Neuropsychiatric complications 3-4 years after stroke: a population-based study of fatigue, depression and cognition

To study the prevalence of and interplay between common neuropsychiatric sequelae 3-4 years after onset of first-ever stroke-specifically post-stroke fatigue (PSF), post-stroke depression (PSD) and post-stroke cognitive impairment (PSCI).

Population-based cohort study.

Catchment area of a Swedish University Hospital.

We recruited individuals with first-ever ischaemic stroke or intracerebral haemorrhage in the initial cohort; 151 of these died prior to follow-up and 47 (12%) were lost to detailed follow-up. We followed up 202 individuals with median age: 72 (IQR 65-79), 40% female, either in clinic, via home visits or via telephone.

Primary outcome measures included PSF (Fatigue Assessment Scale), PSD (Patient Health Questionnaire-9) and PSCI (Montreal Cognitive Assessment). Secondary outcome measures included dependency in activities of daily living (ADL; Barthel Index), health-related quality of life (HRQoL; Short-Form Questionnaire-36, EuroQoL-5D and Stroke Impact Scale) and stroke severity (National Institutes of Health Stroke Scale (NIHSS)).

Significant PSF was present in 46/195 (24%), PSD in 21/191 (11%), and PSCI in 93/173 (54%) respondents. Among 169 participants with available data for all three domains, 100 (59%) had impairment in at least one domain. Participants with PSCI were older than those without (median: 75 vs 67 years; p<0.01), but age did not differ for those with/without PSF or PSD. Among 21 respondents with PSD, 20 (95%) had PSF. PSD and PSF were strongly correlated (ϱ=0.69; p<0.01) and PSF was associated with worse HRQoL (HR: 1.15; 95% CI 1.08 to 1.22; p<0.001). ADL dependency was associated with worse NIHSS at follow-up (B: -3.81; 95% CI -4.77 to -2.85), baseline home care (B: -18.34; 95% CI -26.95 to -9.73) and PSF (B: -0.65; 95% CI -1.05 to -0.26).

PSF, PSD and PSCI are highly prevalent 3-4 years after stroke. PSF and PSD overlap and correlate. PSF is associated with ADL dependency and worse HRQoL. Clinical awareness and research of treatment for neuropsychiatric complications of stroke are needed.