ABSTRACT
BACKGROUND: With improvements in stroke treatments, the number of patients with dramatic recovery is increasing. However, many of them are still complaining of difficulties in returning to work and every day activities. The aim was to assess work and social dysfunctioning in patients with minor to moderate stroke and explore its contributing factors. METHODS: Consecutive patients were prospectively included at a median 7 months after a first-ever stroke. Scores on the Work and Social Adjustment Scale (WSAS), a generic self-reported scale for assessing social functioning, were correlated with scores on the National Institutes of Health Stroke Scale (NIHSS), activities of daily living, Hospital Anxiety and Depression scale (HAD) and MMSE, Iowa Scale of Personality Changes and return to work at 1 year. RESULTS: Among the 84 included patients (mean age 43.5 years), 57 (68%; 95% CI 57 to 78%) complained of significant perturbation of functioning attributed to stroke. WSAS was highly significantly related to modified Rankin scale, daily living activities, Iowa Scale of Personality Changes and return to work at 1 year. Using ordinal logistic regression, the contributors to WSAS were initial neurological severity (NIHSS at admission), HAD and MMSE. CONCLUSIONS: The study showed that up to 68% of our patients complained of significant work and social dysfunction due to stroke, despite a good clinical outcome. This self-estimation was correlated to external validation criteria, stressing the high burden of stroke from the patient's viewpoint. Moreover, when compared across diseases, social dysfunctioning after mild stroke was as important as in other major disabling diseases.
Subject(s)
Social Behavior Disorders/etiology , Social Behavior Disorders/psychology , Stroke/complications , Stroke/psychology , Activities of Daily Living , Adolescent , Adult , Aged , Data Interpretation, Statistical , Female , Humans , Logistic Models , Magnetic Resonance Imaging , Male , Middle Aged , Neuropsychological Tests , Personality Tests , Prognosis , Prospective Studies , Psychometrics , Social Adjustment , Social Behavior , Work , Young AdultABSTRACT
Alzheimer's disease is a frequent neurodegenerative disease, which affects more than one third of elderly persons over 80 years. No curative treatment is currently available for this disease, but symptomatic treatments have produced significant improvements in patients' condition. Cholinesterase inhibitors should be prescribed for early and moderate stages and memantine for more severe stages of the disease. These drugs have an impact on cognitive performances, may delay functional decline and improve behaviour disturbances. From a preventive perspective, evidence of benefit from early management of vascular risk factors is accumulating. In the near future, the improved comprehension of the underlying mechanisms of Alzheimer's disease will hopefully bring new treatments, thats will delay or modify its course.
Subject(s)
Alzheimer Disease/therapy , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Antioxidants , Cholinesterase Inhibitors/therapeutic use , Estrogen Replacement Therapy , Humans , ImmunotherapyABSTRACT
The detection rate of cognitive impairment by general practitioners in elderly hospitalised and ambulatory population is low, ranging from 50 to 73%, and from 24 to 42%, respectively. This is insufficient regarding the importance of an early diagnosis of dementia and Alzheimer's disease, for the patient and his/her proxies, but also for the primary care physician in charge. Thus, all general practitioners should have a strategy for the evaluation of cognitive impairment in elderly patient.
