Related Experiment Video
Updated: Jun 22, 2026
09:10
Determining the Functional Status of the Corticospinal Tract Within One Week of Stroke
Published on: February 22, 2020
Long-term functional recovery after first ischemic stroke: the Northern Manhattan Study
Mandip S Dhamoon1, Yeseon Park Moon, Myunghee C Paik
1Neurological Institute, 710 W 168th Street, Box 206, New York, NY 10032. mdhamoon@neuro.columbia.edu
Stroke
|June 27, 2009
Summary
Functional independence after ischemic stroke declines annually for up to five years, particularly for those with Medicaid or no insurance. This decline is independent of stroke severity or recurrent events.
Area of Science:
- Neurology
- Public Health
- Epidemiology
Background:
- Stroke functional status is crucial but often studied in hospitalized patients with limited follow-up.
- Predictors of long-term functional status after ischemic stroke require further investigation in population-based cohorts.
Purpose of the Study:
- To investigate the long-term functional decline in patients with ischemic stroke over five years.
- To determine if functional decline is independent of recurrent stroke and other risk factors.
- To examine the impact of insurance status on functional outcomes post-stroke.
Main Methods:
- Prospective, population-based study (Northern Manhattan Study) of patients aged >=40 with incident ischemic stroke.
- Functional status assessed using the Barthel Index annually for up to five years.
- Generalized Estimating Equations used to identify predictors of favorable (Barthel Index >=95) versus unfavorable functional status.
Main Results:
- The proportion of patients achieving functional independence (Barthel Index >=95) declined significantly over five years (OR, 0.91; 95% CI, 0.84 to 0.99).
- Patients with Medicaid or no insurance showed a significant decline in functional status (OR, 0.84; P=0.003).
- No significant decline was observed in patients with Medicare/private insurance (OR, 0.99; P=0.92).
Conclusions:
- Functional independence after ischemic stroke decreases annually for up to five years.
- This decline is most pronounced in patients with Medicaid or no health insurance.
- The observed functional decline is independent of stroke severity, age, and recurrent events.
Related Concept Videos
01:15Ischemic Stroke l: Introduction
Ischemic stroke is an acute cerebrovascular condition in which blood flow to a brain region is suddenly interrupted, leading to tissue infarction. Neurons depend on continuous oxygen and glucose supply, so even brief reductions in perfusion cause energy failure, ionic imbalance, and irreversible injury. Ischemic strokes are classified into thrombotic and embolic types based on their underlying mechanisms.Thrombotic MechanismsThrombotic stroke develops when a clot forms within a cerebral artery.
01:15Ischemic Stroke ll: Pathophysiology
An ischemic stroke occurs when a cerebral blood vessel becomes obstructed, most often by a thrombus or embolus, interrupting the delivery of oxygen and glucose to brain tissue. Because neurons rely on continuous aerobic metabolism, energy failure begins within minutes of reduced perfusion. The region receiving the least blood flow becomes the infarct core, an area of irreversible cellular death. Surrounding this core lies the penumbra, a zone of hypoperfused but still viable tissue that is...