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Trajectory of functional decline before and after ischemic stroke: the Northern Manhattan Study

Mandip S Dhamoon1, Yeseon P Moon, Myunghee C Paik

  • 1Department of Neurology, Mount Sinai School of Medicine, New York, NY, USA. mandip.dhamoon@mssm.edu

Stroke
|June 1, 2012
PubMed

Insights

Functional status declines faster after ischemic stroke, especially for those with Medicaid or no insurance. This highlights disparities in post-stroke recovery and care needs for vulnerable populations.

Area of Science:

  • Neurology
  • Public Health
  • Geriatrics

Background:

  • Previous research indicated a delayed functional decline post-ischemic stroke in our cohort.
  • Understanding the long-term functional trajectory before and after stroke is crucial for patient care.

Purpose of the Study:

  • To compare the long-term trajectory of functional status before and after ischemic stroke.
  • To investigate potential disparities in functional decline based on socioeconomic factors.

Main Methods:

  • Prospective, population-based study (Northern Manhattan Study) of stroke-free adults (≥40 years) followed for a median of 11 years.
  • Annual assessment of functional status using the Barthel index (BI).
  • Generalized estimating equations used to model functional decline before and after stroke, with follow-up censored at recurrent stroke.

Main Results:

  • Among 210 participants experiencing ischemic stroke, overall functional decline did not differ significantly before and after stroke.
  • However, participants with Medicaid or no insurance showed a significantly steeper decline in functional status post-stroke compared to pre-stroke (P=0.04).
  • Adjusted analysis revealed a decline of 0.58 BI points/year before stroke versus 1.94 BI points/year after stroke for the uninsured/Medicaid group.

Conclusions:

  • A significantly steeper decline in functional status occurs after ischemic stroke compared to before, particularly among individuals with Medicaid or no insurance.
  • This finding underscores socioeconomic disparities in long-term functional recovery after stroke.
  • Results highlight the need for targeted interventions and support for vulnerable populations post-stroke.
Abstract

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