Long-term performance of instrumental activities of daily living in young and middle-aged stroke survivors-Impact of cognitive dysfunction, emotional problems and fatigue

PLoS One. 2019 May 16;14(5):e0216822. doi: 10.1371/journal.pone.0216822. eCollection 2019.

Abstract

Background: With an upward trend in the number of people who return home to independent living after stroke, the ability to perform more complex activities is becoming an increasingly important long-term outcome after stroke. Although associations between Instrumental Activities of Daily Living (IADL) and cognitive dysfunction, emotional problems, and fatigue have been reported, less is known about the long-term impact of these stroke consequences on the performance of everyday activities in young and middle-aged stroke survivors.

Objective: To explore the impact of cognitive dysfunction, emotional problems, and fatigue on long-term performance of instrumental activities of daily living in young and middle-aged stroke survivors.

Method: Data on stroke survivors, aged 18-69 at index stroke, were collected from the Sahlgrenska Academy Study on Ischaemic Stroke. IADL outcome was assessed using the Frenchay Activities Index (FAI), and the impact of chosen variables was assessed using Spearman´s rank-order correlation and logistic regression.

Results: Seven years after index stroke, 296 stroke survivors (median age of 64) were included in this study. Cognitive dysfunction showed the strongest correlations with FAI outcome and independently explained worse outcome on FAI summary score and the domain of work/leisure activities. Fatigue was independently explanatory of worse outcome on FAI summary score and domestic chores, while depressive symptoms independently explained worse outcome on work/leisure activities. In a subgroup with only those participants who had no or minimal residual neurological deficits at follow-up (NIHSS score 0), cognitive dysfunction independently explained worse outcome on FAI summary score and work/leisure activities. Depressive symptoms independently explained worse outcome on FAI summary score and domestic chores.

Conclusion: Our results show that in young and middle-aged stroke survivors, cognitive dysfunction, depressive symptoms, and fatigue negatively impact performance of IADL even at seven years post stroke onset. Further, we have shown that an impact of both cognitive dysfunction and depressive symptoms can be found also among stroke survivors with mild or no remaining neurological deficits.

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Brain Ischemia / physiopathology*
  • Cognitive Dysfunction / physiopathology*
  • Depression / physiopathology*
  • Fatigue / physiopathology*
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Prospective Studies
  • Registries
  • Stroke / physiopathology*
  • Stroke Rehabilitation
  • Survivors*

Grants and funding

This project was supported by grants from Stroke Centre West, the Research and Development Council of the County of Södra Älvsborg and of Södra Älvsborgs Sjukhus (CB), Stiftelsen Handlanden Hjalmar Svenssons research fund (CB), the Swedish State under the agreement between the Swedish government and the county councils, the ALF agreement (all) Grant number: ALFGBG-720211, Swedish Heart and Lung Foundation (CJ) Grant number:20160316 and the Swedish Research Council (CJ), Grant number: 201802543. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.