Estimates of the prevalence of acute stroke impairments and disability in a multiethnic population

Background and Purpose - The goals of the present study were to estimate th e prevalence of acute impairments and disability in a multiethnic populatio n of first-ever stroke and to identify differences in impairment and early disability between pathological and Bamford subtypes. Associations between impairments and death and disability at 3 months were identifed. Methods - Impairments that occur at the time of maximum neurological defici t were recorded, and disability according to the Barthel Ender (BI) was ass essed 1 week and 3 months after stroke in patients in the South London Stro ke Register. Results - Of 1259 registered patients, 6% had 1 or 2, 31.1% had 3 to 5, 50. 6% had 6 to 10, and 10.6% had > 10 impairments. Common impairments were wea kness (upper limb, 77.4%), urinary incontinence (48.2%), impaired conscious ness (44.7%), dysphagia (44.7%), and impaired cognition (43.9%). Patients w ith total anterior circulation infarcts had the highest age-adjusted preval ence of weakness, dysphagia, urinary incontinence, cognitive impairment, an d disability. Patients with subarachnoid hemorrhage had the highest rates o f coma. Patients with lacunar stroke had the high prevalence of weakness bu t were least affected by disability, incontinence, and cognitive dysfunctio n. Blacks had higher age- and sex-adjusted rates of disability in ischemic stroke (BI < 20, odds ratio 2.76, 95% CI 1.47 to 5.21, P=0.002; BI < 15, od ds ratio 1.8, 95% CI 1.45 to 2.81, P=0.01) but impairment rates similar to those of whites, On multivariable analysis, incontinence, coma, dysphagia, cognitive impairment, and gaze paresis were independently associated with s evere disability (BI < 10) and death at 3 months. Conclusions - The extent of these findings indicates that an acute assessme nt of impairments and disability is necessary to determine the appropriate nursing and rehabilitation needs of patients with stroke.