Impact of Dementia on Outcomes in Patients with Acute Ischemic Stroke: A Cross-Sectional Study of 420,375 Hospitalizations

Abstract

Objective: Analysis of the National Inpatient Sample (NIS) database to evaluate whether patients with dementia were managed with reperfusion therapy, intravascular thrombolysis (IVT) and endovascular thrombectomy (EVT), at lower rates than patients without dementia and determine if this influenced outcomes.

Methods: A retrospective cross-sectional study was conducted using the NIS between 2015 and 2022. We included patients ≥ 18 years-old with AIS and dementia. Primary outcomes were odds of routine discharge, inpatient mortality, and efficacy of endovascular thrombectomy (EVT) and intravascular thrombolysis (IVT).

Results: Patients with dementia and AIS (n = 420,375) had significantly higher NIHSS scores (p < 0.001) and longer length of stay (p < 0.001). They were also less likely to receive EVT (aOR: 0.402, p < 0.001) and less likely to receive IVT (aOR: 0.742. p < 0.001). Patients with dementia and AIS treated with EVT were less likely to undergo routine discharge (aOR: 0.673, p < 0.001) and more likely to suffer inpatient mortality (aOR: 1.68, p < 0.001). Patients with both diagnoses treated with IVT were more likely to undergo routine discharge (aOR: 1.20, p < 0.001) and suffer inpatient mortality (aOR: 1.27, p < 0.001).

Conclusions: Patients with dementia and AIS were 25% less likely to receive IVT and 60% less likely to receive EVT despite their greater stroke severity. Use of EVT and IVT was associated with increased mortality rates in patients with dementia and AIS. At the same time, use of IVT was associated with significantly increased rates of routine discharge in this population. These discrepancies highlight the need to balance the risks and benefits of thrombolytic therapy for each dementia patient.

Keywords: Acute ischemic stroke; Dementia; Endovascular thrombectomy; Intravascular thrombolysis.