Insurance status also had a significant effect on whether function deteriorated over time, Dhamoon said. "Uninsured patients and those covered by Medicaid had a significant decline in function over five years, while those covered by Medicare or private insurance did not," he said.

Access to health care is not just important at the time of a stroke, but in the years after, Dhamoon said. "Those with poorer access to health care may be less likely to get ongoing rehabilitation and may be less able to manage their blood pressure and other risk factors," he said.

In addition, people who were older, had diabetes, were unmarried, had a more severe stroke, had a stroke on their right side or had urinary incontinence within a week of the stroke were more likely to be disabled within five years, Dhamoon noted.

Dhamoon's group is currently studying a group of about 3,000 people who had not had a stroke when they enrolled in the Northern Manhattan Study. The researchers plan to use data gathered over eight or nine years to compare the rate of decline in function between people who have a stroke during the follow-up period and those who don't.

But Dr. Majaz Moonis, director of Stroke Services and the Stroke Prevention Program at the University of Massachusetts Memorial Medical Center, said the study failed to take into account several key factors.

Stroke prevention is a comprehensive management strategy, and the authors did not account for the medication used to prevent a second stroke, Moonis said. "Also, they have not looked at the impact of acute rehabilitation on this delayed decline," he said.

"Personally, in our own stroke prevention clinic over the last eight years of close follow-up, I have not seen such a uniform decline," Moonis said. "The difference may be related to a very close follow-up and intervention as needed. In our stroke prevention service, we
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