Post-Stroke Apathy and Hypersomnia Lead to Worse Outcomes from Acute Rehabilitation
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ORIGINAL ARTICLE
Post-Stroke Apathy and Hypersomnia Lead to Worse Outcomes from Acute Rehabilitation Ari L. Harris & Jessica Elder & Nicholas D. Schiff & Jonathan D. Victor & Andrew M. Goldfine
Received: 18 June 2013 / Revised: 17 September 2013 / Accepted: 6 October 2013 # Springer Science+Business Media New York 2013
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). Forty-four (21 %) of the 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 ten 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 A. L. Harris : A. M. Goldfine (*) Burke Medical Research Institute, Weill Cornell Medical College, 785 Mamaroneck Avenue, White Plains, NY 10605, USA e-mail: [email protected] A. L. Harris Department of Neurology, Physicians Office Building Suite 324, Providence, RI, USA J. Elder Department of Biostatistics and Epidemiology, Weill Cornell Medical College, Burke Medical Research Institute, 785 Mamaroneck Avenue, White Plains, NY 10605, USA N. D. Schiff : J. D. Victor Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medical College, 1300 York Avenue, New York, NY 10605, USA
clinical factors and potential confounds using standardized tools are indicated, and if confirmed, justify studies to identify these patients early and develop targeted interventions. Keywords Apathy . Hypersomnia . Stroke . Rehabilitation
Introduction In addition to the well-recognized motor and sensory deficits in patients with stroke, apathy and hypersomnia can reduce goal-directed behavior and therefore participation in rehabilitation. If reduction in participation due to apathy or hypersomnia affects the rehabilitation process, it could explain some of the variability in recovery [1, 2], and treatment of these conditions could improve patients' response to rehabilitation interventions, reducing disability and improving outcomes. But, as a prerequisite to initiating clinical trials of such treatments, we first need to know the prevalence of these conditions in the acute re
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