The Relationship of Psychiatric Symptoms with Performance-Based and Self-Reported Cognitive Function After Ischemic Stroke.

Elisabeth Kliem,Linas Bieliauskas,Bent Indredavik,Alexander Olsen,Bente Thommessen,Truls Ryum,Elise Gjestad,Paulina Due-Tønnessen,Tormod Fladby,Ramune Grambaite

doi:10.1017/s1355617721000187

Abstract

Findings on the relationship of psychiatric symptoms with performance-based and self-reported cognitive function post-stroke are inconclusive. We aimed to (1) study the relation of depression and anxiety to performance-based cognitive function and (2) explore a broader spectrum of psychiatric symptoms and their association with performance-based versus self-reported cognitive function. Individuals with supratentorial ischemic stroke performed neuropsychological examination 3 months after stroke. For primary analyses, composite scores for memory and attention/executive function were calculated based on selected neuropsychological tests, and the Hospital Anxiety and Depression Scale (HADS) was used. Psychiatric symptoms and self-reported cognitive function for secondary aims were assessed using the Symptom-Checklist-90 - Revised (SCL-90-R). In a sample of 86 patients [mean (M) age: 64.6 ± 9.2; Mini-Mental State Examination (MMSE), 3-7 days post-stroke: M = 28.4 ± 1.7; National Institutes of Health Stroke Scale (NIHSS) after 3 months: M = 0.7 ± 1.6] depressive symptoms (HADS) were associated with poorer memory performance after controlling for age, sex, and education (p ≤ .01). In a subsample (n = 41; Age: M = 65.7 ± 8.1; MMSE: M = 28.4 ± 1.8; NIHSS: M = 1.0 ± 1.9), symptoms of phobic anxiety (SCL-90-R) were associated with poorer performance-based memory and attention/executive function, and symptoms of anxiety (SCL-90-R) with lower attention/executive function. Higher levels of self-reported cognitive difficulties were associated with higher scores in all psychiatric domains (p ≤ .05). Even in relatively well-functioning stroke patients, depressive symptoms are associated with poorer memory. The results also suggest that various psychiatric symptoms are more related to self-reported rather than to performance-based cognitive function. Screening for self-reported cognitive difficulties may not only help to identify patients with cognitive impairment, but also those who need psychological treatment.

Highlights

IntroductionAbout one-third to half of stroke survivors develop psychiatric symptoms (Ferro, Caeiro, & Figueira, 2016)
Stroke affects approximately 14 million people per year worldwide (Johnson et al, 2019), many of whom will experience cognitive impairment and psychiatric symptoms afterIn total, about one-third to half of stroke survivors develop psychiatric symptoms (Ferro, Caeiro, & Figueira, 2016)
To investigate if patients included in subsample analyses significantly differed from those who did not respond to the SCL-90-R, possibly leading to a bias, we compared characteristics of these two subsamples

Summary

Introduction

About one-third to half of stroke survivors develop psychiatric symptoms (Ferro, Caeiro, & Figueira, 2016). Among psychiatric post-stroke sequelae, symptoms like anxiety, depression, and apathy are common (Hackett, Kohler, O’Brien, & Mead, 2014). Such sequelae may be caused by brain damage: Frontal/anterior and basal ganglia strokes, and both large and multiple strokes have been related to depression in the post-acute phase (Medeiros, Roy, Kontos, & Beach, 2020). One-third of stroke patients experience depression after 2–3 years despite excellent physical recoveries (Kapoor et al, 2017)

Methods

Results

Conclusion