Trajectory of functional decline before and after ischemic stroke: The northern manhattan study

Mandip S. Dhamoon, Yeseon P. Moon, Myunghee C. Paik, Ralph L. Sacco, Mitchell S.V. Elkind

Research output: Contribution to journalArticlepeer-review

30 Scopus citations

Abstract

BACKGROUND AND PURPOSE-: Previous research in our cohort showed a delayed decline in functional status after first ischemic stroke. We compared the long-term trajectory of functional status before and after ischemic stroke. METHODS-: The Northern Manhattan Study contains a prospective, population-based study of stroke-free individuals age ≫40 years, followed for a median of 11 years. The Barthel index (BI), a commonly used measure of activities of daily living, was assessed annually. Generalized estimating equations were used to assess functional decline over time before stroke and beginning 6 months after stroke. Follow-up was censored at the time of recurrent stroke. RESULTS-: Among 3298 participants, 210 participants had an ischemic stroke during follow-up and had poststroke BI assessed. Mean age (±SD) was 77±9 years, 38% were men, 52% were Hispanic, 37% had diabetes, and 31% had coronary artery disease. There was no difference in rate of functional decline over time before and after stroke (P=0.51), with a decline of 0.96 BI points per year before stroke (P<0.0001) and 1.24 BI points after stroke (P=0.001). However, when stratified by insurance status, among those with Medicaid or no insurance, in a fully adjusted model, there was a difference in slope before and after stroke (P=0.04), with a decline of 0.58 BI points per year before stroke (P=0.02) and 1.94 BI points after stroke (P=0.001). CONCLUSIONS-: In this large, prospective, population-based study with long-term follow-up, there was a significantly steeper decline in functional status after ischemic stroke compared with before stroke among those with Medicaid or no insurance, after adjusting for confounders.

Original languageEnglish (US)
Pages (from-to)2180-2184
Number of pages5
JournalStroke
Volume43
Issue number8
DOIs
StatePublished - Aug 2012

Keywords

  • disability
  • epidemiology
  • rehabilitation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Clinical Neurology
  • Advanced and Specialized Nursing

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