Clinical analysis of prognosis at 18 months after attack in patients with mild ischemic stroke / 中华老年医学杂志

ABSTRACT

Objective To investigate activities of daily living,depression,anxiety,fatigue and cognitive impairments at 18 months after attack in patients with mild ischemic stroke.Methods In this cross-sectional study,86 patients with acute ischemic stroke were hospitalized in the Neurology Department of Shanghai Ruijin Hospital from January 2013 to April 2013.Among them,58 cases who were eventually interviewed and selected,were divided into mild stroke group[NIHSS ≤3,n=37]and medium-severe stroke group[NIHSS＞3,n=21]according to the admission score of the National Institutes of Health Stroke Scale (NIHSS).Follow-up was done at 1.5 years after stroke to assess NIHSS,modified Rankin scale(mRS),Stroke Impact Scale(SIS),Hamilton depression scale(HAMD),Hamilton Anxiety Scale(HAMA),Modified Fatigue Impact Scale(MFIS)and Montreal Cognitive Assessment(MoCA).Meanwhile,35 patients with high risk of ischemic cerebrovascular disease were evaluated by HAMD,HAMA,MFIS and MoCA.Results Patients in the mild stroke group showed significantly better prognoses identified by the assessed scores of NIHSS[median(M) =0,interquartile range(IQR) =0,z =-3.879],mRS[M=1,IQR =1,z =-2.381],SIS-total score[697.36 ± 85.66,t =2.351] and SIS-Stroke recovery score (84.15 ± 11.94,t-3.696),as well as the SIS partial items,including strength (79.49 ± 15.88,t =2.099),instrumental activities of daily living[M=97.5,IQR=10,z=-2.858],locomotivity[M=97.2,IQR=0,z=3.083],hand function[M 100,IQR=20,z=-2.259]and social participation[M=90.6,IQR=28,z=2.582],at 1.5 year follow-up.These parameters were markedly different from those in the medium-severe group(all P＜0.05).Additionally,the high-risk group for cerebrovascular disorder showed no case with depression,anxiety and fatigue,but showed 10 cases(28.6 ％) with cognitive impairments.Furthermore,the mild stroke group versus the medium-severe stroke group showed a similar incidences of depression (16.2 ％ vs.38.1％,P =0.061),anxiety(10.8 ％ vs.19.0 ％,P =0.443),fatigue (35.1％ vs.38.1％,P =0.822) and cognitive impairments (59.5％ vs.66.7％,P=0.587).Conclusions The motor function-evaluated activities of daily living are little affected in mild ischemic stroke at 18months follow-up,but rates of depression,anxiety,fatigue and cognitive decline are not uncommon.