Cognition after stroke:various perspectives

Through better acute stroke care, more people survive a stroke (cerebral infarction or cerebral haemorrhage) and we increasingly see lightly affected stroke patients with few physical problems (the so-called 'walking and talking' patients), who, however, often experience cognitive problems. This dissertation shows that 3-4 years after the stroke, half of the patients still have cognitive disorders. In addition, 89% of the patients have 1 or more (subjective) cognitive complaints at that time. Personal factors (such as coping strategies and personality characteristics) turned out to be related to the experience of cognitive complaints, in contrast to demographic or stroke-related factors. Care professionals need to become more aware of these personal factors during the rehabilitation period in order to be able to provide better tailor-made care. This is important as cognitive complaints have a major impact on participation problems, which can cause people to get stuck in daily life. Disorders in social cognition also occur in the long term. Social cognition includes the ability of individuals to perceive social information, to interpret the behaviour of others and to respond adequately in social situations. For example, there were disorders in the field of emotion recognition and behavioural regulation. Moreover, these disorders turned out to be related to behavioural change, something that occurs frequently after a stroke. Recognition of disorders in social cognition is important, as psycho-education to patients and their relatives can lead to better understanding and acceptance. Future research should focus on the treatment of disorders in social cognition after a stroke

Social cognition impairments in the long term post stroke

Objective: To examine the presence of social cognition deficits and the relationship between social and general cognition (eg, attention, mental speed, verbal, visual, or memory abilities) in a large sample of chronic stroke patients and to identify stroke-related factors associated with social cognitive performance. Design: Inception cohort study in which social cognition was assessed at 3-4 years post stroke. Setting: Stroke units in 6 general hospitals. Participants: The data of 148 patients were available. Fifty controls without stroke (consisting of partners of patients and acquaintances of researchers) were recruited (N = 198). Interventions: Not applicable. Main Outcome Measures: Patients underwent neuropsychological assessment by means of tests for social cognition (emotion recognition, theory of mind [ToM], empathy, and behavior regulation) and general cognition. Subgroup analysis was performed to compare right hemisphere stroke patients with left hemisphere stroke patients. Correlations between general and social cognition tests were assessed. Multiple regression analyses were performed to identify demographic and stroke-related predictors of social cognitive performance. Results: Patients performed significantly worse on emotion recognition (assessed with the Ekman 60-Faces test on total score as well as on the emotion anger), ToM (assessed with the Cartoon test), and behavior regulation (assessed with the Hayling test). Subgroup analysis revealed no differences between right and left hemisphere patients. Social cognition tests showed significant correlations with each other and with tests for visual perception, language, mental speed, cognitive flexibility, and memory. Older age, low level of education (and for ToM, also female sex) were predictors of worse performance on social cognition tests. Conclusion: Social cognition impairments are present in the long term post stroke, even in a group of mildly affected stroke patients, which may contribute to their long-term problems. Severity of impairments is determined mainly by demographic factors

Social cognition impairments are associated with behavioural changes in the long term after stroke

Background and purpose Behavioural changes after stroke might be explained by social cognition impairments. The aim of the present study was to investigate whether performances on social cognition tests (including emotion recognition, Theory of Mind (ToM), empathy and behaviour regulation) were associated with behavioural deficits (as measured by proxy ratings) in a group of patients with relatively mild stroke. Methods Prospective cohort study in which 119 patients underwent neuropsychological assessment with tests for social cognition (emotion recognition, ToM, empathy, and behaviour regulation) 3–4 years post stroke. Test scores were compared with scores of 50 healthy controls. Behavioural problems were assessed with the Dysexecutive Questionnaire (DEX) self rating and proxy rating scales. Pearson correlations were used to determine the relationship between the social cognition measures and DEX scores. Results Patients performed significantly worse on emotion recognition, ToM and behaviour regulation tests than controls. Mean DEX-self score did not differ significantly from the mean DEX-proxy score. DEX-proxy ratings correlated with tests for emotion recognition, empathy, and behavioural regulation (lower scores on these items were associated with more problems on the DEX-proxy scale). Conclusions Social cognition impairments are present in the long term after stroke, even in a group of mildly affected stroke patients. Most of these impairments also turned out to be associated with a broad range of behavioural problems as rated by proxies of the patients. This strengthens the proposal that social cognition impairments are part of the underlying mechanism of behavioural change. Since tests for social cognition can be administered in an early stage, this would allow for timely identification of patients at risk for behavioural problems in the long term

Temporal evolution and predictors of subjective cognitive complaints up to 4 years after stroke

OBJECTIVE: To examine the temporal evolution of subjective cognitive complaints in the long-term after stroke, and to identify predictors of long-term subjective cognitive complaints. METHODS: Prospective cohort study including 395 stroke patients. Subjective cognitive complaints were assessed at 2 months, 6 months and 4 years post-stroke, using the Checklist for Cognitive and Emotional consequences following stroke (CLCE-24). The temporal evolution of subjective cognitive complaints was described using multilevel growth modelling. Associations between CLCE-24 cognition score at 4 years post-stroke and baseline characteristics, depression, anxiety, cognitive test performance, and adaptive and maladaptive psychological factors were examined. Significant predictors were entered in a multivariate multilevel model. RESULTS: A significant increase in subjective cognitive complaints from 2 months up to 4 years (mean 3.7 years, standard deviation (SD) 0.6 years) post-stroke was observed (p≤0.001). Two months post-stroke, 76% of patients reported at least one cognitive complaint, 72% at 6 months, and 89% at 4 years post-stroke. A higher level of subjective cognitive complaints at 2 months and lower scores on adaptive and maladaptive psychological factors were significant independent predictors of a higher level of subjective cognitive complaints at 4 years post-stroke. CONCLUSION: Post-stroke subjective cognitive complaints increase over time and can be predicted by the extent of subjective cognitive complaints and the presence of adaptive and maladaptive psychological factors in the early phases after stroke

Temporal Evolution of Poststroke Cognitive Impairment Using the Montreal Cognitive Assessment

Background and Purpose-The Montreal Cognitive Assessment (MoCA) is nowadays recommended for the screening of poststroke cognitive impairment. However, little is known about the temporal evolution of MoCA-assessed cognition after stroke. The objective of this study was to examine the temporal pattern of overall and domain-specific cognition at 2 and 6 months after stroke using the MoCA and to identify patient groups at risk for cognitive impairment at 6 months after stroke. Methods-Prospective cohort study in which 324 patients were administered the MoCA at 2 and 6 months post stroke. Cognitive impairment was defined as MoCA= 2 points by 6 months, were defined as reverters. Logistic regression analyses were used to identify determinants of (1) cognitive impairment at 6 months post stroke and (2) reverter status. Results-Between 2 and 6 months post stroke, mean MoCA score improved from 23.7 (3.9) to 24.7 (3.5), P Conclusions-Although cognitive improvement is see

The relationship between social cognition and participation in the long term after stroke

Social cognitive impairments may play a role in participation restrictions after stroke. Understanding their relationship could inform treatment approaches to improve participation. We investigated the relationship between social cognition and participation in the long term after stroke. Of 395 patients participating in a large prospective cohort study, cross-sectional data were available at 3-4 years post-stroke of 118 patients on tests for emotion recognition, theory of mind, empathy, and behaviour regulation. Participation was assessed with the Utrecht Scale for Evaluation of Rehabilitation - Participation (USER-P). Bivariate and multivariate regression analysis were used to examine the relationship between social cognitive domains and participation. The majority suffered from minor stroke (83.1% scored NIHSS 0-4). Only behaviour regulation was related to participation restrictions in bivariate analysis, but social cognitive impairments did not predict participation restrictions in multivariate regression in this group. To conclude, in a sample of minor stroke patients with mild impairments in theory of mind, emotion recognition and behavioural control, there were no associations with restrictions in participation. Research should examine whether a relationship is present in patients with more severe stroke. In addition, measuring social aspects of participation is necessary to further unravel this relationship, to determine treatment targets for improving participation

Psychological factors are associated with subjective cognitive complaints 2 months post-stroke

The aim of this study was to investigate which psychological factors are related to post-stroke subjective cognitive complaints, taking into account the influence of demographic and stroke-related characteristics, cognitive deficits and emotional problems. In this cross-sectional study, 350 patients were assessed at 2 months post-stroke, using the Checklist for Cognitive and Emotional consequences following stroke (CLCE-24) to identify cognitive complaints. Psychological factors were: proactive coping, passive coping, self-efficacy, optimism, pessimism, extraversion, and neuroticism. Associations between CLCE-24 cognition score and psychological factors, emotional problems (depressive symptoms and anxiety), cognitive deficits, and demographic and stroke characteristics were examined using Spearman correlations and multiple regression analyses. Results showed that 2 months post-stroke, 270 patients (68.4%) reported at least one cognitive complaint. Age, sex, presence of recurrent stroke(s), comorbidity, cognitive deficits, depressive symptoms, anxiety, and all psychological factors were significantly associated with the CLCE-24 cognition score in bivariate analyses. Multiple regression analysis showed that psychological factors explained 34.7% of the variance of cognitive complaints independently, and 8.5% (p < .001) after taking all other factors into account. Of all psychological factors, proactive coping was independently associated with cognitive complaints (p < .001), showing that more proactive coping related to less cognitive complaints. Because cognitive complaints are common after stroke and are associated with psychological factors, it is important to focus on these factors in rehabilitation programmes