Functional recoveries of patients with branch atheromatous disease after rehabilitation: Comparison with other types of cerebral infarction and importance of stratification by clinical categories

Article type: Research Article

Authors: Okuda, Yoshinobu^{a; *} | Aoike, Futoshi^a | Matsuzaki, Jo^b | Shiraishi, Shoichi^b | Sugiyama, Shintaro^b | Yoshida, Tomoko^b | Kitamura, Emi^b | Nishida, Fukuko^b | Tanaka, Natsuki^b | Sugiyama, Yasuko^b | Enami, Tomomi^b | Yanagihara, Takehiko^b

Affiliations: [a] Tane Neuro-Rehabilitation Hospital, Osaka, Japan | [b] Department of Neurology, Tane General Hospital, Osaka, Japan

Correspondence: [*] Corresponding author: Yoshinobu Okuda, Tane Neuro-Rehabilitation Hospital, 1-1-45 Minami-ichioka, Minato-ku, Osaka, 552-0011 Japan. Tel.: +81 6 6585 2743; Fax: +81 6 6585 2048; E-mail: y.okuda@tane.or.jp.

Abstract: Background:Functional recoveries after rehabilitation of patients with branch atheromatous disease (BAD) have not been well investigated, however, clinical category of cerebral infarction including BAD itself could be a potential predictive factor for functional outcome. Objective:To describe characteristics of functional recoveries of patients with BAD through comparison with other types of cerebral infarction. Methods:We retrospectively compared outcomes of patients with BAD (N = 222), cardioembolic cerebral infarction (CE: N = 177) and atherothrombotic cerebral infarction (AT: N = 219) by using functional independence measure (FIM) and FIM effectiveness (the proportion of potential for improvement achieved). Results:Univariate analysis showed that FIM on discharge was comparable among three types of cerebral infarction, but that FIM effectiveness in patients with BAD was significantly higher than those with CE or AT. Stratified analysis revealed higher FIM effectiveness in patients with BAD compared to patients with CE or AT, if they were male, younger (≤72 years) or had supratentorial brain lesions. Multiple regression analysis demonstrated that location of the brain lesion (supratentorial vs infratentorial) and gender (male vs female) were significantly associated with FIM on discharge, and that cognitive function on admission as well as gender were significantly associated with FIM effectiveness in patients with BAD, but not in patients with CE or AT. Conclusions:Outcomes after rehabilitation of patients with BAD may be characterized by better functional improvement, especially if patients are male, relatively younger or with supratentorial lesions. The impact and the type of factors related to functional recoveries of patients with BAD may be different from other types of stroke. The present study suggested that clinical category of stroke should be taken into consideration in prediction of outcomes and planning of rehabilitation management.

Keywords: Branch atheromatous disease, cerebral infarction, functional recovery, rehabilitation, predictive factors, stroke

DOI: 10.3233/RNN-211163

Journal: Restorative Neurology and Neuroscience, vol. 39, no. 2, pp. 139-147, 2021