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Long-term disability after lacunar stroke: secondary prevention of small subcortical strokes
Journal article   Open access   Peer reviewed

Long-term disability after lacunar stroke: secondary prevention of small subcortical strokes

Mandip S Dhamoon, Leslie A McClure, Carole L White, Kamakshi Lakshminarayan, Oscar R Benavente, Mitchell S V Elkind and SPS3 Investigators
Neurology, v 84(10), pp 1002-1008
10 Mar 2015
DOI: https://doi.org/10.1212/WNL.0000000000001331
PMID: 25663222
Featured in Collection :   UN Sustainable Development Goals @ Drexel
url
https://doi.org/10.1212/wnl.0000000000001331View
Published, Version of Record (VoR)Open Access (License Unspecified),  Open
url
https://doi.org/10.1212/WNL.0000000000001331View
Published, Version of Record (VoR) Open

Abstract

Activities of Daily Living Age Factors Aged Disability Evaluation Disease Progression Female Follow-Up Studies Humans Male Middle Aged Randomized Controlled Trials as Topic Secondary Prevention Stroke, Lacunar - complications Stroke, Lacunar - prevention & control Time Factors
To determine whether vascular and demographic factors predict worsening disability up to 8 years after lacunar stroke. 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. 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). 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.

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28 citations in Web of Science
33 citations in Scopus

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UN Sustainable Development Goals (SDGs)

This publication has contributed to the advancement of the following goals:

#3 Good Health and Well-Being

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Collaboration types
Domestic collaboration
International collaboration
Web of Science research areas
Clinical Neurology
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