Determinants of disability at 6 months after stroke: The GRECogVASC Study.

Abstract

The aim of this study was to determine the contributions of background disorders responsible for participation restriction as indexed by a structured interview for the modified Rankin Scale (mRS-SI). A subset of 256 patients was assessed at 6months after stroke using the National Institutes of Health Stroke Scale (NIHSS), gait score, comprehensive cognitive battery (yielding a global cognitive Z-score), behavioral dysexecutive disorders (DDs), anxiety and depressive symptoms, epilepsy, and headache. Following bivariate analyses, determinants of participation restriction were selected using ordinal regression analysis with partial odds. Poststroke participation restriction (mRS-SI score>1) was observed in 59% of the patients. In bivariate analyses, mRS-SI score was associated with prestroke mRS-SI score, 6-month NIHSS score, gait score, global cognitive Z-score, behavioral DDs, and presence of anxiety and depression (all: p=0.0001; epilepsy: p=0.3; headache: p=0.7). After logistic regression analysis, NIHSS score was associated with increasing mRS-SI score (p=0.00001). Prestroke mRS-SI score (p=0.00001), behavioral DDs (p=0.0008) and global cognitive Z-score (p=0.01) were associated with both mRS-SIscore >1 and mRS-SIscore >2. In addition, gait score was associated with mRS-SIscore >2 (p=0.00001). This model classified 85% of mRS-SI scores correctly (p=0.001). Structural equation modeling showed the contributions of gait limitation (standardized coefficient [SC]: 0.68; p=0.01), prestroke mRS-SI (SC: 0.41; p=0.01), severity of neurological impairment (SC: 0.16; p=0.01), global cognitive Z-score (SC: -0.14; p=0.05), and behavioral DDs (SC: 0.13; p=0.01). These results provide a statistical model of weights of determinants responsible for poststroke participation restriction and highlight a new independent determinant: behavioral DDs.