Cognitive impairment is differentially associated with depression and anxiety at six-months post-stroke

Abstract

Objective: This study investigated the associations between general cognitive impairment and domain specific cognitive impairment with post-stroke depression and anxiety at six-months post-stroke. Methods: Participants were a subset of 437 stroke patients from the OCS-CARE study who were followed up at a 6 months post-stroke assessment. Depression and anxiety symptoms were assessed by the Hospital Anxiety and Depression Scale sub-scales. General cognitive impairment was assessed using the Montreal Cognitive Assessment and stroke-specific cognitive domain impairments was assessed using the Oxford Cognitive Screen. Multivariable linear regression was used to examine the associations between cognition and depression/anxiety symptoms, controlling for acute stroke severity and ADL impairment, age, sex, education, and co-occurring post-stroke depression/anxiety. Results: Six-month post-stroke depression was associated with six-month impairment on the MoCA (beta [b] =0.96, standard error [SE] =0.31, p=0.006), and all individual domains assessed by the OCS including spatial attention (b=0.67, SE=0.33, p =0.041), executive function (b=1.37, SE=0.47, p=0.004), language processing (b=0.87, SE=0.38, p=0.028), memory (b=0.76, SE=0.37, p=0.040), number processing (b=1.13, SE=0.40, p=0.005), and praxis (b=1.16, SE =0.49, p=0.028). Post-stroke anxiety was associated with impairment on the MoCA (b=1.47, SE=0.42, p=0.001), and spatial attention (b=1.25, SE=0.45, p=0.006), but these associations did not remain significant after controlling for co-occurring post-stroke depression. Conclusion: The different profiles of associations between cognitive impairment and post-stroke depression and anxiety suggest that cognitive impairment is highly related to depressive symptomatology, but associations observed between cognitive impairment and anxiety may actually be the result of co-morbid post stroke depression.