Mental status and health-related quality of life in an elderly population 15 years after limited cerebral ischaemia

With the increased recognition that healthcare evaluations should incorporate patients’ perspectives, the focus of outcome in stroke research has shifted from mere survival and disability to the inclusion of patient-reported health rating scales. Especially in those patients surviving with no or minor sequelae from their original TIA or minor ischaemic stroke (MIS) outcome measures other than disability grades are particularly relevant. The International Classification of Functioning, Disability and Health (ICF) [ 1 ], published by the WHO in 2001 as a model for the description of the components of health, has been used widely as a theoretical framework for outcome research (Fig. 1 ). Although the ICF-frame work addresses many aspects of functioning and health it does not cover patients’ subjective feelings of physical, psychological and social well-being [ 2 ]. Another construct used for research is the WHO “biopsychosocial model” of health [ 3 ], in which health is defined as a state of complete physical, mental and social wellbeing, and not merely the absence of diseases and infirmity. This WHO definition of health is seen by many researchers as synonymous to “Health-Related Quality of life” (HR-QoL) [ 4 ]. Although physical disability and QoL are often related, there are exceptions. A study from New Zealand, for example, found that 6 years after stroke HR-QoL (as measured with the SF-36) was relatively good [ 5 ], whereas a Finnish study showed that stroke patients with little or no physical dysfunction can experience a compromised QoL [ 6 ]. Psychological factors appear to be as important as physical disability in determining QoL [ 7 ]. To date, no precise information is available about the long-term mental status of patients with a history of TIA or MIS, nor about the relation between these mental factors, the physical factors and the patients’ perception of their current health state.