Functional Recovery and Social Outcome after Cerebral Infarction in Young Adults

Abstract

This study was designed to assess the return to work, the poststroke depression and the quality of life after a cerebral infarction in young adults and was conducted on 71 consecutive young patients (aged 15–45 years) affected by a cerebral infarct who were hospitalized for the first time and discharged at least 1 year before the study. Data about risk factors, etiology, side and territory of stroke, social characteristics of the patient (age, sex, profession, educational level, family situation), poststroke seizures, recurrent stroke, other vascular events, and deaths were collected. Neurological deficits were graded with the National Institutes of Health (NIH) Stroke Scale. Poststroke depression (PSD) was quantified using the DSM-IIIR criteria and the Montgomery Asberg Depression Rating Scale. Outcomes were rated with the Ranking Scale, the Barthel Index and the Glasgow Outcome Scale. Quality of life was assessed with the Sickness Impact Profile. Follow-up information was obtained by interview and neurological examination. Follow-up information was obtained in 65 patients at a mean of 31.7 ± 13.0 (range 12–59) months, as 2 patients died and 4 were lost to follow-up and were thus excluded from this study. Poststroke seizures occurred in 7 patients (10.8%) and recurrent strokes in 4 patients (6.2%), but none were fatal. The outcome after stroke among survivors was usually good, since more than two-thirds of the patients (69.8%) reported no problem, 11.1% moderate handicap and one-fifth major handicap. Forty-six patients (73%) returned to work; the time period ranging from several days after stroke to 40 months, with a mean of 8 months. However, adjustments in their occupation were necessary for 12 patients (26.1%). PSD was common, since 48.3% of the patients were classified as depressed. PSD was associated with the localization of the infarct (carotid territory), a severe disability, a bad general outcome, and an absence of return to work. Their opinion about their quality of life was negative among approximately 30% of the patients, especially in emotional and alertness behaviors, social interaction, recreation and pastimes.The general outcome after cerebral infarct in young adults is usually good. However, the risk of a PSD is high, and only half of the patients had returned to their previous work. A remaining psychosocial handicap and depression of sexual activity impaired the quality of life. In multivariate analysis, a low NIH score at admission is a significant predictor for return to work, the absence of PSD, and a good quality of life.

Long-term prognosis of ischemic stroke in young adults

“…According to these scales, in the long-term followup even more than 70%-80% of the patients report no significant problems for daily activities (MRS = 0-2; IB = 100), about 10%-20% report moderate handicaps (MRS = 3), and only about 10% report major handicaps and residual dependency after ischemic stroke (MRS score higher than 3 and/or BI score less than 90) [12,30,41].…”

Chapter 8. Sick leave due to coronary artery disease or stroke

“…One study showed that one in four patients required adaptation of the job (9). Predictors for not returning to work include high age, female gender, stroke in the left cerebral hemisphere, greater level of hemiplegia, lower functional level (ADL) and impaired cognitive capacity.…”

Poststroke depression and its impact on quality of life

“…Reikia pabrėžti, kad depresiją diagnozuoti sudėtinga, jei yra tokių sutrikimų, kaip afazija, anozognozija ir kitų poinsultinių kognityvinių sutrikimų (44). Nustatyta, kad poinsultinė depresija dažnai pasireiškia jauniems pacientams (45,46). Tačiau vyresnio amžiaus pacientai gali būti labiau linkę į depresiją dėl funkcinių ir kognityvinių sutrikimų, buvimo gydymo įstaigose, socialinės pagalbos stokos (39).…”

“…J. P. Neau ir kt. atliko tyrimą, siekdami įvertinti jaunų žmonių grįžimą į darbą, poinsultinę depresiją ir gyvenimo kokybę persirgus GSI (45). Į tyrimą įtrauktas 71 pacientas 15-45 metų amžiaus, patyręs GSI, pirmą kartą hospitalizuotas ir išrašytas iš ligoninės bent vieneri metai iki tyrimo.…”

“…Vis dėlto poinsultinės depresijos rizika yra didelė, ir tik pusė pacientų grįžo į savo ankstesnį darbą. Išliekanti psichologinė ir socialinė negalia, užslopintas lytinis gyvenimas pablogina gyvenimo kokybę (45). M. Sharpe ir kt.…”