J Clin Neurol.  2005 Apr;1(1):59-68. 10.3988/jcn.2005.1.1.59.

Factors Affecting the Quality of Life After Ischemic Stroke: Young Versus Old Patients

• Kim JS
• Choi-Kwon
• Kwon SU
• Lee HJ
• Park KA
• Seo YS

• KMID: 2287714
• DOI: http://doi.org/10.3988/jcn.2005.1.1.59

Abstract

BACKGROUND
Factors affecting the quality of life (QOL) may be different between young and old stroke patients. However, these issues have not yet been properly investigated.
METHODS
We identified 170 young-onset stroke patients (onset between 15 and 45 years of age) who were admitted to the Asan Medical Center. Three hundred and forty follow-up period matched, old-onset stroke patients (onset >45 years of age) were chosen as a control group. A follow-up interview was performed 1~5 years after the onset of stroke in 96 young patients and 160 old patients. With the use of standardized questionnaire, we assessed physical disabilities, activity of daily living (Barthel Index Score, modified Rankin scale), the presence of depression (using DSM IV criteria and Beck Depression Inventory) and socio-economic/job status. The QOL was assessed using the Stroke Specific QOL developed by Williams et al.
RESULTS
The QOL scores were significantly higher in young patients than in old ones. Univariate analysis showed that factors related to low QOL included unemployment, motor impairment, aphasia, dysarthria, dysaphagia and severe modified Rankin score in young patients while poor economic status, unemployment, supratentorial (vs. infratentorial) stroke, anterior (vs. posterior) circulation stroke, the presence of diabetes mellitus, motor impairment, aphasia, dysarthria, dysphagia, visual field defect, severe modified Rankin score, the presence of post-stroke seizures and depression were related to the low QOL in old patients. Cigarette smoking (in old patients) and alcohol drinking (in both young and old patients) were related to high QOL. Multiple regression analysis showed that modified Rankin score was the most important factor explaining low QOL in both groups, while other important factors included depression, visual field defect and anterior circulation stroke in old patients, and the motor dysfunction and dysarthria in young patients.
CONCLUSIONS
We conclude that aside from modified Rankin scale, factors affecting the quality of life are different between these two groups. Recognition of these differences may allow us to develop different strategies to improve the quality of life in stroke patients.

Keyword

Cerebrovascular disease; Quality of life; Young; Age

MeSH Terms

Alcohol Drinking
Aphasia
Chungcheongnam-do
Deglutition Disorders
Depression
Diabetes Mellitus
Dysarthria
Follow-Up Studies
Humans
Quality of Life*
Seizures
Smoking
Stroke*
Unemployment
Visual Fields
Surveys and Questionnaires

Reference

1. Niemi ML, Laaksonen R, Kotila M, Waltimo O. Quality of life 4 years after stroke. Stroke. 1989. 19:1101–1106.

2. Kwa VIH, Limburg M, de Haan RJ. The role of cognitive impairment in the quality of life after ischaemic stroke. J Neurol. 1996. 243:599–604.

3. Jonkman EJ, de Weerd AW, Vrijens NLH. Quality of life after a first ischemic stroke: Long-term developments and correlations with changes in neurological deficit, mood and cognitive impairment. Acta Neurol Scand. 1998. 98:169–175.

4. Carod-Artal J, Egido JA, González JL, de Seijas EV. Quality of life among stroke survivors evaluated 1 year after stroke: experience of a stroke unit. Stroke. 2000. 31:2995–3000.

5. Yoon H. Factors affecting quality of life of the Korean aged stroke patients. Int J Agin Hum Dev. 1997. 44:167–181.

6. Mackenzie AE, Chang AM. Predictors of quality of life following stroke. Disabil Rehabil. 2002. 24:259–265.

7. Ahlsio B, Britton M, Murray V, Theorell T. Disablement and quality of life after stroke. Stroke. 1984. 15:886–890.

8. Parikh RM, Lipsey JR, Robinson RG, Price TR. Two-year longitudinal study of post-stroke mood disorders: dynamic changes in correlates of depression at one and two years. Stroke. 1987. 18:579–584.

9. Astrom M, Asplund K, Astrom T. Psychosocial function and life satisfaction after stroke. Stroke. 1992. 23:527–531.

10. King RB. Quality of life after stroke. Stroke. 1996. 27:1467–1472.

11. Dorman PJ, Waddell F, Slattery J, Dennis M, Sandercock P. Is the EuroQol a valid measure of health-related quality of life after stroke? Stroke. 1997. 28:1867–1882.

12. Williams LS, Kroenke K, Weinberger M, Harris LE, Biller J. Post-stroke depression affects quality of life (QOL) but not other stroke outcome measures. Stroke. 1999. 30:236.

13. de Haan RJ, Limburg M, Van der Muelen JHP, Jacobs HM, Aaronson NK. Quality of life after stroke: impact of stroke type and lesion location. Stroke. 1995. 26:402–408.

14. Bogousslavsky J, Pierre P. Ischemic stroke in patients under age 45. Neurol Clin. 1992. 10:113–124.

15. Kwon SU, Kim JS, Lee JH, Lee MC. Ischemic stroke in Korean young adults. Acta Neurol Scand. 2000. 101:19–24.

16. Kappelle LJ, Adams HP Jr, Heffner ML, Torner JC, Gomez F, Biller J. Prognosis of young adults with ischemic stroke. Stroke. 1994. 25:1360–1365.

17. Neau J-P, Ingrand P, Mouille-Brachet C, Rosier M-P, Couderq C, Alvarez A, et al. Functional recovery and social outcome after cerebral infarction in young adults. Cerebrovasc Dis. 1998. 8:296–302.

18. Hindfelt B, Nilsson O. Long-term prognosis of ischemic stroke in young adults. Acta Neurol Scand. 1992. 86:440–445.

19. Sacco RL. Ginsberg MD, Bogousslavsky J, editors. Prognosis of Stroke. Cerebrovascular Disease: Pathophysiology, Diagnosis, and Management. 1998. Malden, MA: Blackwell Science;879–891.

20. Kim JS, Yoon SS. Stroke subtypes and risk factors in patients living in southern Seoul, Korea: the impact of hypertension control on stroke subtypes. J Stroke Cerebrovasc Dis. 1998. 7:205–210.

21. Kim JS, Choi-Kwon S. Poststroke depression and emotional incontinence; correlation with lesion location. Neurology. 2000. 54:1805–1810.

22. Park K-A, Kim H-S, Kim JS, Kwon SU, Choi-Kwon S. Food intake, frequency, and compliance in stroke patients. Korean J Community Nutrition. 2001. 6(3S):542–552.

23. Williams LS, Weinberger M, Harris L, Clark DO, Biller J. Development of a stroke-specific quality of life scale. Stroke. 1999. 30:1362–1369.

24. Kim MY. Quality of life and the related factors in cerebrovascualr surgery patients. 1998. Seoul, Korea: The graduate school of Seoul National University;The master's thesis.

25. Paciaroni M, Arnold P, van Melle G, Bogousslavksy J. Severe disability at hospital discharge in ischemic stroke survivors. Eur Neurol. 2000. 43:30–34.

26. Hackett ML, Duncan JR, Anderson CS, Broad JB, Bonita R. Health-related quality of life among long-term survivors of stroke. Stroke. 2000. 31:440–447.

27. Glass TA, Matchar DB, Belyea M, Feussner JR. Impact of social support on outcome in first stroke. Stroke. 1993. 24:64–70.