There are discrepancies between neurological severity and activities of daily life (ADL) after stroke. We investigated associations between neurological severity and ADL in patients with ischemic stroke at the convalescent rehabilitation stage. We particularly focused on the severity of leukoaraiosis on magnetic resonance imaging (MRI) and various clinical factors.

The participants included 723 patients with ischemic stroke (484 men and 239 women; mean age, 73.2±8.5 years; subtypes, lacunar infarction [n=54], atherothrombosis [n=305], artery-to-artery embolism [n=105], cardiogenic embolism [n=129], undetermined embolism [n=93], and uncategorized ischemic stroke [n=37]) that were transferred from acute care hospitals for inpatient convalescent rehabilitation. Leukoaraiosis was graded according to periventricular hyperintensity (PVH) and deep white matter hyperintensity on MRI. The National Institutes of Health Stroke Scale (NIHSS) was used to measure neurological severity and the Functional Independence Measure (FIM) was used to assess ADL on admission and at discharge.

Multiple regression analysis revealed that total FIM scores were significantly associated with leukoaraiosis as estimated by PVH grade (P=0.001) and NIHSS score (P<0.001) both on admission and at discharge for all patients, in addition to clinical factors, such as age, history of heart disease, and bilateral infarction lesions. In contrast, multiple regression analysis of NIHSS scores revealed no association with PVH.

Our study revealed that ADL were associated with the degree of leukoaraiosis as indicated by PVH at the convalescent rehabilitation stage in patients with ischemic stroke. However, neurological severity was not associated with leukoaraiosis, likely because the progression patterns and anatomic backgrounds of PVH affect ADL in patients who have had ischemic stroke.