1 Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada.
2 Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada.
J Geriatr Psychiatry Neurol. 2019 Jan;32(1):40-48. doi: 10.1177/0891988718819859.
Independence and reintegration into community roles are important patient-centered outcomes after stroke. Depression and cognitive impairment are common post-stroke conditions that may impair long-term function even years after a stroke. However, screening for these post-stroke comorbidities remains infrequent in stroke prevention clinics and the utility of this screening for predicting long-term higher-level function has not been evaluated.
To evaluate the ability of a validated brief Depression, Obstructive sleep apnea, and Cognitive impairment screen (DOC screen) to predict long-term (2-3 years after stroke) community participation and independence in instrumental activities of daily living post stroke.
One hundred twenty-four patients (mean age, 66.3 [standard deviation = 15.7], 52.4% male) completed baseline depression and cognitive impairment screening at first stroke clinic visit, and telephone interviews 2 to 3 years post stroke to assess community independence (Frenchay Activities Index [FAI]) and participation (Reintegration to Normal Living Index [RNLI]). A subset of these patients also consented to complete detailed neuropsychological testing at baseline. Univariate and multivariate linear (FAI) and logistic (RNLI) regression analyses were used to determine the individual relationship between baseline data (predictors) and follow-up scores.
Older age (β = -0.17, P = .001), greater stroke severity (β = 1.84, P = .015), more depressive (β = -2.41, P = .023), and cognitive (β = -2.15, P = .046) symptoms independently predicted poor instrumental activity ( R = .27; P < .001). Measures of executive dysfunction were the strongest correlates of poor instrumental activity. Higher depression risk was the only significant predictor of participation on the RNLI in regression modeling (odds ratio = 0.46, P = .028).
Baseline DOC screening in stroke prevention clinics shows that symptoms of depression and cognitive impairment are independent predictors of impaired higher-level functioning and community reintegration 2 to 3 years after stroke. Novel rehabilitation and psychological interventions targeting people with these conditions are needed to improve long-term patient-centered outcomes.
独立和重新融入社区角色是中风后以患者为中心的重要结果。中风后常见的抑郁和认知障碍会损害长期功能，即使在中风后数年也是如此。然而，中风预防诊所对这些中风后合并症的筛查仍然很少见，并且尚未评估这种筛查对预测长期更高水平功能的效用。
评估经过验证的简短抑郁、阻塞性睡眠呼吸暂停和认知障碍筛查（DOC 筛查）预测中风后 2-3 年（中风后）社区参与和独立进行日常活动能力的能力。
124 名患者（平均年龄 66.3 [标准差=15.7]，52.4%为男性）在首次中风诊所就诊时完成了基线抑郁和认知障碍筛查，并在中风后 2 至 3 年进行了电话访谈，以评估社区独立性（Frenchay 活动指数[FAI]）和参与度（重返正常生活指数[RNLI]）。这些患者的一部分还同意在基线时完成详细的神经心理学测试。使用单变量和多变量线性（FAI）和逻辑（RNLI）回归分析来确定基线数据（预测因子）和随访分数之间的个体关系。
年龄较大（β=-0.17，P=.001）、中风严重程度较高（β=1.84，P=.015）、抑郁症状更严重（β=-2.41，P=.023）和认知症状（β=-2.15，P=.046）独立预测了较差的工具性活动（R=.27；P<.001）。执行功能障碍的测量是与较差的工具性活动的最强相关因素。较高的抑郁风险是回归模型中参与 RNLI 的唯一显著预测因素（优势比=0.46，P=.028）。
中风预防诊所的基线 DOC 筛查表明，抑郁和认知障碍的症状是中风后 2 至 3 年受损的更高水平功能和社区重新融入的独立预测因素。需要针对这些情况的新型康复和心理干预措施来改善以患者为中心的长期结果。
