Different therapies may be required to support recovery after stroke. Although the primary method is intensive rehabilitation therapy, medications may augment therapist-led rehabilitation. The purpose of this study was to describe the differences in admission motor and cognitive function for stroke patients who received neurostimulants or antidepressants during acute rehabilitation compared with patients without each of these medications, and determine the association between medication use and functional recovery.

We examined data for a patient cohort who received acute rehabilitation at three facilities in the United States from 2009–2014. From the electronic medical record we obtained sociodemographics, clinical characteristics, and whether neurostimulants or antidepressants were prescribed and administered within one week of rehabilitation admission. Functional status as the outcome was measured by the Functional Independence Measure (FIM - higher score is better function). After excluding patients using both medications, we modeled use of each medication for its association with FIM motor, cognitive and total scores at discharge from inpatient rehabilitation.

Patients in this cohort were 66 years of age (median), 49% were female, and the acute rehabilitation length of stay was 16 days (median). Neurostimulants or antidepressants were not prescribed for 2159 patients whereas 526 (19.6%) received a neurostimulant and 700 (24.5%) an antidepressant. Motor and cognitive functions were significantly more impaired on admission for patients who received the neurostimulant or the antidepressant (Fig. 1). After adjusting for sociodemographics and clinical characteristics, receipt of neurostimulants or antidepressants was not associated with discharge FIM motor and was associated with a lower discharge FIM-cognitive score (P<0.01).

In this stroke rehabilitation patient cohort, medication therapy with neurostimulants and antidepressants was associated with more impaired cognitive function at discharge but no longer a difference in motor function. Further research is needed to determine how medications interact to assist in functional recovery.