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. 2020 Aug 21:12:907-916.
doi: 10.2147/CLEP.S260243. eCollection 2020.

Association Between Common Infections and Incident Post-Stroke Dementia: A Cohort Study Using the Clinical Practice Research Datalink

Caroline E Morton  1   2 , Harriet J Forbes  1 , Neil Pearce  3 , Liam Smeeth  1 , Charlotte Warren-Gash  1
Affiliations

Association Between Common Infections and Incident Post-Stroke Dementia: A Cohort Study Using the Clinical Practice Research Datalink

Caroline E Morton et al. Clin Epidemiol. .

Abstract

Purpose: To investigate the association between common infections and post-stroke dementia in a UK population-based cohort.

Materials and methods: A total of 60,392 stroke survivors (51.2% male, median age 74.3 years, IQR 63.9-82.4 years) were identified using primary care records from the Clinical Practice Research Datalink (CPRD) linked to Hospital Episode Statistics (HES) with no history of dementia. Primary exposure was any GP-recorded infection (lower respiratory tract infection (LRTI), urinary tract infection (UTI) requiring antibiotics, skin and soft tissue infection requiring antibiotics) occurring after stroke. The primary outcome was incident all-cause dementia recorded in primary care records. In sensitivity analyses, we restricted to individuals with linked hospital records and expanded definitions to include ICD-10 coded hospital admissions. We used multivariable Cox regression to investigate the association between common infections and dementia occurring from 3 months to 5 years after stroke.

Results: Of 60,392 stroke survivors, 20,969 (34.7%) experienced at least one infection and overall 4512 (7.5%) developed dementia during follow-up. Early dementia (3 months to 1-year post-stroke) risk was increased in those with at least one GP-recorded infection (HR 1.44, 95% CI 1.21-1.71), with stronger associations when hospitalised infections were included (HR 1.84, 95% CI 1.58-2.14). Late dementia (1-5 years) was only associated with hospitalised, but not with GP-recorded, infections.

Conclusion: There was evidence of an association between common infections and post-stroke dementia, strongest in the 3-12 months following stroke. Better understanding of this relationship could help inform knowledge of pathways to dementia post-stroke and targeting of preventive interventions.

Keywords: cohort study; electronic health records; infections; post-stroke dementia.

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Conflict of interest statement

Charlotte Warren-Gash reports grants from Wellcome during the conduct of the study. This work was supported by a Wellcome Intermediate Clinical Fellowship to CWG (201440_Z_16_Z). The authors report no other potential conflicts of interest for this work.

Figures

Figure 1
Figure 1
Flowchart of study participants.
See this image and copyright information in PMC

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