title: Influence of cerebral white matter lesions on the activities of daily living of older patients with mild stroke.
abstract: OBJECTIVE
  Neurological symptom severity is a prognostic factor for post-stroke activities of daily living (ADL). Recently, it has been reported that white matter lesions indicate poor functional prognosis in patients with stroke. The present study investigated the influence of white matter lesions on the ADL of older patients with stroke who have mild neurological symptoms.
  
  
  METHODS
  We investigated ADL at discharge in 44 patients with stroke (men, n = 27; women, n = 17; mean age 78 years [range 71-85 years]) aged ≥65 years with National Institutes of Health Stroke Scale scores of ≤5 (cerebral infarction, n = 37; cerebral hemorrhage, n = 7). We used single correlation analysis and multiple regression analysis to investigate factors that correlated with ADL at discharge. ADL at discharge was also evaluated on the basis of white matter lesion severity (Fazekas classification, grades 0-3).
  
  
  RESULTS
  Single correlation analysis showed that age (r = -0.36, P = 0.016), male sex (r = 0.362, P = 0.016), neurological symptom severity (r = -0.361, P = 0.016), ADL on starting rehabilitation (r = 0.685, P < 0.001) and white matter lesion severity (r = -0.361, P = 0.016) significantly correlated with ADL at discharge. Multiple regression analysis showed that ADL on starting rehabilitation (β = 0.519, t = 4.723, P < 0.001) and white matter lesion severity (β = -0.309, t = -3.057, P < 0.01) were statistically significant prognostic factors for ADL at discharge. ADL at discharge score was significantly lower in the group with high white matter lesion severity (Fazekas, grade 2) than in the other two groups (Fazekas, grade 0, P < 0.01; Fazekas, grade 1, P < 0.05).
  
  
  CONCLUSIONS
  Severe white matter lesions are a prognostic factor for poor ADL at discharge in older patients with stroke who have mild neurological symptoms. Geriatr Gerontol Int 2016; 16: 942-947.
authors.affiliation: Division of Rehabilitation Medicine, Nagoya City University Hospital, Nagoya, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Yamashita
authors.affiliation: Division of Rehabilitation Medicine, Nagoya City University Hospital, Nagoya, Japan.
authors.forename: Ikuo
authors.initials: I
authors.lastname: Wada
authors.affiliation: Division of Rehabilitation Medicine, Nagoya City University Hospital, Nagoya, Japan.
authors.forename: Mitsuya
authors.initials: M
authors.lastname: Horiba
authors.affiliation: Division of Rehabilitation Medicine, Nagoya City University Hospital, Nagoya, Japan.
authors.forename: Kento
authors.initials: K
authors.lastname: Sahashi
mesh_terms: D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D015999:Multivariate Analysis; D009483:Neuropsychological Tests; D010351:Patient Discharge / Q000706:statistics & numerical data; D011379:Prognosis; D012044:Regression Analysis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012737:Sex Factors; D020521:Stroke / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome; D066127:White Matter / Q000000981:diagnostic imaging* / Q000473:pathology*
keywords: activities of daily living; cerebral white matter lesion; older; prognosis; stroke