Department of Neurology, OLVG, Amsterdam, The Netherlands.
Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands.
J Neurol. 2020 Nov;267(11):3354-3361. doi: 10.1007/s00415-020-09999-7. Epub 2020 Jun 24.
Cognitive and emotional problems occur frequently after stroke. Patients with minor stroke are more likely to be discharged home. This paper compares early cognitive and emotional outcomes in patients discharged home after stroke versus patients discharged to inpatient rehabilitation, and examines the effect of cognitive and emotional outcomes on long-term participation.
In this multicenter prospective cohort study, patients with stroke were assessed at two months with the Hospital Anxiety and Depression Scale (HADS), the Checklist for Cognitive and Emotional Consequences following Stroke (CLCE-24) and the Montreal Cognitive Assessment (MoCA). One year post stroke, participation was assessed with the Restriction subscale of the Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-P Restriction).
The study included 332 patients. Two months post stroke, anxiety and cognitive problems were equally prevalent among patients discharged home (n = 243; 73%) and patients discharged to inpatient rehabilitation (n = 89; 27%) (HADS-A = 4.8 ± 3.9 versus 4.6 ± 4.0, p = 0.747; MoCA < 26: 66.7% versus 70.8%, p = 0.477; CLCE-cognition = 3.0 ± 2.9 versus 3.3 ± 2.8, p = 0.499). Depressive symptoms were less severe in patients discharged home (HADS-D = 4.3 ± 3.9 versus 5.5 ± 3.8, p = 0.010). In patients discharged home, cognitive complaints were predictive of long-term participation (B = - 2.03; 95% CI - 3.15, - 0.90), while cognitive or emotional outcomes were not predictive in patients discharged to inpatient rehabilitation.
Cognitive and emotional problems at two months post stroke were comparable between patients discharged home and those discharged to inpatient rehabilitation. For patients discharged home, cognitive complaints were predictive of long-term participation.
认知和情绪问题在卒中后经常发生。小卒中患者更有可能出院回家。本文比较了出院回家和出院到住院康复的卒中患者的早期认知和情绪结果，并探讨了认知和情绪结果对长期参与的影响。
在这项多中心前瞻性队列研究中，在卒中后 2 个月，使用医院焦虑抑郁量表（HADS）、卒中后认知和情绪后果检查表（CLCE-24）和蒙特利尔认知评估（MoCA）评估患者。卒中后 1 年，使用康复参与评估的乌得勒支量表的限制亚量表（USER-P 限制）评估参与情况。
本研究共纳入 332 例患者。卒中后 2 个月，出院回家的患者（n=243；73%）和出院到住院康复的患者（n=89；27%）的焦虑和认知问题同样普遍（HADS-A=4.8±3.9 与 4.6±4.0，p=0.747；MoCA<26：66.7%与 70.8%，p=0.477；CLCE-认知=3.0±2.9 与 3.3±2.8，p=0.499）。出院回家的患者抑郁症状较轻（HADS-D=4.3±3.9 与 5.5±3.8，p=0.010）。在出院回家的患者中，认知抱怨是长期参与的预测因素（B=−2.03；95%CI−3.15，−0.90），而在出院到住院康复的患者中，认知或情绪结果均不是预测因素。
出院回家和出院到住院康复的卒中患者在卒中后 2 个月的认知和情绪问题相当。对于出院回家的患者，认知抱怨是长期参与的预测因素。
