22. European Stroke Conference 14:30-16:00 Oral Session Room 9,10 Rehabilitation and reorganisation after stroke B Chairs: S.C. Cramer, USA and A. Leff, UK 10 Rehabilitation and reorganisation after stroke B 14:30 - 14:40 Cognitive determinants of return to work after a stroke M. Hommel1, B. Naegele2, S. Miguel3, A. Jaillard4 University Hospital, Grenoble, FRANCE1,University Hospital, Grenoble, FRANCE2, Uni-versity Hospital, Grenoble, FRANCE3, University Hospital, Grenoble, FRANCE4 Background Despite the known relation to age, about 20% of strokes occur at vocational age and they have a major individual and societal impact. As work market requires higher professional skills as-sociated with higher cognitive capabilities, we studied the cognitive determinants of return to work (RTW). Methods We prospectively included patients in a subacute infarcts cohort (N=156) and in a confirma-tory chronic stroke cohort (N=62). The patients were non demented (MMSE≥23). We collected demographic including previous occupation, social and familial, imaging, and diag-nostic data. Using a comprehensive neuropsychological battery of tests, we assessed cognition within the first month in the first cohort and after 6±3 months in the confirmatory. General and instrumental functions, memory, executive functions and working memory were the cognitive domains explored. RTW was assessed at the 1 year follow-up visit in all the patients. We used confirmatory factor analysis to estimate the cognitive domains and logistic regressions for test-ing the predictors of return to work. Results Age, previous occupation, stroke severity, and depression were associated with RTW in univar-iate comparisons. Tests from each cognitive domain were predictive of RTW after correction for multiple comparisons. All cognitive domains but memory were predictive of RTW. In mul-tivariate analysis, age (0.01), depression (0.01) and working memory (< 0.000) were the pre-dictors of RTW in both cohorts. The cognitive domain working memory was the best predictor of RTW overall, and carries more information than a fast global cognitive evaluation such as MMSE when considering RTW. Conclusion Cognition was the main factor of RTW after stroke. Working memory was the best marker of cognitive deficits when considering RTW. It suggests focusing rehabilitation trials on working memory deficits. 9 Epidemiology of stroke 15:50 - 16:00 Ethnic and age disparities in incidence of stroke over time: analysis from the South Lon-don Stroke Register over 16 years Y. Wang1, A.G. Rudd2, C.D.A. Wolfe3 Division of Health and Social Care Research, King’s College London, London, UNITED KINGDOM1,Division of Health and Social Care Research, King’s College London, London, UNITED KINGDOM2, Division of Health and Social Care Research, King’s College London, London, UNITED KINGDOM3 Objectives: To investigate ethnic and age disparities in stroke incidence over time from an in-ner- city population-based stroke register. Methods: Trends in stroke incidence and prior-to-stroke risk factors were investigated with the South London Stroke Register (SLSR), a population-based register, covering a multiethnic pop-ulation of 271,817 inhabitants in South London with 63% white, 28% black, and 9% of other ethnic group. Age-, ethnicity- and sex- specific incidence rates with 95% confidence intervals were calculated assuming a Poisson distribution and their trends over time tested by the Co-chran- Armitage test. Results: 4251 patients with first-ever stroke were registered between 1995 and 2010. Total stroke incidence reduced by 34.4% over the 16-year period from 202.6 to 132.9 per 100,000 population (p<0.0001). Similar declines in stroke incidence were observed in men (228.2 to 143.6) and women (177.9 to 121.4), white (190.6 to 126.2) and black (264.1 to 148.2), and pa-tients aged over 55 years (658.4 to 419.5) (all significant with p<0.0001), but not in patients aged under 55 years (24 to 20.7, not significant with p>0.05). The mean age at stroke decreased significantly from 71.6 years in 1995-1998 to 69.4 years in 2007-2010 (p=0.0002). The propor-tion of all strokes aged < 55 years increased from 10% in 1995 to 20.4% in 2010. The reduction in prevalence of prior-to-stroke risk factors was mostly seen in white patients over 55 years, while an increase in diabetes was observed in younger black patients aged under 55 years. Conclusions: Total stroke incidence decreased over a 16-year time period. However, this was not seen in younger age groups. Stroke risk increased in younger age and black groups. The advances in risk factor reduction observed in white groups over age 55 years failed to be trans-ferred to younger age groups for both black and white. 144 © 2013 S. Karger AG, Basel Scientific Programme
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