The association between abnormal communication and neuropsychiatric outcomes after hemorrhagic stroke
Nikhil Avadhani1, Kara Melmed1, Benjamin Brush1, Aaron Lord1, Kaitlin Hanley2, Jennifer Frontera1, Koto Ishida1, Jose Torres1, Leah Dickstein1, David Kahn1, Ting Zhou1, Ariane Lewis1
1Department of Neurology, 2Speech and Language Pathology, NYU Langone Medical Center
Objective:
The objective of this study was to identify neuropsychiatric outcomes associated with abnormal communication 3 months after hemorrhagic stroke.
Background:
Hemorrhagic stroke survivors can have neuropsychiatric dysfunction including deficits in communication ability. Understanding the relationship between abnormal communication and other neuropsychiatric outcomes can guide surveillance and interventions.
Design/Methods:
Patients with non-traumatic intracerebral or subarachnoid hemorrhage (ICH or SAH) admitted at an urban academic medical center between January 2015 and December 2024 were assessed by telephone 3 months post-discharge using the Quality of Life in Neurological Disorders (Neuro-QoL) short form inventories to assess communication, cognitive impairment, anxiety, depression, social participation and the Barthel Index. Univariate and multivariate analysis were used to evaluate the relationship between abnormal communication (Neuro-QoL t-score <100) and neuropsychiatric outcome in patients with 1) ICH or SAH and 2) ICH only.
Results:
Of 108 patients (68 ICH and 30 SAH), there were 59 (54.6%) with abnormal communication, 52 (49.1%) with cognitive impairment, 46 (44.2%) with anxiety, 30 (28.8%) with depression, and 62 (59.6%) with abnormal social participation 3-months post-bleed and the median Barthel Index was 100 (IQR 80-100). On univariate analysis of the full cohort, poor communication was associated with (p<0.05): cognitive impairment, anxiety, depression, abnormal social participation, and Barthel Index. On multivariate analysis, poor communication was only associated with cognitive impairment [OR 25.2 (7.02 – 113), p<0.001]. On univariate analysis of the ICH cohort, poor communication was associated with: cognitive impairment, anxiety, abnormal social participation, and Barthel Index. On multivariate analysis, poor communication was only associated with cognitive impairment [OR 9.63 (2.32 – 47.3), p=0.003].
Conclusions:
Abnormal communication after hemorrhagic stroke is associated with cognitive impairment, even after controlling for other neuropsychiatric outcomes. Speech and language therapy is advisable in patients with cognitive impairment after hemorrhagic stroke. Additional investigation into the relationship between communication and cognitive impairment is needed.
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