Aked J, Delavaran Hossein, Wennerström Fredrik, Lindgren Arne
Department of Clinical Sciences Lund Neurology, Lund University, Lund, Sweden
Department of Medicine, Blekinge Hospital, Karlskrona.
BMJ Open. 2025 Jul 6;15(7):e096908. doi: 10.1136/bmjopen-2024-096908.
To study the prevalence of and interplay between common neuropsychiatric sequelae 3-4 years after onset of first-ever stroke-specifically post-stroke fatigue (PSF), post-stroke depression (PSD) and post-stroke cognitive impairment (PSCI).
Population-based cohort study.
Catchment area of a Swedish University Hospital.
We recruited individuals with first-ever ischaemic stroke or intracerebral haemorrhage in the initial cohort; 151 of these died prior to follow-up and 47 (12%) were lost to detailed follow-up. We followed up 202 individuals with median age: 72 (IQR 65-79), 40% female, either in clinic, via home visits or via telephone.
Primary outcome measures included PSF (Fatigue Assessment Scale), PSD (Patient Health Questionnaire-9) and PSCI (Montreal Cognitive Assessment). Secondary outcome measures included dependency in activities of daily living (ADL; Barthel Index), health-related quality of life (HRQoL; Short-Form Questionnaire-36, EuroQoL-5D and Stroke Impact Scale) and stroke severity (National Institutes of Health Stroke Scale (NIHSS)).
Significant PSF was present in 46/195 (24%), PSD in 21/191 (11%), and PSCI in 93/173 (54%) respondents. Among 169 participants with available data for all three domains, 100 (59%) had impairment in at least one domain. Participants with PSCI were older than those without (median: 75 vs 67 years; p<0.01), but age did not differ for those with/without PSF or PSD. Among 21 respondents with PSD, 20 (95%) had PSF. PSD and PSF were strongly correlated (ϱ=0.69; p<0.01) and PSF was associated with worse HRQoL (HR: 1.15; 95% CI 1.08 to 1.22; p<0.001). ADL dependency was associated with worse NIHSS at follow-up (B: -3.81; 95% CI -4.77 to -2.85), baseline home care (B: -18.34; 95% CI -26.95 to -9.73) and PSF (B: -0.65; 95% CI -1.05 to -0.26).
PSF, PSD and PSCI are highly prevalent 3-4 years after stroke. PSF and PSD overlap and correlate. PSF is associated with ADL dependency and worse HRQoL. Clinical awareness and research of treatment for neuropsychiatric complications of stroke are needed.
研究首次卒中发病3 - 4年后常见神经精神后遗症——具体为卒中后疲劳（PSF）、卒中后抑郁（PSD）和卒中后认知障碍（PSCI）的患病率及其相互作用。
基于人群的队列研究。
瑞典某大学医院的服务区域。
我们在初始队列中招募了首次发生缺血性卒中或脑出血的个体；其中151人在随访前死亡，47人（12%）失访未能进行详细随访。我们对202名个体进行了随访，这些个体的年龄中位数为72岁（四分位间距65 - 79岁），40%为女性，随访方式包括门诊、家访或电话随访。
主要结局指标包括PSF（疲劳评估量表）、PSD（患者健康问卷 - 9）和PSCI（蒙特利尔认知评估量表）。次要结局指标包括日常生活活动能力（ADL；巴氏指数）、健康相关生活质量（HRQoL；简明健康调查问卷 - 36、欧洲五维度健康量表和卒中影响量表）以及卒中严重程度（美国国立卫生研究院卒中量表（NIHSS））。
在195名受访者中，46人（24%）存在显著的PSF，191名受访者中有21人（11%）存在PSD，173名受访者中有93人（54%）存在PSCI。在169名具有所有三个领域可用数据的参与者中，100人（59%）在至少一个领域存在损伤。患有PSCI的参与者比未患PSCI的参与者年龄更大（中位数：75岁对67岁；p<0.01），但患有/未患有PSF或PSD的参与者年龄无差异。在21名患有PSD的受访者中，20人（95%）患有PSF。PSD和PSF高度相关（ϱ = 0.69；p<0.01），且PSF与较差的HRQoL相关（HR：1.15；95%CI 1.08至1.22；p<0.001）。随访时ADL依赖与较差的NIHSS评分相关（B： - 3.81；95%CI - 4.77至 - 2.85）、基线家庭护理情况相关（B： - 18.34；95%CI - 26.95至 - 9.73）以及PSF相关（B： - 0.65；95%CI - 1.05至 - 0.26）。
卒中后3 - 4年，PSF、PSD和PSCI非常普遍。PSF和PSD重叠且相关。PSF与ADL依赖和较差的HRQoL相关。需要提高对卒中神经精神并发症的临床认识并开展相关治疗研究。
