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Abstract
Objectives: To determine whether vascular and demographic factors predict worsening disability up to 8 years after lacunar stroke.
Methods: SPS3 (Secondary Prevention of Small Subcortical Strokes) was a clinical trial in lacunar stroke patients with annual assessment of disability using the Older Americans Resources and Survey instrumental activities of daily living (IADL) scale (range 0–14). Generalized estimating equations modeled the likelihood of disability (IADL <14) over time, adjusting for demographics, medical risk factors, cognition, mood, stroke location, and geographic region in univariate and multivariable models. IADL assessments after recurrent stroke were censored. We stratified by study region and age quartile.
Results: Among 2,820 participants, mean age was 63.4 years (SD 10.8), 63% were male, 36% had diabetes, 90% hypertension, and 10% prior stroke. Mean follow-up was 3.7 years. In multivariable models, female sex, education, diabetes, nonregular alcohol use, prior stroke, Cognitive Abilities Screening Instrument score, depression, mild cognitive impairment, and stroke location were associated with disability. The youngest age quartile had decreased odds of disability over time (odds ratio 0.90 per year, 95% confidence interval 0.85–0.95), whereas the oldest age quartile had increased odds (2.20, 95% confidence interval 1.75–2.75). Americans and Latin Americans had >2-fold greater odds of disability per year compared with Spaniards (p < 0.0001).
Conclusions: In lacunar stroke patients, older age was associated with worsening long-term disability, even without recurrence. Worse long-term function was associated with diabetes, cognitive status, and prior stroke, and regional differences may be attributable to variations in health care delivery or scale interpretation.
GLOSSARY
- CASI=
- Cognitive Abilities Screening Instrument;
- CI=
- confidence interval;
- DSM=
- Diagnostic and Statistical Manual of Mental Disorders;
- IADL=
- instrumental activities of daily living;
- MCI=
- mild cognitive impairment;
- OR=
- odds ratio;
- PHQ-9=
- Patient Health Questionnaire, 9-item;
- QOL=
- quality of life;
- SPS3=
- Secondary Prevention of Small Subcortical Strokes
Footnotes
SPS3 coinvestigators are listed on the Neurology® Web site at Neurology.org.
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Supplemental data at Neurology.org
- Received April 4, 2014.
- Accepted in final form November 13, 2014.
- © 2015 American Academy of Neurology
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