Morsund Åse Hagen, Ellekjær Hanne, Gramstad Arne, Reiestad Magnus Tallaksen, Midgard Rune, Sando Sigrid Botne, Jonsbu Egil, Næss Halvor
Department of Neurology, Møre and Romsdal Health Trust, Molde hospital, Molde and Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway.
Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim and Stroke Unit, Department of Internal Medicine, St Olavs hospital, University Hospital of Trondheim, Norway.
J Stroke Cerebrovasc Dis. 2020 Sep;29(9):105036. doi: 10.1016/j.jstrokecerebrovasdis.2020.105036. Epub 2020 Jun 23.
To study the effect of cognitive function, fatigue and emotional symptoms on employment after a minor ischemic stroke compared to non-ST-elevation myocardial infarction (NSTEMI).
We included 217 patients with minor ischemic stroke and 133 NSTEMI patients employed at baseline aged 18-70 years. Minor stroke was defined as modified Rankin scale (mRS) 0-2 at day seven or at discharge if before. Included NSTEMI patients had the same functional mRS. We applied a selection of cognitive tests and the patients completed questionnaires measuring symptoms of anxiety, depression and fatigue at follow up. Stroke patients were tested at three and 12 months and NSTEMI at 12 months.
The patients still employed at 12 monthswere significantly younger than the unemployed patients and the NSTEMI patients employed were significantly older than the stroke patients (59 vs 55 years, p < .001). In total, 82 % of stroke patients and 90 % of the NSTEMI patients employed at baseline were still employed at 12 months (p = 06). Stroke patients at work after 12 months had higher education than unemployed patients. There were no difference between employed and unemployed patients in risk factors or location of cerebral ischemic lesions. Cognitive function did not change significantly in the stroke patients from three to 12 months. For stroke patients, we found a significant association between HADS-depression and unemployment at 12 months (p = 04), although this association was not present at three months. Lower age and higher educational level were associated with employment at 12 months for all patients.
Age and education are the main factors influencing the ability to stay in work after a minor stroke. Employed stroke patients were younger than the NSTEMI patients, but there was no difference in the frequencies in remaining employed. The employment rate at 12 months was high despite the relatively high prevalence of cognitive impairment in both groups.
研究与非ST段抬高型心肌梗死（NSTEMI）相比，轻度缺血性卒中后认知功能、疲劳和情绪症状对就业的影响。
我们纳入了217例轻度缺血性卒中患者和133例基线时就业的年龄在18 - 70岁的NSTEMI患者。轻度卒中定义为第7天改良Rankin量表（mRS）评分为0 - 2分，若在此之前出院则以出院时评分为准。纳入的NSTEMI患者具有相同的功能性mRS评分。我们进行了一系列认知测试，患者在随访时完成了测量焦虑、抑郁和疲劳症状的问卷。卒中患者在3个月和12个月时接受测试，NSTEMI患者在12个月时接受测试。
12个月时仍在就业的患者明显比失业患者年轻，且就业的NSTEMI患者明显比卒中患者年龄大（59岁对55岁，p <.001）。总体而言，基线时就业的卒中患者中有82%、NSTEMI患者中有90%在12个月时仍在就业（p = 0.06）。12个月后仍在工作的卒中患者比失业患者受教育程度更高。就业和失业患者在危险因素或脑缺血病变部位方面没有差异。卒中患者从3个月到12个月认知功能没有显著变化。对于卒中患者，我们发现12个月时医院焦虑抑郁量表（HADS）抑郁评分与失业之间存在显著关联（p = 0.04），尽管3个月时不存在这种关联。所有患者中，年龄较小和教育水平较高与12个月时就业相关。
年龄和教育是影响轻度卒中后继续工作能力的主要因素。就业的卒中患者比NSTEMI患者年轻，但继续就业的频率没有差异。尽管两组认知障碍患病率相对较高，但12个月时的就业率较高。
