Functional outcome of elderly survivors of ischemic stroke: a retrospective study comparing nonhypercholesterolemic and hypercholesterolemic patients.

BACKGROUND: Total cholesterol is significantly associated with increased risk of ischemic stroke. Patients with ischemic stroke and high cholesterol levels may show better functional outcome after rehabilitation. OBJECTIVES: To study the possible interrelations between hypercholesterolemia and functional outcome in elderly survivors of ischemic stroke. METHODS: We conducted a retrospective chart review study of consecutive patients (age > or = 60 years) with acute stroke admitted to a geriatric rehabilitation ward in a university-affiliated hospital. The presence or absence of hypercholesterolemia was based on registry data positive for hypercholesterolemia, defined as total cholesterol > or = 200 mg/dl (5.17 mmol/L). Functional outcome of patients with hypercholesterolemia (Hchol) and without (NHchol) was assessed by the Functional Independence Measurement scale (FIM) at admission and discharge. Data were analyzed by t-test and chi-square test, as well as linear regression analysis. RESULTS: The complete data for 551 patients (age range 60-96 years) were available for final analysis; 26.7% were diagnosed as having hypercholesterolemia. Admission total FIM scores were significantly higher in patients with Hchol (72.1 +/- 24.8) compared with NHchol patients (62.2 +/- 24.7) (P < 0.001). A similar difference was found at discharge (Hchol 90.8 +/- 27.9 vs. NHchol 79.7 +/- 29.2, P < 0.001). However, total FIM change upon discharge was similar in both groups (18.7 +/- 13.7 vs. 17.6 +/- 13.7, P = 0.4). Regression analyses showed that high Mini Mental State Examination scores (beta = 0.13, P = 0.01) and younger age (beta = -0.12, P = 0.02) were associated with higher total FIM change scores upon discharge. Total cholesterol was not associated with better total FIM change on discharge (beta = -0.012, P = 0.82). CONCLUSIONS: Elderly survivors of stroke with Hchol who were admitted for rehabilitation showed higher admission and discharge FIM scores but similar functional FIM gains as compared to NHchol patients. High cholesterol levels may be useful in identifying older individuals with a better rehabilitation potential.

Elevated blood urea, independent of glomerular filtration rate (GFR), confers increased risk of adverse functional outcome in elderly hip fracture patients.

This retrospective cohort study investigated the possible interrelations of GFR and functional outcome in elderly hip fracture patients. The final analyses comprised 499 consecutive patients undergoing standard medical, surgical and rehabilitation treatment in an orthogeriatric unit of a tertiary care hospital. Functional outcomes were assessed by Functional Independence Measurement (FIM™) scores. Kidney function was assessed by blood urea and creatinine, as well as by GFR according to the modification diet of renal disease study (MDRDS) formula. Mean age was 83.60 ± 5.14 and mean GFR 61.07 ± 17.22 ml/min. GFR was <60 ml/min in 91.8% out of all patients. FIM admission and discharge scores, and gains, were not associated with GFR values, except for discharge motor FIM which was significantly higher in patients with GFR greater than 30 ml/min (p = 0.043). In regression analysis, GFR was associated with motor FIM at discharge (ß = 0.028, p = 0.022). Neither GFR nor creatinine was associated with discharge total FIM. In contrast, lower admission urea levels were predictive of higher motor (correlation coefficient (CC) = 0.151, odds ratio (OR) 0.132, 95% confidence interval (CI) = 0.027-0.237, p = 0.013) and total FIM scores (CC = -0.022, OR = 0.978, 95%CI = 0.960-0.997, p = 0.022) at discharge. We suggest that GFR and creatinine are poorly associated with functional outcome. Instead, urea is more likely to predict functional outcome, and may serve as more reliable biomarker for the prognostication of functional outcome.

Atrial fibrillation predicts cognitive impairment in patients with ischemic stroke.

BACKGROUND: Atrial fibrillation (AF) is considered as a risk factor for cognitive impairment. METHODS: This retrospective chart review study was conducted in a patient stroke rehabilitation ward of a university-affiliated referral hospital. The participants were 707 patients admitted for a standard rehabilitation course after an ischemic stroke. Cognitive status was assessed by the Mini-Mental State Examination (MMSE), and scores lower than 24 points were considered as suggestive of cognitive impairment. RESULTS: Atrial fibrillation, age, gender, diabetes, and dementia emerged as the only statistically significant parameters differing between those with MMSE score lower than 24 or higher. In a multiple logistic regression analysis, AF (odds ratio 1.6, 95% confidence interval 1.03-2.47, P = .03) was associated with an increased risk of cognitive impairment. CONCLUSIONS: Our findings suggest that atrial fibrillation upon admission is independently associated with lower MMSE scores in patients with ischemic stroke.