Functional recovery after ischemic stroke—A matter of age

Knoflach, Michael; Matosevic, Benjamin; Rucker, M. J.; Furtner, Martin; Mair, A.; Wille, Georg; Zangerle, Alexandra; Werner, Philipp; Ferrari, Julia; Schmidauer, Ch.; Seyfang, Leonhard; Kiechl, Stefan; Willeit, Johann

doi:10.1212/wnl.0b013e31824367ab

Cited by 206 publications

(165 citation statements)

References 32 publications

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“…It is generally in line with previous reports. 14,[18][19][20] However, our findings show that if the effectiveness of treatment is measured using a composite end point of mRS 0 to 2 or returning to prestroke mRS, the benefit in patients with prestroke mRS of 3 to 5 may match the benefit in patients with prestroke mRS of 2. During 3 months after thrombolysis, ≈1 in 3 patients from both groups returned to his/her previous mRS score.…”

Section: Discussionmentioning

confidence: 72%

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Role of Preexisting Disability in Patients Treated With Intravenous Thrombolysis for Ischemic Stroke

Karliñski

Kobayashi

Członkowska

et al. 2014

Stroke

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Background and Purpose— Little is known about the effect of thrombolysis in patients with preexisting disability. Our aim was to evaluate the impact of different levels of prestroke disability on patients’ profile and outcome after intravenous thrombolysis. Methods— We analyzed the data of all stroke patients admitted between October 2003 and December 2011 that were contributed to the Safe Implementation of Treatments in Stroke–Eastern Europe (SITS-EAST) registry. Patients with no prestroke disability at all (modified Rankin Scale [mRS] score, 0) were used as a reference in multivariable logistic regression. Results— Of 7250 patients, 5995 (82%) had prestroke mRS 0, 791 (11%) had prestroke mRS 1, 293 (4%) had prestroke mRS 2, and 171 (2%) had prestroke mRS ≥3. Compared with patients with mRS 0, all other groups were older, had more comorbidities, and more severe neurological deficit on admission. There was no clear association between preexisting disability and the risk of symptomatic intracranial hemorrhage. Prestroke mRS 1, 2, and ≥3 were associated with increased risk of death at 3 months (odds ratio, 1.3, 2.0, and 2.6, respectively) and lower chance of achieving favorable outcome (achieving mRS 0–2 or returning to the prestroke mRS; 0.80, 0.41, 0.59, respectively). Patients with mRS ≥3 and 2 had similar vascular profile and favorable outcome (34% versus 29%), despite higher mortality (48% versus 39%). Conclusions— Prestroke disability does not seem to independently increase the risk of symptomatic intracranial hemorrhage after thrombolysis. Despite higher mortality, 1 in 3 previously disabled patients may return to his/her prestroke mRS. Therefore, they should not be routinely excluded from thrombolytic therapy.

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Section: Discussionmentioning

confidence: 72%

“…19,20 Older age, stroke severity, and preadmission dependency additionally increase the risk of stroke-related pneumonia, which also strongly predicts poor outcome. 21 According to our data, 3-month mortality is higher with every level of prestroke disability, starting from 28% (preexisting mRS of 1) up to 48% (preexisting mRS of 3-5).…”

Section: Discussionmentioning

confidence: 99%

Role of Preexisting Disability in Patients Treated With Intravenous Thrombolysis for Ischemic Stroke

Karliñski

Kobayashi

Członkowska

et al. 2014

Stroke

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“…6,9,30 In our study, older age was associated with a poorer functional status in the medium term. As other investigators 27,31,32 have reported, age plays an important role in the functional recovery of patients, both at the time of discharge from the hospital and 6 months after a stroke, because scores on the Barthel Index decrease with age. This finding may indicate that older patients have poorer health status, which would affect their ability to recover and their degree of dependence.…”

Section: Discussionmentioning

confidence: 76%

Functional Status and Disability in Patients After Acute Stroke: A Longitudinal Study

López-Espuela

Pedrera‐Zamorano

Jiménez-Caballero

et al. 2016

American Journal of Critical Care

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Background Stroke is a major public health problem. Objective To use the Barthel Index to evaluate basic activities of daily living in stroke survivors and detect any predictors of functional outcome at 6 months after stroke. Methods In an observational longitudinal study, data were gathered on consecutive patients admitted to the comprehensive stroke unit at Hospital San Pedro de Alcantara, Cáceres, Spain. Sociodemographic and clinical data were obtained prospectively at hospital admission and during follow-up 6 months later. Information on type of stroke, score on the Barthel Index, findings from the neurological evaluation, and other relevant data were collected. Results Of 236 patients admitted, 175 participated in the study. Mean age was 69.60 (SD, 12.52) years, 64.6% were men, and mortality was 12.8%. Six months after experiencing a stroke, 84.8% of patients had returned to their own homes, 8.0% were institutionalized, and the others were residing at a family member’s home. Scores on the Barthel Index 6 months after stroke correlated with baseline scores on the National Institute of Health Stroke Scale (r = −0.424; P < .001) and with depressive mood 6 months after stroke (r = −0.318; P < .001). Age was negatively associated with Barthel Index scores at the time of hospital discharge and 6 months after stroke. Conclusions Functional status 6 months after stroke was influenced by age, sex, stroke severity, type of stroke, baseline status, mood, and social risk. Comorbid conditions, socioeconomic level, and area of residence did not affect patients’ functional status.

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“…The history of previous depression is a risk factor for the occurrence of post-stroke depression 7 . In addition, age is an inverse predictor of post-stroke functional independence 25 and lower functional dependence is related to PSD 7 . Thus, it is suggested that the elderly have a greater risk of developing depression after stroke.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and predictors of post stroke depression among elderly stroke survivors

Santos

Rodrigues

Pontes-Neto

2016

Arq. Neuro-Psiquiatr.

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Objective To identify the prevalence of post stroke depression (PSD) and their socio-demographic and clinical predictors among elderly stroke survivors after hospital discharge to home. Methods In this cross-sectional study, 90 elderly stroke survivors were evaluated 14 days after hospital discharge with the following scales: National Institutes of Health Stroke Scale, Functional Independence Measure, and Geriatric Depression Scale – 15 items (GDS-15). PSD was defined as a score > 5 on GDS-15. After univariate analyses, a multivariate logistic regression model was built to identify independent predictors of PSD. Results Fourteen days after hospital discharge, 27.7% (95%CI 18.1 to 37.2) of elderly stroke survivors had PSD. Functional dependence was the only independent predictor of PSD (OR: 1.04 95%CI: 1.01 to 1.09; p = 0.02). Conclusion After stroke, depressive symptoms are common among elderly survivors. The degree of functional dependency is the main predictor of PSD among elderly stroke patients in Brazil.

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Functional recovery after ischemic stroke—A matter of age

Abstract: Age emerged as a highly significant inverse predictor of good functional outcome after ischemic stroke independent of stroke severity, characteristics, and complications with the age-outcome association exhibiting a nonlinear scale and extending to young stroke patients.

Cited by 206 publications

References 32 publications

Role of Preexisting Disability in Patients Treated With Intravenous Thrombolysis for Ischemic Stroke

Role of Preexisting Disability in Patients Treated With Intravenous Thrombolysis for Ischemic Stroke

Functional Status and Disability in Patients After Acute Stroke: A Longitudinal Study

Prevalence and predictors of post stroke depression among elderly stroke survivors

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