Auckland Stroke Outcomes Study. Part 2: Cognition and functional outcomes 5 years poststroke.

BACKGROUND

Understanding the extent of long-term neuropsychological deficits poststroke and their contribution to functional outcomes is essential for evidence-based rehabilitation and resource planning, and could improve stroke outcomes. However, most existing neuropsychological stroke data are not population-based, examine limited outcomes, and have short-term follow-up.

METHODS

This population-based long-term stroke follow-up study examined associations between neuropsychological deficits (memory, executive function, information processing speed [IPS], visuoperceptual/construction ability, language), depression, and a range of functional outcomes and their interrelationships 5 years poststroke.

RESULTS

The greatest proportion of the 307 participants exhibited neuropsychological functioning within the average range, and about 30%-50% performed at lower levels on most measures; few performed above the average range. Deficits were most common in executive functioning and IPS, and 30.4% of participants were depressed. While correlation analyses indicate all cognitive domains are significantly related to functional outcomes, multiple regression analyses showed that only IPS and visuoperceptual ability made significant independent contributions to functional outcomes over and above age, depression, and current Barthel Index. Depression also made a significant and independent contribution to functional outcomes.

CONCLUSION

A considerable proportion of 5-year stroke survivors experience neuropsychological deficits, with these being more likely to involve IPS and executive functioning. Visuoperceptual/construction abilities, visual memory, and IPS were independently associated with handicap, disability, and health-related quality of life over and above contributions made by age, depression, and stroke severity, suggesting these areas are important targets for rehabilitation to improve overall stroke recovery and should be evaluated in future randomized controlled trials.