Psychotropic Polypharmacy Impairs Walking Independence in Post-Stroke Patients

Abstract

Background Psychotropic drugs are associated with adverse outcomes in older adults. However, evidence on the effect of psychotropic use on walking ability in post-stroke patients is lacking. Aim This study examined the association between psychotropic medication use and walking independence in post-stroke patients. Methods This retrospective cohort study included stroke patients admitted for convalescent rehabilitation at a Japanese hospital between 2020–2022. Psychotropic medications (benzodiazepines, hypnotics, antipsychotics, antidepressants) prescribed at admission were recorded. The primary outcome was walking independence at discharge, defined as a Functional Independence Measure (FIM) walk score ≥ 6. Logistic regression analyses examined the association between the number of psychotropic drugs and walking independence, adjusting for potential confounders. Results Of the 709 patients enrolled, 559 (mean age 75.5 years, 52.8% male) were included in the analysis. At admission, 25.4% of patients used psychotropic drugs. In the adjusted analysis, the number of psychotropic medications was independently associated with lower walking independence at discharge (OR 0.620, 95% CI 0.428–0.897, p = 0.011). Hypnotic use specifically showed a negative impact on walking independence (OR 0.331, 95% CI 0.154–0.708, p = 0.004). However, psychotropic drug use was not significantly associated with improvement in FIM-motor scores. Conclusion Greater psychotropic polypharmacy at admission, particularly with hypnotics, was associated with reduced likelihood of achieving walking independence after stroke rehabilitation. Judicious use of psychotropic medications may be warranted when ambulation is a critical goal for older post-stroke patients.