There were 36,978 patients with pre-existing dementia hospitalized for acute stroke one-to-one matched on age to stroke hospitalizations without dementia. Patients with dementia were less likely to receive thrombolysis (aOR [adjusted odds ratio] = 0.77, 99% CI 0.67-0.88), EVT (aOR = 0.49, 99% CI 0.43-0.54), and mechanical ventilation (aOR = 0.82, 99% CI 0.78-0.87). Conversely, gastrostomy placement was more likely for patients with pre-existing dementia (aOR = 1.26, 99% CI [1.14-1.39]). Patients with dementia were less likely to die in the hospital (aOR = 0.90, 99% CI [0.84-0.96]), however, had greater odds of mortality when accounting for inpatient death or hospice discharge (aOR = 1.52, 99% CI 1.40-1.65). 

Hospitalized patients with acute stroke and pre-existing dementia are less likely to receive interventions for acute stroke and face increased risk of mortality. Hospice discharge is important to consider when assessing total mortality for inpatients with stroke and pre-existing dementia.