The prevalence and course of neuropsychiatric symptoms in stroke patients impact functional recovery during in-hospital rehabilitation.

BACKGROUND: Neuropsychiatric symptoms are common after stroke and are distressing symptoms. They may persist after the acute event and negatively impact rehabilitation, functioning, and patients' quality of life. OBJECTIVES: To elucidate the prevalence and course of neuropsychiatric symptoms in stroke patients during rehabilitation, we prospectively investigated the trajectory change of neuropsychiatric symptoms and the association between these symptoms and functional recovery. METHODS: This observational study enrolled 204 stroke patients consecutively admitted to the rehabilitation ward. We administered the Neuropsychiatric Inventory-Nursing Home Version (NPI-NH) for evaluating the neuropsychiatric symptoms (e.g., apathy and depression) and the Functional Independence Measure (FIM) and Montebello Rehabilitation Factor Score (MRFS) for functional recovery. RESULTS: The cumulative prevalence of neuropsychiatric symptoms was 48% during hospitalization; depression, anxiety, and sleep disturbances were most frequent. Binomial logistic regression analyses revealed that the factors associated with deterioration of neuropsychiatric symptoms during hospitalization included premorbid depression (odds ratio: 18.628, P = .001), the length of stay from onset to rehabilitation ward admission (odds ratio: 1.022, P = .012), motor FIM at admission (odds ratio: 0.950, P < .001), and NPI-NH at admission (odds ratio: 0.923, P = .011). Stepwise multiple regression analyses revealed that the NPI-NH at admission was associated with the MRFS (ß = -0.128, P = .037). CONCLUSION: Neuropsychiatric symptoms are common in stroke patients undergoing rehabilitation and have a substantially negative impact on rehabilitation outcomes. Stroke patients with prolonged acute-phase hospitalization and low functioning at admission must be monitored to detect any deterioration in the neuropsychiatric state.

Functional outcomes of inpatient rehabilitation in very elderly patients with stroke: differences across three age groups.

Background As the population continues to age rapidly, clarifying the factors affecting the prognosis in very elderly stroke patients is essential to enhance the quality of their rehabilitation. Objectives To compare the functional recovery of elderly stroke patients classified into three age groups and to identify the predictors of functional recovery in the very elderly following acute inpatient rehabilitation. Methods Observational study: We collected data on 461 stroke patients in the neurology and neurosurgery ward and classified them into three age groups (65-74, 75-84, and ≥ 85 years). Functional recovery was compared among groups using the functional independence measure (FIM) at discharge and ADL recovery rate was compared using the Montebello rehabilitation factor score (MRFS). Multiple regression analysis was used to identify and compare the factors associated with functional recovery in each age group. Results Functional recovery in the ≥ 85 years group was lower than that in other age groups. Factors associated with activities of daily living (ADL) status (FIM at discharge) in the ≥ 85 years group were premorbid dependence (ß = -0.183, p = 0.011), motor paralysis (ß = -0.238, p = 0.001), and cognitive function (ß = 0.586, p < 0.001). Furthermore, the impact of cognitive function grew as age increased. Factors associated with ADL recovery rates (MRFS) in the ≥ 85 years group were non-paretic limb function (ß = -0.294, p = 0.004) and cognitive function (ß = 0.201, p = 0.047). Conclusions This study identified the factors associated with functional recovery among very elderly stroke patients. Effective forms of rehabilitation for very elderly stroke patients that take these factors into consideration need to be investigated.