FUNCTIONAL RECOVERY AND SOCIAL OUTCOME AFTER CEREBRAL INFARCTION IN YOUNG-ADULTS

This study was designed to assess the return to work, the poststroke d epression and the quality of life after a cerebral infarction in young adults and was conducted on 71 consecutive young patients (aged 15-45 years) affected by a cerebral infarct who were hospitalized for the f irst time and discharged at least 1 year before the study. Data about risk factors, etiology, side and territory of stroke, social character istics of the patient (age, sex, profession, educational level, family situation), poststroke seizures, recurrent stroke, other vascular eve nts, and deaths were collected. Neurological deficits were graded with the National Institutes of Health (NIH) Stroke Scale. Poststroke depr ession (PSD) was quantified using the DSM-IIIR criteria and the Montgo mery Asberg Depression Rating Scale. Outcomes were rated with the Rank ing Scale, the Barthel Index and the Glasgow Outcome Scale. Quality of life was assessed with the Sickness Impact Profile. Follow-up informa tion was obtained by interview and neurological examination. Follow-up information was obtained in 65 patients at a mean of 31.7 +/- 13.0 (r ange 12-59) months, as 2 patients died and 4 were lost to follow-up an d were thus excluded from this study. Poststroke seizures occurred in 7 patients (10.8%) and recurrent strokes in 4 patients (6.2%), but non e were fatal. The outcome after stroke among survivors was usually goo d, since more than two-thirds of the patients (69.8%) reported no prob lem, 11.1% moderate handicap and one-fifth major handicap. Forty-six p atients (73%) returned to work; the time period ranging from several d ays after stroke to 40 months, with a mean of 8 months. However, adjus tments in their occupation were necessary for 12 patients (26.1%). PSD was common, since 48.3% of the patients were classified as depressed. PSD was associated with the localization of the infarct (carotid terr itory), a severe disability, a bad general outcome, and an absence of return to work. Their opinion about their quality of life was negative among approximately 30% of the patients, especially in emotional and alertness behaviors, social interaction, recreation and pastimes. The general outcome after cerebral infarct in young adults is usually good . However, the risk of a PSD is high, and only half of the patients ha d returned to their previous work. A remaining psychosocial handicap a nd depression of sexual activity impaired the quality of life. In mult ivariate analysis, a low NIH score at admission is a significant predi ctor for return to work, the absence of PSD, and a good quality of lif e.