The Relation Between Subjective and Objective Assessment of Cognitive and Physical Functioning in Community-Dwelling Stroke Survivors

Abstract

<h3>Research Objectives</h3> To investigate the relation between subjectively and objectively assessed cognitive and physical functioning among community-dwelling stroke survivors, and to examine the association of stroke severity with subjectively and objectively assessed cognitive and physical impairments. <h3>Design</h3> Secondary data analysis of a cross-sectional, multi-site study. <h3>Setting</h3> Community. <h3>Participants</h3> One hundred twenty-seven community-dwelling stroke survivors (mean age 57.4; 48.8% female) who were at least one year after discharge from rehabilitation. <h3>Interventions</h3> Not applicable. <h3>Main Outcome Measures</h3> Objective cognitive functioning measured by the NIH Toolbox Cognition Battery and the Executive Function Performance Test (EFPT). Subjective cognitive functioning measured by the Quality of Life in Neurological Disorders (Neuro-QoL) Applied Cognition. Objective and subjective physical functioning measured by the NIH Toolbox 2-Minute Walk Test and the Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function, respectively. <h3>Results</h3> A strong positive correlation was found between subjective and objective physical functioning (r = 0.52; P < 0.001), whereas the association between subjective and objective cognitive functioning was nonsignificant. Compared to moderate stroke survivors, mild stroke survivors had lower odds for objective cognitive impairment (total cognition: odds ratio [OR] = 0.28, 95% confidence interval [CI] = 0.12 to 0.64; fluid cognition: OR = 0.34, 95% CI = 0.14 to 0.81; functional cognition: OR = 0.22, 95% CI = 0.08 to 0.61), objective physical impairment (OR = 0.27, 95% CI = 0.08 to 0.86), and subjective physical impairment (OR = 0.37, 95% CI = 0.15 to 0.93). However, no significant association was found between stroke severity and subjective cognitive impairment. <h3>Conclusions</h3> The discordance between objective and subjective cognitive functioning contradicts the conventional assumption that perceived functioning reflects actual performance. Our findings suggest that unique information may be captured in each approach and that they are not interchangeable. As such, incorporating both objective and subjective measures into routine assessment is recommended for clinicians to comprehensively characterize and early identify post-stroke cognitive and physical impairments, enhancing the recognition and management of functional consequences of stroke by clinicians as well as stroke survivors and caregivers. <h3>Author(s) Disclosures</h3> None disclosed.