Quality of life after stroke : clinical, functional, psychosocial and cognitive correlates

Abstract

<div lang="en" class="abs"><p class="abs_header">Abstract</p><p>Depression is a common consequence of stroke and it is known to be associated with deterioration of quality of life. However, only limited information is available on the relationships between depression and communicative and cognitive disorders. Moreover, the present knowledge of the determinants of the domains of quality of life is limited, and little is known of e.g. the changes in sexual behaviour of stroke patients and their spouses. This prospective study was carried out to evaluate the prevalence of post-stroke depression and aphasia and to study their interrelationships and neuropsychological and functional correlates. The particular aim of the study was to investigate the domain-specific quality of life, and to assess its clinical and sociodemographic correlates, and to study the impact of stroke on the sexual functions of stroke patients and their spouses. The study consisted of 156 first-ever stroke patients.</p><p>Depression was diagnosed in 53% of the patients at 3 months and in 42% of the patients at 12 months post-stroke according to DSM-III-R-criteria. One third of the patients were aphasic, 70% of them at 3 months and 62% at 12 months after stroke suffering from depression. Among the aphasic patients the prevalence of major depression increased from 11% to 33% during the 12 months follow-up. There was an association between post-stroke depression and cognitive impairment, the domains most likely to be defective being memory, non-verbal problem solving, and attention and psychomotor speed. The non-verbal neuropsychological test performance in the aphasic patients was significantly inferior to that of the patients with dominant hemisphere lesion without aphasia.</p><p>The quality of life of the patients was low at 3 months after the stroke, and it did not improve during the follow-up of a year. The test domains most often impaired were Physical functioning, Physical role limitations, Vitality and General health. Depression, although mostly minor, and being married emerged as significant independent contributors to low score value of Vitality and Physical role limitations. All the analyzed aspects of sexuality were commonly decreased as a consequence of stroke both in the patients and their spouses. Nocturnal erections were impaired in 21 (55%) of the male patients.</p><p>The present results demonstrate that more than half of the patients after stroke suffer from depression and the frequency of major depression seems to increase over time, especially among the aphasic patients. Both depression and aphasia increase the liability of cognitive deficits. Stroke affects various dimensions of quality of life extensively, and the most important determinants entailing low quality of life seem to be depression, and, interestingly, being married. As a part of quality of life, sexual function and satisfaction with sexual life are impaired both in stroke patients and spouses. These findings call for multidimensional evaluation of stroke patients and provide new challenges for stroke rehabilitation.</p></div>