Drugs Aging. 2026 Aug 4. doi: 10.1007/s40266-026-01326-5. Online ahead of print.
ABSTRACT
BACKGROUND: Polypharmacy is a known risk factor for adverse outcomes during stroke rehabilitation; however, evidence is limited on whether nutritional status modifies this association. This study investigated whether the association between polypharmacy and functional recovery in patients after stroke differed according to body mass index (BMI), an anthropometric indicator related to nutritional status.
METHODS: This retrospective cohort study included patients with stroke admitted to a convalescent rehabilitation ward in Japan between January 2015 and December 2024. Patients with cerebral infarction, intracerebral hemorrhage, or subarachnoid hemorrhage were eligible. Polypharmacy was defined as the prescription of five or more medications at admission. Patients were classified by BMI according to the criteria of the Japan Society for the Study of Obesity: underweight (< 18.5 kg/m2), normal weight (18.5 to < 25.0 kg/m2), and obese (≥ 25.0 kg/m2). The primary outcome was the functional independence measure (FIM)-motor score at discharge, and secondary outcomes were the FIM-cognitive score at discharge and home discharge. Multivariable regression analyses were used to evaluate whether BMI category modified the association between polypharmacy and each outcome.
RESULTS: Among 1245 patients (median age, 75 years; 54.3% men), a significant negative interaction between polypharmacy and underweight status was observed for the FIM-motor score at discharge (B = – 4.396, 95% CI – 8.693 to – 0.100). In the underweight group, patients with polypharmacy had significantly lower adjusted FIM-motor scores than those without (65.3 versus 69.8; p = 0.020). No significant association between polypharmacy and functional recovery was found in the normal-weight or obese groups. Polypharmacy was not associated with FIM-cognitive scores or home discharge rates in any BMI category.
CONCLUSIONS: Polypharmacy was associated with modestly poorer activities of daily living at discharge primarily among underweight patients after stroke. These findings suggest that BMI category may help identify patients who could benefit from closer medication assessment, although the clinical magnitude of the association was limited.
PMID:42550458 | DOI:10.1007/s40266-026-01326-5
