Uncovering stroke's psychological impact

The long-term effects of stroke are relatively well-documented. However, a new study published in the journal Neurology finds that the impact runs much deeper than just the physical.

The most common type of stroke is an ischemic stroke, in which blood supply to parts of the brain is blocked, often by a blood clot.

These account for 87 percent of all strokes.

Because the neural tissue is starved of oxygen and nutrients, it dies, causing a range of long-lasting effects.

The types of function that are disrupted depend on the region of brain that is affected, and the severity of the disruption will depend on how much tissue is damaged.

Although every stroke is different, there are certain after effects that commonly occur, including paralysis (often on one side of the body), weakness, vision and memory problems, and difficulty with speech.

Looking deeper into stroke

Study author Dr. Irene L. Katzan, from the Cleveland Clinic in Ohio, wanted to find out more about the aftermath of stroke. She explains what drove her to investigate stroke survivors in more detail and what she wanted to achieve.

"After a stroke, people who have only mild disability can often have 'hidden' problems that can really affect their quality of life. And, for people with more disability, what bothers them the most? Problems with sleep? Depression? Fatigue?"

"Not many studies have asked people how they feel about these problems," she explains, "and we doctors have often focused just on physical disability or whether they have another stroke."

To examine these queries, Dr. Katzan — also a member of the American Academy of Neurology — investigated more than 1,000 people who had had an ischemic stroke. The results were published this week.

The participants were asked some questions regarding their physical functioning and other, more psychological factors, such as anxiety, fatigue, sleep issues, cognitive skills (such as planning and organizing), how much their pain levels affect their life, and how happy they are with their current social activities and roles.

The questionnaires were completed, on average, 100 days after the stroke, and around 25 percent of participants needed help to complete this task.

Understanding the issues

With the exception of depression and sleep, individuals with stroke had scores significantly lower than the general population across all other domains. The most stark differences, unsurprisingly, were found in physical activities.

Well over half of the individuals with stroke rated their satisfaction with social roles and social activities markedly worse than the general population.

This finding, in particular, could be useful when designing long-term care for people who have experienced stroke.

As Dr. Katzan explains, "People may benefit from social support programs, and previous studies have shown a benefit from efforts to improve the social participation of people with stroke, especially exercise programs."

When it came to executive functioning — skills including organizing and planning — the findings were similar; almost half of those with stroke scored themselves much lower than the rest of the population.

"The social participation and executive functioning skills are areas that have not received a lot of attention in stroke rehabilitation," says Dr. Katzan.

"We need to better understand how these areas affect people's well-being and determine strategies to help optimize their functioning."

Dr. Irene L. Katzan

The findings offer a new insight into the challenges that people with stroke face. However, the authors are quick to mention certain limitations in their study.

For instance, the average age of participants was 62 — 7 years younger than the average age when a stroke normally occurs. Also, participants tended to have milder strokes than average.

There were also some areas that were missed from the study. For instance, communication — which is known to be a concern for many people following stroke — was not covered.

The researchers hope that these results might help to inform future therapies and rehabilitation programs for individuals with stroke, with a particular focus on social support.