Influence of Preexisting Cognitive Impairment on Clinical Severity of Ischemic Stroke: The Dijon Stroke Registry.

Background and Purpose- The ongoing ageing population is associated with an increasing number of patients with stroke who have preexisting cognitive impairment. This study aimed to evaluate clinical severity in patients with ischemic stroke according to prestroke cognitive status. Methods- Patients with ischemic stroke were prospectively identified among residents of Dijon, France using a population-based registry (2013-2017). Prestroke cognitive status (no impairment, mild cognitive impairment [MCI], or dementia) was recorded, and severity at stroke onset was measured using the National Institutes of Health Stroke Scale (NIHSS) score. Association between prestroke cognitive status and severity was evaluated using ordinal regression analysis models in which the NIHSS score was considered as a categorical variable. Results- Among the 1048 patients (mean age, 76.3±15.2 years; 54.0% women), a greater severity was observed in those with MCI (n=132; median NIHSS: 6; interquartile range, 2-15), and those with dementia (n=164; median NIHSS: 7; interquartile range, 3-16), than in patients without cognitive impairment (n=752; median NIHSS: 3; interquartile range, 1-9). MCI (odds ratio [OR], 1.70 [95% CI, 1.21-2.38]; P=0.002) and dementia (OR, 2.24 [95% CI, 1.65-3.04]; P<0.001) were both associated with a greater severity at onset. The association was still observed after adjustment for clinical variables and proximal arterial occlusion (OR, 1.52 [95% CI, 1.02-2.28]; P=0.04 for MCI; OR, 2.16 [95% CI, 1.45-3.22]; P<0.001 dementia). Further adjustment for prestroke handicap slightly reduced the magnitude of the association (OR, 1.49 [95% CI, 0.98-2.25]; P=0.06 for MCI, and OR, 1.98 [95% CI, 1.26-3.12]; P=0.02 for dementia). The greater severity in patients with prestroke cognitive impairment was not specifically driven by a more severe impairment of either motor or language function. Conclusions- Patients with preexisting cognitive impairment suffered more severe ischemic stroke. This result could reflect a lower brain tolerance of acute ischemia. Further studies are needed to explore the underlying mechanisms that could be targeted from therapeutic perspectives focusing on neuroprotection.

Long-Term Relative Survival after Stroke: The Dijon Stroke Registry.

OBJECTIVE: The aim of this study was to assess long-term survival after stroke and to compare survival profiles of patients according to stroke subtypes, age, and sex, using relative survival (RS) method. METHODS: All patients with a first-ever stroke were prospectively recorded in the population-based Dijon Stroke Registry from 1987 to 2016. RS is the survival that would be observed if stroke was the only cause of death. Ten-year RS was estimated using a flexible parametric model of the cumulative excess mortality rate, which was obtained by matching the observed all-cause mortality in the stroke cohort to the expected mortality in the general population. A separate model was fitted for each stroke subtypes, first fitted for each age and sex separately, and then adjusted for age and sex. RESULTS: In total, 5,259 patients (mean age 74.9 ± 14.3 years, 53% women) were recorded including 4,469 ischemic strokes (IS), 655 intracerebral hemorrhages (ICH), and 135 undetermined strokes. In IS patients, unadjusted RS was 82% at 1 year and decreased to 62% at 10 years. Adjusted RS showed a lower survival in older age groups (p < 0.001), but no difference between men and women (p = 0.119). In ICH patients, unadjusted RS was 56 and 42% at 1 and 10 years, respectively, with a lower adjusted survival in older age groups (p < 0.001), but no sex differences (p = 0.184). CONCLUSION: This study showed that RS after stroke is lower in older than in younger patients but without significant sex differences, and survival profiles differ according to stroke subtypes. Since RS allows a better estimation of stroke-related death than observed survival does, especially in old patients, such a method is adapted to provide reliable information when considering long-term outcome.

Impact of the Ageing Population on the Burden of Stroke: The Dijon Stroke Registry.

BACKGROUND: We aimed to evaluate the impact of the ageing population on temporal trends in burden of stroke and to provide projections for the coming years. METHODS: Stroke cases (ischemic strokes, spontaneous intracerebral hemorrhages, or undetermined strokes) were prospectively identified between 1987 and 2015 in Dijon, France, using a population-based registry. Age-standardized incidence rates of first-ever and recurrent stroke were calculated, and their temporal trends were assessed using age- and sex-adjusted annual incidence rate ratios (RR). RESULTS: The population of Dijon increased by 3.8% over time, with an increase by 28% in the number of residents aged ≥75 years. We recorded 5,899 strokes including 5,101 patients with a first-ever event. Incidence of first-ever stroke was stable both in people < 75 and ≥75 years old, but an increase in standardized incidence rates of total strokes was noted due to a rise in the incidence of recurrent stroke (from 4.7/100,000/year in 1987-1994 to 12.3/100,000/year in 2009-2015 in people < 75 years old, RR 1.036; p < 0.001; from 74/100,000/year in 1987-1994 to 200/100,000/year in 2009-2015 in people ≥75 years, RR 1.040; p < 0.001). The absolute number of first-ever strokes increased by 43%, and that of total stroke events rose by 58% over time, with a more pronounced increase in people ≥75 years old (+47 and +65% respectively). The annual number of patients who survived > 90 days after a first-ever stroke increased by 90%. According to demographic projections, the total number of strokes will increase by 55% (+65% patients ≥75 years, and +25% patients < 75 years) by 2,030 in Dijon. CONCLUSIONS: Ageing and growth of the population led to a rise in the absolute number of strokes, especially in the elderly, that is expected to increase dramatically in the coming years. Improved stroke care was accompanied with an increase in stroke survivors that contributed to a rise in recurrent events. Urgent action is needed to meet this epidemiological challenge.

Increasing Burden of Stroke: The Dijon Stroke Registry (1987-2012).

BACKGROUND: We aimed to provide a representation of the global burden of stroke. METHODS: All cases of stroke were prospectively identified through the population-based registry of Dijon, France (1987-2012). Attack rates and mortality rates (defined as stroke leading to death within 30 days) were standardized to the European standard. Sex differences and temporal trends were evaluated by calculating rate ratios (RRs). RESULTS: In all, 5,285 stroke cases (52.7% women) were recorded. The standardized attack rate was 98.2/100,000/year and the mortality rate was 12/100,000/year, and both were lower in women than in men (RR 0.67, p < 0.001, and RR 0.70, p < 0.001, respectively). Attack rates increased over time (RR 1.016; 95% CI 1.013-1.020) irrespective of the stroke subtype. In contrast, mortality rates declined (RR 0.985; 95% CI 0.976-0.995) with decreasing rates for ischemic stroke but no change for intracerebral hemorrhage and subarachnoid hemorrhage. The sex gap in both attack and mortality rates remained stable. Between the first (1987-1991) and the last (2007-2012) study periods, the annual number of stroke patients who survived beyond 30 days rose by 55%, Conclusions: Increasing attack rates and decreasing mortality have led to a rise in the number of stroke survivors in the population, thus indicating a growing need for the implementation of dedicated services.

Temporal Trends in Sex Differences With Regard to Stroke Incidence: The Dijon Stroke Registry (1987-2012).

BACKGROUND AND PURPOSE: We evaluated temporal trends in stroke incidence between men and women to determine whether changes in the distribution of vascular risk factors have influenced sex differences in stroke epidemiology. METHODS: Patients with first-ever stroke including ischemic stroke, spontaneous intracerebral hemorrhage, subarachnoid hemorrhage, and undetermined stroke between 1987 and 2012 were identified through the population-based registry of Dijon, France. Incidence rates were calculated for age groups, sex, and stroke subtypes. Sex differences and temporal trends (according to 5-year time periods) were evaluated by calculating incidence rate ratios (IRRs) with Poisson regression. RESULTS: Four thousand six hundred and fourteen patients with a first-ever stroke (53.1% women) were recorded. Incidence was lower in women than in men (112 versus 166 per 100 000/y; IRR, 0.68; P<0.001), especially in age group 45 to 84 years, and for both ischemic stroke and intracerebral hemorrhage. From 1987 to 2012, the lower incidence of overall stroke in women was stable (IRR ranging between 0.63 and 0.72 according to study periods). When considering stroke subtype, a slight increase in the incidence of ischemic stroke was observed in both men (IRR, 1.011; 95% confidence interval, 1.005-1.016; P=0.001) and women (IRR, 1.013; 95% confidence interval, 1.007-1.018; P=0.001). The sex gap in incidence remained unchanged in ischemic stroke and intracerebral hemorrhage. Conversely, the lower subarachnoid hemorrhage incidence in women vanished with time because of an increasing incidence. CONCLUSIONS: The sex gap in stroke incidence did not change with time except for subarachnoid hemorrhage. Despite lower rates, more women than men experience an incident stroke each year because of a longer life expectancy.

Contemporary Epidemiology of Transient Ischemic Attack in Dijon, France (2013-2015).

BACKGROUND: We aimed to evaluate the epidemiological features of transient ischemic attack (TIA). METHODS: All TIAs were prospectively collected in Dijon, France, using a population-based registry (2013-2015). TIAs were considered the first-ever in patients who had no previous cerebrovascular events (CVEs); otherwise they were considered recurrent TIAs. Annual incidence (first-ever TIAs) and attack rates (first-ever and recurrent TIAs) were calculated. RESULTS: Four hundred twenty TIAs were registered (255 first-ever and 165 recurrent TIAs, mean age: 74.1 ± 15.7 years). The age-standardized incidence rate (to the 2013 European population) was 61 (95% CI 46-76) and the attack rate was 81 (95% CI 64-99) per 100,000/year. Patients with TIA as a recurrent event had a greater prevalence of risk factors and preventive treatments. However, one third of them were not receiving antithrombotic agents or antihypertensive treatments, and half were not treated with statins at the time of their recurrence. The mean ABCD2 score was 4.3 ± 1.3, and 72% of patients had a high risk of recurrence (score ≥4). In patients with available MRI (23%), an infarct lesion was seen in 15.5%. CONCLUSIONS: TIA is a frequent occurrence and a large proportion of patients have a high risk of recurrence, thus highlighting the need to establish dedicated emergency services to administer prompt secondary prevention.

Associations between Thyroid Stimulating Hormone Levels and Both Severity and Early Outcome of Patients with Ischemic Stroke.

We aimed to investigate associations between serum thyroid stimulating hormone (TSH) levels and both severity and outcome after ischemic stroke (IS). A total of 731 patients consecutive IS patients were enrolled (mean age 69.4 ± 15.4, 61.6% men), and serum TSH levels were measured at admission and analyzed according to the tertiles of their distribution (<0.822 vs. 0.822-1.6 vs. >1.6 mUI/l). Associations between TSH and both severity at admission (National Institutes of Health Stroke Scale (NIHSS) scores <5 vs. ≥5) and functional outcome at discharge assessed by the modified Rankin Scale were analyzed using logistic regression and ordinal logistic regression models, respectively. High TSH levels were independently associated with both a decreased risk of NIHSS score ≥5 at admission (prevalence proportion ratio = 0.62; 95% CI 0.41-0.94, p = 0.024 for tertile 3 vs. tertile 1). In addition, patients with high TSH levels had a better functional outcome at discharge (OR 0.43; 95% CI 0.30-0.60, p < 0.001 for tertile 2 vs. tertile 1; OR 0.39; 95% CI 0.27-0.56, p < 0.001 for tertile 3 vs. tertile 1). The mechanisms underlying these associations and their potential exploitation in terms of therapeutic strategies need to be explored.

Hospitalization within the first year after stroke: the Dijon stroke registry.

BACKGROUND AND PURPOSE: This population-based study aimed to identify unplanned hospitalization within the first year after stroke to determine factors associated with it and consequences on survival. METHODS: All first-ever acute strokes occurring in Dijon, France, from 2009 to 2011, were prospectively collected from a population-based registry. Demographics and clinical data, including stroke severity measured by the National Institutes of Health Stroke Scale and disability after stroke, were recorded. For each patient, the first unplanned hospitalization that occurred within 1 year after stroke was retrieved by linking data with the national French Hospital Discharge Database. Predictors of hospitalization and survival at 1 year were identified using logistic regression models. RESULTS: Among the 613 patients recorded, 94 (15.3%) were excluded because of early death. Of the 519 remaining patients, 167 (32.2%) were hospitalized at 1 year. Subsequent hospitalization led to in-hospital death for 16 (9.6%) patients. In multivariable analyses, only a history of hypertension and atrial fibrillation were associated with hospitalization. In stratified analyses, the National Institutes of Health Stroke Scale score was associated with a higher risk of hospitalization (odds ratio, 1.13; 95% confidence interval, 1.03-1.22; P=0.006), whereas only a trend was noted for disability (odds ratio, 2.26; 95% confidence interval, 0.82-6.22; P=0.113) in patients who returned home after the index stroke. Hospitalization was negatively associated with being alive at 1 year (odds ratio, 0.36; 95% confidence interval, 0.19-0.66; P<0.01). CONCLUSIONS: Stroke survivors are at high risk of hospitalization after the episode, and subsequent admission is associated with poor survival, thus highlighting the need for follow-up interventions after discharge to prevent readmission.

Stroke associated with giant cell arteritis: a population-based study.

BACKGROUND: Giant cell arteritis (GCA) is the most common vasculitis in people ≥50 years and can be associated with stroke. We aimed to evaluate the epidemiology and characteristics of stroke in patients with GCA. METHODS: All patients with a biopsy-proven diagnosis of GCA were identified among residents of the city of Dijon, France (152 000 inhabitants), between 2001 and 2012 using a prospective database. Among these, patients who suffered from stroke were retrieved by crossing data from the population-based Dijon Stroke Registry. Demographics and clinical features were recorded. We considered that the stroke was GCA-related if the stroke revealed GCA or occurred between the onset of symptoms and 4 weeks after the start of treatment. RESULTS: Among the 57 biopsy-proven patients with GCA (incidence rate 10.9/100 000/year in individuals ≥50 years), 4 (7.0%) experienced a GCA-related stroke. Three were men and all had ≥2 vascular risk factors and were ≥80 years. The stroke was vertebrobasilar for 3/4 patients and undetermined for the remaining one. The incidence rate of GCA-related stroke in patients ≥50 years was 0.76/100 000/year (95% CI 0 to 2.47), 1.36/100 000/year in men (95% CI 0 to 3.63) and 0.33/100 000/year (95% CI 0 to 1.45) in women. CONCLUSIONS: This population-based study demonstrated that GCA-related stroke essentially affects the vertebrobasilar territory and mainly occurs in old men with associated vascular risk factors. Although rare, GCA symptoms must be searched for in elderly patients with stroke, and optimal vascular prevention must be conducted carefully in patients with GCA with a high vascular risk before initiating GCA treatment.

iScore for predicting institutional care after ischemic stroke: a population-based study.

BACKGROUND: We assessed whether the iScore could predict the need for poststroke institutional care. METHODS: Patients with acute ischemic stroke living in Dijon, France, were recorded between 2006 and 2011, using a population-based stroke registry. The iScore was calculated for each patient. A logistic regression model was used to assess the performance of the iScore for predicting the need for placement in a care institution. The discrimination and calibration of the model were assessed using the c statistic and the Hosmer-Lemeshow goodness-of-fit test, respectively. RESULTS: Of the 1199 patients recorded, 124 were excluded because of early death and 95 because of missing for variables included in the iScore. Of the remaining 980 patients, 522 (53.3%) returned home and 458 (46.7%) required placement in a care institution. The median iScore was 123 (interquartile range, 97-148), and the proportion of patients who required placement in a care institution increased with each quintile of risk score. The discrimination of the model was good with a c statistic of .75 (95% confidence interval, .72-.78), as was calibration (P = .35). CONCLUSIONS: The iScore could be useful for predicting the need for placement in a care institution in ischemic stroke patients. Further studies are required to confirm this finding.

Trends in the incidence of ischaemic stroke in young adults between 1985 and 2011: the Dijon Stroke Registry.

BACKGROUND: Recent data have suggested that stroke incidence in young people may be rising. In this population-based study, we aimed to determine whether the incidence of stroke in people aged <55 years old had changed over the last three decades. METHODS: All cases of first-ever stroke (ischaemic stroke, spontaneous intracerebral haemorrhage, and undetermined stroke) occurring in Dijon, France, from 1985 to 2011 were prospectively collected from a population-based registry. Incidence rates were calculated and temporal trends were analysed by age groups and stroke subtypes using a Poisson regression to estimate incidence rate ratios (IRR). Risk factors and premorbid treatments were analysed. RESULTS: Over the 27-year study period, 4506 patients were recorded (53% women, mean age 74.6±14.4, 10.1% aged <55 years). An increase in overall stroke incidence was noted, as was a rise in ischaemic stroke in individuals aged <55 years (IRR 1.308; 95% CI 0.982 to 1.741, p=0.066 for period 1994-2002 vs period 1985-1993, and IRR 1.697; 95% CI 1.340 to 2.150, p<0.001 for period 2003-2011 vs period 1994-2002), which was consistent for men and women. In these young patients, smoking was the most frequent risk factor (43%). CONCLUSIONS: Multiple factors may account for the increased incidence of ischaemic stroke in people aged <55 years including changes in vascular risk factors, better awareness of the disease and treatment options in the population and among practitioners leading to more frequent referrals for specialised care, and improvements in stroke diagnosis. Stroke prevention must be encouraged even in young adults.

Mortality following stroke during and after acute care according to neighbourhood deprivation: a disease registry study.

BACKGROUND: Neighbourhood deprivation has been shown to be inversely associated with mortality 1 month after stroke. Whether this disadvantage begins while patients are still receiving acute care is unclear. We aimed to study mortality after stroke specifically in the period while patients are under acute care and the ensuing period when they are discharged to home or other care settings. METHODS: Our sample includes 1760 incident strokes (mean age 75, 48% men, 86% ischaemic) identified between 1998 and 2010 by the population-based stroke registry of Dijon (France). We used Cox regression to study all-cause mortality up to 90 days after stroke occurrence. RESULTS: Overall, 284 (16.1%) patients died during the 90 days following stroke. Prior to stroke, risk factors prevalence (eg, high blood pressure and diabetes) and acute care management did not vary across deprivation levels. There was no association between deprivation and mortality while patients were in acute care (HR comparing the highest to the lowest tertiles of deprivation: 1.01, 95% CI 0.71 to 1.43). After discharge, however, age and gender adjusted mortality gradually increased with deprivation (HR 2.08, 95% CI 1.07 to 4.02). This association was not modified when stroke type and severity were accounted for. CONCLUSIONS: The gradient of higher poststroke mortality with increasing neighbourhood deprivation was noticeable only after acute hospital discharge. Quality of postacute care and social support are potential determinants of these variations.

Prevalence and prognostic value of headache on early mortality in acute stroke: the Dijon Stroke Registry.

OBJECTIVE: To evaluate the prevalence of headache at onset and its association with 1-month mortality in stroke patients. METHODS: All patients with stroke in Dijon, France (2006-2011), were prospectively identified using a population-based registry. Cox regression models were used to evaluate the association between headache and 30-day all-cause mortality. RESULTS: Among 1411 stroke patients, data about headache were obtained for 1391 (98.6%) of whom 1185 had an ischemic stroke (IS), 201 had an intracerebral hemorrhage (ICH) and five had a stroke of undetermined etiology. Headache was found in 253 (18.2%) patients and was more frequent in those with ICH than in those with IS (46.3% vs 13.5%, p < 0.001). Overall 30-day mortality was 11.7%, and was greater for patients with than those without headache (17.0% vs 10.5%, unadjusted HR 1.70; 95% CI 1.20-2.41, p = 0.003). In multivariable analysis, an association between headache and 30-day mortality was observed (HR 1.51; 95% CI 1.02-2.25, p = 0.042). In stratified analyses, headache was associated with 30-day mortality in ICH (HR 2.09; 95% CI 1.18-3.71, p = 0.011) but not in IS (HR 1.01; 95% CI 0.53-1.92, p = 0.97). CONCLUSION: Headache at stroke onset is associated with a higher risk of early mortality in patients with ICH.

Intracerebral haemorrhage profiles are changing: results from the Dijon population-based study.

Incidence of intracerebral haemorrhage over the past three decades is reported as stable. This disappointing finding is questionable and suggests that any reduction in intracerebral haemorrhage incidence associated with improvements in primary prevention, namely, better control of blood pressure, might have been offset by an increase in cases of intracerebral haemorrhage owing to other factors, including the use of antithrombotic drugs in the ageing population. Therefore, we aimed to analyse trends in intracerebral haemorrhage incidence from 1985 to 2008 in the population-based registry of Dijon, France, taking into consideration the intracerebral haemorrhage location, the effect of age and the changes in the distribution of risk factors and premorbid treatments. Incidence rates were calculated and temporal trends were analysed by age groups (<60, 60-74 and ≥75 years) and intracerebral haemorrhage location (lobar or deep) according to study periods 1985-92, 1993-2000 and 2001-08. Over the 24 years of the study, 3948 patients with first-ever stroke were recorded. Among these, 441 had intracerebral haemorrhage (48.3% male), including 49% lobar, 37% deep, 9% infratentorial and 5% of undetermined location. Mean age at onset increased from 67.3 ± 15.9 years to 74.7 ± 16.7 years over the study period (P < 0.001). Overall crude incidence was 12.4/100,000/year (95% confidence interval: 11.2-13.6) and remained stable over time. However, an ∼80% increase in intracerebral haemorrhage incidence among people aged ≥75 years was observed between the first and both second and third study periods, contrasting with a 50% decrease in that in individuals aged <60 years, and stable incidence in those aged 60-74 years. This result was attributed to a 2-fold increase in lobar intracerebral haemorrhage in the elderly, concomitantly with an observed rise in the premorbid use of antithrombotics at this age, whatever the intracerebral haemorrhage location considered. In conclusion, intracerebral haemorrhage profiles have changed in the past 20 years, suggesting that some bleeding-prone vasculopathies in the elderly are more likely to bleed when antithrombotic drugs are used, as illustrated by the rise in the incidence of lobar intracerebral haemorrhage in the elderly, in which cerebral amyloid angiopathy may be strongly implicated. Future research should focus on the impact and management of antithrombotics in patients with intracerebral haemorrhage, which may differ according to the underlying vessel disease.

Smoking status and severity of ischemic stroke. A population-based study.

We aimed to investigate the impact of smoking status on clinical severity in patients with ischemic stroke event (IS). Patients were prospectively identified among residents of the city of Dijon, France (ca. 151,000 inhabitants), using a population-based registry, between 2006 and 2011. Demographic and clinical data were recorded. The initial clinical severity was quantified by the means of the National Institutes of Health Stroke Scale (NIHSS). Multivariable ordinal logistic regression was used to assess the effect of smoking status on severity. Among the 1,056 recorded patients with IS, data about smoking status were available for 973 (92.1%), of whom 658 (67.3%) were non-smokers, 187 (19.2%) were current smokers, and 128 (13.2%) were former smokers. Compared with non-smoking, former smoking was associated with less severe IS (OR 0.55; 95% CI 0.38-0.82, p = 0.003), whereas this association was not found for current smokers (OR 0.97; 95% CI 0.69-1.36, p = 0.856). Further work is needed to understand the underlying mechanisms of this finding.

The impact of World and European Football Cups on stroke in the population of Dijon, France: a longitudinal study from 1986 to 2006.

BACKGROUND: Acute stress may trigger vascular events. We aimed to investigate whether important football competitions involving the French football team increased the occurrence of stroke. METHODS: We retrospectively retrieved data of fatal and nonfatal stroke during 4 World Football Cups (1986, 1998, 2002, and 2006) and 4 European Championships (1992, 1996, 2000, and 2004), based on data from the population-based Stroke Registry of Dijon, France. One period of exposure was analyzed: the period of competition extended to 15 days before and after the competitions. The number of strokes was compared between exposed and unexposed corresponding periods of preceding and following years using Poisson regression. RESULTS: A total of 175 strokes were observed during the exposed periods compared with 192 and 217 strokes in the unexposed preceding and following periods. Multivariate regression analyses showed an overall 30% significant decrease in stroke numbers between periods of competition and unexposed periods of following year (risk ratio (RR) = 1.3; 95% confidence interval [CI] = 1.0-1.6; P = .029) but not with that of preceding year (RR = 1.1; 95% CI = .9-1.3; P = .367). This was mostly explained by a 40% decrease in stroke numbers during European Championships, compared with the unexposed following periods (RR = 1.4; 95% CI = 1.0-1.9; P = .044) in stratified analyses by football competitions. CONCLUSIONS: Watching European football competitions had a positive impact in the city of Dijon with a decrease of stroke numbers. European championship is possibly associated with higher television audience and long-lasting euphoria although other factors may be involved. Further studies using nationwide data are recommended to validate these findings.

Population-based validation of the iScore for predicting mortality and early functional outcome in ischemic stroke patients.

BACKGROUND: We aimed to determine the accuracy of the iScore for predicting mortality and early disability following ischemic stroke in a French population-based study. METHODS: All patients with acute ischemic stroke were identified among residents of the city of Dijon, France, between 2006 and 2011, using a population-based stroke registry. The 30-day iScore and 1-year iScore were calculated. A logistic regression model was used to assess the performance of the iScore for predicting both 30-day and 1-year mortality, and poor functional outcome at discharge (modified Rankin Scale score of 3-6). The discrimination and calibration of the model were assessed using the c-statistic and the Hosmer-Lemeshow goodness-of-fit test, respectively. RESULTS: Among the 1,199 ischemic stroke patients recorded, 107 (8.9%) were excluded because at least one item of data was missing. For the remaining 1,092 patients, the c-statistic was 0.85 (95% CI: 0.82-0.89) for 30-day and 0.84 (0.81-0.87) for 1-year mortality, and calibration was good (p = 0.82 and p = 0.96, respectively, for the Hosmer-Lemeshow test). Similar results were found for disability (c-statistic 0.81, 95% CI: 0.79-0.84, and p = 0.45 for the Hosmer-Lemeshow test). CONCLUSION: This is the first population-based study to demonstrate the accuracy of the iScore for predicting mortality and early disability in ischemic stroke patients.

Prior transient ischemic attack and dementia after subsequent ischemic stroke.

Although functional recovery and survival after ischemic stroke seem to improve in patients with prior transient ischemic attack (TIA), little is known about the effect of prior TIA on poststroke cognition. To evaluate the impact of prior TIA on dementia, 1697 nonaphasic patients who survived the first month after their first-ever ischemic stroke were identified from the population-based registry of Dijon, France, from 1985 to 2007 and divided into 3 groups according to the time interval between prior TIA and stroke (<4 wk, ≥4 wk, no TIA). Outcome was dementia diagnosed by neurologists using Diagnostic and Statistical Manual of mental disorders-III or IV criteria over the first month after stroke. Multivariate analyses were performed using logistic regression models. The prevalence of dementia after stroke was 20.6% [95% confidence interval (CI), 18.5-22.7], 26.8% (95% CI, 13.3-40.4), and 33.1% (95% CI, 27.3-38.9) among patients without TIA, with a prestroke TIA≥4 weeks, and with a prestroke TIA<4 weeks, respectively. Patients with prestroke TIA<4 weeks (adjusted odds ratio: 1.83; 95% CI, 1.32-2.52; P=0.0003) had a higher risk of dementia than those without TIA.

Prevalence of early dementia after first-ever stroke: a 24-year population-based study.

BACKGROUND AND PURPOSE: No data about temporal change in the prevalence of poststroke dementia are available. We aimed to evaluate trends in the prevalence of early poststroke dementia. METHODS: From 1985 to 2008, overall first-ever strokes occurring within the population of the city of Dijon, France (150 000 inhabitants) were recorded. The presence of dementia was diagnosed during the first month after stroke, according to Diagnostic and Statistical Manual of Mental Disorders, Third and Fourth Editions criteria. Time trends were analyzed according to 4 periods: 1985 to 1990, 1991 to 1996, 1997 to 2002, and 2003 to 2008. Logistic regression was used for nonmultivariate analyses. RESULTS: Over the 24 years, 3948 first-ever strokes were recorded. Among patients with stroke, 3201 (81%) were testable of whom 653 (20.4%) had poststroke dementia (337 women and 316 men). The prevalence of nontestable (mostly due to death) patients declined from 28.0% to 10.2% (P<0.0001). Multivariate analysis revealed significant temporal changes in the prevalence of poststroke dementia; prevalence in the second and fourth periods was, respectively, almost half and twice that in the first period. The prevalence of poststroke dementia associated with lacunar stroke was 7 times higher than that in intracerebral hemorrhage but declined over time as did prestroke antihypertensive medication. Age, several vascular risk factors, hemiplegia, and prestroke antiplatelet agents were associated with an increased prevalence of poststroke dementia. CONCLUSIONS: This study covering a period of 24 years highlights temporal changes in the prevalence of early dementia after first-ever stroke. These changes may be explained by concomitant determinants of survival and incidence such as stroke care management or prestroke medication.

Incidence of stroke and socioeconomic neighborhood characteristics: an ecological analysis of Dijon stroke registry.

BACKGROUND AND PURPOSE: Studies have shown higher stroke incidence in areas with higher levels of deprivation. We aimed to determine the pattern of association between various area socioeconomic status (SES) indicators and stroke incidence in specific sex and age groups. METHODS: Data are from the Dijon stroke registry for the period 1995 to 2003. The analyses included 1255 cases aged older than 40 (median age, 76.8). Poisson regression was used to model stroke incidence according to the SES level of 61 small areas. RESULTS: Among women, stroke incidence was higher in neighborhoods with large income inequality (incidence rate ratio, 1.34; P=0.003), higher proportions of unemployed (1.24; P=0.02), of non-French nationals (1.21, P=0.02), and of rented housing (1.31; P=0.03). Areas with a higher proportion of people aged older than 60 were associated with lower stroke incidence (incidence rate ratio, 0.72; P=0.01). Analysis by specific age-groups showed stronger effects among the 60- to 74-year-olds. Among men, no associations between SES and stroke incidence were identified overall but analysis by age groups showed significant effect among the 40- to 59-year-olds. In this age group, incidence rate ratios were 1.47 for unemployment (P=0.01), 1.86 for no car ownership (P=0.02), and 1.56 for income inequality (P=0.01). Among stroke cases, no trend in vascular risk factors prevalence according to area SES was identified. CONCLUSIONS: Variations of stroke incidence were more marked for the SES indicators of wealth and of income inequality. They were apparent at an earlier age in men and showed a stronger gradient among women.