Background:
Neuropsychiatric symptoms are common after stroke and are distressing
symptoms. They may persist after the acute event and negatively impact
rehabilitation, functioning, and patients' quality of life.
Objectives:
To elucidate the prevalence and course of neuropsychiatric symptoms in
stroke patients during rehabilitation, we prospectively investigated the
trajectory change of neuropsychiatric symptoms and the association
between these symptoms and functional recovery.
Methods:
This observational study enrolled 204 stroke patients consecutively
admitted to the rehabilitation ward. We administered the
Neuropsychiatric Inventory-Nursing Home Version (NPI-NH) for evaluating
the neuropsychiatric symptoms (e.g., apathy and depression) and the
Functional Independence Measure (FIM) and Montebello Rehabilitation
Factor Score (MRFS) for functional recovery.
Results: The
cumulative prevalence of neuropsychiatric symptoms was 48% during
hospitalization; depression, anxiety, and sleep disturbances were most
frequent. Binomial logistic regression analyses revealed that the
factors associated with deterioration of neuropsychiatric symptoms
during hospitalization included premorbid depression (odds ratio:
18.628, P = .001), the length of stay from onset to rehabilitation ward admission (odds ratio: 1.022, P = .012), motor FIM at admission (odds ratio: 0.950, P < .001), and NPI-NH at admission (odds ratio: 0.923, P = .011). Stepwise multiple regression analyses revealed that the NPI-NH at admission was associated with the MRFS (β = −0.128, P = .037).
Conclusions:
Neuropsychiatric symptoms are common in stroke patients undergoing
rehabilitation and have a substantially negative impact on
rehabilitation outcomes. Stroke patients with prolonged acute-phase
hospitalization and low functioning at admission must be monitored to
detect any deterioration in the neuropsychiatric state.
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