To investigate the impact of objective cognitive impairment, negative affect, and fatigue on cognitive complaint in a postacute (mean=6.64±1.32mo) sample of patients with ischemic stroke.
Specialized stroke units at major metropolitan hospitals.
Patients with first-ever ischemic stroke (N=25) aged between 50 and 85 years with relatively good neurologic recovery (National Institutes of Health Stroke Scale score ≤7) during the postacute period. Participants were excluded from the study if there was a documented history of psychiatric illness, neurologic disease, dementia, or a moderate or severe aphasia.
Main Outcome Measures
Cognitive complaint as measured by the A-B Neuropsychological Assessment Schedule.
Ninety percent of the patients reported some level of cognitive difficulty in everyday life. Fatigue, cognitive slowing, memory difficulties, and poor concentration were the most frequently reported complaints. More than half of all participants had significant impairment in at least 1 cognitive domain after their stroke. A standard multiple regression was performed to evaluate the relative impact of negative affect, fatigue, and objective cognitive functioning on subjective cognitive complaint. This model accounted for 61% of the variance in total subjective cognitive complaint (R=.78, F3,21=10.96, P<.001), with depression being the only variable to make a significant independent contribution to the prediction of subjective cognitive complaint.
Cognitive complaints are reported by almost all patients after a stroke. Although 50% of the participants had objective evidence of a cognitive impairment, neither objective cognitive impairment nor fatigue predicted cognitive complaint independently of negative affect. Clinicians who receive reports of cognitive complaints in the postacute period after stroke should be alert to the possibility of psychological distress in their patient.
List of abbreviations:ABNAS (A-B Neuropsychological Assessment Schedule), NIHSS (National Institutes of Health Stroke Scale), RBANS (Repeatable Battery for the Assessment of Neuropsychological Status)
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- Ischaemic stroke in New Zealand.N Z Med J. 1994; 107: 443-446
- Cost-effective intervention in stroke.Pharmacoeconomics. 1992; 2: 468-499
- Stroke: development, prevention and treatment with peptidase inhibitors.Peptides. 2000; 21: 1965-1973
- Auckland stroke outcome study, part 2: cognition and functional outcomes 5 years post stroke.Neurology. 2010; 75: 1608-1616
- Cognitive complaints in the early phase after stroke are not indicative for cognitive impairment.J Neurol Neurosurg Psychiatry. 2008; 79: 143-146
- Patients' and relatives' reports of disturbances 9 months after stroke: subjective changes in physical functioning, cognition, emotion, and behavior.Arch Phys Med Rehabil. 2005; 86: 1587-1593
- Possible interpretation of subjective complaints in patients with spontaneous subarachnoid haemorrhage.J Rehabil Med. 2004; 36: 63-69
- Subjective changes in emotion, cognition and behaviour after stroke: factors affecting the perceptions of patients and partners.J Clin Exp Neuropsychol. 2002; 24: 1032-1045
- Assessment of memory complaint in age-associated memory impairment: the MAC-Q.Int Psychogeriatr. 1992; 4: 165-176
- Memory complaints and memory impairment in older individuals.J Am Geriatr Soc. 1996; 44: 44-49
- Do memory complaints indicate the presence of cognitive impairment? – Results of a field study.Eur Arch Psychiatry Clin Neurosci. 1999; 249: 197-204
- Prevalence and determinants of cognitive complaints after aneurysmal subarachnoid hemorrhage.Cerebrovas Dis. 2010; 29: 557-563
- Memory complaints in chronic stroke patients are predicted by memory self-efficacy rather than memory capacity.Cerebrovasc Dis. 2011; 31: 566-672
- Subjective memory complaints and objective memory impairment in the Vienna-Transdanube aging community.J Am Geriatr Soc. 2004; 52: 263-268
- Memory complaints in healthy young and elderly adults: reliability of memory reporting.Aging Ment Health. 2008; 12: 177-182
- Prevalence and predictors of pain and fatigue after stroke: a population based study.Int J Rehabil Res. 2006; 29: 329-333
- Dimensions of post-stroke fatigue: a two-year follow-up study.Cerebrovasc Dis. 2008; 26: 134-141
- Fatigue after stroke.Arch Phys Med Rehabil. 1999; 80: 173-178
- Neurological and psychosocial outcome 4 to 7 years after subarachnoid hemorrhage.Neurosurgery. 1997; 41: 25-34
- The Neurotoxicity Scale: the validity of a patient-based scale, assessing neurotoxicity.Epilepsy Res. 1995; 20: 229-239
- The Neurotoxicity Scale-II: results of a patient-based scale assessing neurotoxicity in patients with epilepsy.Epilepsy Res. 1997; 27: 165-173
- The A-B Neuropsychological Assessment Schedule (ABNAS): the further refinement of a patient-based scale of patient-perceived cognitive functioning.Epilepsy Res. 2001; 43: 227-237
- The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS).The Psychological Corporation, New York1998
- Neuropsychological Assessment.4th ed. Oxford University Pr, New York2004
- Construct and predictive validity of the Repeatable Battery for the Assessment of Neuropsychological Status in the evaluation of stroke patients.J Clin Exp Neuropsychol. 2005; 27: 16-32
- The validity of the repeatable battery of neuropsychological status in acute stroke.Clin Neuropsychol. 2006; 20: 702-715
- Early post-stroke cognition in stroke rehabilitation patients predicts functional outcome at 13 months.Dement Geriatr Cogn Disord. 2011; 31: 379-387
- The Multidimensional Fatigue Scale (MFI) psychometric qualities of an instrument to assess fatigue.J Psychosom Res. 1995; 39: 315-325
- Fatigue in ovarian carcinoma patients a neglected issue?.Cancer. 2003; 97: 1564-1572
- The Hospital Anxiety and Depression Scale.Acta Psychiatr Scand. 1983; 67: 361-370
- The A–B Neuropsychological Assessment Schedule (ABNAS): the relationship between patient-perceived drug related cognitive impairment and results of neuropsychological tests.Seizure. 2002; 11: 231-237
- The moderating role of negative affect on objective verbal memory performance and subjective memory complaints in healthy older adults.J Int Neuropsychol Soc. 2008; 14: 327-336
- The link between depressive symptoms, negative cognitive bias and memory complaints in older adults.Aging Ment Health. 2007; 11: 708-715
- Subjective cognitive complaints, memory performance, and depressive affect in old age: a change-oriented approach.Int J Aging Hum Dev. 2003; 57: 339-366
- Cognitive performance and subjective complaints before and after remission of major depression.Cognitive Neuropsychiatry. 2007; 12: 25-45
- Subjective memory complaints in geriatric depression.Am J Psychiatry. 1985; 142: 1103-1105
- Experience of severe fatigue long after stroke and its relation to depressive symptoms and disease characteristics.Eur Neurol. 2001; 451: 28-33
- Domain-specific cognitive recovery after first-ever stroke: a follow-up study of 111 cases.J Int Neuropsychol Soc. 2005; 11: 795-806
- Using Multivariate Statistics.4th ed. Allyn and Bacon, Needham Heights2001
- Training memory self-efficacy in the chronic stage after stroke: a randomized control trial.Neurorehabil Neural Repair. 2013; 27: 110-117
Published online: March 25, 2013
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© 2013 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.