Five-Year Outcome of a Stroke Cohort in Martinique, French West Indies

Abstract

Background and Purpose-Limited information exists on stroke among black populations outside the United States and United Kingdom. Part 1 of the Etude Réalisée en Martinique et Centrée sur l'Incidence des Accidents vasculaires cérebraux (ERMANCIA) provided strong epidemiologic data on the incidence of first-ever stroke in a black Caribbean population and showed a 40% greater incidence of stroke in Martinique than in continental France. In ERMANCIA part 2, we evaluated the long-term outcomes of our cohort. Methods-Survivors of a first stroke from this prospective, community-based, stroke incidence study were reassessed at 5 years according to standardized procedures and criteria, including the modified Rankin scale, Barthel Index, Montgomery-Asberg Depression-Rating Scale, Mini-Mental State Examination, treatment compliance, and blood pressure control. Results-Of the 293 survivors of the original 580 (50.5%) patients who were still alive 5 years after stroke, 262 (89.4%)were assessed. Among these survivors, 66.4% were functionally independent and 43% were completely autonomous for activities of daily living, but 25.8% were depressed and 58.9% were cognitively impaired. Only 50 of 170 (29.4%) of the hypertensive patients achieved their target blood pressure. Conclusions-These results highlight the very poor blood pressure control and the very high rate of cognitive impairment in Martinican patients after stroke. As a consequence, a poststroke prevention network was established in Martinique. (Stroke. 2010;41:594-599.)

Estimates of Outcomes Up to Ten Years after Stroke: Analysis from the Prospective South London Stroke Register

“…Data from our analyses confirm fluctuation in rates of depression over 10 y, with an average of 31% of patients having depression. In Martinique, depression at 5 y after stroke was estimated at 25.8%, using the Montgomery-Asberg Depression Rating Scale [41].…”

Natural History, Predictors, and Associations of Depression 5 Years After Stroke

“…33 The associations between depression and stroke severity, impaired cognition, dependence, low activity levels, and social isolation had been observed only soon after stroke. 2,4 -12,33,34 Unlike many studies, [2][3][4][5][6][7][8][9][10][11][12][13][14]17,20 treatment for depression predicted depression 3 months and 5 years after stroke. Factors involved in the etiology of depression before stroke that are still present after the event may explain this association.…”

Depression and Functional Status Among African American Stroke Survivors in Inpatient Rehabilitation

“…5, 6 Independent of the timing and instrument used for assessment, previous reports of depression among African American stroke survivors range from 10.2 to 43.9%. 3, 7–10 Although depression among African American stroke survivors negatively impacts overall health and quality of life, 11, 12 the association with functional recovery is unclear.…”

“…Of these 15, seven studies reported depression specifically among Africa American stroke survivors of which only 4 studies reported function. 3,7–9 However, no studies to date have specifically measured depression and functional status among African American stroke survivors who receive inpatient rehabilitation. There is a significant lack of knowledge of the prevalence of depression among African American stroke survivors and the association of their depression with functional outcomes.…”