Stroke survivors who felt uncomfortable sharing their thoughts and feelings about their condition and future had slower physical and cognitive recovery after their stroke, according to a preliminary study to be presented at the American Stroke Association’s International Stroke Conference 2026. The analysis found that difficulty sharing feelings with family or friends was as important as the severity of the stroke for identifying patients who would experience greater disability and poorer physical function one year later.
Researchers investigated whether social constraints on sharing feelings and emotions predicted loneliness and functional and cognitive disability one year after a stroke. The analysis included more than 700 participants in the STRONG (Stroke, sTress,RehabilitatiON, andGenetics) study, conducted at 28 U.S. sites. In the current study, researchers assessed participants’ perception of social constraints at 3 months after their stroke, after the initial healing period.
Stroke survivors identified a person they regularly depend on, often a family member serving as a caregiver, and answered questions about their interactions. The analysis found that one year after the stroke, people who felt less able to openly share their feelings at 90 days were more likely to experience several challenges: They felt lonelier, had more difficulty with everyday activities such as feeding or bathing, and experienced greater problems with thinking skills including memory, attention and language.
"The level of social constraint after 90 days was just as effective at predicting overall disability and physical function one year later as the initial severity of the stroke," said lead study author E. Alison Holman, Ph.D., a professor of nursing at the University of California Irvine. For many stroke-focused health care professionals, the severity of the stroke is the gold standard for understanding how well or poorly a person will be doing down the road.
American Stroke Association volunteer expert Amytis Towfighi, M.D., FAHA, said, "While social support is increasingly recognized as beneficial after stroke, less is known about how social constraints affect recovery. This study is one of the first to assess their influence on long-term psychological, cognitive and functional outcomes. The findings offer valuable insights that can inform interventions to improve post-stroke recovery." More information about stroke recovery is available at https://www.stroke.org.
The study included 763 participants with an average age of 63 years who enrolled in the trial while hospitalized after a mild to moderate stroke. Researchers assessed participants during their first hospitalization and again at 3-, 6- and 12-months post-stroke. At one year, physical and cognitive function were assessed using the modified Rankin Scale and the results of the Montreal Cognitive Assessment administered during a telephone call.
Loneliness was rated using three items from the UCLA Loneliness Scale, assessed at every follow-up at 3, 6, and 12 months post-stroke. At 90 days, the degree of discomfort expressed by the stroke survivors in relation to their concerns was rated using two items from the Social Constraints Scale. After controlling for age, gender, race, stroke severity and stress 2-10 days after the stroke, researchers analyzed the association between more social constraints at 3 months with loneliness and recovery levels at one year.
Dipika Aggarwal, a neurologist from Kansas City, Missouri, who experienced a stroke in 2019, described her personal experience. "Sharing my story helped me heal. It gave me hope to hear from others and feel less alone," said Aggarwal, who now volunteers for the American Stroke Association. "The social, financial and psychological aspects of recovery are huge, and we don’t talk about them enough. My advice to other stroke survivors: don’t keep things hush-hush. Seek support, allow yourself to be vulnerable and connect with people who understand what you’re going through."
Holman encouraged other stroke researchers to inquire about what’s going on in patients’ social environment early after a stroke to understand if it may influence recovery and to provide support. For caregivers, Holman encourages "making room, a safe space, for people to talk about their stroke, let them talk about their feelings and what they’re going through so they can process what has happened and what’s going on." The researchers noted that if these results are confirmed in future studies, interventions could be designed to help stroke survivors face fewer social challenges.
According to the American Heart Association’s 2026 Heart Disease and Stroke Statistics, stroke is now the #4 leading cause of death in the U.S. The study featured in this news release is a research abstract presented at the American Heart Association/American Stroke Association’s scientific meetings and is not peer-reviewed, with findings considered preliminary until published as full manuscripts in a peer-reviewed scientific journal. Additional resources about life after stroke are available through the American Stroke Association at https://www.stroke.org.
