Stroke: Non-motor Sequelae, Medical Co-morbidity and Patterns of Intervention after Referral to a Special Interest Service D. R. Collins, D. O'Neill Age-Related Health Care, Meath Hospital, Dublin 8. Abstract Stroke poses a considerable financial burden on the health services as well as contributing to enormous personal suffering. A study was undertaken in 100 patients over 65 years old in a geriatric unit. Neuro-radiology confirmed cerebral infarcts in 91 and 89 per cent had additional neuro- medical problems. Specific sequelae of stroke occured in 53 per cent of which 21 per cent related to dysphagia. Among various treatments 61 per cent were referred for physiotherapy and occupational and speech/language therapy. Knowledge of the nature and timing of complications is important in planning stroke services and the input of early medical specialist assessment has been shown to influence mortality and rehabilitation outcome. Introduction Stroke disease poses not only the second greatest financial burden on the health service but also causes enormous personal suffering. Up to one third of care of the elderly beds in the Britain and one in eight of all medical beds are occupied by stroke patients 1. Stroke is the commonest cause of severe physical disability and frequently causes cognitive impairment. There have been several important advances in the treatment of stroke. Recent meta-analyses of organised stroke care has shown not only an increased survival rate but also shorter length of stay and increased functional recovery2. A challenge from this paper has been to find out why stroke units are more effective. It is possible that the early detection and treatment of medical co-morbidity and early referral to the interdiscplinary team are critical factors in the success of stroke teams. Effective rehabilitation is often hampered by significant and unrecognised neuro- medical complications 3, or else by sequelae of stroke such as swallow disorder. Specialist medical input has been shown to be a vital component of detection and treatment of these complications in other countries 4. We assessed the potential for specialist medical input as well as opportunities for therapist intervention in a cohort of patients with stroke referred to a geriatric medical service from the general medical setting. Methods A retrospective study was undertaken on 100 consecutive patients over the age of 65 referred to our geriatric medical service from the general medical setting because of stroke, over an eleven month period. This number represented 56 per cent of the strokes admitted to the hospital during that period. A standard pro-forma is used in all consultations and the following data was collected: principal and secondary diagnoses of active illness after assessment, Barthel Activity of Daily Living Scale and an itemized list of suggested interventions. Diagnosis of stroke was based on history, clinical examination and computerized tomographic evidence of cerebrovascular disease in all cases. The presence or absence of aphasia or swallow disorder by bedside clinical asessment 5 and cognitive impairment (including visuospatial neglect and agnosia syndromes), was noted in particular. Results There were 59 female and 41 male patients with a mean age of 70 yr (range 66-84). Neuro-radiology revealed 91 with cerebral infarcts, 5 with haemorrhagic infarcts and 4 with intracerebral bleeds. One or more significant neuro-medical problems in addition to stroke were detected in 89 per cent of this stroke population. The range ~f significant eo-morbidities was up to 7 with an average of 3 per patient. Neuro-psychiatric problems were commonest (54 per cent) with 17 per cent of patients having clinically significant depression while 49 per cent showed evidence of cognitive impairment using the Folstein Mini-Mental State examination, modified for Irish use 6,7 and clinical assessment for neglect and agnosia. Specific sequelae of stroke and non-long tract neurological problems were noted in 53 per cent of patients, of which 21 per cent were swallow disorders, the remainder relating to visual field defects, dysphasias, vascular epilepsy and parkinsonism. Overt cardiovascular disease was detected in 47 per cent of patients: atrial fibrillation, hypertension and ischaemic heart disease were the commonest diseases recorded. Disorders of the renal tract were evident in 28 per cent of cases: incontinence and urinary tract infection being the most common problems. Sixteen per cent of patients had current active rheumatological disease and gastro-intestinal pathology was present in 15 per cent, most commonly peptic ulcer disease. Endocrine disorders, mainly diabetes and hypothyroidism were noted in 13 per cent of patients. Significant respiratory disease was present in 14 per cent cases. The advice and input of each consultation was analysed. Specific investigative tests and procedures were advised in 48 per cent of consultations: this advice included 33