Mi-Sun Oh

Stroke awareness decreases prehospital delay after acute ischemic stroke in korea

BackgroundDelayed arrival at hospital is one of the major obstacles in enhancing the rate of thrombolysis therapy in patients with acute ischemic stroke. Our study aimed to investigate factors associated with prehospital delay after acute ischemic stroke in Korea.MethodsA prospective, multicenter study was conducted at 14 tertiary hospitals in Korea from March 2009 to July 2009. We interviewed 500 consecutive patients with acute ischemic stroke who arrived within 48 hours. Univariate and multivariate analyses were performed to evaluate factors influencing prehospital delay.ResultsAmong the 500 patients (median 67 years, 62% men), the median time interval from symptom onset to arrival was 474 minutes (interquartile range, 170-1313). Early arrival within 3 hours of symptom onset was significantly associated with the following factors: high National Institutes of Health Stroke Scale (NIHSS) score, previous stroke, atrial fibrillation, use of ambulance, knowledge about thrombolysis and awareness of the patient/bystander that the initial symptom was a stroke. Multivariable logistic regression analysis indicated that awareness of the patient/bystander that the initial symptom was a stroke (OR 4.438, 95% CI 2.669-7.381), knowledge about thrombolysis (OR 2.002, 95% CI 1.104-3.633) and use of ambulance (OR 1.961, 95% CI 1.176-3.270) were significantly associated with early arrival.ConclusionsIn Korea, stroke awareness not only on the part of patients, but also of bystanders, had a great impact on early arrival at hospital. To increase the rate of thrombolysis therapy and the incidence of favorable outcomes, extensive general public education including how to recognize stroke symptoms would be important.

Long-Term Outcomes of Acute Ischemic Stroke in Patients Aged 80 Years and Older

Purpose Short life expectancy influences decision-making when treating very old patients with acute ischemic stroke (AIS). We investigated mortality and survival duration in very old AIS patients (≥ 80 years) who received hospital care. Patients and Methods Mortality data were obtained from medical records, structured telephone inquiries, death certificates from the Korean National Statistical Office, and social security data 5 ± 1.9 years after stroke onset. Age, gender, vascular risk factors, and functional outcomes from modified Rankin scales (MRS) at discharge were analyzed as predictors of mortality. Results Among 134 patients, 92 (68.7%) died. On Kaplan-Meier analysis, duration of survival of patients aged 80 - 84 years was longer than those aged 85 - 89 or 90 - 94 (24 ± 6.4, 8 ± 7.3, 7 ± 2.0 months, respectively, p = 0.002). Duration of survival of patients discharged in a state of MRS 0 - 1 was longer than the remaining groups at 47 ± 4.8 months (p < 0.001). In Cox proportional hazard analysis, age and MRS at discharge were independent predictors of mortality. Conclusion Long-term outcomes of very old patients with AIS are not uniformly grave, therefore predictors of mortality and estimated duration of survival should be considered during decision- making for treatment.

P3-024: The temporal lobes and recognition memory: A comparison of false recognition among Alzheimer’s disease, subcortical vascular dementia, and Parkinson’s disease

Among these subjects, 86 were diagnosed as Alzheimer’s Disease (AD), 173 were Questionable Dementia (QD), and 223 were normal or subjective memory complaint (NL/SMC). All the subjects showed an increase in new learning from trial 1 to trial 6 on the SRT, with the NL/SMC subjects having a greater increase (from 5.1 to 9.5) than QD subjects (from 4.0 to 7.5) and AD subjects (from 2.6 to 4.8). The t-tests indicate statistically significant differences between any two diagnostic groups on each individual learning trial (p 0.001). There were also significant differences (p 0.01) for the 15-minute delayed free recall (DFR) among three diagnostic groups (NL/SMC 8.0 vs. QD 5.5 vs. AD 1.6). Similar results were shown on the CASI domain and total scores (CASI total score: NL/SMC 91.2 vs. QD 86.5 vs. AD 73.2) in differentiating the 3 studied groups. The QD subjects showed a greater % decrease on the SRT DFR score (31.3%) than on CASI total score (5.2%) and on MMSE score (5.7%) as compared with the NL/SMC subjects. These results indicate that the 12-item SRT is a more sensitive and useful test than CASI and MMSE in assessing subjects in the early stage of dementia.