Cognitive function is an important determinant of employment amongst young ischaemic stroke survivors with good physical recovery.
cognition
employment
long-term outcome
young ischaemic stroke
Journal
European journal of neurology
ISSN: 1468-1331
Titre abrégé: Eur J Neurol
Pays: England
ID NLM: 9506311
Informations de publication
Date de publication:
11 2021
11 2021
Historique:
revised:
03
07
2021
received:
14
04
2021
accepted:
06
07
2021
pubmed:
10
7
2021
medline:
27
10
2021
entrez:
9
7
2021
Statut:
ppublish
Résumé
This cross-sectional cohort study aims at investigating young ischaemic stroke survivors with good physical recovery 7 years post-stroke in order to analyze the relation between late cognitive ability and employment. Consecutive ischaemic stroke survivors participating in the Sahlgrenska Academy Study on Ischemic Stroke, <55 years of age at stroke onset, and with no or minimal persisting neurological deficits corresponding to a score ≤2 on the National Institutes of Health Stroke Scale at long-term follow-up 7 years post-stroke were included. At this follow-up, the participants were assessed with respect to general cognitive function, processing speed, executive functions, cardiovascular risk factors, self-reported employment, cognitive difficulties, fatigue, depressive symptoms, anxiety and physical function. Seven years post-stroke 112/142 (79%) had part-time or full-time work and 30/142 (21%) had full-time disability pension or sick leave. Compared to those with full-time disability pension or sick leave, participants with current employment demonstrated significantly better performance with respect to general cognitive function and processing speed, and significantly lower self-ratings for cognitive difficulties, physical limitations, fatigue and depressed mood. Multivariable logistic regression selected self-rated memory (odds ratio [OR] 2.61, 95% confidence interval [CI] 1.61-4.21), processing speed (OR 3.50, 95% CI 1.67-7.33) and self-rated communication skills (OR 3.46, 95% CI 1.75-6.85) as most important correlates (area under the curve 0.83-0.87) of having current employment. This study indicates that cognitive dysfunction is an important contributor to long-term work disability amongst young stroke survivors with good physical recovery.
Sections du résumé
BACKGROUND AND PURPOSE
This cross-sectional cohort study aims at investigating young ischaemic stroke survivors with good physical recovery 7 years post-stroke in order to analyze the relation between late cognitive ability and employment.
METHODS
Consecutive ischaemic stroke survivors participating in the Sahlgrenska Academy Study on Ischemic Stroke, <55 years of age at stroke onset, and with no or minimal persisting neurological deficits corresponding to a score ≤2 on the National Institutes of Health Stroke Scale at long-term follow-up 7 years post-stroke were included. At this follow-up, the participants were assessed with respect to general cognitive function, processing speed, executive functions, cardiovascular risk factors, self-reported employment, cognitive difficulties, fatigue, depressive symptoms, anxiety and physical function.
RESULTS
Seven years post-stroke 112/142 (79%) had part-time or full-time work and 30/142 (21%) had full-time disability pension or sick leave. Compared to those with full-time disability pension or sick leave, participants with current employment demonstrated significantly better performance with respect to general cognitive function and processing speed, and significantly lower self-ratings for cognitive difficulties, physical limitations, fatigue and depressed mood. Multivariable logistic regression selected self-rated memory (odds ratio [OR] 2.61, 95% confidence interval [CI] 1.61-4.21), processing speed (OR 3.50, 95% CI 1.67-7.33) and self-rated communication skills (OR 3.46, 95% CI 1.75-6.85) as most important correlates (area under the curve 0.83-0.87) of having current employment.
CONCLUSION
This study indicates that cognitive dysfunction is an important contributor to long-term work disability amongst young stroke survivors with good physical recovery.
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
3692-3701Informations de copyright
© 2021 The Authors. European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.
Références
Feigin VL, Nichols E, Alam T, et al. Global, regional, and national burden of neurological disorders, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2019;18(5):459-480. https://doi.org/10.1016/S1474-4422(18)30499-X
Krishnamurthi RV, Moran AE, Feigin VL, et al. Stroke prevalence, mortality and disability-adjusted life years in adults aged 20-64 years in 1990-2013: data from the Global Burden of Disease 2013 Study. Neuroepidemiology. 2015;45(3):190-202. https://doi.org/10.1159/000441098. Erratum in: Neuroepidemiology. 2016;46(3):181. PMID: 26505983.
Maaijwee NAMM, Rutten-Jacobs LCA, Schaapsmeerders P, van Dijk EJ, de Leeuw FE. Ischaemic stroke in young adults: risk factors and long-term consequences. Nat Rev Neurol. 2014;10(6):315-325. https://doi.org/10.1038/nrneurol.2014.723
Varona JF, Bermejo F, Guerra JM, Molina JA. Long-term prognosis of ischemic stroke in young adults. Study of 272 cases. J Neurol. 2004;251(12):1507-1514. https://doi.org/10.1007/s00415-004-0583-0.
Hindfelt B, Nilsson O, Long-term prognosis of ischemic stroke in young adults. Acta Neurol Scand. 1992;86(5):440-445. https://doi.org/10.1111/j.1600-0404.1992.tb05120.x
Pinter D, Enzinger C, Gattringer T, et al. Prevalence and short-term changes of cognitive dysfunction in young ischaemic stroke patients. Eur J Neurol. 2019;26(5):727-732. https://doi.org/10.1111/ene.13879
Schaapsmeerders P, Maaijwee NAM, van Dijk EJ, et al. Long-term cognitive impairment after first-ever ischemic stroke in young adults. Stroke. 2013;44(6):1621-1628. https://doi.org/10.1161/STROKEAHA.111.000792
Barker-Collo S, Feigin VL, Parag V, Lawes CMM, Senior H. Auckland Stroke Outcomes Study: Part 2: Cognition and functional outcomes 5 years poststroke. Neurology. 2010;75(18):1608-1616. https://doi.org/10.1212/WNL.0b013e3181fb44c8
Hommel M, Trabucco-Miguel S, Joray S, Naegele B, Gonnet N, Jaillard A. Social dysfunctioning after mild to moderate first-ever stroke at vocational age. J Neurol Neurosurg Psychiatry. 2009;80(4):371-375.
Blomgren C, Samuelsson H, Blomstrand C, Jern C, Jood K, Claesson L. Long-term performance of instrumental activities of daily living in young and middle-aged stroke survivors-impact of cognitive dysfunction, emotional problems and fatigue. PLoS One. 2019;14(5):e0216822. https://doi.org/10.1371/journal.pone.0216822
Vestling M, Tufvesson B, Iwarsson S. Indicators for return to work after stroke and the importance of work for subjective well-being and life satisfaction. J Rehabil Med. 2003;35(3):127-131. https://doi.org/10.1080/16501970310010475
Ashley KD, Lee LT, Heaton K. Return to work among stroke survivors. Workplace Health Saf. 2019;67(2):87-94. https://doi.org/10.1177/2165079918812483
Edwards JD, Kapoor A, Linkewich E, Swartz RH. Return to work after young stroke: a systematic review. Int J Stroke. 2018;13:243-256. https://doi.org/10.1177/1747493017743059
Wang Y-C, Kapellusch J, Garg A. Important factors influencing the return to work after stroke. Work. 2014;47(4):553-559. https://doi.org/10.3233/WOR-131627
Kauranen T, Turunen K, Laari S, Mustanoja S, Baumann P, Poutiainen E. The severity of cognitive deficits predicts return to work after a first-ever ischaemic stroke. J Neurol Neurosurg Psychiatry. 2013;84(3):316-321. https://doi.org/10.1136/jnnp-2012-302629
Musolino R, La Spina P, Granata A, et al. Ischaemic stroke in young people: a prospective and long-term follow-up study. Cerebrovasc Dis. 2003;15(1-2):121-128. https://doi.org/10.1159/000067139
Aarnio K, Rodríguez-Pardo J, Siegerink B, et al. Return to work after ischemic stroke in young adults: a registry-based follow-up study. Neurology. 2018;91(20):e1909-e1917. https://doi.org/10.1212/WNL.0000000000006510
Fride Y, Adamit T, Maeir A, et al. What are the correlates of cognition and participation to return to work after first ever mild stroke? Top Stroke Rehabil. 2015;22(5):317-325. https://doi.org/10.1179/1074935714Z.0000000013
Kotila M, Waltimo O, Niemi M-L, Laaksonen R, Lempinen M. The profile of recovery from stroke and factors influencing outcome. Stroke. 1984;15(6):1039-1044. https://doi.org/10.1161/01.STR.15.6.1039
Ntsiea M, Van Aswegen H, Lord S, Olorunju SS. The effect of a workplace intervention programme on return to work after stroke: a randomised controlled trial. Clin Rehabil. 2015;29(7):663-673. https://doi.org/10.1177/0269215514554241
Tanaka H, Toyonaga T, Hashimoto H. Functional and occupational characteristics predictive of a return to work within 18 months after stroke in Japan: implications for rehabilitation. Int Arch Occup Environ Health. 2014;87(4):445-453. https://doi.org/10.1007/s00420-013-0883-8
van der Kemp J, Kruithof WJ, Nijboer TCW, van Bennekom CAM, van Heugten C, Visser-Meily JMA. Return to work after mild-to-moderate stroke: work satisfaction and predictive factors. Neuropsychol Rehabil. 2019;29(4):638-653. https://doi.org/10.1080/09602011.2017.1313746
Waje-Andreassen U, Thomassen L, Jusufovic M, et al. Ischaemic stroke at a young age is a serious event - final results of a population-based long-term follow-up in Western Norway. Eur J Neurol. 2013;20(5):818-823. https://doi.org/10.1111/ene.12073
Jood K, Ladenvall C, Rosengren A, Blomstrand C, Jern C. Family history in ischemic stroke before 70 years of age: the Sahlgrenska Academy Study on Ischemic Stroke. Stroke. 2005;36(7):1383-1387. https://doi.org/10.1161/01.STR.0000169944.46025.09
Saltin B, Grimby G. Physiological analysis of middle-aged and old former athletes: comparison with still active athletes of the same ages. Circulation. 1968;38(6):1104-1115. https://doi.org/10.1161/01.CIR.38.6.1104
Grimby G, Börjesson M, Jonsdottir IH, Schnohr P, Thelle DS, Saltin B. The "Saltin-Grimby Physical Activity Level Scale" and its application to health research. Scand J Med Sci Sports. 2015;25(S4):119-125.
Duncan WP, Wallace MD, Lai JS, Johnson JD, Embretson JS, Laster JL. The Stroke Impact Scale Version 2.0: Evaluation of reliability, validity, and sensitivity to change. Stroke. 1999;30(10):2131-2140. https://doi.org/10.1161/01.STR.30.10.2131
Prigatano GP, Amin K, Rosenstein LD. Administration and scoring manual for the BNI Screen for higher cerebral functions. Phoenix, Arizona, US: Barrow Neurological Institute; 1995.
Esbjörnsson E, Hofgren C, Larsson J, Denvall V. BNI Screen for Higher Cerebral Functions. (Translation, Swedish manual and norms). Stockholm, Sweden: Pearson Assessment; 2008.
Boosman H, Visser-Meily JMA, Post MWM, Duits A, van Heugten CM. Validity of the Barrow Neurological Institute (BNI) Screen for higher cerebral functions in stroke patients with good functional outcome. Clin Neuropsychol. 2013;27(4):667-680. https://doi.org/10.1080/13854046.2013.777787
Hofgren C, Esbjörnsson E, Aniansson H, Sunnerhagen KS. Application and validation of the Barrow Neurological Institute Screen for higher cerebral functions in a control population and in patient groups commonly seen in neuro-rehabilitation. J Rehabil Med. 2007;39(7):547-553. https://doi.org/10.2340/16501977-0085
Wilson B, Cockburn J, Halligan P. The behavioural inattention test. Fareham. Hants, England: Thames Valley Test Company; 1978.
Strauss E, Sherman EMS, Spreen O. A compendium of neuropsychological tests: administration, norms, and commentary, 3rd edn. Oxford, NY: Oxford University Press; 2006.
Delis D, Kaplan E, Kramer J. D-KEFS, Delis-Kaplan Executive Function System. San Antonio, TX: The Psychological Corporation; 2001.
Zimmerman P, Fimm B. Test Battery for Attentional Performance, Manual. Herzogenrath, Germany: PsyTest; 2007.
Zigmond AS, Snaith RP. The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand. 1983;67(6):361-370. https://doi.org/10.1111/j.1600-0447.1983.tb09716.x
Sullivan M, Karlsson J, Ware JE. The Swedish SF-36 Health Survey-I. Evaluation of data quality, scaling assumptions, reliability and construct validity across general populations in Sweden. Soc Sci Med (1982). 1995;41(10):1349-1358. https://doi.org/10.1016/0277-9536(95)00125-Q
Tanaka H, Toyonaga T, Hashimoto H. Functional and occupational characteristics associated with very early return to work after stroke in Japan. Arch Phys Med Rehabil. 2011;92(5):743-748. https://doi.org/10.1016/j.apmr.2010.12.009
Doucet T, Muller F, Verdun-Esquer C, Debelleix X, Brochard P. Returning to work after a stroke: a retrospective study at the Physical and Rehabilitation Medicine Center La Tour de Gassies. Ann Phys Rehabil Med. 2012;55(2):112-127. https://doi.org/10.1016/j.rehab.2012.01.007
Black-Schaffer RM, Osberg JS. Return to work after stroke: development of a predictive model. Arch Phys Med Rehabil. 1990;71(5):285-290.
Su C-Y, Wuang Y-P, Lin Y-H, Su J-H. The role of processing speed in post-stroke cognitive dysfunction. Arch Clin Neuropsychol. 2015;30(2):148-160. https://doi.org/10.1093/arclin/acu057
Wallin A, Nordlund A, Jonsson MBK, et al. Alzheimer's disease-subcortical vascular disease spectrum in a hospital-based setting: overview of results from the Gothenburg MCI and Dementia Studies. J Cereb Blood Flow Metab. 2016;36(1):95-113.
Van Patten R, Merz ZC, Mulhauser K, Fucetola R. Multivariable prediction of return to work at 6-month follow-up in patients with mild to moderate acute stroke. Arch Phys Med Rehabil. 2016;97(12):2061-2067. https://doi.org/10.1016/j.apmr.2016.06.006
Morsund ÅH, Ellekjaer H, Gramstad A, et al. Factors influencing employment after minor stroke and NSTEMI. J Stroke Cerebrovasc Dis. 2020;29(9):105036. https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.105036