Background and purpose: Prestroke dementia is frequent but usually not identified. Non-valvular atrial fibrillation (NVAF)is independently associated with an increased risk for dementia. However, the frequency and det...Background and purpose: Prestroke dementia is frequent but usually not identified. Non-valvular atrial fibrillation (NVAF)is independently associated with an increased risk for dementia. However, the frequency and determinants of prestroke dementia in patients with NVAF have never been evaluated. Objective: The aim of this study was to determine the frequency of prestroke dementia and associated factors in patients with a previously known NVAF. Methods: This is an ancillary study of Stroke in Atrial Fibrillation Ensemble II (SAFE II), an observational study conducted in patients with a previously known NVAF, consecutively admitted for an acute stroke in French and Italian centers. Prestroke dementia was evaluated by the IQCODE in patients with a reliable informant. Patients were considered as demented before stroke when their IQCODE score was ≥ 104. Results: of 204 patients, 39 (19.1 % ; 95 % confidence interval [CI]: 13.7 % - 24.5 % ) patients met criteria for prestroke dementia. The only variable independently associated with prestroke dementia was increasing age (adjusted odds ratio for 1 year increase in age: 1.10; 95 % CI: 1.04- 1.17), and there was a non-significant tendency for previous ischemic stroke or TIA and arterial hypertension. Conclusion: One fifth of stroke patients with a previously known NVAF were already demented before stroke. The main determinant of prestroke dementia is increasing age. A large cohort is necessary to identify other determinants.展开更多
Background and Abstract:Objective: An optimal management of vascular risk factors, associated with antithrombotic drugs and carotid surgery when appropriate, reduces the risk of a new vascular event after stroke. Alth...Background and Abstract:Objective: An optimal management of vascular risk factors, associated with antithrombotic drugs and carotid surgery when appropriate, reduces the risk of a new vascular event after stroke. Although secondary prevention is not optimal in many patients in practice, the question of whether there is an improvement over time remains unanswered. The aim of our study was to test the hypothesis that secondary prevention measures after cerebral ischemia improve over time. Method: We included 123 consecutive patients in 1994, and 125 consecutive patients in 2002, who were admitted to a neurological department for any reason and had had an episode of cerebral ischemia less than 6 years earlier. We compared the groups for the management of arterial hypertension, hypercholesterolemia, diabetes mellitus and smoking. We recorded the values of blood pressure, biological parameters, and presence of antithrombotic therapy, lipid- lowering and anti- hypertensive drugs. Whether patients were properly treated or not, was determined by a comparison between their current treatment and guidelines available when recruited. Results: Prevention was not optimal in 96 of 123 (78% ) patients in 1994, and in 77 of 125 (62% ) in 2002. Vascular risk factors were better identified and managed in 2002 than in 1994, especially for hypercholesterolemia. Antithrombotic therapies, statins and anti- hypertensive drugs, except calcium channel blockers, were more often used in 2002. The proportion of patients in whom arterial hypertension and hypercholesterolemia were identified was higher in 2002, but the proportion of patients identified as diabetics remained stable. However, the proportion of patients with blood pressure > 140/90 mmHg, glycemia ≥ 126 mg/dl, total cholesterol level ≥ 240 mg/dl, or being current smokers, were significantly lower in 2002 than in 1994. Conclusion: Although most of patients with previous cerebral ischemia did not receive an optimal management of their risk factors in 2002, there was an improvement over an 8- year period.展开更多
文摘Background and purpose: Prestroke dementia is frequent but usually not identified. Non-valvular atrial fibrillation (NVAF)is independently associated with an increased risk for dementia. However, the frequency and determinants of prestroke dementia in patients with NVAF have never been evaluated. Objective: The aim of this study was to determine the frequency of prestroke dementia and associated factors in patients with a previously known NVAF. Methods: This is an ancillary study of Stroke in Atrial Fibrillation Ensemble II (SAFE II), an observational study conducted in patients with a previously known NVAF, consecutively admitted for an acute stroke in French and Italian centers. Prestroke dementia was evaluated by the IQCODE in patients with a reliable informant. Patients were considered as demented before stroke when their IQCODE score was ≥ 104. Results: of 204 patients, 39 (19.1 % ; 95 % confidence interval [CI]: 13.7 % - 24.5 % ) patients met criteria for prestroke dementia. The only variable independently associated with prestroke dementia was increasing age (adjusted odds ratio for 1 year increase in age: 1.10; 95 % CI: 1.04- 1.17), and there was a non-significant tendency for previous ischemic stroke or TIA and arterial hypertension. Conclusion: One fifth of stroke patients with a previously known NVAF were already demented before stroke. The main determinant of prestroke dementia is increasing age. A large cohort is necessary to identify other determinants.
文摘Background and Abstract:Objective: An optimal management of vascular risk factors, associated with antithrombotic drugs and carotid surgery when appropriate, reduces the risk of a new vascular event after stroke. Although secondary prevention is not optimal in many patients in practice, the question of whether there is an improvement over time remains unanswered. The aim of our study was to test the hypothesis that secondary prevention measures after cerebral ischemia improve over time. Method: We included 123 consecutive patients in 1994, and 125 consecutive patients in 2002, who were admitted to a neurological department for any reason and had had an episode of cerebral ischemia less than 6 years earlier. We compared the groups for the management of arterial hypertension, hypercholesterolemia, diabetes mellitus and smoking. We recorded the values of blood pressure, biological parameters, and presence of antithrombotic therapy, lipid- lowering and anti- hypertensive drugs. Whether patients were properly treated or not, was determined by a comparison between their current treatment and guidelines available when recruited. Results: Prevention was not optimal in 96 of 123 (78% ) patients in 1994, and in 77 of 125 (62% ) in 2002. Vascular risk factors were better identified and managed in 2002 than in 1994, especially for hypercholesterolemia. Antithrombotic therapies, statins and anti- hypertensive drugs, except calcium channel blockers, were more often used in 2002. The proportion of patients in whom arterial hypertension and hypercholesterolemia were identified was higher in 2002, but the proportion of patients identified as diabetics remained stable. However, the proportion of patients with blood pressure > 140/90 mmHg, glycemia ≥ 126 mg/dl, total cholesterol level ≥ 240 mg/dl, or being current smokers, were significantly lower in 2002 than in 1994. Conclusion: Although most of patients with previous cerebral ischemia did not receive an optimal management of their risk factors in 2002, there was an improvement over an 8- year period.
