What is the prevalence of disability due to cerebrovascular accident (CVA) or stroke?

From the Guidelines

Stroke is a leading contributor to long-term disability, with approximately 45% of persons aged 15 to 50 years having at least moderate disability after a stroke 1. The prevalence of disability due to stroke is a significant concern, with stroke being the fifth most prevalent cause of death in the United States, accounting for 1 out of every 21 deaths in the nation 1. The spectrum of disability resulting from stroke manifests diversely, including motor weakness and sensory disturbances, impairments in speech and swallowing, vision loss or neglect, cognitive challenges involving inattention or memory loss, and emotional difficulties, such as mood disorders or anxiety 1.

Key Points

• Approximately 45% of persons aged 15 to 50 years have at least moderate disability after a stroke 1
• Stroke is the fifth most prevalent cause of death in the United States, accounting for 1 out of every 21 deaths in the nation 1
• The spectrum of disability resulting from stroke manifests diversely, including motor weakness, sensory disturbances, impairments in speech and swallowing, vision loss or neglect, cognitive challenges, and emotional difficulties 1
• Early rehabilitation is crucial for improving outcomes, ideally beginning within 24-48 hours after stroke when medically stable 1

Recommendations

• Tailored rehabilitative efforts should start as soon as clinically feasible to maximize functional outcomes 1
• Rehabilitation typically includes physical, occupational, and speech therapy tailored to individual needs 1
• The severity of disability correlates with stroke size, location, and how quickly treatment was received, with patients receiving treatment within 3-4.5 hours of symptom onset generally experiencing better outcomes 1

From the Research

Prevalence of Disability due to Stroke

• Stroke is a major cause of disability in the elderly, with its prevalence increasing due to enhanced survival and a growing elderly population 2.
• The incidence of stroke is decreasing, but its prevalence in the population is increasing, making it essential to estimate and understand disability following stroke 2.
• A comprehensive model of disability in older stroke survivors suggests that economic and medical context are associated with disability directly and indirectly through physical impairment 3.
• Neighborhood context is also associated with disability, although the effect is small compared to medical factors 3.
• Stroke and dementia are the leading causes of neurological disability and death worldwide, accounting for 87.2% of neurological deaths and 61.7% of neurological disability-adjusted life years (DALYs) in 2019 4.
• The global burden of stroke is substantial, with an estimated cost of over US$721 billion and a 70.0% increase in incident strokes, 43.0% deaths from stroke, 102.0% prevalent strokes, and 143.0% DALYs from 1990 to 2019 5.
• The majority of the global stroke burden resides in lower-income and lower-middle-income countries (LMIC), highlighting the need for targeted interventions to reduce the burden of stroke 5.

Risk Factors and Prevention

• Modifiable risk factors, such as hypertension, unhealthy diet, smoking, and obesity, contribute to the burden of stroke and dementia 4.
• Understanding these risk factors and their attribution to DALYs and deaths can inform strategies for prevention and mitigation of stroke and dementia 4.
• The use of aspirin plus clopidogrel versus aspirin mono-therapy for ischemic stroke has been shown to reduce the risk of recurrent ischemic stroke, but may increase the risk of bleeding 6.