Working status is related to post stroke/TIA cognitive decline: data from the TABASCO study

Hen Hallevi, Jeremy Molad, Efrat Kliper, Estelle Seyman, Dana Niry, Natan M. Bornstein, Einor Ben Assayag*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Background and Aims: Occupational 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. Methods: We 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. Results: Ninty 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. Conclusions: Pre-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.

Original languageEnglish
Article number105019
JournalJournal of Stroke and Cerebrovascular Diseases
Volume29
Issue number9
DOIs
StatePublished - Sep 2020

Funding

FundersFunder number
U.S. - Israel Bi-national Science FoundationAARG-16-442861
U.S.-Israel Bi-national Science Foundation
Alzheimer's Association
American Federation for Aging Research

    Keywords

    • Brain atrophy
    • Occupational status
    • Post-stroke retirement
    • Work type

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