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Working before and after a stroke improves recovery rates

Adult stroke patients who are employed prior to and after suffering strokes are more likely than unemployed adults to have healthier minds two years post stroke, according to preliminary research presented at the American Stroke Association's International Stroke Conference 2018, a world premier meeting dedicated to the science and treatment of cerebrovascular disease for researchers and clinicians.

"Studies have shown stroke greatly increases dementia risk, and occupational status might influence how stroke survivors fare years after having a stroke," said study author Dr Einor Ben Assayag, senior researcher in the neurology department at Tel-Aviv Sorasky Medical Centre, Tel-Aviv, Israel. "We looked at how occupational status, brain health and cognitive decline might be interrelated after stroke."

Ben Assayag and colleagues studied 252 working-age adult stroke survivors from the TABASCO study. They analysed brain health early on after stroke, as well as cognitive changes, at one year and two years after stroke. "A novel aspect of this study was we also studied the association of inflammation with occupational status and cognitive changes after stroke," she said.

They found:
People who were unemployed before stroke were more than three times (320%) more likely than those who were employed to develop cognitive decline within two years from the initial stroke.
In addition to having lower cognitive results post-stroke, those who were unemployed before stroke were more likely to have worse neurological deficit, higher depression scores and more elevated inflammation.
Adults who weren't working before having a stroke were more likely to have unhealthy brain changes defined as reduced cortical thickness and white matter volume on imaging studies.
Those who were unemployed prior to stroke were more likely to have type 2 diabetes and high blood pressure.
During the two years of the study, 4.4 percent of participants died and 8.9% developed cognitive decline.
Returning to work after stroke was associated with lower cognitive decline risk.

"The message here is 'keep on working,'" Ben Assayag said. "Rates of death and cognitive decline were higher among the unemployed people we studied. In fact, being unemployed was by itself a risk factor for cognitive decline and death."

A limitation of the study is that it included only mild stroke or transient ischemic attack (TIA) patients, and not people with more severe strokes.

Abstract
Background: Stroke considerably increases the risk of dementia, while occupational status may influence physically and mentally long-term outcome after the event. We aimed to evaluate the interrelationship between occupational status, brain pathology on imaging and cognitive decline in a longitudinal post-stroke cohort.
Methods: Data from 252 persons at working age (<65 years), with first-ever stroke from the TABASCO study was available. All patients underwent 3T MRI, inflammatory markers and cognitive assessment during the acute phase, 12 and 24 months thereafter.
Results: The working rate before stroke was 68.7%, and 60.4% 12 months later. Pre-stroke unemployment was associated with reduced cortical thickness and white matter volume, severity of the neurological deficit, poorer cognitive scores at 12 and 24 months, higher depression scores, and elevated inflammation (p=0.002, p=0.049, p=0.001, p=0.002, p<0.001, p=0.011, p<0.001, p=0.02, respectively). Unemployed subjects suffered also from higher prevalence of Type 2 diabetes mellitus (T2DM) and hypertension compared to employed subjects (p=0.016, p=0.006, respectively). During the follow-up, 4.4% of the participants died and 8.9% developed cognitive decline. Mortality and cognitive decline were higher among unemployed compared to employed participants (p<0.001, p=0.001, respectively). Multiple regression, controlling for age, sex, education, vascular risk factors, and ApoE4, revealed that T2DM, stroke severity and pre-stroke unemployment were independent predictors of this decline (OR=3.2, 5.2, 3.2, respectively); while gender and pre-stroke unemployment predicted mortality (OR=11.4,16.2, respectively). Return to work after the event was also associated with decreased prevalence of cognitive decline.
Conclusions: Pre-stroke unemployment was independently associated with brain atrophy, depression, higher mortality, and poorer performance in cognitive evaluation 2 years post-stroke. T2DM, stroke severity and pre-stroke unemployment were independent predictors of this decline, as well as early retirement after the stroke. These results emphasizing the advantage of employment versus early retirement in an attempt to reserve health and cognitive abilities.

Authors
Hen Hallevi, Jeremy Molad, Amos Korczyn, Efrat Kliper, Ludmila Shopin, Eitan Auriel, Shani Shenhar-Tsarfaty, Victoria Volfson, Natan M Bornstein, Einor Ben Assayag

[link url="https://www.sciencedaily.com/releases/2018/01/180125230401.htm"]American Heart Association material[/link]
[link url="http://stroke.ahajournals.org/content/49/Suppl_1/ATMP92"]Stroke journal abstract[/link]

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