Consequences of Mild Stroke in Persons <75 Years – A 1-Year Follow-Up

Abstract

Background and Purpose: Mild strokes can be neglected regarding subtle sequels as fatigue, and cognitive and emotional changes. We have addressed this topic by exploring late consequences of an initially mild stroke (Barthel score ≧50). Accordingly, we assayed impairment, disability and handicap data 1 year after the first-ever stroke in persons <75 years, focusing on symptoms as fatigue, concentration difficulties, memory disturbances, emotional lability, stress resistance, anxiety and uneasiness, symptoms comprised in the astheno-emotional disorder (AED), and its relation to life satisfaction. Results: The mean value of the Barthel Index was 99.5 (SD 0.5) and 25% scored 0–1 on the Oxford Handicap Scale. AED was diagnosed in 71% of the patients, and fatigue was experienced by 72%. AED correlated significantly with life satisfaction, handicap and depression. Life satisfaction was significantly below that of norm values according to satisfaction with life as a whole, sex life and ability to manage selfcare. Conclusions: Our findings emphasize that ‘hidden dysfunctions’ not so easily discovered within the hospital context are common consequences of mild stroke. The concept of mild stroke as principally founded in motor function or ability in P-ADL therefore seems to be insufficient with respect to the patient long-term perspective.

Inflammation and the Silent Sequelae of Stroke

“…Most studies of PSD are cross-sectional; the longitudinal studies that have been done tend to be small and have limited follow-up [4]. Fatigue, defined as a feeling of weariness, tiredness, or lack of energy, affects up to three-quarters of patients who suffer stroke [5][6][7][8][9][10][11][12]. Similar to PSD, most studies of PSF are cross-sectional in design and do not adequately address the natural history of PSF [13].…”

“…The consequences of PSF are further illustrated by the fact that patients who complain of fatigue are more likely to be dependent for their activities of daily living and are more likely to require institutional care; mortality is also higher in patients with PSF [11,[25][26][27]. Among patients with mild stroke, fatigue is the most common complaint and is identified as the major issue restricting their life style [7,10]. It is thus not surprising that PSF is more predictive of a lower health-related quality of life after stroke than actual neurological dysfunction [28].…”

Hidden Dysfunctioning in Subacute Stroke

“…1 Thus, the concept of stroke, as principally founded in motor function or ability in activities of daily living, may be insufficient with respect to changes in cognitive functioning. 2 Subtle CDF may indeed be missed within the hospital context and revealed only when returning to previous socioprofessional activities, leading to social handicap even more disturbing because unrecognized. 3,4 Research on CDF in subacute stroke, outside dementia, has evidenced widespread cognitive deficits, CDF rates varying from 31% to 77%.…”

Poststroke Fatigue Is Still a Neglected Issue: Findings from an Internet-Based Study on the Need for Information and Treatment in The Netherlands

“…Persisting fatigue is a common and debilitating consequence of stroke even in patients with good recovery [1][2][3][4]. Prevalence rates of poststroke fatigue (PSF) are substantial, varying between 38 and 73% [4].…”

“…As no unequivocal associations with clinical or demographical variables, such as stroke type, age, sex, or education, have been found, all patients who have experienced a stroke may be at risk to develop this symptom [4]. Furthermore, PSF has been found to have a negative effect on quality of life [2,10], rehabilitation outcomes [11], and even mortality [12][13][14]. However, PSF is often misdiagnosed [11,15,16] and evidence-based clinical guidelines for dealing with PSF are scarce [17,18].…”