Disability Lingers More than a Decade After Stroke

You mean you blithering idiots didn't know this before? Spasticity has NO cure, so the 30% of survivors that get this will never recover.
My disability hasn't gotten worse but hasn't gotten better either, spasticity and fatigue still suck. It has been 11 years now. 
https://www.medpagetoday.com/Cardiology/Strokes/68718?

But trajectory of increasing disability not as steep after MI

• by Nicole Lou, Contributing Writer, MedPage Today October 23, 2017

The increase in disability after a stroke is no one-off event, as researchers found a hastening in the deterioration of functional status lasting more than 10 years after the event.
Around the time of stroke, patients experienced an increase in disability of 0.88 points on a 12-point scale (95% CI 0.57-1.20), whereas those who had an MI gained 0.20 points (95% CI 0.06-0.35), according to Mandip Dhamoon, MD, DrPH, of the Icahn School of Medicine at Mount Sinai in New York City, and colleagues.
The slow and steady annual increase in disability more than tripled after stroke (0.06 points per year before versus 0.15 additional points per year after), speeding up worsening of functional status for many patients. MI patients, on the other hand, saw no ramp-up in their disability trajectory after their event (0.04 points per year versus 0.02 additional points per year), they wrote online in JAMA Neurology.
"Stroke is traditionally seen as a discrete, monophasic event, and functional status has been assumed to stabilize following the 3- to 6-month recovery period after stroke, unless recurrent events occur. However, we present evidence that a single ischemic stroke continues to be associated with a gradual increase in disability over the long-term after stroke," Dhamoon's group said.
"Several lines of evidence support the paradigm proposed here of progressive brain dysfunction caused by cerebrovascular injury. First, stroke is caused by conditions, including vascular risk factors and inflammation, that may have an ongoing and cumulative effect on vessel and neuronal function, including small vessels in the case of lacunar stroke and carotid arteries in the case of large-artery strokes. In addition to causing recurrent strokes, vascular risk factors cause subclinical or covert brain injury manifest as infarcts and leukoaraiosis that may reduce functional status over the long term."
A stroke's long-term adverse effects leading to accelerated functional decline may be treatable, the authors suggested.
"We showed that participants who eventually have a stroke do not have a higher slope of increasing disability before stroke than do those who do not eventually have a stroke," they also noted.
For the analysis, the investigators pulled files from the Cardiovascular Health Study. Included were Medicare-eligible individuals who expected to reside the same area for at least 3 years at the time of enrollment in the 1989-1993 period (n=5,888; mean age 72.8; 42.4% men). They excluded those who needed a wheelchair and those getting hospice care, radiotherapy, or chemotherapy.
Longitudinal follow-up averaged more than 13 years.
Disability as measured on a 12-point scale evaluating a patient's ability to perform 12 daily activities: walking around home, getting out of bed, eating, dressing, bathing, using the toilet, heavy housework, light housework, shopping, preparing meals, paying bills, and using the telephone. This definition of disability tasks are so low level they should be discarded. Most people have much higher demands like working, running, swimming, biking that need to be recovered back. The bar is set way too low. I expect 100% recovery to all previous tasks. Get there. 

Dhamoon and co-authors disclosed no relevant relationships with industry.

• Primary Source

  JAMA Neurology

  Source Reference: Dhamoon MS, et al "Disability trajectories before and after stroke and myocardial infarction: the Cardiovascular Health Study" JAMA Neurol 2017; DOI:10.1001/jamaneurol.2017.2802.