Optimism in older adults improves functional recovery after stroke

CHICAGO — For older adults who experience first-time stroke, approaching recovery with optimism improves functional recovery, according to a poster at the American Neurological Association annual meeting.

“We don’t have a great idea of why patients recover or don’t recover,” Kelly L. Sloane, MD, assistant professor of neurology, physical medicine and rehabilitation at the University of Pennsylvania Perelman School of Medicine, said. “In cardiovascular literature, they describe that optimism and lack of depression are associated with better outcomes after myocardial infarction, so we are trying to address that question of psychological health and recovery after stroke.”

Sloane and colleagues sought to evaluate the associations of optimism and depression with functional recovery in stroke survivors.

The longitudinal cohort study utilized data from the 2005-’06 Stroke Recovery in Underserved Populations study, which included 879 participants aged 50 years or older with first-time stroke who were admitted to an inpatient medical rehabilitation facility.

Optimism was assessed by response to a simple question about the prospect of recovery, while depression was defined by a score of greater than 16 on the Center for Epidemiologic Studies Depression scale. Participants were split into four categories based on their responses: optimistic with depression, optimistic without depression, pessimistic with depression and pessimistic without depression.

Functional Independence Measure (FIM) scores were used to reassess stroke outcomes at the time of discharge from hospital, 3 months after stroke and 1 year after stroke. Data analysis included linear mixed models with random intercepts and slopes, with the model adjusted for age, sex, race, education, length of rehabilitation stay, number of medical comorbidities, stroke symptoms and medical complications.

Results showed that stroke survivors in all four categories improved FIM scores in the first year following stroke, and that those who were optimistic began their recovery at a higher level of function at post-stroke baseline. Participants in the optimistic/without depression group had the highest level of recovery in the 3 months after stroke, then experienced minimal recovery in the following 9 months, while those in the pessimistic/with depression group displayed slow but stable rates of recovery at both 3-month and 1-year timepoints.

Data also revealed that pessimism combined with depression was associated with worse functional outcome 1 year following stroke, and that depression in the post-stroke period was linked to inhibited neuroplasticity.

“We believe that this patient population is potentially a vulnerable population for poor recovery after stroke,” Sloane said. “There may be interventions that can target this population like cognitive behavioral therapy or antidepressants that can help them navigate recovery.”