TY - JOUR
T1 - Pre-Stroke Cholinesterase Inhibitor Treatment Is Beneficially Associated with Functional Outcome in Patients with Acute Ischemic Stroke and Pre-Stroke Dementia
T2 - The Fukuoka Stroke Registry
AU - Wakisaka, Yoshinobu
AU - Matsuo, Ryu
AU - Nakamura, Kuniyuki
AU - Ago, Tetsuro
AU - Kamouchi, Masahiro
AU - Kitazono, Takanari
N1 - Funding Information:
Dr. Kamouchi has received honoraria from Mitsubishi Tanabe Pharma, Ono Pharmaceutical, Pfizer, Bayer, and Daiichi-Sankyo and fees for consulting from Daiichi-Sankyo. Dr. Kitazono has received grants from Takeda, Daiichi-Sankyo, Chugai Pharmaceutical, Astellas, Boehringer Ingelheim, MSD, Bristol-Myers Squibb, EA Pharma, Shionogi, Mitsubishi Tanabe Pharma, Eisai, Sanofi, Pfizer, Torii Pharmaceutical, Otsuka Pharmaceutical, Asahi Kasei Medical, Kissei, Zeria, Ono Pharmaceutical, Taisho Pharma, Tei-jin Pharma, Kyowa Kirin, Mochida Pharmaceutical, Eli Lilly, and honoraria from Daiichi-Sankyo, Bayer, and Chugai Pharmaceutical. The other authors have no conflicts of interest to declare.
Funding Information:
This study was supported by the Japan Society for the Promotion of Science (JSPS), KAKENHI, from the Japanese Ministry of Education, Culture, Sports, Science and Technology (Grant numbers 26293158, 17H04143, 18K09944, and 19K09530)
Publisher Copyright:
© 2021 S. Karger AG, Basel. Copyright: All rights reserved.
PY - 2021/7/1
Y1 - 2021/7/1
N2 - Introduction: Pre-stroke dementia is significantly associated with poor stroke outcome. Cholinesterase inhibitors (ChEIs) might reduce the risk of stroke in patients with dementia. However, the association between pre-stroke ChEI treatment and stroke outcome remains unresolved. Therefore, we aimed to determine this association in patients with acute ischemic stroke and pre-stroke dementia. Methods: We enrolled 805 patients with pre-stroke dementia among 13,167 with ischemic stroke within 7 days of onset who were registered in the Fukuoka Stroke Registry between June 2007 and May 2019 and were independent in basic activities of daily living (ADLs) before admission. Primary and secondary study outcomes were poor functional outcome (modified Rankin Scale [mRS] score: 3-6) at 3 months after stroke onset and neurological deterioration (≥2-point increase in the NIH Stroke Scale [NIHSS] during hospitalization), respectively. Logistic regression analysis was used to evaluate associations between pre-stroke ChEI treatment and study outcomes. To improve covariate imbalance, we further conducted a propensity score (PS)-matched cohort study. Results: Among the participants, 212 (26.3%) had pre-stroke ChEI treatment. Treatment was negatively associated with poor functional outcome (odds ratio: 0.68 [95% confidence interval: 0.46-0.99]) and neurological deterioration (0.52 [0.31-0.88]) after adjusting for potential confounding factors. In the PS-matched cohort study, the same trends were observed between pre-stroke ChEI treatment and poor functional outcome (0.61 [0.40-0.92]) and between the treatment and neurological deterioration (0.47 [0.25-0.86]). Conclusions: Our findings suggest that pre-stroke ChEI treatment is associated with reduced risks for poor functional outcome and neurological deterioration after acute ischemic stroke in patients with pre-stroke dementia who are independent in basic ADLs before the onset of stroke.
AB - Introduction: Pre-stroke dementia is significantly associated with poor stroke outcome. Cholinesterase inhibitors (ChEIs) might reduce the risk of stroke in patients with dementia. However, the association between pre-stroke ChEI treatment and stroke outcome remains unresolved. Therefore, we aimed to determine this association in patients with acute ischemic stroke and pre-stroke dementia. Methods: We enrolled 805 patients with pre-stroke dementia among 13,167 with ischemic stroke within 7 days of onset who were registered in the Fukuoka Stroke Registry between June 2007 and May 2019 and were independent in basic activities of daily living (ADLs) before admission. Primary and secondary study outcomes were poor functional outcome (modified Rankin Scale [mRS] score: 3-6) at 3 months after stroke onset and neurological deterioration (≥2-point increase in the NIH Stroke Scale [NIHSS] during hospitalization), respectively. Logistic regression analysis was used to evaluate associations between pre-stroke ChEI treatment and study outcomes. To improve covariate imbalance, we further conducted a propensity score (PS)-matched cohort study. Results: Among the participants, 212 (26.3%) had pre-stroke ChEI treatment. Treatment was negatively associated with poor functional outcome (odds ratio: 0.68 [95% confidence interval: 0.46-0.99]) and neurological deterioration (0.52 [0.31-0.88]) after adjusting for potential confounding factors. In the PS-matched cohort study, the same trends were observed between pre-stroke ChEI treatment and poor functional outcome (0.61 [0.40-0.92]) and between the treatment and neurological deterioration (0.47 [0.25-0.86]). Conclusions: Our findings suggest that pre-stroke ChEI treatment is associated with reduced risks for poor functional outcome and neurological deterioration after acute ischemic stroke in patients with pre-stroke dementia who are independent in basic ADLs before the onset of stroke.
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U2 - 10.1159/000514368
DO - 10.1159/000514368
M3 - Article
C2 - 33744892
AN - SCOPUS:85103398082
SN - 1015-9770
VL - 50
SP - 390
EP - 396
JO - Cerebrovascular Diseases
JF - Cerebrovascular Diseases
IS - 4
ER -