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Post-Stroke Apathy and Hypersomnia Lead to Worse Outcomes from Acute Rehabilitation

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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 clinical factors and potential confounds using standardized tools are indicated, and if confirmed, justify studies to identify these patients early and develop targeted interventions.

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Acknowledgments

We thank Cathy Dwyer, Janet Herbold and Michael Reding from the Burke Rehabilitation Hospital for assistance with acquiring and interpreting the original data. We gratefully acknowledge funding support from the Burke Medical Research Institute.

Conflict of Interest

Ari Harris declares that he has no conflict of interest. Jessica Elder declares that she has no conflict of interest. Nicholas Schiff declares that he has no conflict of interest. Jonathan Victor declares that he has no conflict of interest. Andrew Goldfine declares that he has no conflict of interest.

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Authors and Affiliations

  1. Burke Medical Research Institute, Weill Cornell Medical College, 785 Mamaroneck Avenue, White Plains, NY, 10605, USA

    Ari L. Harris & Andrew M. Goldfine

  2. Department of Neurology, Physicians Office Building Suite 324, Providence, RI, USA

    Ari L. Harris

  3. Department of Biostatistics and Epidemiology, Weill Cornell Medical College, Burke Medical Research Institute, 785 Mamaroneck Avenue, White Plains, NY, 10605, USA

    Jessica Elder

  4. Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medical College, 1300 York Avenue, New York, NY, 10605, USA

    Nicholas D. Schiff & Jonathan D. Victor

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  1. Ari L. Harris
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Correspondence to Andrew M. Goldfine.

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Harris, A.L., Elder, J., Schiff, N.D. et al. Post-Stroke Apathy and Hypersomnia Lead to Worse Outcomes from Acute Rehabilitation. Transl. Stroke Res. 5, 292–300 (2014). https://doi.org/10.1007/s12975-013-0293-y

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  • DOI: https://doi.org/10.1007/s12975-013-0293-y

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