Prevalence, predictors, and patterns of patient reported non-motor outcomes six months after stroke: a prospective cohort study

Background

Adverse non-motor outcomes have a major impact on patients and caregivers after stroke, but knowledge of their prevalence, predictors and patterns across multiple health domains remains limited; we therefore aimed to obtain these data in a large observational prospective cohort study.

Methods

We included data from the Stroke Investigation Group in North and Central London (SIGNAL) registry based at the University College London Hospitals (UCLH) Comprehensive Stroke Service which serves a multi-ethnic population of ∼1.6 million people. In adult patients diagnosed with acute stroke due to cerebral ischaemia or intracerebral haemorrhage (ICH) from January 2017 to January 2020 we evaluated non-motor outcomes (anxiety, depression, fatigue, sleep disturbance, social participation, pain, bowel dysfunction, bladder dysfunction, mood problems, communication problems, activities of daily living (ADL), memory and thinking problems) at 6-month follow-up. We evaluated baseline predictors in multivariable logistic regression, and correlations between domains using kappa statistics.

Findings

Follow-up was complete for 3080 of 3338 (92.3%) eligible surviving patients (2534 ischaemic stroke, 547 with ICH; mean age 71.2 years, 1379 (44.8%) female, 1774 (59.3%) white). The most prevalent adverse non-motor outcomes were fatigue 1756 (57%), reduced social participation 1694 (55%), sleep disturbance 1663 (54%), and constipation 1355 (44%). The rates of adverse non-motor outcomes in ⩾ 1, ⩾ 2, ⩾ 3, ⩾ 4, and ⩾ 5 domains were 2310 (75%), 1571 (51%), 1519 (49%), 1232 (40%), and 801 (26%), respectively. Factors associated with adverse non-motor outcomes included stroke due to ICH, stroke severity, previous stroke, or history of cardiovascular disease. We identified moderate correlations between fatigue and sleep disturbance (kappa = 0.72); memory and thinking impairment and reduced ADL (kappa = 0.68); and communication problems and ADL (kappa = 0.70).

Interpretation

Adverse non-motor outcomes are highly prevalent and often multiple at 6-months after stroke: 75% have at least one affected domain; fatigue, sleep disturbance, and reduced social participation each affect over 50% of survivors, and 26% of patients report ≥5 adverse outcomes. Our findings suggest an urgent need to better detect and mitigate these outcomes to improve quality of life after stroke.

Funding

The National Institute for Health and Care Research (NIHR) UCLH Biomedical Research Centre.