Young stroke survivors with favourable modified Rankin Scale scores still experience high rates of fatigue, anxiety and other non-motor symptoms six months post-stroke, research indicates.

Prevalence rates of adverse non-motor outcomes did not differ significantly between patients with mRS scores of 0-1 versus 2-5, according to findings from the University College London Young Stroke Systematic Evaluation Study (ULYSSES).

This suggests that good functional recovery (as per the mRS) “does not necessarily equate to a good outcome in non-motor domains,” the researchers noted, in a paper published in the Journal of Neurology, Neurosurgery & Psychiatry [link here].

The prospective hospital-based cohort study included 493 consecutive patients under 55 years old admitted to University College London Hospitals with ischaemic stroke or intracerebral haemorrhage between 2017 and 2020.

The findings revealed a variety of adverse non-motor outcomes six months post-stroke: fatigue (55%); reduced social participation (47%); sleep disturbance (46%); anxiety (35%); depression (32%); bowel dysfunction (26%); pain interference (18%); and bladder dysfunction (15%).

Overall, 91% of patients reported one or more adverse outcomes and 27% reported four or more.

Bowel and bladder dysfunction were linked with the highest burden of co-occurring outcomes, with 33% and 36% of patients, respectively, experiencing such symptoms in parallel with four or more adverse non-motor outcomes, the authors said.

Fatigue and reduced social participation also frequently occurred in tandem, with 30% of patients reporting both outcomes, according to the paper.

Notably, there were no significant differences in prevalence for any of the outcomes between patients with favourable (0–1) versus unfavourable (2–5) mRS scores.

“This finding highlights the limitations of the mRS in capturing the impact of stroke in young adults and indicates that mRS 0–1 might, therefore, not be appropriate to define a ‘favourable’ outcome,” the authors noted.

“Instead, a comprehensive, domain-specific approach may be needed to accurately assess non-motor aspects of recovery”.

Meanwhile, the authors said they did not find any independent predictors for high non-motor outcome burden (≥3 adverse outcomes), “which highlights the difficulty in identifying patients who would benefit most from targeted early interventions”. 

However, anxiety was predicted by ICH (OR 1.92; p=0.019) and higher education levels (per decile increase in education deprivation, OR 1.12; p=0.012), while pain interference was predicted by stroke severity on admission (per National Institutes of Health Stroke Scale 10-point increase, OR 1.54; p=0.025).

Overall, the findings suggest a need for rehabilitation resources that are more targeted toward the younger population of stroke patients, the researchers said.

“Young stroke patients are often in their most economically productive and demanding years of employment and may face additional unique challenges, such as caregiving responsibilities. 

“Developing targeted interventions and support systems will be essential for improving long-term recovery and facilitating reintegration into daily life for young stroke patients,” they stressed.