Pre-stroke activities of daily living do not predict functional decline after stroke in a cohort of community dwelling older subjects at risk for vascular disease

Background & purpose: Pre-stroke impairment of activities of daily living (ADL) is considered a major determinant for functional outcome after stroke. However, findings are based on studies in stroke patients in which pre-stroke information is gathered retrospectively, with inherent risks of selection and recall bias. The objective of this study was to verify the predictive value of pre-stroke ADL with respect to ADL decline in a large prospective cohort of community dwelling older subjects with known vascular risk factors or vascular disease, thereby minimizing selection and recall bias. Methods: Within the four-year study follow-up of a cohort including 5,804 community dwelling older subjects from three countries at risk for vascular disease, incident stroke survivors were identified. Incident myocardial infarction (MI) survivors and the remaining study survivors without incident vascular events served as comparison groups. Multivariate logistic regression analyses for each of the aforementioned groups were performed to assess associations between pre-stroke ADL by the Barthel Index (BI) and Instrumental Activities of Daily Living (IADL) scale and risk for ADL decline. Results: In stroke survivors, neither pre-event BI (n = 230, OR 1.00 (95% CI 0.83–1.23)) nor IADL (OR 1.07 (95% CI 0.94 – 1.20)) predicted risk of post-stroke ADL decline in contrast to ADL decline after MI (n = 443, OR 0.83 (95% CI 0.70–0.98) and 0.87 (95% CI 0.78–0.97) respectively) and the group without vascular events (n = 4336, OR 0.85 (95% CI 0.78–0.92) and 0.87 (95% CI 0.83–0.92) respectively). Conclusions: In the present prospective cohort of community dwelling older subjects with known vascular risk factors, pre-stroke ADL measured by BI and IADL scale did not predict post-stroke ADL decline.