Neurology Medical News about long-term functional recovery;ischemic stroke

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Long-term functional recovery after first ischemic stroke. The Northern Manhattan Study
Stroke, 06/29/09

Dhamoon MS et al. – The proportion of pts with functional independence after stroke declines annually for up to 5 yrs; effects are greatest for those with Medicaid or no health insurance. Decline is independent of age, stroke severity, and other predictors of functional decline and occurs even among pts without recurrent stroke or myocardial infarction.

Methods

Study of whether ischemic stroke pts experience functional decline over 5 yrs independent of recurrent stroke and other risk factors
Population-based Northern Manhattan Study of pts age ≥40 yrs with incident ischemic stroke
Prospective study with Barthel Index at 6 mo and annually to 5 yrs
Baseline stroke severity: mild (NIH Stroke Scale <6), moderate (6-13), and severe (≥14)
Follow-up censored at death, recurrent stroke, or myocardial infarction

Results

Of 525 pts, mean age 68.6±12.4 yrs, 45.5% male, 54.7% Hispanic, 54.7% Medicaid/no insurance, 35.1% moderate stroke
Proportion with Barthel Index ≥95 declined over time
Changes in Barthel Index by insurance status confirmed by significant interaction term; pts with Medicaid/no insurance declined vs no decline for pts with Medicare/private insurance

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