Stroke survivors with high levels of optimism had lower inflammation levels, reduced stroke severity and less physical disability after three months, compared to those who are less optimistic, according to preliminary research presented at the Nursing Symposium of the American Stroke Association International Stroke Conference 2020 in Los Angeles.
In a small study of 49 stroke survivors, researchers examined the relationship among optimism, inflammation, stroke severity and physical disability for three months after a stroke. Researchers said that understanding how these elements relate to or impact one another may provide a scientific framework to develop new strategies for stroke recovery.
"Our results suggest that optimistic people have a better disease outcome, thus boosting morale may be an ideal way to improve mental health and recovery after a stroke," said Dr Yun-Ju Lai, the study's first author and a postdoctoral fellow in the neurology department at The University of Texas Health Science Centre at Houston.
Post-stroke inflammation is detrimental to the brain and impairs recovery. Optimism has been associated with lower inflammation levels and improved health outcomes among people with medical conditions, however, no prior studies assessed if this association exists among stroke patients.
This pilot study is a secondary analysis of data collected from a repository of neurological diseases. Outcomes included optimism levels from the revised Life Orientation Test, a standard psychological tool for measuring optimism; stroke severity evaluation through the National Institutes of Health Stroke Scale, and levels of inflammatory markers – interleukin-6 (IL-6), tumour necrosis factor alpha (TNF) and C-reactive protein (CRP).
As optimism levels increased, stroke severity and the inflammatory markers IL-6 and CRP decreased even after considering other possible variables. However, this was not true of TNF. "Patients and their families should know the importance of a positive environment that could benefit the patient," Lai said. "Mental health does affect recovery after a stroke."
Abstract
Introduction: Post-stroke inflammation is detrimental to the brain and leads to impaired recovery. Optimism has been associated with lower inflammation and better health outcomes among people with medical conditions, but no studies have assessed this association in stroke population. The overall goals were to examine the relationship between optimism, stroke severity, physical disability, and inflammation during hospitalization and to evaluate this relationship over the three-month post-stroke period.
Hypothesis: Patients with higher levels of optimism have lower stroke severity on presentation, less physical disability, decreased inflammation, and better recovery during the first three months after stroke compared to those with lower levels of optimism.
Methods: This pilot study is a secondary analysis of data prospectively collected from the BioRepository of Neurological Diseases biobank. Outcomes included optimism level measured by the revised Life Orientation Test (LOT-R), stroke severity evaluated via the NIHSS, physical recovery defined by the mRS, and levels of inflammatory markers (IL-6, TNFα, and CRP) assessed by ELISA. Spearman’s correlation, Wilcoxon signed-rank test, multiple linear regression, and mixed-effect regression model were used to determine the relationship among the variables.
Results: The sample consisted of 49 subjects at baseline and 13 subjects at 3-month follow-up. LOT-R scores were negatively correlated with NIHSS (ρ= -.41, p=.003), mRS (ρ= -.30, p=.05), and inflammatory markers IL-6 (ρ= -.44, p=.008) and CRP (ρ= -.40, p=.02), but not with TNFα. After adjusting for potential confounders, NIHSS and CRP remained negatively correlated with the optimism level. For every unit increase of LOT-R, subject’s NIHSS scores decreased by .27 point (p=.001), mRS decreased by .11 point (p=.03), and level of CRP decreased 148.6 ng/ml (p=.02). However, LOT-R was not correlated with mRS the three-month follow-up.
Conclusion: Optimistic stroke survivors showed lower inflammation, less stroke severity, and less physical disability. Although the number of patients was low in this initial cohort, understanding this relationship may provide a scientific framework whereby new strategies for stroke recovery can be developed.
Authors
Yun-Ju Lai, Diego Morales-Scheihing, Frank W Blixt, Yashasvee Munshi, Brina V Bui, Louise D McCullough
[link url="https://www.sciencedaily.com/releases/2020/02/200212084408.htm"]American Heart Association material[/link]
[link url="https://www.ahajournals.org/doi/10.1161/str.51.suppl_1.WP466"]Stroke abstract[/link]