Post-Stroke Apathy and Hypersomnia Lead to Worse Outcomes from Acute Rehabilitation

Abstract

Apathy and hypersomnia occur after stroke and, by definition, reduce participation in rehabilitation, but their effect on outcome from acute rehabilitation is not known. We performed a retrospective review of 213 patients admitted to a stroke-specialized acute rehabilitation unit in the United States. All patients had ischemic or hemorrhagic stroke, and no dementia or dependence on others pre-stroke. We diagnosed apathy and hypersomnia using standardized documentation by treating therapists. We used multiple regression analysis to control for overall impairment (combination of strength, cognitive and sensory measures), age, time since stroke, and stroke type (ischemic or hemorrhagic). 44 (21%) of patients had persistent apathy, and 12 (5.6%) had persistent hypersomnia. Both groups were more impaired in cognition, sustained attention, and more likely to be treated for depression. Patients with apathy were 2.4 times more likely to go to a nursing home, and had discharge FIM scores 12 points below the mean. Patients with hypersomnia were 10 times more likely to go to a nursing home, and had discharge FIM scores 16 points below the mean. These findings indicate that studies to prospectively define these clinical factors and potential confounds using standardized tools are indicated, and if confirmed, justify studies to identify these patients early and develop targeted interventions.

Quantifying Poststroke Apathy With Actimeters

“…Previous studies have found that patients with post-stroke apathy recover slower during acute rehabilitation {2; 3; 17; 18}. Here we confirmed this finding as apathy severity correlated with change in FIM from admission to discharge (Pearson r = −0.44, p-value <0.001).…”

“…Our finding that apathy correlates with less recovery of disability (FIM) during rehabilitation stay is consistent with other studies {2; 3; 17; 18}. The mechanism by which apathy affects recovery is not clear.…”

Sleep and Cognitive Abnormalities in Acute Minor Thalamic Infarction

“…In fact, increases of stage 1 sleep as well as decreases of stages 2 and 3 in the patients, which was independent of the hemisphere affected by the stroke, remained abnormal, representing a ''sleep EEG signature'' of thalamic infarcts. Our data are in line with previous observations in which these persistent disturbances in sleep patterns have been reported [16]. In addition, during the acute phase, our patients had significantly more episodes of sleep-related breathing disorder, both central and obstructive, than healthy controls.…”

The Impact of Pre-Stroke Depressive Symptoms, Fatalism, and Social Support on Disability after Stroke

“…Finally, the PHQ-9 scale assesses disinterest which relates to apathy and hypersomnia (26). Both of these factors have been shown to be associated with willingness to participate in therapy and poor outcome after stroke (27). Awareness of the presence of pre-stroke depressive symptoms in stroke survivors may help practitioners identify patients at risk for post-stroke depression and poor outcomes.…”