Stroke Associated With Long-Term Brain Effects, Accelerated Functional Decline

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Stroke may be associated with long-term neurological adverse effects that result in accelerated functional decline and disability.
Stroke may be associated with long-term neurological adverse effects that result in accelerated functional decline and disability.

Stroke may be associated with long-term neurologic adverse effects that result in accelerated functional decline and disability, according to a study published in JAMA Neurology.

A total of 5888 Medicare-eligible patients from the population-based, prospective Cardiovascular Health Study were included in this analysis. Ischemic stroke occurred in 382 patients during the follow-up period, with myocardial infarction (MI) occurring in another 395 patients. Follow-up data on stroke outcomes, particularly disability, were collected. Disability was assessed using the activities of daily living scales.

Participants had ≥1 disability assessment following ischemic stroke or MI event. Stroke was associated with a greater increase in disability near the time of the event (95% CI, 0.57-1.20; P < .001) when compared with MI (95% CI, 0.06-0.35; P = .006).

In addition, there was a greater chance for disability after stroke (95% CI, 0.004-0.30; P =.04) vs before stroke (95% CI, 0.002-0.12; P =.04). There was no significant difference between disability before (95% CI, 0.004-0.08; P =.03) vs after (95% CI, -0.07 to 0.11; P =.69) an MI event.  

One of the key limitations of this study is its small sample size. Additionally, this study did not assess the size or severity of the stroke, nor did it use imaging strategies to determine whether other factors contributed to the higher rates of disability among those who have had a stroke.

A potential mechanism of post-stroke functional decline and disability may involve progressive cardiovascular impairment and decreased fitness.

“Stroke intervention trials that measure recurrent events or disability at a single follow-up time as outcomes may miss the progressive disability that we observed,” the investigators cautioned.

Reference

Dhamoon MS, Longstreth WT Jr, Bartz TM, Kaplan RC, Elkind MSV. Disability trajectories before and after stroke and myocardial infarction: the Cardiovascular Health Study [published online October 23, 2017]. JAMA Neurol. doi:10.1001/jamaneurol.2017.2802

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