Young Adults with Stroke: A Scoping Review of Epidemiology, Sequelae and Rehabilitation Needs Restricted; Files Only

Joseph, Justin (Spring 2023)

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Background: Worldwide 80 million individuals have experienced a stroke in their lifetime, and 10% of affecting young adults.1, 2 Incidence levels of stroke in young adults continues to rise; 36% in person aged 35-44 and 27% persons aged 18-34 between the years of 2003 and 2012.3, 4 Observable racial and ethnic disparities in outcomes within YAS (Young Adult Stroke) population.1, 3-6 The objective of this scoping review is to synthetize the literature and summarize the epidemiological factors, clinical characteristics, and utilization of post-acute care services among YAS.  

Methods: Peer-reviewed manuscripts from PubMed, PsycINFO, Web of Science, EMBASE and CINAHL with search terms “young,” “stroke” and “cerebrovascular accident” were retrieved. Studies between 2003-2021 and including individuals with stroke between ages of 18-65 were included. To adhere to PRISMA guidelines, two reviewers independently screened each abstract and full-text article. The search yielded 11,858 articles, 5,097 were excluded as duplicates, 3,491 articles were excluded during title and abstract screening leaving 2,347 articles to be considered in the full-text review. A total of 187 articles were included following full text review. 

Results: The review included a total of 1,093,366 YAS, ranging in age from 18 to 65 years. The mean age of YAS was 37 years (n=127 studies). The definition of young adults varied across studies, with 43% studies defining young adults as18 to 50 years old, 26% studies using a range 18-45 years old, and 12% studies defining young adults as 30-65 years old. The mean National Institutes of Health Stroke Scale (NIHSS) score was 6.6 (n=12 studies). The average mortality rate among YAS was 1.4% (n=19). The mean length of stay was 10 days (n=7). Minimal reporting of stroke incidence across racial groups found YAS were 61% white, 23% Black, 10% Hispanic, 5% other, 1% Asian/Pacific Islander, and less than 1% Native (n=14). Risk factors unique to YAS reported oral contraceptives (n=4), hyperhomocysteinaemia (n=4) and patent foramen ovale (n=6). Post stroke sequelae among YAS included impairments with motor, cognition (12%; n=21), anxiety (40%; n=7), and depression (40%; n=14). Functional outcomes were reported using a modified Rankin Score (mRS), where 58% of YAS had a mRS 0-2 and 42% had a mRS >2 (n=21). Unaddressed psychosocial needs led to feelings of fear and isolation. Lastly, post-acute care discharge disposition and return to work were reported with 56% of YAS discharged home and 63% of YAS returned to full-time work (n=19). 

Conclusions: Unique risk factors, increasing incidence and prevalence, racial disparities, unknown etiologies, lack of understanding of fiscal impact, and outcomes are all factors contributing to the importance of understanding YAS. Future studies including YAS, describing their demographics and clinical make up adequately (racial/ethnic background, age stratification, etiology, unique risk factors), and develop and test interventions and services focused for YAS based on their unique needs and risk factors.  

Table of Contents

Table of Contents:

Motivation: 1

Introduction: 3

Methods: 6

Design: 6

Search Strategy: 6

Screening: 7

Data Extraction: 8

Variables: 8

Results: 10

Studies Summary: 10

Demographics: 10

Incidence: 11

Risk Factors: 12

Post-Acute Care Outcomes: 12

Discussion: 13

Conclusion: 15

Tables and Figures: 16

Bibliography: 37

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