Long-term psychological outcomes following stroke: The OX-CHRONIC study

Abstract

Introduction: Stroke survivors rate longer-term (>2 years) psychological recovery as their top priority, but data on how frequently psychological consequences occur is lacking. Prevalence of cognitive impairment, depression/anxiety, fatigue, apathy and related psychological outcomes, and whether rates are stable in long-term stroke, is unknown. Patients and Methods: N = 105 long-term stroke survivors (M [SD] age = 72.92 [13.01]; M [SD] acute NIHSS = 7.39 [6.25]; 59.0% Male; M [SD] years post-stroke = 4.57 [2.12]) were recruited (potential N = 208). Participants completed 3 remote assessments, including a comprehensive neuropsychological battery, and questionnaires on emotional distress, fatigue, apathy and other psychological outcomes. Ninety participants were re-assessed one year later. Stability of outcomes was assessed by Cohen's d and percent Minimal Clinically Important Difference changes between time points. Results: On the Montreal Cognitive Assessment 65.3% scored <26. On the Oxford Cognitive Screen 45.9% had at least one cognitive impairment. Attention (27.1%) and executive function (40%) were most frequently impaired. 23.5% and 22.5% had elevated depression/anxiety respectively. Fatigue (51.4%) and apathy (40.5%) rates were high. Attention (d = -0.12; 85.8% stable) and depression (d = 0.09, 77.1% stable) were the most stable outcomes. Only perceptuomotor abilities (d = 0.69; 40.4% decline) and fatigue (d = -0.33; 37.2% decline) worsened over one year. Cognitive impairment, depression/anxiety, fatigue and apathy all correlated with worse quality of life. Discussion: Nearly half of participants >2 years post-event exhibited psychological difficulties, which impact long-term quality of life. Conclusion: Stroke is a chronic condition requiring long-term psychological support.

Competing Interest Statement

ND is a developer of the Oxford Cognitive Screen but does not receive any remuneration from its use. TJQ chairs the DMC for a vascular cognitive impairment trial supported by NovoNordisk; TJQ has provided outcomes assessment and advisory board input for trials in cognition for Novartis, NovoNordisk.

Clinical Protocols

https://journals.sagepub.com/doi/full/10.1177/23969873211046120

Funding Statement

This study was funded by a Priority Programme Grant from the Stroke Association (SA PPA 18/100032). ND (Advanced Fellowship NIHR302224) is funded by the National Institute for Health Research (NIHR). The project was supported by the National Institute for Health Research (NIHR) Oxford Health BRC. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR, NHS or the UK Department of Health and Social Care.

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The Health Research Authority - South Central Berkshire Research Ethics Committee approved this study (REC Reference: 19/SC/0520)

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

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I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

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I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

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Data Availability

All data produced in the present study are available online at osf.io/y2mev

https://osf.io/y2mev

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