Abstract
Background: The long-term quality of life (QoL) effects of stroke on younger patients has not been adequately compared to older stroke patients. Methods: We included patients from the Secondary Prevention of Small Subcortical Strokes (SPS3) trial, who had a lacunar stroke within the last 6 months. We divided the cohort into younger patients aged <55 years versus older patients aged ≥55. The primary outcome was a 12 domain stroke specific QoL scale (ss-QoL), measured at one year from enrollment. The ss-QoL scores range from 0-5, with higher scores indicating better QoL. We fit linear regression models to the 12 domains and their mean, and adjusted for 90-day mRS, gender, white race, history of MI, diabetes, HTN, COPD, and level of education. After identifying domains of interest, we examined specific questions within domains to compare the mean score on individual questions using Student’s t-test. Results: We included 2,542 patients with a mean (SD) age of 62.8 (10.7) and 64% were male. Younger stroke patients comprised 26.5% (673/2,542) of the cohort and had a mean (SD) ss-QoL score of 4.18 (0.75) compared to 4.24 (0.69) of the older patients, a difference which was significant in the adjusted model (p=0.015). Younger stroke patients had significantly lower scores on the following individual ss-QoL domains compared to older stroke patients: language, thinking, personality, mood, family roles, and energy (Table 1). The three questions that younger stroke patients had the most difference with older patients were “in the past week I was discouraged about my future” (young vs old, 3.7 vs 4.0, p<0.001), “…had little confidence in myself” (4.0 vs 4.3, p<0.001), and “…was irritable” (3.7 vs 3.9, p<0.001). Conclusion: After lacunar stroke, compared to older patients, younger patients score worse on stroke specific quality of life at 1-1.5 years after stroke, particularly in domains related to mood. This under-appreciated impact of stroke in the young warrants additional research.
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