• M Pasquini, D Leys, M Rousseaux, F Pasquier, and H Hénon.
• Department of Neurology (Stroke Unit), Lille University Hospital, Lille, France.
• J. Neurol. Neurosurg. Psychiatr. 2007 Jan 1; 78 (1): 565956-9.

Background And PurposePre-existing cognitive decline and new-onset dementia are common in patients with stroke, but their influence on institutionalisation rates is unknown.ObjectiveTo evaluate the influence of cognitive impairment on the institutionalisation rate 3 years after a stroke.Design(1) The previous cognitive state of 192 consecutive patients with stroke living at home before the stroke (with the Informant Questionnaire on COgnitive Decline in the Elderly (IQCODE)), (2) new-onset dementia occurring within 3 years and (3) institutionalisation rates within 3 years in the 165 patients who were discharged alive after the acute stage were prospectively evaluated.ResultsIndependent predictors of institutionalisation over a 3-year period that were available at admission were age (adjusted odds ratio (adjOR) for 1-year increase = 1.08; 95% confidence interval (CI) 1.03 to 1.15), severity of the neurological deficit (adjOR for 1-point increase in Orgogozo score = 0.97; 95% CI 0.96 to 0.99) and severity of cognitive impairment (adjOR for 1-point increase in IQCODE score = 1.03; 95% CI 1 to 1.06). Factors associated with institutionalisation at 3 years that were present at admission or occurred during the follow-up were age (adjOR for 1-year increase = 1.17; 95% CI 1.07 to 1.27) and any (pre-existing or new) dementia (adjOR = 5.85; 95% CI 1.59 to 21.59), but not the severity of the deficit of the neurological deficit.ConclusionAge and cognitive impairment are more important predictors of institutionalisation 3 years after a stroke than the severity of the physical disability.

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