Liang Yannis Yan, Wang Lisha, Yang Ying, Chen Yangkun, Mok Vincent C T, Ungvari Gabor S, Chu Winnie C W, Kim Jong S, Tang Wai-Kwong
Stroke Center and Department of Neurology, The First Affiliated Hospital, Jinan University, Guangzhou, China.
Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, Hong Kong.
Front Psychiatry. 2020 Sep 8;11:563930. doi: 10.3389/fpsyt.2020.563930. eCollection 2020.
Behavioral dysexecutive syndrome (BDES) is one common neuropsychiatric comorbidity after stroke. Despite evidences suggesting the adverse effect of BDES on the survivors' outcome, little is known about the association between BDES and the health-related quality of life (HRQoL) among stroke survivors and how BDES impacts the HRQoL. This study aimed to address these questions.
This study included 219 patients with acute ischemic stroke consecutively admitted to a regional hospital in Hong Kong. BDES was defined as a Chinese version of the Dysexecutive Questionnaire (DEX) score of ≥20 assessed at three months after stroke. The HRQoL was assessed with the Chinese version of the Stroke-Specific Quality of Life (SSQoL) questionnaire encompassing 12 domains. Multivariate linear regression models were employed to examine the association between BDES symptoms and the SSQoL total and domain scores. Structural equation model (SEM) was further constructed to delineate the linking pathways linking BDES and the HRQoL.
The study sample compromised mainly older patients with mild to moderate ischemic stroke. Compared with patients without BDES, those with BDES exhibited poorer performances regarding with the summarized SSQoL (226.2 ± 18.8 vs. 200.3 ± 29.8, p < 0.001) and almost all domains. The BDES symptoms were independently contributed to the whole HRQoL (SSQoL total score) (β = -0.20, p = 0.002), specifically to the domains in personality (β = -0.34, p < 0.001), language (β = -0.22, p = 0.01), and work/productivity (β = -0.32, p < 0.001), after adjusting demographic and clinical characteristics in linear models. The impacts of the BDES symptoms on the HRQoL were mainly explained by the indirect path mediated by depression and anxiety (path coefficient = -0.27, p < 0.05) rather than physical disability, while the resting was elucidated by the path directly linking BDES to the HRQoL (path coefficient = -0.17, p < 0.05).
The present study preliminarily demonstrated a potential association between BDES and a lower level of the HRQoL, predominantly in domains of personality, language, and work/productivityafter acute ischemic stroke. This study also offered insights into the underlying mechanisms linking BDES and the HRQoL, implicating that integrative psychological therapies were urged to achieve better HRQoL after stroke.
行为执行功能障碍综合征（BDES）是卒中后一种常见的神经精神共病。尽管有证据表明BDES对幸存者的预后有不良影响，但对于卒中幸存者中BDES与健康相关生活质量（HRQoL）之间的关联以及BDES如何影响HRQoL知之甚少。本研究旨在解决这些问题。
本研究纳入了连续入住香港一家地区医院的219例急性缺血性卒中患者。BDES被定义为卒中后三个月评估的中文版执行功能障碍问卷（DEX）得分≥20分。采用中文版卒中特异性生活质量（SSQoL）问卷对HRQoL进行评估，该问卷涵盖12个领域。采用多元线性回归模型检验BDES症状与SSQoL总分及各领域得分之间的关联。进一步构建结构方程模型（SEM）来描绘BDES与HRQoL之间的联系路径。
研究样本主要包括患有轻度至中度缺血性卒中的老年患者。与无BDES的患者相比，有BDES的患者在汇总的SSQoL方面表现较差（226.2±18.8对200.3±29.8，p<0.001），几乎所有领域均如此。在调整线性模型中的人口统计学和临床特征后，BDES症状独立影响整体HRQoL（SSQoL总分）（β=-0.20，p=0.002），特别是在人格（β=-0.34，p<0.001）、语言（β=-0.22，p=0.01）和工作/生产力（β=-0.32，p<0.001）领域。BDES症状对HRQoL的影响主要由抑郁和焦虑介导的间接路径解释（路径系数=-0.27，p<0.05），而非身体残疾，而其余部分则由BDES直接与HRQoL相连的路径解释（路径系数=-0.17，p<0.05）。
本研究初步证明了BDES与较低水平的HRQoL之间存在潜在关联，主要体现在急性缺血性卒中后的人格、语言和工作/生产力领域。本研究还深入探讨了BDES与HRQoL之间的潜在机制，提示迫切需要综合心理治疗以改善卒中后的HRQoL。
