Cognitive and emotional symptoms in patients with first-ever mild stroke: The syndrome of hidden impairments.

Abstract

ObjectiveTo evaluate the prevalence of cognitive and emotional impairments one year after first-ever mild stroke in younger patients.DesignProspective, observational, cohort study.SubjectsA consecutive sample of 117 previously cognitively healthy patients aged 18–70 years with mild stroke (National Institutes of Health Stroke Scale score ≤ 3) were included in 2 hospitals in Norway during a 2-year period.MethodsAt 12-month follow-up, patients were assessed using validated instruments for essential cognitive domains, fatigue, depression, anxiety, apathy and pathological laughter and crying.ResultsIn total, 78 patients (67%) had difficulty with one or a combination of the cognitive domains psychomotor speed, attention, executive and visuospatial function, and memory. Furthermore, 50 patients (43%) had impairment in either one or a combination of the emotional measures for anxiety, depressive symptoms, fatigue, apathy or emotional lability. A total of 32 patients (28%) had both cognitive and emotional impairments. Only 21 patients (18%) scored within the reference range in all the cognitive and emotional tools.ConclusionHidden impairments are common after first-ever mild stroke in younger patients. Stroke physicians should screen for hidden impairments using appropriate tools.LAY ABSTRACTMany patients with minimal or no apparent neurological deficits after stroke may experience cognitive and emotional symptoms. The quality of life and functioning of these patients may be reduced. Our research group studied 117 previously cognitively healthy patients aged 70 years or younger with mild stroke 12 months after the stroke event. They were assessed for cognitive and emotional impairments using validated tests for cognitive function, fatigue, depression, anxiety, and apathy. Only 21 patients (18%) scored within the normal range in these tests. In conclusion, “hidden impairments” are common among younger stroke patients. It is important for patients, their surroundings and stroke physicians to be aware that such difficulties can occur after even a mild stroke.