After Stroke, Many Suffer from 'Hidden' Disabilities

Many stroke survivors suffer from “hidden” problems that go much deeper than physical disability alone. A new study investigates the prevalence of these post-stroke problems, such as fatigue, anxiety, thinking difficulties and dissatisfaction with social life.

The findings are published in the journal Neurology.

“After a stroke, people who have only mild disability can often have ‘hidden’ problems that can really affect their quality of life,” said study author Irene L. Katzan, M.D., M.S., of the Cleveland Clinic in Ohio and a member of the American Academy of Neurology.

“And for people with more disability, what bothers them the most? Problems with sleep? Depression? Fatigue? Not many studies have asked people how they feel about these problems, and we doctors have often focused just on physical disability or whether they have another stroke.”

The research involved 1,195 subjects who had suffered an ischemic stroke, a stroke where blood flow to part of the brain is blocked. The participants answered questions about their physical functioning, fatigue, anxiety, sleep problems, thinking skills such as planning and organizing, how much their pain affects other aspects of their life and their satisfaction with their current social roles and activities.

On average, the participants completed the questionnaires around 100 days after their stroke; about a quarter of the participants needed help from a family member to fill them out. Researchers also measured their level of disability.

In every area except for sleep and depression, stroke survivors had scores that were considerably worse than those in the general population. Not surprisingly, the area in which stroke survivors were most affected was physical functioning, where 63 percent had scores notably worse than those of the general population. Stroke survivors had an average score of 59, where a score of 50 is considered the population average.

Regarding the question about whether they were satisfied with their social roles and activities, 58 percent of stroke patients had scores meaningfully worse than those of the general population.

“People may benefit from social support programs and previous studies have shown a benefit from efforts to improve the social participation of people with stroke, especially exercise programs,” said Katzan.

The thinking skills of stroke patients, such as executive function, or planning and organizing, were also impacted, with 46 percent having scores that were meaningfully worse than the population average.

“The social participation and executive functioning skills are areas that have not received a lot of attention in stroke rehabilitation,” Katzan said. “We need to better understand how these areas affect people’s well-being and determine strategies to help optimize their functioning.”

The study had some limitations: The patients in the study had experienced milder strokes than average, and the questionnaires did not ask about other problems that can occur after stroke, such as communication issues. Also, the average age of participants was 62, which is lower than the average age of 69 for people with stroke overall.

Source: American Academy of Neurology