Abstract Details

Title Post-Stroke Arousal Disorders Lead to Worse Outcomes from Acute Rehabilitation

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P05 - (-)

Poster/Presentation
Number 242

Objective

Background BACKGROUND: Stroke can impair the brain's arousal and arousal-regulation systems, presenting with somnolence and apathy. For patients in acute rehabilitation, the prevalence and effects on outcome of these disorders are not well known.

Design/Methods DESIGN/METHODS: We performed a retrospective review of 213 patients admitted to a stroke-specialized acute rehabilitation unit. All patients had ischemic or hemorrhagic stroke, and had no history of dementia or dependence on others at baseline. We determined the presence of somnolence and apathy using standardized documentation by treating therapists. We required that the behaviors were persistent (present in over half of the daily progress notes) to ensure they did not reflect brief stressors (e.g., sleep disturbances or infections). Outcome measures were disposition (nursing home vs. home) and disability (FIM) at discharge. We used multiple regression analysis to control for initial impairment (combination of strength, cognitive and sensory measures), age, time since stroke, and stroke type (ischemic or hemorrhagic).

Results RESULTS: 12 (6%) of patients had persistent somnolence and 44 (21%) had persistent apathy. Patients with arousal disorders were more impaired in strength (Motricity Index), cognition (MMSE), sustained attention (therapist report), and more likely to be diagnosed as depressed. Nursing home discharge correlated both with somnolence (OR 10 (1.3 to 76)) and apathy (OR 2.41 (1.01 to 5.74)). Discharge FIM also correlated with somnolence (beta -16.23 (-24.59 to -7.87)) and apathy (beta -12.44 (-17.25 to -7.64)).

Conclusions CONCLUSIONS: Arousal disorders, including somnolence and apathy, are common after stroke in patients who go to acute rehabilitation. These disorders are associated with a lower likelihood of home discharge and more disability, even after accounting for impairment and age. Arousal disorders may serve as important targets to improve outcomes post stroke.

Authors/Disclosures
Andrew M. Goldfine, MD (GSK) PRESENTER	No disclosure on file
Ari L. Harris, MD	No disclosure on file
Nicholas D. Schiff, MD	Dr. Schiff has received publishing royalties from a publication relating to health care. Dr. Schiff has received personal compensation in the range of $500-$4,999 for serving as a study section member with NIH. Dr. Schiff has a non-compensated relationship as a Guidelines Panel Member with AAN that is relevant to AAN interests or activities.
	No disclosure on file
Rozalina Dimitrova, MD, MPH (Allergan, Inc)	No disclosure on file

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