Optimistic stroke survivors enjoy better health outcomes

Optimism appears to be beneficial among stroke survivors, leading to lower physical disability, lighter stroke severity and suppressed inflammation, according to a new study presented at the recently concluded International Stroke Conference of the American Stroke Association (ISC 2020).

“Our results suggest that optimistic people have a better disease outcome, thus boosting morale may be an ideal way to improve mental health and recovery after a stroke,” according to Yun-Ju Lai, lead author and postdoctoral fellow in the neurology department at The University of Texas Health Science Centre at Houston.

Forty-nine stroke survivors were enrolled at baseline, though by 3-month follow-up, the sample size had decreased to 13 survivors. Researchers found a significant and negative correlation between optimism and stroke severity, as measured by the National Institutes of Health Stroke Scale (NIHSS; ρ, –0.41; p=0.003). [ISC 2020, abstract WP466]

Similarly, optimistic participants seemed to have a better inflammatory profile. Optimism scores were negatively and significantly correlated with biomarkers such as interleukin-6 (ρ, –0.44; p=0.008) and C-reactive protein (CRP; ρ, –0.40; p=0.02). In contrast, no such association was found for tumour necrosis factor-α.

Physical recovery was likewise better in optimistic survivors. Scores in the modified Rankin scale were significantly and inversely associated with optimism (ρ, –0.30; p=0.05).

Notably, adjusting for potential confounders did not attenuate the effects of optimism on health outcomes after stroke. The NIHSS score, for instance, remained associated, dropping by 0.27 points with each unit improvement in the optimism score (p=0.001). The same change in optimism prompted a significant 0.11-point reduction in modified Rankin scale scores (p=0.03).

The same was true for the inflammation profile. Each unit increase in optimism was correlated with a 148.6-ng/mL decrease in CRP (p=0.02), while its effect on interleukin-6 was attenuated. Tumour necrosis factor-α remained unrelated.

“Optimism has been associated with lower inflammation and better health outcomes among people with medical conditions, but no studies have assessed this association in stroke population,” Lai said. “The overall goals were to examine the relationship between optimism, stroke severity, physical disability and inflammation during hospitalization and to evaluate this relationship over the 3-month poststroke period.”

In the present pilot study, participant information was retrieved from the BioRepository of Neurological Diseases biobank. Optimism was evaluated using the revised Life Orientation Test, a standard psychological tool. Enzyme-linked immunosorbent assays were performed for the measurement of inflammatory biomarkers.

“Although the number of patients was low in this initial cohort, understanding this relationship may provide a scientific framework whereby new strategies for stroke recovery can be developed,” Lai pointed out.

“Patients and their families should know the importance of a positive environment that could benefit the patient,” she added. “Mental health does affect recovery after a stroke.”