Predicting Cognitive Functioning, Activities of Daily Living, and Participation 6 Months after Mild to Moderate Stroke.

Abstract

Predicting neurocognitive and functional outcomes in stroke is an important clinical task, especially in rehabilitation settings. We assessed acute predictors of cognitive and functional outcomes 6 months after mild to moderate stroke. We conducted a retrospective analysis of acute clinical data and 6-month follow-up telephone interviews for 498 mild to moderate stroke patients. Predictors were sociodemographic variables, the National Institute of Health Stroke Scale (NIHSS), basic physical measures, the Mesulam Cancellation Test, the Short Blessed Test (SBT), Trails A/B, and the Boston Naming Test. The outcome variables were the Communication, Memory and Thinking, ADL/IADLs, and Participation subscales from the Stroke Impact Scale. We conducted four hierarchical multiple regression analyses with demographic variables and the NIHSS score entered into the first step, followed by physical variables in the second step, and neuropsychological variables in the final step. Physical variables explained more variance in ADL/IADLs and Participation outcomes than in Communication and Memory and Thinking outcomes, while cognitive predictors exhibited the opposite trend. The SBT was the only significant independent predictor of Communication and Memory and Thinking (p's < .001), while the NIHSS was the only measure that significantly predicted ADL/IADLs (p < .001) and Participation (p = .002). Poorer performance on screening measures predicted worse cognitive and functional outcomes 6 months post-stroke. These results support the clinical utility of administering brief screening instruments during acute recovery from mild to moderate stroke. Neuropsychologists should prioritize performance on screening measures assessing acute neurologic status and cognitive dysfunction when making recommendations for post-stroke rehabilitation.