Prospective analysis of long-term trajectories of functional scores before and after a diagnosis of stroke

Limited data exist on long-term trajectories of functional scores before and after stroke diagnosis. We analyzed 1325, 754, 3907, and 2902 incident strokes from China Health and Retirement Longitudinal Study (CHARLS), English Longitudinal Study of Ageing (ELSA), Health and Retirement Study (HRS), and Survey of Health, Ageing and Retirement in Europe (SHARE), respectively. Two non-stroke participants were matched to each stroke case by age and gender. Linear mixed models estimated trajectories of functional scores over time in individuals with and without stroke. Here we show that individuals with stroke have fewer memory but more depressive symptoms than those without stroke in most years from stroke onset with the largest difference several years after stroke onset. A steeper decline in memory is found among stroke patients for several years before and after stroke onset (adjusted β (95% CI) for annual change in CHARLS: −0.062 (−0.074, −0.049), ELSA: −0.024 (−0.03, −0.018), HRS: −0.026 (−0.03, −0.023)). Stroke participants have greater limitations in activities of daily living (ADL) than non-stroke participants, starting several years before stroke onset, with the difference increasing for five years after stroke onset. After that, the difference remains stable or decreases. Similar results are seen in instrumental ADL and the frailty index. Women have greater increases in CESD, mobility limitations, and frailty index compared with men. Our analysis of data from multiple countries identifies the period when related functional scores show the greatest change, highlighting a critical window for stroke prevention and management. Stroke is a leading cause of disability, often affecting a person’s memory, daily independence, mood, and overall health. Using long-term health data from over 8000 stroke survivors and matched controls in China, the UK, Europe, and the US, we tracked changes in memory, daily activities, depression, and frailty. We found that people who had a stroke experienced faster declines in memory and more rapid increases in depression and difficulties with daily tasks, both before and after their diagnosis, compared to those without stroke. The most significant changes occurred in the few years immediately surrounding the stroke event. These results identify a critical window—spanning the years just before and after a stroke—when function declines most rapidly. This highlights the opportunity for targeted prevention and rehabilitation strategies to improve long-term outcomes for stroke survivors. Shang et al. examine long-term changes in memory, daily activities, depression, and frailty in stroke survivors and matched controls in China, the UK, Europe, and the US. Stroke patients have faster declines in memory and more rapid increases in depression and difficulties with daily tasks, before and after diagnosis, compared to controls.