{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T06:00:29Z","timestamp":1790316029642,"version":"4.1.0"},"reference-count":42,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"12","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:sec>\n            <jats:title>Background and Purpose:<\/jats:title>\n            <jats:p>Many patients with ischemic stroke present with multiple comorbidities that threaten survival and recovery. This study sought to determine the risks of adverse long-term stroke outcomes associated with multimorbid diabetes mellitus and depression.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods:<\/jats:title>\n            <jats:p>Retrospective analysis of prospectively collected data on consecutive patients without premorbid dementia admitted from the community for a first-ever acute ischemic stroke to comprehensive stroke centers across Ontario, Canada (2003\u20132013). Premorbid histories of diabetes mellitus and depression were ascertained within 5 years before stroke admission. Adjusted hazard ratios (aHR [95% CI]) of admission to long-term care, incident dementia, readmission for stroke or transient ischemic attack and all-cause mortality, over time among those discharged back into the community poststroke.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>\n              Among 23\u2009579 stroke admissions, n=20\u2009201 were discharged back into the community. Diabetes mellitus and depression were associated with synergistic hazards of admission to long-term care (X\n              <jats:sup>2<\/jats:sup>\n              =5.4;\n              <jats:italic>P<\/jats:italic>\n              =0.02) over a median follow-up of 5.6 years. This interaction was observed among women specifically; depression multimorbidity showed particularly high hazards of admission to long-term care (aHR\n              <jats:sub>Depression<\/jats:sub>\n              =1.57 [1.24\u20131.98]) and incident dementia (aHR\n              <jats:sub>Depression<\/jats:sub>\n              =1.85 [1.40\u20132.44]) among women with diabetes mellitus. In the whole cohort, diabetes mellitus and depression were associated individually with long-term care admission (aHR\n              <jats:sub>Diabetes<\/jats:sub>\n              =1.20 [1.12\u20131.29]; aHR\n              <jats:sub>Depression<\/jats:sub>\n              =1.19 [1.04\u20131.37]), incident dementia (aHR\n              <jats:sub>Diabetes<\/jats:sub>\n              =1.14 [1.06\u20131.23]; aHR\n              <jats:sub>Depression<\/jats:sub>\n              =1.27 [1.08\u20131.49]), stroke\/transient ischemic attack readmission (aHR\n              <jats:sub>Diabetes<\/jats:sub>\n              =1.18 [1.10\u20131.26]; aHR\n              <jats:sub>Depression<\/jats:sub>\n              =1.24 [1.07\u20131.42]), and all-cause mortality (aHR\n              <jats:sub>Diabetes<\/jats:sub>\n              =1.29 [1.23\u20131.36]; aHR\n              <jats:sub>Depression<\/jats:sub>\n              =1.16 [1.05\u20131.29]).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>The risks of dementia and needing long-term care in the years after surviving a stroke were particularly elevated among women when premorbid diabetes mellitus and depression occurred together. Long-term stroke recovery strategies might target high-risk patients with mood and metabolic multimorbidity.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/strokeaha.120.031068","type":"journal-article","created":{"date-parts":[[2020,10,14]],"date-time":"2020-10-14T14:58:32Z","timestamp":1602687512000},"page":"3531-3540","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":20,"title":["Depression and Diabetes Mellitus Multimorbidity Is Associated With Loss of Independence and Dementia Poststroke"],"prefix":"10.1161","volume":"51","author":[{"given":"Michael","family":"Ouk","sequence":"first","affiliation":[{"name":"Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON (M.O., C.-Y.W., J.C.-M., N.H., K.L.L., E.L., R.H.S., S.E.B., B.J.M., W.S.)."},{"name":"Department of Pharmacology and Toxicology (M.O., C.-Y.W., K.L.L., W.S.), University of Toronto, ON."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Che-Yuan","family":"Wu","sequence":"additional","affiliation":[{"name":"Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON (M.O., C.-Y.W., J.C.-M., N.H., K.L.L., E.L., R.H.S., S.E.B., B.J.M., W.S.)."},{"name":"Department of Pharmacology and Toxicology (M.O., C.-Y.W., K.L.L., W.S.), University of Toronto, ON."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Colby-Milley","sequence":"additional","affiliation":[{"name":"Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON (M.O., C.-Y.W., J.C.-M., N.H., K.L.L., E.L., R.H.S., S.E.B., B.J.M., W.S.)."},{"name":"Canadian Partnership for Stroke Recovery, Toronto, ON (J.C.-M., R.H.S., S.E.B., B.J.M., W.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiming","family":"Fang","sequence":"additional","affiliation":[{"name":"ICES, Toronto, ON (J.F., L.Z., B.R.S., R.H.S., M.K.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Limei","family":"Zhou","sequence":"additional","affiliation":[{"name":"ICES, Toronto, ON (J.F., L.Z., B.R.S., R.H.S., M.K.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Baiju R.","family":"Shah","sequence":"additional","affiliation":[{"name":"Department of Medicine and Institute for Health Policy, Management, and Evaluation, (B.R.S., M.K.K.), University of Toronto, ON."},{"name":"ICES, Toronto, ON (J.F., L.Z., B.R.S., R.H.S., M.K.K.)."},{"name":"Divisions of Endocrinology and Obstetric Medicine, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON (B.R.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathan","family":"Herrmann","sequence":"additional","affiliation":[{"name":"Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON (M.O., C.-Y.W., J.C.-M., N.H., K.L.L., E.L., R.H.S., S.E.B., B.J.M., W.S.)."},{"name":"Department of Medicine (Psychiatry), Sunnybrook Health Sciences Centre (N.H., K.L.L.), University of Toronto, ON."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7024-6637","authenticated-orcid":true,"given":"Krista L.","family":"Lanct\u00f4t","sequence":"additional","affiliation":[{"name":"Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON (M.O., C.-Y.W., J.C.-M., N.H., K.L.L., E.L., R.H.S., S.E.B., B.J.M., W.S.)."},{"name":"Department of Pharmacology and Toxicology (M.O., C.-Y.W., K.L.L., W.S.), University of Toronto, ON."},{"name":"Department of Medicine (Psychiatry), Sunnybrook Health Sciences Centre (N.H., K.L.L.), University of Toronto, ON."},{"name":"University Health Network Toronto Rehabilitation Institute, Toronto, ON (K.L.L., M.L., W.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Linkewich","sequence":"additional","affiliation":[{"name":"Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON (M.O., C.-Y.W., J.C.-M., N.H., K.L.L., E.L., R.H.S., S.E.B., B.J.M., W.S.)."},{"name":"Department of Occupational Science and Occupational Therapy (E.L.), University of Toronto, ON."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9746-6381","authenticated-orcid":true,"given":"Marcus","family":"Law","sequence":"additional","affiliation":[{"name":"Department of Family and Community Medicine (M.L.), University of Toronto, ON."},{"name":"University Health Network Toronto Rehabilitation Institute, Toronto, ON (K.L.L., M.L., W.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard H.","family":"Swartz","sequence":"additional","affiliation":[{"name":"Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON (M.O., C.-Y.W., J.C.-M., N.H., K.L.L., E.L., R.H.S., S.E.B., B.J.M., W.S.)."},{"name":"Department of Medicine (Neurology), Sunnybrook Health Sciences Centre (R.H.S., S.E.B.), University of Toronto, ON."},{"name":"Canadian Partnership for Stroke Recovery, Toronto, ON (J.C.-M., R.H.S., S.E.B., B.J.M., W.S.)."},{"name":"ICES, Toronto, ON (J.F., L.Z., B.R.S., R.H.S., M.K.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3444-9928","authenticated-orcid":true,"given":"Moira K.","family":"Kapral","sequence":"additional","affiliation":[{"name":"Department of Medicine and Institute for Health Policy, Management, and Evaluation, (B.R.S., M.K.K.), University of Toronto, ON."},{"name":"ICES, Toronto, ON (J.F., L.Z., B.R.S., R.H.S., M.K.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7093-8289","authenticated-orcid":true,"given":"Sandra E.","family":"Black","sequence":"additional","affiliation":[{"name":"Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON (M.O., C.-Y.W., J.C.-M., N.H., K.L.L., E.L., R.H.S., S.E.B., B.J.M., W.S.)."},{"name":"Department of Medicine (Neurology), Sunnybrook Health Sciences Centre (R.H.S., S.E.B.), University of Toronto, ON."},{"name":"Canadian Partnership for Stroke Recovery, Toronto, ON (J.C.-M., R.H.S., S.E.B., B.J.M., W.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bradley J.","family":"MacIntosh","sequence":"additional","affiliation":[{"name":"Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON (M.O., C.-Y.W., J.C.-M., N.H., K.L.L., E.L., R.H.S., S.E.B., B.J.M., W.S.)."},{"name":"Department of Medical Biophysics (B.J.M.), University of Toronto, ON."},{"name":"Canadian Partnership for Stroke Recovery, Toronto, ON (J.C.-M., R.H.S., S.E.B., B.J.M., W.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9275-4787","authenticated-orcid":true,"given":"Jodi D.","family":"Edwards","sequence":"additional","affiliation":[{"name":"University of Ottawa Heart Institute (J.D.E.), University 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