Working status is related to post stroke/TIA cognitive decline: data from the TABASCO study |
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| Institution: | 2. Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel;3. Brain Center, Shaare Zedek Medical Center, Jerusalem, Israel;2. Department of Medical service, Affiliated Nanhua Hospital, University of South China, Hengyang 421001, Hunan Province, PR China;3. Graduate School of University of South China, Hengyang 421101, Hunan Province, PR China;2. China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China;3. The First Hospital of Qiqihar, Qiqihar, China;4. Affiliated Qiqihar Hospital, Southern Medical University, Qiqihar, China;5. Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China;2. Department of Vascular Neurosurgery, New Era Stroke Care and Research Institute, The PLA Rocket Force Characteristic Medical Center, Beijing 100088, PR China;3. Central Laboratory of Research Department, The PLA Rocket Force Characteristic Medical Center, Beijing 100088, PR china;2. Post-Graduate Program in Cardiology and Cardiovascular Sciences, Medical School, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil;3. Neurology Division, Hospital de Clínicas de Porto Alegre, Brazil;2. Gloucestershire Research Support Service, Gloucestershire Royal Hospital, UK;3. Neurology, Medical College of Georgia, Augusta University, USA;2. Department of Radiology and Research Institute of Clinical Medicine of Jeonbuk, National University-Biomedical Research Institute of Jeonbuk National University Hospital, 567 Baekje-daero, Deokjin-gu, Jeonju 561-756, Republic of Korea |
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| Abstract: | Background and AimsOccupational status may influence physical and mental post-stroke outcomes. We aimed to evaluate the association between occupational status and type, or engagement in social and family activities, neuroimaging measures and cognitive decline (CD) in a prospective cohort of stroke patients.MethodsWe included 273 first-ever stroke survivors at working age. All patients underwent 3T MRI at admission, as well as clinical and cognitive assessments at admission, 6, 12 and 24 months thereafter.ResultsNinty nine (36.3%) of the participants were unemployed prior to the stroke. Age, sex, work type, other comorbidities, stroke severity or location were not associated with return to work. Patients who returned to work (87.4%) had better cognitive results and less depressive symptoms than those who retired after the event.Pre-stroke unemployment was associated with diabetes mellitus, hypertension, dyslipidemia, depression, poorer cognitive scores and brain atrophy. During the follow-up, 11% developed CD. CD was more common among previously unemployed than employed participants (19.2% vs. 6.3%, p = 0.001). Multiple regression adjusted for risk factors, revealed that pre-stroke unemployment was an independent predictor of CD (HR, 3.0; 95% CI: 1.06–8.44). Furthermore, engagement in mentally stimulating jobs decreased the risk for CD.ConclusionsPre-stroke unemployment and post-stroke work disruption were each associated with depression and poorer cognitive performance up to two years post-stroke, as well as with brain atrophy at admission. Retirement after the stroke may increase the risk of developing CD. These results highlight the importance of continued employment in preserving cognitive abilities among stroke survivors. |
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