Prevalence, Trajectory, and Factors Associated With Patient-Reported Nonmotor Outcomes After Stroke

Abstract

ImportanceThe evidence on nonmotor outcomes after acute ischemic stroke and intracerebral hemorrhage (ICH) is limited and domain-specific. The prevalence, natural history, and factors associated with nonmotor outcomes across multiple domains are unclear.ObjectiveTo synthesize the published data and to identify the prevalence, natural history, and factors associated with multidomain nonmotor outcome burden in patients with stroke.Data SourcesA search of PubMed, MEDLINE, EMBASE, and PsycINFO databases between January 1999 to June 2023 was supplemented by search of bibliographies of the key articles.Study SelectionThe analysis included prospective cohort studies that reported nonmotor outcomes across 10 domains: anxiety, depression, fatigue, sleep disturbance, social participation, pain, bladder dysfunction, bowel dysfunction (constipation and fecal incontinence), and sexual dysfunction assessed by patient-reported scales.Data Extraction and SynthesisTwo reviewers independently assessed studies, extracting baseline data, nonmotor prevalence, and follow-up information. Pooled prevalence of nonmotor outcomes was estimated using random-effects models. Meta-regression models were used to analyze natural history and factors associated with nonmotor outcomes. Subgroup analysis was used to assess prevalence by symptom description within each nonmotor domain. Publication bias and study quality were assessed using funnel plots and the Newcastle-Ottawa scale.ResultsA total of 279 prospective cohort studies met the inclusion criteria (117 440 participants with stroke; median [IQR] age, 65 [59-70] years; 209 of 279 studies with more male than female participants) with a nonmotor outcome follow-up period ranging from 30 days to 10 years after stroke. The most prevalent adverse nonmotor outcomes by pooled prevalence were sleep disturbance (59.9%; 95% CI, 53.9%-63.9%), sexual dysfunction (59.8%; 95% CI, 50.0%-69.5%), constipation (58.2%; 95% CI, 53.9%-62.6%), reduced social participation (56.5%; 95% CI, 52.1%-60.8%), bladder dysfunction (45.9%; 95% CI, 38.0%-53.8%), and fatigue (45.2%; 95% CI, 40.7%-49.5%). Meta-regression analysis showed no significant improvement over time for most nonmotor outcomes, except pain (coefficient = −11.0%; P = .05) and sexual dysfunction (coefficient = −24.1%; P < .001). The heterogeneity ranged between 52% and 98% across all studies. The common factors associated with adverse nonmotor outcomes were female sex, studies with mixed stroke cohort (ischemic stroke or ICH), and older age.Conclusions and RelevancePatient-reported nonmotor outcomes were common after stroke. Sexual dysfunction, sleep disturbance, constipation, reduced social participation, bladder dysfunction, and fatigue were most prevalent. These adverse outcomes often persisted over time, especially in women, older adults, and those in studies with mixed stroke cohorts.

The Association of Depression, Anxiety, and Quality of Life with Sexual Function in Young-to-Middle-Aged Stroke Patients: A Case-Control Study

“…Notably, the impact of stroke was not limited to overall sexual function; patients demonstrated significantly higher ASEX scores-indicating greater impairment-across all sub-dimensions of sexual function compared to controls. These results align with recent literature reporting sexual issues in 33% to 70% of stroke patients (Geller & Wong, 2025;Latella et al, 2024;Vikan et al, 2021), ranking sexual dysfunction as one of the most common non-motor outcomes following sleep disturbances (Ozkan et al, 2025).…”

The Association of Depression, Anxiety, and Quality of Life with Sexual Function in Young-to-Middle-Aged Stroke Patients: A Case-Control Study

“…Notably, the impact of stroke was not limited to overall sexual function; patients demonstrated significantly higher ASEX scores-indicating greater impairment-across all sub-dimensions of sexual function compared to controls. These results align with recent literature reporting sexual issues in 33% to 70% of stroke patients (Geller & Wong, 2025;Latella et al, 2024;Vikan et al, 2021), ranking sexual dysfunction as one of the most common non-motor outcomes following sleep disturbances (Ozkan et al, 2025).…”

“How involved do you feel?” The PILS-Stroke questionnaire: a Rasch-built measure of social participation after stroke

“…To date, there is no consensus in literature regarding the influence of stroke type on participation There are reports of better functional outcomes for hemorrhagic stroke ( 41 ), while others claim the opposite ( 42 ). The time since stroke onset showed no meaningful correlation with reported social participation, aligning with recent findings suggesting that the prevalence of participation restrictions tends to persist over time following a stroke ( 3 , 43 ). Finally, there was a positive correlation between decreased social involvement with the severity of disability (assessed with the mRS), as expected based on previously published literature ( 37 , 44 ).…”

“…In the domain of body functions , there was a moderate correlation between depressive symptoms and social participation, aligning with previous studies ( 37 , 44 – 46 ). Depression affects about one in four stroke survivors ( 3 ) and is known to limit participation and to be exacerbated by social isolation ( 47 ). Addressing depression may therefore be an important clinical target to improve social participation.…”

Mobile Health Interventions Across the Stroke Care Continuum: A Scoping Review

“…Furthermore, the therapeutic targets are narrow: motor rehabilitation dominated, and cognitive, speech, and behavioral domains were addressed by only a minority of studies. Given that post-stroke cognitive impairment affects up to 60% of stroke survivors [ 32 ], and post-stroke depression affects up to 28% [ 33 ], the underrepresentation of these domains represents a clinically significant gap in the current mHealth literature.…”

The Association of Depression, Anxiety, and Quality of Life with Sexual Function in Young-to-Middle-Aged Stroke Patients: A Case-Control Study

“…Notably, the impact of stroke was not limited to overall sexual function; patients demonstrated significantly higher ASEX scores-indicating greater impairment-across all sub-dimensions of sexual function compared to controls. These results align with recent literature reporting sexual issues in 33% to 70% of stroke patients (Geller & Wong, 2025;Latella et al, 2024;Vikan et al, 2021), ranking sexual dysfunction as one of the most common non-motor outcomes following sleep disturbances (Ozkan et al, 2025).…”

“How involved do you feel?” The PILS-Stroke questionnaire: a Rasch-built measure of social participation after stroke

“…To date, there is no consensus in literature regarding the influence of stroke type on participation There are reports of better functional outcomes for hemorrhagic stroke ( 41 ), while others claim the opposite ( 42 ). The time since stroke onset showed no meaningful correlation with reported social participation, aligning with recent findings suggesting that the prevalence of participation restrictions tends to persist over time following a stroke ( 3 , 43 ). Finally, there was a positive correlation between decreased social involvement with the severity of disability (assessed with the mRS), as expected based on previously published literature ( 37 , 44 ).…”

“…In the domain of body functions , there was a moderate correlation between depressive symptoms and social participation, aligning with previous studies ( 37 , 44 – 46 ). Depression affects about one in four stroke survivors ( 3 ) and is known to limit participation and to be exacerbated by social isolation ( 47 ). Addressing depression may therefore be an important clinical target to improve social participation.…”

Mobile Health Interventions Across the Stroke Care Continuum: A Scoping Review

“…Furthermore, the therapeutic targets are narrow: motor rehabilitation dominated, and cognitive, speech, and behavioral domains were addressed by only a minority of studies. Given that post-stroke cognitive impairment affects up to 60% of stroke survivors [ 32 ], and post-stroke depression affects up to 28% [ 33 ], the underrepresentation of these domains represents a clinically significant gap in the current mHealth literature.…”

The Association of Depression, Anxiety, and Quality of Life with Sexual Function in Young-to-Middle-Aged Stroke Patients: A Case-Control Study

“…Notably, the impact of stroke was not limited to overall sexual function; patients demonstrated significantly higher ASEX scores-indicating greater impairment-across all sub-dimensions of sexual function compared to controls. These results align with recent literature reporting sexual issues in 33% to 70% of stroke patients (Geller & Wong, 2025;Latella et al, 2024;Vikan et al, 2021), ranking sexual dysfunction as one of the most common non-motor outcomes following sleep disturbances (Ozkan et al, 2025).…”

“How involved do you feel?” The PILS-Stroke questionnaire: a Rasch-built measure of social participation after stroke

“…To date, there is no consensus in literature regarding the influence of stroke type on participation There are reports of better functional outcomes for hemorrhagic stroke ( 41 ), while others claim the opposite ( 42 ). The time since stroke onset showed no meaningful correlation with reported social participation, aligning with recent findings suggesting that the prevalence of participation restrictions tends to persist over time following a stroke ( 3 , 43 ). Finally, there was a positive correlation between decreased social involvement with the severity of disability (assessed with the mRS), as expected based on previously published literature ( 37 , 44 ).…”

“…In the domain of body functions , there was a moderate correlation between depressive symptoms and social participation, aligning with previous studies ( 37 , 44 – 46 ). Depression affects about one in four stroke survivors ( 3 ) and is known to limit participation and to be exacerbated by social isolation ( 47 ). Addressing depression may therefore be an important clinical target to improve social participation.…”

Mobile Health Interventions Across the Stroke Care Continuum: A Scoping Review

“…Furthermore, the therapeutic targets are narrow: motor rehabilitation dominated, and cognitive, speech, and behavioral domains were addressed by only a minority of studies. Given that post-stroke cognitive impairment affects up to 60% of stroke survivors [ 32 ], and post-stroke depression affects up to 28% [ 33 ], the underrepresentation of these domains represents a clinically significant gap in the current mHealth literature.…”