Published Online
on August 2, 2007

A more recent version of this article appeared on September 1, 2007

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Submitted on November 20, 2006
Revised on January 2, 2007
Accepted on January 8, 2007

Stroke Symptoms in Individuals Reporting No Prior Stroke or Transient Ischemic Attack Are Associated With a Decrease in Indices of Mental and Physical Functioning

George Howard DrPH^*; Monika M. Safford MD; James F. Meschia MD; Claudia S. Moy PhD; Virginia J. Howard MSPH; LeaVonne Pulley PhD; Camilo R. Gomez MD; and Martha Crowther PhD

From the Department of Biostatistics (G.H.), School of Public Health, University of Alabama at Birmingham, Birmingham, Ala; the Deep South Center on Effectiveness at the Birmingham VA Medical Center and the Division of Preventive Medicine (M.M.S.), University of Alabama at Birmingham, Birmingham, Ala; the Mayo Clinic (J.F.M.), Jacksonville, Fla; the National Institute of Neurological Disorders and Stroke, National Institutes of Health (C.S.M.), Bethesda, Md; the Department of Epidemiology (V.J.H., L.P.), School of Public Health, University of Alabama at Birmingham, Birmingham, Ala; the Department of Health Behavior (L.P.), University of Arkansas Health Science University, Little Rock, Ark; the Alabama Neurological Institute (C.R.G.), Birmingham, Ala; and the Department of Health Behavior (M.C.), School of Public Health, University of Alabama at Birmingham, Birmingham, Ala.

^* To whom correspondence should be addressed. E-mail: ghoward{at}uab.edu.

Background and Purpose—Stroke symptoms in the absence of recognized stroke are common, but potential associated dysfunctions have not been described.

Methods—We assessed quality-of-life measures using the Physical and Mental Component Summary scores of the Short Form 12 (PCS-12 and MCS-12) in the REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort. Differences in mean PCS-12 and MCS-12 scores were assessed among participant groups symptoms-free (n=16 090); history of stroke symptoms but free of stroke/transient ischemic attack (n=3404); history of stroke (n=1491); and history of transient ischemic attack (n=818).

Results—Participants with symptoms (but no diagnosis) had average PCS-12 scores 5.5 (95% CI: 5.2 to 5.9) points lower than those without symptoms, a difference similar to transient ischemic attack (6.0; 95% CI: 5.3 to 6.7) and over one half the effect of stroke (8.4; 95% CI: 8.0 to 9.0). MCS-12 scores were 2.7 (95% CI: 2.4 to 3.0) points lower for those with symptoms, -0.5 for transient ischemic attack (95% CI: 0.0 to -1.1), and -1.6 for stroke (95% CI: -1.2 to -2.0). Differences in demographic and vascular risk factors, health behaviors, physiological measures, and indices of socioeconomic status did not fully explain these differences. Those reporting history of weakness or numbness had larger current decrements in physical functioning, and those reporting history of inability to express themselves or understand language had larger current decrements in mental functioning.

Conclusions—Individuals with clinically consistent symptoms but no stroke diagnosis have a lower quality of life than those without symptoms. The difference in physical functioning is substantial with a smaller decline in mental functioning. Apart from so-called "silent stroke," there appear to be many individuals with possibly symptomatic cerebrovascular disease—either stroke or transient ischemic attack—who are not being diagnosed. Furthermore, these symptomatic but undiagnosed strokes may not be benign.

Key words: cerebrovascular disorders • cohort studies • health-related quality of life

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