Quality of life in patients with TIA and minor ischemic stroke

Abstract

Objective: We investigated health-related quality of life (HRQOL) in patients with TIA and minor ischemic stroke (MIS) using Neuro-QOL, a validated, patient-reported outcome measurement system.Methods: Consecutive patients with TIA or MIS who had (1) modified Rankin Scale (mRS) score of 0 or 1 at baseline, (2) initial NIH Stroke Scale score of #5, (3) no acute reperfusion treatment, and (4) 3-month follow-up, were recruited. Recurrent stroke, disability by mRS and Barthel Index, and Neuro-QOL scores in 5 prespecified domains were prospectively recorded. We assessed the proportion of patients with impaired HRQOL, defined as T scores more than 0.5 SD worse than the general population average, and identified predictors of impaired HRQOL using logistic regression.Results: Among 332 patients who met study criteria (mean age 65.7 years, 52.4% male), 47 (14.2%) had recurrent stroke within 90 days and 41 (12.3%) were disabled (mRS .1 or Barthel Index ,95) at 3 months. Any HRQOL impairment was noted in 119 patients (35.8%). In multivariate analysis, age (adjusted odds ratio [OR] 1.02, 95% confidence interval [CI] 1.01-1.04), initial NIH Stroke Scale score (adjusted OR 1.39, 95% CI 1.17-1.64), recurrent stroke (adjusted OR 2.10, 95% CI 1.06-4.13), and proxy reporting (adjusted OR 3.94, 95% CI 1.54-10.10) were independent predictors of impaired HRQOL at 3 months.Conclusions: Impairment in HRQOL is common at 3 months after MIS and TIA. Predictors of impaired HRQOL include age, index stroke severity, and recurrent stroke. Future studies should include HRQOL measures in outcome assessment, as these may be more sensitive to mild deficits than traditional disability scales. Neurology ® 2015;85:1957-1963 GLOSSARY BI 5 Barthel Index; CI 5 confidence interval; DWI 5 diffusion-weighted imaging; HRQOL 5 health-related quality of life; MIS 5 minor ischemic stroke; mRS 5 modified Rankin Scale; NIHSS 5 NIH Stroke Scale; OR 5 odds ratio.Patients with TIA and minor ischemic stroke (MIS) account for the majority of stroke patients who present for emergency care in the United States.1 Mild symptoms on presentation is a common reason for exclusion from IV tissue plasminogen activator administration.2 Acute ischemic stroke leads to decreases in health-related quality of life (HRQOL), even among those who have no or minimal poststroke disability.3 Although the outcomes of most patients with minor symptoms, defined by a low NIH Stroke Scale (NIHSS) score, are favorable, approximately 25% of such patients become disabled. 2Stroke outcomes traditionally have utilized disability scales of functional status, which often fail to represent the full effect of disease and treatment. The modified Rankin Scale (mRS) and Barthel Index (BI) are the most frequently used tools to measure disability and handicap after stroke. 4 With National Institute of Neurological Disorders and Stroke funding to address these limitations, Neuro-QOL was developed as a clinically robust and validated patient-reported HRQOL assessment tool for adults and children wit...

Disparities in the Use of Seizure Medications After Intracerebral Hemorrhage

“…4 Levetiracetam has fewer side effects than phenytoin, and any adverse effects on cognition or behavior are likely to be detected only in patients already considered to have a “good outcome.” 13 Other validated scores of health-related quality of life and cognition could be a useful adjunct. 14, 15 …”

Predicting Domain-Specific Health-Related Quality of Life Using Acute Infarct Volume

“…Demographics, baseline functioning, insurance status, risk factors, hospital course, discharge disposition, interval rehabilitation services, and recurrent stroke 10 were prospectively recorded. History of hypertension, diabetes mellitus, dyslipidemia, prior stroke, atrial fibrillation or flutter, and cardiac disease (history or angina, myocardial infarction, coronary bypass or intervention, or congestive heart failure) were defined by documented history, medications, or findings at presentation.…”

“…At 3 months, patients or their proxies completed 4 domain-specific assessments using the Neuro-QOL instrument (SF Version 1.0): upper extremity function (fine motor activity, reaching activities), lower extremity function (mobility including walking on stairs or uneven surfaces), applied cognition–executive function (planning, organizing, calculating, working with memory and learning), and applied cognition– general concerns (perceived difficulties with abilities such as memory, attention, and decision-making). Proxy assessments have been validated in previous studies featuring stroke populations 10, 16 . Neuro-QOL results were expressed as T scores referenced to general United States population (with enrichment from a clinical neurologic sample) demographics with mean 50 and standard deviation (SD) 10 17, 18 ; additional information available at www.neuroqol.org 8 .…”

CASE-REPORT Dysregulation of gene expression in a patient with depressive disorder after transient ischemic attack confirmed by a neurophysiological neuromarker

“…Although depression may affect functional recovery and quality of life after TIA, the condition is often ignored (Paolucci, 2008;Sangha et al, 2015). Only a minority of patients is diagnosed properly and even fewer are treated in the common clinical practice (Mirski et al, 2015;Trystuła et al, 2016).…”