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Neuropsychiatric complications 3-4 years after stroke : A population-based study of fatigue, depression and cognition

Aked, J. LU orcid ; Delavaran, Hossein LU ; Wennerström, Fredrik and Lindgren, Arne LU (2025) In BMJ Open 15(7).
Abstract

Objectives 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). Design Population-based cohort study. Setting Catchment area of a Swedish University Hospital. Participants 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 and secondary outcome measures Primary outcome measures... (More)

Objectives 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). Design Population-based cohort study. Setting Catchment area of a Swedish University Hospital. Participants 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 and secondary outcome measures 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)). Results 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). Conclusions 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.

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author
; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Cognition, Depression & mood disorders, Fatigue, Stroke
in
BMJ Open
volume
15
issue
7
article number
e096908
publisher
BMJ Publishing Group
external identifiers
  • pmid:40623741
  • scopus:105010501828
ISSN
2044-6055
DOI
10.1136/bmjopen-2024-096908
language
English
LU publication?
yes
id
eb73fd39-b581-4d85-9c7e-19c2a965c5fc
date added to LUP
2025-12-12 13:33:50
date last changed
2025-12-13 03:00:10
@article{eb73fd39-b581-4d85-9c7e-19c2a965c5fc,
  abstract     = {{<p>Objectives 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). Design Population-based cohort study. Setting Catchment area of a Swedish University Hospital. Participants 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 and secondary outcome measures 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)). Results 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&lt;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&lt;0.01) and PSF was associated with worse HRQoL (HR: 1.15; 95% CI 1.08 to 1.22; p&lt;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). Conclusions 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.</p>}},
  author       = {{Aked, J. and Delavaran, Hossein and Wennerström, Fredrik and Lindgren, Arne}},
  issn         = {{2044-6055}},
  keywords     = {{Cognition; Depression & mood disorders; Fatigue; Stroke}},
  language     = {{eng}},
  number       = {{7}},
  publisher    = {{BMJ Publishing Group}},
  series       = {{BMJ Open}},
  title        = {{Neuropsychiatric complications 3-4 years after stroke : A population-based study of fatigue, depression and cognition}},
  url          = {{http://dx.doi.org/10.1136/bmjopen-2024-096908}},
  doi          = {{10.1136/bmjopen-2024-096908}},
  volume       = {{15}},
  year         = {{2025}},
}