Long-term psychological outcomes following stroke: The OX-CHRONIC study

Abstract

AbstractBackgroundStroke survivors rate longer-term (>2 years) psychological recovery as their top priority, but data on how frequently psychological consequences occur is lacking. Prevalence of cognitive impairment, depression/anxiety, fatigue, apathy and related psychological outcomes, and whether rates are stable in long-term stroke, is unknown.MethodsN= 105 long-term stroke survivors (M[SD] age = 72.92 [13.01];M[SD] acute NIH Stroke Severity Score = 7.39 [6.25]; 59.0% Male;M[SD] years post-stroke = 4.57 [2.12]) were recruited (potentialN= 208). Participants completed 3 remote assessments, including a comprehensive neuropsychological battery, and questionnaires on emotional distress, fatigue, apathy and other psychological outcomes. Ninety participants were re-assessed one year later. Stability of outcomes was assessed by Cohen’sdeffect size estimates and percent Minimal Clinically Important Difference changes between time points.ResultsOn the Montreal Cognitive Assessment 65.3% scored <26. On the Oxford Cognitive Screen 45.9% had at least one cognitive impairment. Attention (27.1%) and executive function (40%) were most frequently impaired. 23.5% and 22.5% had elevated depression/anxiety respectively. Fatigue (51.4%) and apathy (40.5%) rates were high. Attention (d= −0.12; 85.8% stable) and depression (d= 0.09, 77.1% stable) were the most stable outcomes. Following alpha-adjustments, only perceptuomotor abilities (d= 0.69; 40.4% decline) and fatigue (d= −0.33; 37.2% decline) worsened over one year. Cognitive impairment, depression/anxiety, fatigue and apathy all correlated with worse quality of life.ConclusionNearly half of participants >2 years post-event exhibited psychological difficulties, which impact long-term quality of life. Stroke is a chronic condition requiring long-term psychological support.