Association Between Behavioral Dysexecutive Syndrome and the Health-Related Quality of Life Among Stroke Survivors

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Abstract

Aim

Behavioral dysexecutive syndrome (BDES) is one common neuropsychiatric comorbidity after stroke. Despite evidences suggesting the adverse effect of BDES on the survivors’ outcome, little is known about the association between BDES and the health-related quality of life (HRQoL) among stroke survivors and how BDES impacts the HRQoL. This study aimed to address these questions.

Methods

This study included 219 patients with acute ischemic stroke consecutively admitted to a regional hospital in Hong Kong. BDES was defined as a Chinese version of the Dysexecutive Questionnaire (DEX) score of ≥20 assessed at three months after stroke. The HRQoL was assessed with the Chinese version of the Stroke-Specific Quality of Life (SSQoL) questionnaire encompassing 12 domains. Multivariate linear regression models were employed to examine the association between BDES symptoms and the SSQoL total and domain scores. Structural equation model (SEM) was further constructed to delineate the linking pathways linking BDES and the HRQoL.

Results

The study sample compromised mainly older patients with mild to moderate ischemic stroke. Compared with patients without BDES, those with BDES exhibited poorer performances regarding with the summarized SSQoL (226.2 ± 18.8 vs. 200.3 ± 29.8, p < 0.001) and almost all domains. The BDES symptoms were independently contributed to the whole HRQoL (SSQoL total score) (β = −0.20, p = 0.002), specifically to the domains in personality (β = −0.34, p < 0.001), language (β = −0.22, p = 0.01), and work/productivity (β = −0.32, p < 0.001), after adjusting demographic and clinical characteristics in linear models. The impacts of the BDES symptoms on the HRQoL were mainly explained by the indirect path mediated by depression and anxiety (path coefficient = −0.27, p < 0.05) rather than physical disability, while the resting was elucidated by the path directly linking BDES to the HRQoL (path coefficient = −0.17, p < 0.05).

Conclusion

The present study preliminarily demonstrated a potential association between BDES and a lower level of the HRQoL, predominantly in domains of personality, language, and work/productivityafter acute ischemic stroke. This study also offered insights into the underlying mechanisms linking BDES and the HRQoL, implicating that integrative psychological therapies were urged to achieve better HRQoL after stroke.

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Most cited references 32

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Normed and nonnormed fit indexes are frequently used as adjuncts to chi-square statistics for evaluating the fit of a structural model. A drawback of existing indexes is that they estimate no known population parameters. A new coefficient is proposed to summarize the relative reduction in the noncentrality parameters of two nested models. Two estimators of the coefficient yield new normed (CFI) and nonnormed (FI) fit indexes. CFI avoids the underestimation of fit often noted in small samples for Bentler and Bonett's (1980) normed fit index (NFI). FI is a linear function of Bentler and Bonett's non-normed fit index (NNFI) that avoids the extreme underestimation and overestimation often found in NNFI. Asymptotically, CFI, FI, NFI, and a new index developed by Bollen are equivalent measures of comparative fit, whereas NNFI measures relative fit by comparing noncentrality per degree of freedom. All of the indexes are generalized to permit use of Wald and Lagrange multiplier statistics. An example illustrates the behavior of these indexes under conditions of correct specification and misspecification. The new fit indexes perform very well at all sample sizes.

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Author and article information

Contributors

Yannis Yan Liang: URI : https://loop.frontiersin.org/people/452405

Ying Yang: URI : https://loop.frontiersin.org/people/566046

Yangkun Chen: URI : https://loop.frontiersin.org/people/598609

Vincent C. T. Mok: URI : https://loop.frontiersin.org/people/156499

Wai-Kwong Tang: URI : https://loop.frontiersin.org/people/125814

Journal

Journal ID (nlm-ta): Front Psychiatry

Journal ID (iso-abbrev): Front Psychiatry

Journal ID (publisher-id): Front. Psychiatry

Title: Frontiers in Psychiatry

Publisher: Frontiers Media S.A.

ISSN (Electronic): 1664-0640

Publication date (Electronic): 08 September 2020

Publication date Collection: 2020

Volume: 11

Electronic Location Identifier: 563930

Affiliations

[1] ¹ Stroke Center and Department of Neurology, The First Affiliated Hospital, Jinan University , Guangzhou, China

[2] ² Department of Psychiatry, The Chinese University of Hong Kong , Hong Kong, Hong Kong

[3] ³ Department of Neurology, Dongguan People’s Hospital , Dongguan, China

[4] ⁴ Department of Medicine and Therapeutics, The Chinese University of Hong Kong , Hong Kong, Hong Kong

[5] ⁵ University of Notre Dame Australia/Graylands Hospital , Perth, WA, Australia

[6] ⁶ Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong , Hong Kong, Hong Kong

[7] ⁷ Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine , Seoul, South Korea

[8] ⁸ Shenzhen Research Institute, The Chinese University of Hong Kong , Hong Kong, Hong Kong

Author notes

Edited by: Xenia Gonda, Semmelweis University, Hungary

Reviewed by: Edwin Lee, The University of Hong Kong, Hong Kong; Ada Fung, Hong Kong Polytechnic University, Hong Kong

*Correspondence: Wai-Kwong Tang, tangwk@ 123456cuhk.edu.hk

This article was submitted to Mood and Anxiety Disorders, a section of the journal Frontiers in Psychiatry

Article

DOI: 10.3389/fpsyt.2020.563930

PMC ID: 7506061

SO-VID: 65f0ee54-1225-4bb3-af3e-ffe804ef25c3

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

History

Date received : 21 May 2020

Date accepted : 14 August 2020

Page count

Figures: 2, Tables: 3, Equations: 0, References: 33, Pages: 8, Words: 4291

Funding

Funded by: National Natural Science Foundation of China 10.13039/501100001809

Funded by: Fundamental Research Funds for the Central Universities 10.13039/501100012226

Funded by: Medical Science and Technology Foundation of Guangdong Province 10.13039/501100009330

Association Between Behavioral Dysexecutive Syndrome and the Health-Related Quality of Life Among Stroke Survivors

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Abstract

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Methods

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Measurement of Glucocorticoid Receptor Signaling in Major Depression

Most cited references 32

Comparative fit indexes in structural models.

Alternative Ways of Assessing Model Fit

Development of the World Health Organization WHOQOL-BREF Quality of Life Assessment

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