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Predictors of Subjective Cognitive Complaint in Postacute Older Adult Stroke Patients

Published:March 25, 2013DOI:https://doi.org/10.1016/j.apmr.2013.02.026

      Abstract

      Objective

      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.

      Design

      Cross-sectional study.

      Setting

      Specialized stroke units at major metropolitan hospitals.

      Participants

      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.

      Interventions

      Not applicable.

      Main Outcome Measures

      Cognitive complaint as measured by the A-B Neuropsychological Assessment Schedule.

      Results

      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.

      Conclusions

      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.

      Keywords

      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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