Diagnostic procedures in ischaemic stroke patients with dementia. a population-based study

Authors

  • Yannick Béjot,

    Corresponding author
    1. Dijon Stroke Registry, EA4184, Department of Neurology, Medical School, University Hospital of Dijon, University of Burgundy, Dijon, France
    2. Centre Mémoire, Ressources et Recherche, Memory Clinic, University Hospital of Dijon, Dijon, France
    • Correspondence: Yannick Béjot, Dijon Stroke Registry, Service de Neurologie, Hôpital Général, 3 Rue du Faubourg Raines, 21033 Dijon, France.

      E-mail: ybejot@yahoo.fr

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  • Agnès Jacquin,

    1. Dijon Stroke Registry, EA4184, Department of Neurology, Medical School, University Hospital of Dijon, University of Burgundy, Dijon, France
    2. Centre Mémoire, Ressources et Recherche, Memory Clinic, University Hospital of Dijon, Dijon, France
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  • Odile Troisgros,

    1. Department of Rehabilitation, University Hospital of Dijon, Dijon, France
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  • Olivier Rouaud,

    1. Dijon Stroke Registry, EA4184, Department of Neurology, Medical School, University Hospital of Dijon, University of Burgundy, Dijon, France
    2. Centre Mémoire, Ressources et Recherche, Memory Clinic, University Hospital of Dijon, Dijon, France
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  • Corine Aboa-Eboulé,

    1. Dijon Stroke Registry, EA4184, Department of Neurology, Medical School, University Hospital of Dijon, University of Burgundy, Dijon, France
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  • Marie Hervieu,

    1. Dijon Stroke Registry, EA4184, Department of Neurology, Medical School, University Hospital of Dijon, University of Burgundy, Dijon, France
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  • Guy-Victor Osseby,

    1. Dijon Stroke Registry, EA4184, Department of Neurology, Medical School, University Hospital of Dijon, University of Burgundy, Dijon, France
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  • Maurice Giroud

    1. Dijon Stroke Registry, EA4184, Department of Neurology, Medical School, University Hospital of Dijon, University of Burgundy, Dijon, France
    2. Centre Mémoire, Ressources et Recherche, Memory Clinic, University Hospital of Dijon, Dijon, France
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  • Conflict of interest: None declared.
  • Funding: The Dijon Stroke Registry is supported by the French Institute for Public Health Surveillance (InVS) and Inserm. Y. B. received financial support from the ‘Journées Neurologiques de Langue Française’ and the Regional Council of Burgundy.

Abstract

Background

Dementia is a frequent condition in stroke patients.

Aims

To investigate the effect of dementia on access to diagnostic procedures in ischaemic stroke patients.

Methods

All cases of ischaemic stroke from 2006 to 2010 were identified from the population-based Stroke Registry of Dijon, France. Patients' characteristics were recorded, as was the use of brain computed tomography scans, brain magnetic resonance imaging, electrocardiogram, echocardiography, and Doppler ultrasonography of the cervical arteries. Dementia was diagnosed according to Diagnostic and Statistical Manual of Mental Disorders-IV criteria. Logistic regression models were used to evaluate the associations between dementia and the use of the diagnostic procedures.

Results

Of the 907 patients recorded, 104 were excluded because of death and inability to test cognition. Among the remaining 803 patients, 149 (18·5%) had dementia. Almost all of the patients underwent a brain computed tomography scan and an electrocardiogram during their stay. In contrast, the use of both Doppler ultrasonography of the cervical arteries (79·2% versus 90·2%, P < 0·001), echocardiography (32·9% versus 43·6%, P = 0·02), and brain magnetic resonance imaging (21·5% versus 34·4%, P < 0·001) were significantly lower in stroke patients with dementia than in those without. In multivariate logistic regression, dementia was associated with a lower use of both Doppler ultrasonography (odds ratio = 0·49; 95% confidence interval: 0·29–0·81, P = 0·005), echocardiography (odds ratio = 0·57; 95% confidence interval: 0·37–0·89, P = 0·012), brain magnetic resonance imaging (odds ratio = 0·55; 95% confidence interval: 0·34–0·89, P = 0·015), and a comprehensive assessment (odds ratio = 0·62; 95% confidence interval: 0·40–0·96, P = 0·033).

Conclusion

Demented patients were less likely to undergo diagnostic procedures after ischaemic stroke. Further studies are needed to determine whether this lower utilization could account for the reported excess in recurrent events in these patients.

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