Hallevi Hen, Molad Jeremy, Kliper Efrat, Seyman Estelle, Niry Dana, Bornstein Natan M, Ben Assayag Einor
Departments of Neurology and Radiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel.
Departments of Neurology and Radiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
J Stroke Cerebrovasc Dis. 2020 Sep;29(9):105019. doi: 10.1016/j.jstrokecerebrovasdis.2020.105019. Epub 2020 Jun 17.
Occupational status may influence physical and mental post-stroke outcomes. We aimed to evaluate the association between occupational status and type, or engagement in social and family activities, neuroimaging measures and cognitive decline (CD) in a prospective cohort of stroke patients.
We included 273 first-ever stroke survivors at working age. All patients underwent 3T MRI at admission, as well as clinical and cognitive assessments at admission, 6, 12 and 24 months thereafter.
Ninty nine (36.3%) of the participants were unemployed prior to the stroke. Age, sex, work type, other comorbidities, stroke severity or location were not associated with return to work. Patients who returned to work (87.4%) had better cognitive results and less depressive symptoms than those who retired after the event. Pre-stroke unemployment was associated with diabetes mellitus, hypertension, dyslipidemia, depression, poorer cognitive scores and brain atrophy. During the follow-up, 11% developed CD. CD was more common among previously unemployed than employed participants (19.2% vs. 6.3%, p = 0.001). Multiple regression adjusted for risk factors, revealed that pre-stroke unemployment was an independent predictor of CD (HR, 3.0; 95% CI: 1.06-8.44). Furthermore, engagement in mentally stimulating jobs decreased the risk for CD.
Pre-stroke unemployment and post-stroke work disruption were each associated with depression and poorer cognitive performance up to two years post-stroke, as well as with brain atrophy at admission. Retirement after the stroke may increase the risk of developing CD. These results highlight the importance of continued employment in preserving cognitive abilities among stroke survivors.
职业状况可能会影响中风后的身体和心理结局。我们旨在评估中风患者前瞻性队列中职业状况与类型、社会和家庭活动参与度、神经影像学指标以及认知衰退（CD）之间的关联。
我们纳入了273名处于工作年龄的首次中风幸存者。所有患者在入院时接受了3T磁共振成像（MRI）检查，并在入院时、此后6个月、12个月和24个月进行了临床和认知评估。
99名（36.3%）参与者在中风前失业。年龄、性别、工作类型、其他合并症、中风严重程度或部位与重返工作无关。重返工作的患者（87.4%）比中风后退休的患者认知结果更好，抑郁症状更少。中风前失业与糖尿病、高血压、血脂异常、抑郁、较差的认知评分和脑萎缩有关。在随访期间，11%的患者出现了认知衰退。认知衰退在先前失业的参与者中比就业参与者更常见（19.2%对6.3%，p = 0.001）。对风险因素进行多元回归调整后发现，中风前失业是认知衰退的独立预测因素（风险比，3.0；95%置信区间：1.06 - 8.44）。此外，从事脑力刺激工作可降低认知衰退的风险。
中风前失业和中风后工作中断均与中风后两年内的抑郁和较差的认知表现以及入院时的脑萎缩有关。中风后退休可能会增加发生认知衰退的风险。这些结果凸显了持续就业对中风幸存者保持认知能力的重要性。
