Long-term outcome of young patients after ischaemic stroke or transient ischaemic attack: Insights from a multicentre study

Int J Stroke. 2025 Jul 9:17474930251359422. doi: 10.1177/17474930251359422. Online ahead of print.

ABSTRACT

BACKGROUND: The long-term non-motor outcome of young adults with ischaemic stroke (IS) or transient ischaemic 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 centres. 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%); 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 outcome in this young stroke cohort.

PMID:40631738 | DOI:10.1177/17474930251359422