Auswirkungen eines nicht-medikamentösen Gewichtsreduktionsprogramms bei Schlaganfallpatienten auf Post-Stroke Depression, Lebensqualität und Demenz
Schlaganfälle stellen, nicht nur aufgrund der primären Mortalität und Morbidität, sondern auch durch sekundäre Krankheitsfolgen wie Depression, reduzierte Lebensqualität und kognitive Defizite ein gesellschaftliches und gesundheitsökonomisches Problem dar. Die Pflegebedürftigkeit und Abhängigkeit na...
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Table of Contents: Stroke and its consequences pose a relevant social and health economical problem to our society. This is not only due to its primary mortality and morbidity but to a relevant degree also to secondary effects like the development of post-stroke depression, reduced health-related quality of life and post-stroke cognitive deficit. The need for care and dependence after suffering a stroke is often high. Developing further stroke specific diseases and impairment can hinder the patient’s return into an independent social, family and work life and can furthermore lead to higher mortality. Most existing concepts of secondary prevention after stroke focus on preventing re-occurrence of cerebrovascular events. One possible approach of secondary prevention of stroke is to encourage weight-loss in overweight and obese patients, although this is not yet recommended by all guidelines due to unclear evidence. More research is necessary to strengthen the evidence regarding this approach. Overweight and obesity are also risk factors for developing depressive symptoms, reduced quality of life and cognitive deficits. We developed the question whether a drug-free weight loss program could work, not only as a secondary prevention for stroke, but also as a prevention for post-stroke depression and cognitive impairment as well as reduced health-related quality of life. For this randomized, controlled trial at the University Medical Center of Marburg (Universitätsklinik Marburg) we enrolled 114 overweight or obese stroke patients to take part either in a weight-loss program or to receive a one-hour nutritional consulting class as part of the placebo group. The weight-loss program consisted of a 15-week formula-drink based diet to achieve a marked calorie deficit, physiotherapy and nutritional consulting to support a return to a healthy regular diet. The patients received a baseline examination, 6 months after index stroke and were then randomized into the respective study groups. Follow-up surveys were conducted 12 months and 18 months after stroke. Both study groups were homogenous in regards to anthropometrics and baseline test results. The study intervention showed good results regarding the trend of the anthropometrical parameters including body-mass-index. The average body-mass-index dropped considerably for participants of the intervention group and increased markedly for the patients in the placebo group resulting in statistically significant differences between the study groups at the time of all follow up surveys. The weight-loss resulted in distinct effects on health-related quality of life. The participants of the intervention group experienced a marked increase of health-related quality of life, which could be shown with any of the used questionnaires. In the placebo group we registered a decreased health related quality of life over the duration of the trial, differing significantly from the intervention group. Regarding the effects of the weight-loss program on depressive symptoms the data are inconclusive with large margins of error and therefore no statistical significance. The results of the tests for cognitive impairment showed a significant difference between groups at 18 months, with the intervention group showing constant, non-pathologic results over the duration of the trial and the placebo group showing reduced cognitive function consistent with mild cognitive impairment. To summarize the results, we can conclude with statistical certainty that the weight-loss intervention shows a direct effect on health-related quality of life. The intervention was effective in preventing a reduction in health-related quality of life after stroke and even leading to slight improvements. These are important findings as reduced health-related quality of life not only leads to suffering for the affected, it can also directly lead to increased mortality. The data regarding the intervention effect on depressive symptoms were not of high enough quality to conclude any clinical relevance. As to the impact on cognition we could show that the weight-loss intervention was effective in preventing post-stroke cognitive impairment from occurring during the duration of the trial, while patients in the placebo group showed decreased test results consistent with mild cognitive impairment. Altogether the results of this study are sufficient enough to recommend participation in a weight-loss program to overweight or obese stroke patients in order to maintain or improve health-related quality of life and to prevent the development of post-stroke cognitive impairment. Yet we recommend to conduct further research with larger study populations and with the inclusion of patients with a wider range of stroke severity to solidify this evidence.