Young stroke survivors appear fine—but hidden cognitive and mental health problems persist
A 10-year study of stroke patients in their 40s found that three-quarters recovered well physically, yet more than one-quarter developed cognitive impairment and anxiety lingered even among those with excellent recovery. The findings suggest employers and insurers underestimate the true cost of stroke in younger workers and need better long-term monitoring protocols.
Originaltitel: Long-term outcome of young patients after ischemic stroke or transient ischemic attack: Insights from a multicenter study
Background: The long-term non-motor outcome of young adults with ischemic stroke (IS) or transient ischemic attack (TIA) is poorly understood. Aims: Therefore, in this observational cohort study, we explored the prevalence of impairment and factors influencing clinical and neuropsychological outcomes and return-to-work a decade post-stroke. Methods: After a median follow-up duration of 10.4 years, 163 patients (median age at index event: 46.0 years, 44.8% female, 121 IS and 42 TIA) of the “Stroke in Young Fabry Patients study” attended an in-person follow-up in three European centers. We assessed clinical, neuropsychological, and return-to-work data. Results: A decade post-stroke, most patients (74.8%) showed excellent outcome, scoring 0–1 on the modified Rankin Scale (mRS) and 68.0% had returned to work. However, at follow-up, 27.2% of patients showed cognitive impairment and 27.6% suffered from fatigue. Anxiety and depression were reported by 38.0% and 18.5%, respectively. Even among patients with excellent functional outcome (mRS 0–1), 24.6% showed cognitive problems, 37.7% suffered from anxiety, 22.1% from fatigue, and 12.4% from depression. Female patients had higher rates of anxiety (52.1% vs. 26.7%), fatigue (37.0% vs. 20.0%), and depression (27.4% vs. 11.2%), compared to male patients.In linear regression, female sex was associated with a higher likelihood for anxiety (odds ratio (OR = 2.89, 95% confidence interval (CI) = 0.62-5.16), fatigue (OR = 3.23, CI = 1.52-4.93), and depression (OR = 2.86, CI = 1.12-4.59). Hypertension at follow-up (52.1%) was associated with worse functional outcome (OR = 3.03, CI = 1.32-6.95), while patients smoking at follow-up (20.2%) had higher rates of anxiety (OR = 4.09, CI = 1.21-6.97) and depression (OR = 3.40, CI = 0.87-5.21). Conclusions: Despite excellent functional outcome, many young stroke patients experience neuropsychological impairment, highlighting the need for targeted screening and treatment. Particularly young women are at higher risk for post-stroke depression, anxiety, and fatigue. Hypertension and smoking were modifiable risk factors contributing to worse outcomes in this young stroke cohort.