title: Quality of life declines after first ischemic stroke. The Northern Manhattan Study.
abstract: OBJECTIVE
  Quality of life (QOL) after stroke is poorly characterized. We sought to determine long-term natural history and predictors of QOL among first ischemic stroke survivors without stroke recurrence or myocardial infarction (MI).
  
  
  METHODS
  In the population-based, multiethnic Northern Manhattan Study, QOL was prospectively assessed at 6 months and annually for 5 years using the Spitzer QOL index (QLI), a 10-point scale. Functional status was assessed using the Barthel Index (BI) at regular intervals, and cognition using the Mini-Mental State Examination at 1 year. Generalized estimating equations estimated the association between patient characteristics and repeated QOL measures over 5 years. Follow-up was censored at death, recurrent stroke, or MI.
  
  
  RESULTS
  There were 525 incident ischemic stroke patients >/=40 years (mean age 68.6 +/- 12.4 years). QLI declined after stroke (annual change -0.10, 95% confidence interval -0.17 to -0.04), after adjusting for age, sex, race-ethnicity, education, insurance, depressed mood, stroke severity, bladder continence, and stroke laterality. This decline remained when BI >/=95 was added to the model as a time-dependent covariate, and functional status also predicted QLI. Changes in QLI over time differed by insurance status (p for interaction = 0.0017), with a decline for those with Medicaid/no insurance (p < 0.0001) but not Medicare/private insurance (p = 0.98).
  
  
  CONCLUSIONS
  In this population-based study, QOL declined annually up to 5 years after stroke among survivors free of recurrence or MI and independently of other risk factors. QLI declined more among Medicaid patients and was associated with age, mood, stroke severity, urinary incontinence, functional status, cognition, and stroke laterality.
authors.affiliation: Neurological Institute, Department of Neurology, College of Physicians and Surgeons, Columbia University, 710 W. 168th Street, New York, NY 10032, USA. msd2102@mail.cumc.columbia.edu
authors.forename: M S
authors.initials: MS
authors.lastname: Dhamoon
authors.forename: Y P
authors.initials: YP
authors.lastname: Moon
authors.forename: M C
authors.initials: MC
authors.lastname: Paik
authors.forename: B
authors.initials: B
authors.lastname: Boden-Albala
authors.forename: T
authors.initials: T
authors.lastname: Rundek
authors.forename: R L
authors.initials: RL
authors.lastname: Sacco
authors.forename: M S V
authors.initials: MS
authors.lastname: Elkind
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000453:epidemiology / Q000503:physiopathology* / Q000523:psychology*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007348:Insurance, Health / Q000706:statistics & numerical data; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D009519:New York City / Q000453:epidemiology; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D020127:Recovery of Function; D012008:Recurrence; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000503:physiopathology* / Q000523:psychology*; D014481:United States; D014505:Urban Population / Q000706:statistics & numerical data