Background and purpose

Cognitive and emotional problems occur frequently after stroke. Patients with minor stroke are more likely to be discharged home. This paper compares early cognitive and emotional outcomes in patients discharged home after stroke versus patients discharged to inpatient rehabilitation, and examines the effect of cognitive and emotional outcomes on long-term participation.

Methods

In this multicenter prospective cohort study, patients with stroke were assessed at two months with the Hospital Anxiety and Depression Scale (HADS), the Checklist for Cognitive and Emotional Consequences following Stroke (CLCE-24) and the Montreal Cognitive Assessment (MoCA). One year post stroke, participation was assessed with the Restriction subscale of the Utrecht Scale for Evaluation of Rehabilitation—Participation (USER-P Restriction).

Results

The study included 332 patients. Two months post stroke, anxiety and cognitive problems were equally prevalent among patients discharged home (n = 243; 73%) and patients discharged to inpatient rehabilitation (n = 89; 27%) (HADS-A = 4.8 ± 3.9 versus 4.6 ± 4.0, p = 0.747; MoCA < 26: 66.7% versus 70.8%, p = 0.477; CLCE-cognition = 3.0 ± 2.9 versus 3.3 ± 2.8, p = 0.499). Depressive symptoms were less severe in patients discharged home (HADS-D = 4.3 ± 3.9 versus 5.5 ± 3.8, p = 0.010). In patients discharged home, cognitive complaints were predictive of long-term participation (B = − 2.03; 95% CI − 3.15, − 0.90), while cognitive or emotional outcomes were not predictive in patients discharged to inpatient rehabilitation.

Conclusions

Cognitive and emotional problems at two months post stroke were comparable between patients discharged home and those discharged to inpatient rehabilitation. For patients discharged home, cognitive complaints were predictive of long-term participation.

中文翻译：

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中风后的早期认知和情绪结果与出院目的地无关。

背景和目的

中风后经常发生认知和情绪问题。轻度中风的患者更有可能出院。本文比较了卒中后出院患者与住院康复患者的早期认知和情感结局，并考察了认知和情感结局对长期参与的影响。

方法

在这项多中心前瞻性队列研究中，中风患者在两个月时通过医院焦虑和抑郁量表（HADS），中风后认知和情绪后果清单（CLCE-24）和蒙特利尔认知评估（MoCA）进行了评估。脑卒中发生一年后，通过乌特勒支评估康复－参与程度量表的限制子量表（USER-P限制量）评估参与程度。

结果

该研究包括332名患者。脑卒中后两个月，出院患者（n  = 243; 73％）和住院康复患者（n  = 89; 27％）中的焦虑和认知问题同样普遍（HADS-A = 4.8±3.9对4.6±4.0 ，p  ＝ 0.747； MoCA ＜26：66.7％对70.8％，p  ＝ 0.477； CLCE认知＝ 3.0±2.9对3.3±2.8，p  ＝ 0.499）。出院患者的抑郁症状较轻（HADS-D = 4.3±3.9对5.5±3.8，p  = 0.010）。在出院的患者中，认知障碍可预测长期参与（B =-2.03；95％CI-3.15，-0.90），而出院住院患者的认知或情绪结果却无法预测。

结论

中风后两个月出院的患者和出院后康复的患者在认知和情绪上的问题相当。对于出院的患者，认知障碍可预测其长期参与。