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Common nonmotor outcomes after a stroke include sleep disturbance, sexual and bladder dysfunction, constipation, lower social participation, and fatigue.

Sleep disturbance, sexual dysfunction, constipation, and reduced participation in social activities were reported by more than half of patients who had a stroke, according to results from a systematic review and meta-analysis published in JAMA Network Open.

The investigation, which spanned 279 prospective cohort studies and included a total of 117,440 patients, focused on adverse nonmotor outcomes reported by patients 30 days through 10 years after experiencing a stroke. Some 57.3% of the studies included only patients with ischemic stroke, 40.5% included mixed cohorts, and 2.2% focused on intracerebral hemorrhage.

“In this systematic review and meta-analysis, poststroke nonmotor outcomes were highly prevalent,” David J. Werring, PhD, and colleagues wrote.

Study Population & Prevalent Nonmotor Outcomes

With a respective pooled prevalence of 59.9% and 59.8%, the most prevalent adverse nonmotor outcomes after stroke were sleep disturbance and sexual dysfunction, according to the analysis. Other prevalent outcomes were constipation (pooled prevalence, 58.2%), decreased social participation (56.5%), bladder dysfunction (45.9%), and fatigue (45.2%).

The least prevalent nonmotor outcomes were fecal incontinence (7.0%), depression (25.8%), anxiety (26.9%), and pain (28.6%).

Only two domains—pain and sexual dysfunction—showed statistically significant improvement over 10 years of follow-up in meta-regression analysis.

“We found no statistically significant reduction in adverse prevalence for the other 8 nonmotor outcome domains, including those that were most prevalent, such as sleep, constipation, social participation, and fatigue,” the researchers wrote.

Factors Associated With Nonmotor Outcomes

The most common factor associated with adverse nonmotor outcomes was a mixed stroke cohort (ischemic stroke) and intracerebral hemorrhage). Compared with studies that included only ischemic stroke cohorts, those with mixed cohorts reported higher odds of constipation (researchers reported a 3.51 odds ratio [OR]), reduced social participation (2.69 OR), anxiety (2.06 OR), fatigue (1.53 OR), sexual dysfunction (1.51 OR), and pain (1.07 OR).

Other factors associated with a higher prevalence of adverse nonmotor outcomes were female sex, being older than 55 years, and hospital-based study design.

“The persisting high prevalence of most domains suggest[s] a major unmet health care need; strategies to detect, prevent, and treat poststroke nonmotor outcomes are urgently needed across the stroke care pathway, from hospital to community care settings,” Dr. Werring and colleagues wrote.