title: Low well-being is an independent predictor for stroke in elderly patients with diabetes mellitus.
abstract: OBJECTIVE
  To examine whether psychological factors are risk factors for the development of stroke in elderly diabetic patients.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Outpatient clinic.
  
  
  METHODS
  Three hundred seventy-six diabetic outpatients free of stroke; mean age 75.
  
  
  METHODS
  Well-being and diabetes-specific burden were assessed at baseline using the Philadelphia Geriatric Center morale scale and the Elderly Diabetes Burden Scale (EDBS), respectively. Symptomatic stroke was defined as a focal neurological deficit with rapid onset that persists for more than 24 hours, supported by brain computed tomography or magnetic resonance imaging.
  
  
  RESULTS
  During the 3-year follow-up period, 25 symptomatic strokes (24 ischemic strokes and 1 cerebral hemorrhage) occurred. Low scores on the morale scale (</=7) were significant predictors for stroke after adjustment for age; sex; body mass index; hemoglobin A1c level; systolic blood pressure; serum levels of total cholesterol, triglycerides, and high-density lipoprotein cholesterol; smoking; and previous ischemic heart disease (IHD) (hazard ratio (HR)=3.0, 95% confidence interval (CI)=1.2-7.3, P=.017). The relationship between low morale scores and future stroke remained significant after adjusting for socioeconomic factors and microalbuminuria. Increased symptom burden and social burden, but not dietary restrictions, worry about diabetes mellitus (DM), treatment satisfaction, and burden by tablets or insulin of EDBS, were also significant predictors for stroke after adjustment for age, sex, duration of DM, previous IHD, and microalbuminuria (HR=2.6, 95% CI=1.1-6.5, P=.039).
  
  
  CONCLUSIONS
  Low well-being and symptom burden were predictors of stroke in elderly patients with diabetes mellitus (DM), although the causal relationship remains unknown.
authors.affiliation: Department of Endocrinology, Tokyo Metropolitan Geriatric Medical Center, Tokyo, Japan. fwic3817@mb.infoweb.ne.jp
authors.forename: Atsushi
authors.initials: A
authors.lastname: Araki
authors.forename: Yukari
authors.initials: Y
authors.lastname: Murotani
authors.forename: Fumi
authors.initials: F
authors.lastname: Kamimiya
authors.forename: Hideki
authors.initials: H
authors.lastname: Ito
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000523:psychology*; D003928:Diabetic Nephropathies / Q000453:epidemiology; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D009013:Morale; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011788:Quality of Life; D012306:Risk; D012959:Socioeconomic Factors; D013315:Stress, Psychological / Q000150:complications*; D020521:Stroke / Q000453:epidemiology* / Q000523:psychology*