Treatment for the secondary prevention of stroke in older patients: The influence of dementia status

OBJECTIVE: To investigate the influence of dementia status on treatment for the secondary prevention of stroke in older patients. DESIGN: Based on patient examinations and medical record review, we investi gated the frequency of aspirin and/or warfarin use at hospital discharge fo r the prevention of recurrent stroke in older patients hospitalized with ac ute ischemic stroke. SETTING: A Large academic medical center. PARTICIPANTS: A cohort of 272 patients, mean age 72.1 +/- 8.5 years. MEASUREMENTS: We performed neurologic examinations and reviewed medical rec ords to investigate the effects of a clinical diagnosis of dementia and oth er potentially relevant factors on treatment with aspirin or warfarin at ho spital discharge. RESULTS: Thirty-one patients (11.4%) were not prescribed aspirin or warfari n at hospital discharge. Logistic regression determined that dementia (odds ratio (OR) = 2.57, 95% confidence interval (CI), 1.04-6.30) was a signific ant-independent determinant of nontreatment with aspirin or warfarin, adjus ting for abnormal gait (OR = 2.01, CI, .88-4.59); discharge to a nursing ho me or other institutional residence (OR = 2.55, CI, .83-7.81); cardiac dise ase (OR = .39, CI, .16-.95); cortical infarct location (OR = .45, CI, .18-1 .10); male sex (OR = .47, CI, .20-1.15); age 80+ (OR = 1.14, CI, .46-2.82) and age 70-79 (OR = .96, CI, .32-2.88) versus age 60-69. CONCLUSIONS: Our results suggest that dementia is a significant independent determinant of nontreatment with aspirin or warfarin when other wise indic ated for the prevention of recurrent stroke. The underutilization of aspiri n and warfarin in older stroke patients with dementia may be a modifiable b asis for their increased risk of recurrence and death.