FUNCTIONAL OUTCOME IN PATIENTS WITH LACUNAR INFARCTION

Background and Purpose Little is known about the prognosis and the pre dictive factors for functional outcome after lacunar infarction. Our a im was to analyze this issue in more detail and with a longer follow-u p than in previous reports. Methods Functional outcome was assessed in 81 consecutive patients with a first-ever stroke and clinical and MRI findings compatible with lacunar infarction. We measured impairment ( motor, sensory, and cognitive function), disability (Katz's Index of A ctivities of Daily Living [ADL] and four instrumental activities), and handicap (Oxford Handicap Scale). Tnt patients were followed up for 3 years. Results During follow-up, 6% of the patients died and 21% had recurrent strokes, mostly new lacunar infarcts. A fast initial recover y was found in most patients. At 1 year, 12% were dependent in persona l ADL, which after 3 years had increased to 24%, mostly as a result of the effects of recurrent strokes. In a logistic multivariate regressi on model, moderate or severe hemiparesis 1 month after stroke onset wa s the strongest predictor of physical dependence or death at 3 years ( P<.001), followed by white matter hyperintensities on MRI (P<.01). Age , vascular risk factors, and recurrent stroke were not statistically s ignificant independent predictors of functional outcome. Conclusions F unctional outcome regarding physical independence was favorable in mos t patients. Motor impairment and white matter disease were the stronge st predictors of a poor functional outcome. Recurrent stroke increased disability and handicap but was not a statistically significant indep endent risk factor. Measurements of personal ADL alone were insensitiv e in detecting the consequences of stroke in many patients with preser ved self-care ability, who still experienced disability and handicap.