Stress an important factor in stroke recovery, study shows

Both past trauma and acute stress right after a stroke can affect long-term outcomes.
A woman shows signs of stress.

Stroke is a leading cause of disability. Some people recover well after a stroke, and some do not. As a result, it’s crucial to understand the things that affect how well people bounce back after a stroke. Yet, until now, surprisingly little research has been done on the link between stroke recovery and certain types of stress.

A study published in the journal Stroke in November 2023 sheds new light on this subject. It looked at two specific kinds of stress:

  • Lifetime stress: Very stressful or traumatic events that people experienced in the past
  • Poststroke acute stress: The sudden stress that people experience immediately after being diagnosed with a new stroke

“We found that higher lifetime stress predicted more poststroke acute stress. And this acute stress was a major player in stroke outcomes, even a year later,” says Steven Cramer, MD, a UCLA stroke neurologist and coauthor of the study.

Dr. Cramer is a nationally recognized expert on recovery after stroke. He was the recipient of the 2023 Outstanding Neurorehabilitation Clinician-Scientist Award from the American Society of Neurorehabilitation.

What the study revealed

The new Stroke paper was based on data from the STRONG study, led by Dr. Cramer and UC Irvine researcher Alison Holman, PhD. The study included 763 patients from 28 stroke centers across the U.S. These patients took part in assessments at multiple time points, including:

  • Within a few days after a stroke diagnosis
  • Three months after the stroke
  • Twelve months after the stroke

The researchers found that having a history of trauma going as far back as childhood was tied to greater stress immediately after a stroke.

“People who have experienced a major life stressor may develop a different internal model for how they think about themselves and the world,” Dr. Cramer says. “If they have a stroke, they may tell themselves, ‘I can’t handle this.’ Or they may worry nonstop.”

In turn, being very stressed right after a stroke was tied to more impairment in movement and thinking skills at the three-month and 12-month assessments. Part of the reason may be that people who feel swamped by stress are unable to focus on their stroke recovery. They may turn down rehab therapy or plunge into depression.

Less stress, better outcomes

Although this was a large study, further research is needed to confirm the findings. But these results could have implications for how stroke is treated.

“Our findings indicate that it is important to measure stress consistently and treat it early in patients with a new stroke,” Dr. Cramer says. Treatment options may include talk therapy, drug therapy or a combination of the two.

Dr. Cramer adds, “Measuring lifetime stress and acute stress at the time of stroke admission and initiating an appropriate treatment plan could profoundly change the trajectory of recovery after patients leave the hospital.”

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