<0.001, respectively). Although the rate of rtPA was higher in patients with PED than those with non-PED (P=0.0398), there was no significant difference of the rate of mechanical thrombectomy (MT) and rtPA with MT (P>0.05) and intracerebral hemorrhage between PED and non-PED groups (Both P>0.05). The frequencies of poor functional outcome were significantly higher in patients with PED than in those without PED (80.2 vs. 57.0%, P < 0.0001). In multivariable analyses, age [odds ratio (OR) 1.05, 95% confidence interval (CI) 1.00-1.09, P=0.0318], pre-stroke mRS (OR; 2.05, 95% CI 1.61-2.67, P<0.001), initial National Institutes of Health Stroke Scale score (OR; 1.21, 95% CI 1.16-1.27, P<0.001) and parenchymal hematoma type1/2 (OR; 5.35, 95% CI 1.15-24.88, P=0.0323), but not PED (OR; 1.74, 95% CI 0.76-3.98, P=0.1919), were associated with poor functional outcome. Conclusions: PED is not independently associated with poor functional outcome upon discharge after adjustment for baseline characteristics, pre-stroke dependency, initial stroke severity or stroke management.