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Pioneering Rehabilitation

Burke Medical Research Institute Scientists Report Post-Stroke Apathy and Hypersomnia Lead to Worse Outcomes in Medical Journal

Published October 31, 2013

New findings from a retrospective study conducted at Burke Rehabilitation Center has found that post-stroke apathy and hypersomnia negatively affected patients’ acute rehabilitation outcomes. This is the first U.S. study that has focused on apathy and hypersomnia as contributors to post-stroke recovery.

“People don’t typically look at apathy and hypersomnia as factors affecting outcomes, despite 35 percent of post-stroke patients being diagnosed with apathy” said Andrew Goldfine, M.D., assistant professor of neurology at Burke Medical Research Institute (BMRI) and attending neurologist at Burke Rehabilitation Hospital. “Rather than addressing apathy, patients are often diagnosed as depressed and treated with anti-depressants. However, previous studies have found that these drugs don’t help.”

Dr. Goldfine, also an assistant professor of neurology at Weill Cornell Medical College, along with collaborators Jessica Elder, Ph.D., instructor of biostatistics and epidemiology at BMRI and Cornell; Nicholas D. Schiff, M.D., professor of neurology and neuroscience at Cornell; Jonathan D. Victor, M.D., Ph.D., professor of neurology at Cornell; and Ari L. Harris, M.D., neurology resident at Alpert Medical School, published their findings in the October issue of Translational Stroke Research.

Dr. Goldfine and his team retrospectively studied 213 stroke patients who were admitted to the stroke-specialized unit at Burke Rehabilitation Hospital who had no dementia or dependence on others pre-stroke. The team reviewed the standardized documentation provided by Burke treating therapists to diagnose apathy (lack of initiation) and hypersomnia (low arousal) in patients and how those factors influenced rehabilitation.

The team found that 21 percent of patients had persistent apathy and 5.6 percent had persistent hypersomnia. Taking account the patients’ overall impairment, age, time since stroke and stroke type, they found that patients at all stroke severities who had either apathy or hypersomnia exhibited less cognition and attention span. At discharge, patients with apathy were 2.4 times more likely to go to a nursing home and scored 12 points lower on Burke’s overall impairment measure (FIM) than those without apathy or hypersomnia. Patients with hypersomnia were 10 times more likely to go to a nursing home and scored 16 points lower on the FIM.

“This study confirms that there is a problem and we need further research to learn more about these conditions so that we can find treatments for them,” Dr. Goldfine noted.

Dr. Goldfine and his team are following up this retrospective review with a prospective study using formal research scales and serial measurements of impairment and participation. If the new study confirms what the retrospectively study has found, further studies would then focus on targeted treatments for apathy and hypersomnia.

“Adequate treatment at an early stage could potentially improve the patients’ response rate and give them better outcomes,” Dr. Goldfine added.