title: Long-term disability after lacunar stroke: secondary prevention of small subcortical strokes.
abstract: OBJECTIVE
  To determine whether vascular and demographic factors predict worsening disability up to 8 years after lacunar stroke.
  
  
  METHODS
  SPS3 (Secondary Prevention of Small Subcortical Strokes) was a clinical trial in lacunar stroke patients with annual assessment of disability using the Older Americans Resources and Survey instrumental activities of daily living (IADL) scale (range 0-14). Generalized estimating equations modeled the likelihood of disability (IADL <14) over time, adjusting for demographics, medical risk factors, cognition, mood, stroke location, and geographic region in univariate and multivariable models. IADL assessments after recurrent stroke were censored. We stratified by study region and age quartile.
  
  
  RESULTS
  Among 2,820 participants, mean age was 63.4 years (SD 10.8), 63% were male, 36% had diabetes, 90% hypertension, and 10% prior stroke. Mean follow-up was 3.7 years. In multivariable models, female sex, education, diabetes, nonregular alcohol use, prior stroke, Cognitive Abilities Screening Instrument score, depression, mild cognitive impairment, and stroke location were associated with disability. The youngest age quartile had decreased odds of disability over time (odds ratio 0.90 per year, 95% confidence interval 0.85-0.95), whereas the oldest age quartile had increased odds (2.20, 95% confidence interval 1.75-2.75). Americans and Latin Americans had >2-fold greater odds of disability per year compared with Spaniards (p < 0.0001).
  
  
  CONCLUSIONS
  In lacunar stroke patients, older age was associated with worsening long-term disability, even without recurrence. Worse long-term function was associated with diabetes, cognitive status, and prior stroke, and regional differences may be attributable to variations in health care delivery or scale interpretation.
authors: From the Department of Neurology (M.S.D.), Mount Sinai School of Medicine, New York, NY; Department of Biostatistics (L.A.M.), University of Alabama at Birmingham; School of Nursing (C.L.W.), University of Texas Health Sciences Center, San Antonio; Department of Neurology (K.L.), University of Minnesota Medical Center, Minneapolis; Department of Neurology (O.R.B.), University of British Columbia, Vancouver, Canada; Departments of Neurology and Epidemiology (M.S.V.E.), Columbia University, New York, NY. mandip.dhamoon@mssm.edu.
authors: Mandip S
authors: MS
authors: Dhamoon
authors: From the Department of Neurology (M.S.D.), Mount Sinai School of Medicine, New York, NY; Department of Biostatistics (L.A.M.), University of Alabama at Birmingham; School of Nursing (C.L.W.), University of Texas Health Sciences Center, San Antonio; Department of Neurology (K.L.), University of Minnesota Medical Center, Minneapolis; Department of Neurology (O.R.B.), University of British Columbia, Vancouver, Canada; Departments of Neurology and Epidemiology (M.S.V.E.), Columbia University, New York, NY.
authors: Leslie A
authors: LA
authors: McClure
authors: From the Department of Neurology (M.S.D.), Mount Sinai School of Medicine, New York, NY; Department of Biostatistics (L.A.M.), University of Alabama at Birmingham; School of Nursing (C.L.W.), University of Texas Health Sciences Center, San Antonio; Department of Neurology (K.L.), University of Minnesota Medical Center, Minneapolis; Department of Neurology (O.R.B.), University of British Columbia, Vancouver, Canada; Departments of Neurology and Epidemiology (M.S.V.E.), Columbia University, New York, NY.
authors: Carole L
authors: CL
authors: White
authors: From the Department of Neurology (M.S.D.), Mount Sinai School of Medicine, New York, NY; Department of Biostatistics (L.A.M.), University of Alabama at Birmingham; School of Nursing (C.L.W.), University of Texas Health Sciences Center, San Antonio; Department of Neurology (K.L.), University of Minnesota Medical Center, Minneapolis; Department of Neurology (O.R.B.), University of British Columbia, Vancouver, Canada; Departments of Neurology and Epidemiology (M.S.V.E.), Columbia University, New York, NY.
authors: Kamakshi
authors: K
authors: Lakshminarayan
authors: From the Department of Neurology (M.S.D.), Mount Sinai School of Medicine, New York, NY; Department of Biostatistics (L.A.M.), University of Alabama at Birmingham; School of Nursing (C.L.W.), University of Texas Health Sciences Center, San Antonio; Department of Neurology (K.L.), University of Minnesota Medical Center, Minneapolis; Department of Neurology (O.R.B.), University of British Columbia, Vancouver, Canada; Departments of Neurology and Epidemiology (M.S.V.E.), Columbia University, New York, NY.
authors: Oscar R
authors: OR
authors: Benavente
authors: From the Department of Neurology (M.S.D.), Mount Sinai School of Medicine, New York, NY; Department of Biostatistics (L.A.M.), University of Alabama at Birmingham; School of Nursing (C.L.W.), University of Texas Health Sciences Center, San Antonio; Department of Neurology (K.L.), University of Minnesota Medical Center, Minneapolis; Department of Neurology (O.R.B.), University of British Columbia, Vancouver, Canada; Departments of Neurology and Epidemiology (M.S.V.E.), Columbia University, New York, NY.
authors: Mitchell S V
authors: MS
authors: Elkind
mesh_terms: D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D004185:Disability Evaluation; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D055502:Secondary Prevention; D059409:Stroke, Lacunar / Q000150:complications* / Q000517:prevention & control; D013997:Time Factors