Factors affecting the quality of life after ischemic stroke: young versus old patients.
Factors affecting the quality of life after ischemic stroke: young versus old patients.
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DOI：
10.3988/jcn.2005.1.1.59
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发表时间：
2005-04
期刊：
影响因子：
--
通讯作者：
Seo YS
中科院分区：
文献类型：
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作者：
Kim JS;Choi-Kwon S;Kwon SU;Lee HJ;Park KA;Seo YS
影响青年和老年脑卒中患者生活质量的因素可能不同。然而，这些问题尚未得到适当调查。我们确定了170名在牙山医疗中心住院的中风患者（发病年龄在15至45岁之间）。选择340例随访期匹配的老年脑卒中患者（发病年龄>45岁）作为对照组。对96例青年脑卒中患者和160例老年脑卒中患者在发病后1~5年进行随访。使用标准化问卷，我们评估了身体残疾，日常生活能力（Barthel指数评分，改良兰金量表），抑郁症的存在（使用DSM IV标准和贝克抑郁量表）和社会经济/工作状况。采用威廉姆斯等制定的卒中特异性生活质量量表进行生活质量评价。单因素分析显示，青年患者的失业、运动障碍、失语、构音障碍、吞咽障碍和严重的改良兰金评分与生活质量低有关，而经济状况差、失业、幕上（与幕下）卒中，前部（与后）循环卒中、存在糖尿病、运动障碍、失语症、构音障碍、吞咽困难、视野缺损、重度改良兰金评分，脑卒中后癫痫发作和抑郁的发生与老年患者生活质量低下有关。吸烟（老年患者）和饮酒（青年和老年患者）与高生活质量有关。多元回归分析显示，改良兰金评分是两组患者生活质量低下的最重要因素，其他重要因素包括老年患者的抑郁、视野缺损和前循环卒中，青年患者的运动功能障碍和构音障碍。除改良兰金量表外，影响生活质量的因素在两组间存在差异。认识到这些差异可能使我们能够制定不同的策略来改善中风患者的生活质量。
Factors affecting the quality of life (QOL) may be different between young and old stroke patients. However, these issues have not yet been properly investigated. We identified 170 young-onset stroke patients (onset between 15 and 45 years of age) who were admitted to the Asan Medical Center. Three hundred and forty follow-up period matched, old-onset stroke patients (onset >45 years of age) were chosen as a control group. A follow-up interview was performed 1~5 years after the onset of stroke in 96 young patients and 160 old patients. With the use of standardized questionnaire, we assessed physical disabilities, activity of daily living (Barthel Index Score, modified Rankin scale), the presence of depression (using DSM IV criteria and Beck Depression Inventory) and socio-economic/job status. The QOL was assessed using the Stroke Specific QOL developed by Williams et al. The QOL scores were significantly higher in young patients than in old ones. Univariate analysis showed that factors related to low QOL included unemployment, motor impairment, aphasia, dysarthria, dysaphagia and severe modified Rankin score in young patients while poor economic status, unemployment, supratentorial (vs. infratentorial) stroke, anterior (vs. posterior) circulation stroke, the presence of diabetes mellitus, motor impairment, aphasia, dysarthria, dysphagia, visual field defect, severe modified Rankin score, the presence of post-stroke seizures and depression were related to the low QOL in old patients. Cigarette smoking (in old patients) and alcohol drinking (in both young and old patients) were related to high QOL. Multiple regression analysis showed that modified Rankin score was the most important factor explaining low QOL in both groups, while other important factors included depression, visual field defect and anterior circulation stroke in old patients, and the motor dysfunction and dysarthria in young patients. We conclude that aside from modified Rankin scale, factors affecting the quality of life are different between these two groups. Recognition of these differences may allow us to develop different strategies to improve the quality of life in stroke patients.