Introduction: The protective effects of estrogen are widely known following brain injury and waning female sex hormones such as estrogen and prolactin with age are associated with decline in cognitive performance. In this study, we focus on the relationship between female sex hormones and outcome following stroke, specifically how these hormones affect level of disability and responsiveness to rehabilitation following stroke.
Methods: Sex hormone levels were evaluated in 54 female stroke survivors with a mean latency of 98.8 days (SEM ± 23.06). Age differences in hormone levels and disability were evaluated according to younger (Y; M=39.3, SEM ± 1.5) and older (O; M=58.4, SEM ± 1.2) age categories. Functional ability was assessed with the Disability Rating Scale (DRS), Independent Living Scale (ILS) and the Mayo-Portland Adaptability Inventory 4 (MPAI). All patients underwent post acute rehabilitation.
Results: The Y group had higher levels of estradiol (p<0.05) and prolactin (p<0.05) compared to the O group. Correspondingly, follicle stimulating (FSH) and luteinizing hormones (LH) were higher in the O group (p<0.05). The Y group had lower disability according DRS, ILS activities of daily living (ADL) subscale and MPAII (p<0.05). High levels of prolactin were correlated with better performance in ADL’s (p<0.005). Estradiol correlated with lower disability as measured by MPAI (p<0.005). High values of FSH were associated with lower initiation as assessed by a subscale of the ILS. Analysis of changes in outcome measures before and after rehabilitation showed that both groups benefited equally.
Conclusions: Hormones are predictive of levels of disability and independence in ADL’s. Sex hormone levels in post-stroke patients should be considered for prognostication. In spite of hormonal differences both groups benefit from rehabilitation.