BACKGROUND: Cognitive impairment is frequently seen in patients with stroke. The possible correlation between cognitive function and functional mobility has been proposed; however, the prognostic importance of early cognitive function in recovery of mobility has not been investigated in patients with stroke.
OBJECTIVE: The objective of this study is to investigate whether the cognitive function in the acute phase can independently predict the recovery of mobility after stroke, and to determine the cut-off value of each cognitive evaluation test for community ambulation at six months.
METHODS: Seventy two patients underwent four domain-specific neuropsychological evaluation tests at about two weeks after stroke; these included the word list memory test (WMT), construction praxis test (CPT), verbal fluency test (VFT) and Boston naming test (BNT). The Functional Ambulation Category (FAC) and ambulatory zone (AZ) at six months after stroke were investigated as outcome variables. The domain-specific cognitive function, along with other possible predictors for functional mobility, was analyzed with regression analysis.
RESULTS: The z-scores of WMT (p = 0.018) and VFT (p = 0.012) were related to the independence in ambulation. The z-scores of VFT (p = 0.006) and CPT (p = 0.009) were predictors for community ambulation, with the cut-off values of –2.215 for VFT, and of –0.845 for CPT.
CONCLUSIONS: Cognitive impairment in the acute phase of stroke can be an independent prognostic factor of functional mobility. Domain-specific neuropsychological evaluation tests should be considered in the acute phase of stroke to predict the recovery of functional mobility.
AmboniM., BaroneP., IupparielloL., ListaI., TranfagliaR., FasanoA., ... SorrentinoG. (2012). Gait patterns in Parkinsonian patients with or without mild cognitive impairment. Movement Disorders: Official Journal of the Movement Disorder Society, 27(12), 1536–1543.
2.
AtkinsonH. H., CesariM., KritchevskyS. B., PenninxB. W. J. H., FriedL. P., GuralnikJ. M., & WilliamsonJ. D. (2005). Predictors of combined cognitive and physical decline. Journal of the American Geriatrics Society, 53(7), 1197–1202.
3.
AtkinsonH. H., RosanoC., SimonsickE. M., WilliamsonJ. D., DavisC., AmbrosiusW. T., ... KritchevskyS. B. (2007). Cognitive function, gait speed decline, and comorbidities: The health, aging and body composition study. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 62(8), 844–850.
4.
BaumC. M., ConnorL. T., MorrisonT., HahnM., DromerickA. W., & EdwardsD. F. (2008). Reliability, validity, and clinical utility of the Executive Function Performance Test: A measure of executive function in a sample of people with stroke. The American Journal of Occupational Therapy: Official Publication of the American Occupational Therapy Association, 62(4), 446–455.
5.
BlakeH., McKinneyM., TreeceK., LeeE., & LincolnN. B. (2002). An evaluation of screening measures for cognitive impairment after stroke. Age and Ageing, 31(6), 451–456.
6.
BlandM. D., SturmoskiA., WhitsonM., ConnorL. T., FucetolaR., HuskeyT., ... LangC. E. (2012). Prediction of discharge walking ability from initial assessment in a stroke inpatient rehabilitation facility population. Archives of Physical Medicine and Rehabilitation, 93(8), 1441–1447.
7.
BleA., VolpatoS., ZulianiG., GuralnikJ. M., BandinelliS., LauretaniF., ... FerrucciL. (2005). Executive function correlates with walking speed in older persons: The InCHIANTI study. Journal of the American Geriatrics Society, 53(3), 410–415.
8.
CarlsonM. C., FriedL. P., XueQ. L., Bandeen-RocheK., ZegerS. L., & BrandtJ. (1999). Association between executive attention and physical functional performance in community-dwelling older women. The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 54(5), S262–S270.
9.
DesmondD. W., MoroneyJ. T., SanoM., & SternY. (1996). Recovery of cognitive function after stroke. Stroke, 27(10), 1798–1803.
10.
DickJ. P., GuiloffR. J., StewartA., BlackstockJ., BielawskaC., PaulE. A., & MarsdenC. D. (1984). Mini-mental state examination in neurological patients. Journal of Neurology, Neurosurgery, and Psychiatry, 47(5), 496–499.
11.
DierckxE., EngelborghsS., De RaedtR., De DeynP. P., D’HaenensE., VerteD., & Ponjaert-KristoffersenI. (2011). The 10-word learning task in the differential diagnosis of early Alzheimer’s disease and elderly depression: A cross-sectional pilot study. Aging & Mental Health, 15(1), 113–121.
12.
FiskJ. E., & SharpC. A. (2004). Age-related impairment in executive functioning: Updating, inhibition, shifting, and access. Journal of Clinical and Experimental Neuropsychology, 26(7), 874–890.
GalskiT., BrunoR. L., ZorowitzR., & WalkerJ. (1993). Predicting length of stay, functional outcome, and aftercare in the rehabilitation of stroke patients. The dominant role of higher-order cognition. Stroke, 24(12), 1794–1800.
15.
GramstadA., AarslandD., & NaessH. (2011). Cognitive profile of elderly patients with mild stroke. Dementia and Geriatric Cognitive Disorders Extra, 1(1), 409–417.
16.
GreenM. F., KernR. S., & HeatonR. K. (2004). Longitudinal studies of cognition and functional outcome in schizophrenia: Implications for MATRICS. Schizophrenia Research, 72(1), 41–51.
17.
GrossA. L., RebokG. W., UnverzagtF. W., WillisS. L., & BrandtJ. (2011). Word list memory predicts everyday function and problem-solving in the elderly: Results from the ACTIVE cognitive intervention trial. Neuropsychology, Development, and Cognition. Section B, Aging, Neuropsychology and Cognition, 18(2), 129–146.
18.
HankeyG. J., JamrozikK., BroadhurstR. J., ForbesS., & AndersonC. S. (2002). Long-term disability after first-ever stroke and related prognostic factors in the perth community stroke study, 1989–1990. Stroke, 33(4), 1034–1040.
19.
HerutiR. J., LuskyA., DanknerR., RingH., DolgopiatM., BarellV., ... AdunskyA. (2002). Rehabilitation outcome of elderly patients after a first stroke: Effect of cognitive status at admission on the functional outcome. Archives of Physical Medicine and Rehabilitation, 83(6), 742–749.
20.
HillR. D., BäckmanL., & FratiglioniL. (1995). Determinants of functional abilities in dementia. Journal of the American Geriatrics Society, 43(10), 1092–1097.
21.
HoldenM. K., GillK. M., MagliozziM. R., NathanJ., & Piehl-BakerL. (1984). Clinical gait assessment in the neurologically impaired. Reliability and meaningfulness. Physical Therapy, 64(1), 35–40.
22.
HoltzerR., VergheseJ., XueX., & LiptonR. B. (2006). Cognitive processes related to gait velocity: Results from the Einstein Aging Study. Neuropsychology, 20(2), 215–223.
23.
JorgensenH. S., ReithJ., NakayamaH., KammersgaardL. P., RaaschouH. O., & OlsenT. S. (1999). What determines good recovery in patients with the most severe strokes? The copenhagen stroke study. Stroke, 30(10), 2008–2012.
24.
KalmarJ. H., GaudinoE. A., MooreN. B., HalperJ., & DelucaJ. (2008). The relationship between cognitive deficits and everyday functional activities in multiple sclerosis. Neuropsychology, 22(4), 442–449.
25.
KnoflachM., MatosevicB., RückerM., FurtnerM., MairA., WilleG., ... WilleitJ. (2012). Functional recovery after ischemic stroke–a matter of age: Data from the Austrian Stroke Unit Registry. Neurology, 78(4), 279–285.
26.
LambertyG. J., KennedyC. M., & FlashmanL. A. (1995). Clinical utility of the CERAD word list memory test. Applied Neuropsychology, 2(3-4), 170–173.
27.
LarsonE. B., KirschnerK., BodeR. K., HeinemannA. W., ClorfeneJ., & GoodmanR. (2003). Brief cognitive assessment and prediction of functional outcome in stroke. Topics in Stroke Rehabilitation, 9(4), 10–21.
28.
LeeD. Y., LeeK. U., LeeJ. H., KimK. W., JhooJ. H., KimS. Y., ... WooJ. I. (2004). A normative study of the CERAD neuropsychological assessment battery in the Korean elderly. Journal of the International Neuropsychological Society: JINS, 10(1), 72–81.
29.
LiK.-Y., LinK.-C., WangT.-N., WuC.-Y., HuangY.-H., & OuyangP. (2012). Ability of three motor measures to predict functional outcomes reported by stroke patients after rehabilitation. Neuro Rehabilitation, 30(4), 267–275.
30.
ManesF., SpringerJ., JorgeR., & RobinsonR. G. (1999). Verbal memory impairment after left insular cortex infarction. Journal of Neurology, Neurosurgery, and Psychiatry, 67(4), 532–534.
31.
MartinK. L., BlizzardL., WoodA. G., SrikanthV., ThomsonR., SandersL. M., & CallisayaM. L. (2013). Cognitive function, gait, and gait variability in older people: A population-based study. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 68(6), 726–732.
32.
MehrholzJ., WagnerK., RutteK., MeissnerD., & PohlM. (2007). Predictive validity and responsiveness of the functional ambulation category in hemiparetic patients after stroke. Archives of Physical Medicine and Rehabilitation, 88(10), 1314–1319.
33.
MiyaiI., SuzukiT., KangJ., & VolpeB. T. (2000). Improved functional outcome in patients with hemorrhagic stroke in putamen and thalamus compared with those with stroke restricted to the putamen or thalamus. Stroke, 31(6), 1365–1369.
34.
MurrayC. J., & LopezA. D. (1997). Mortality by cause for eight regions of the world: Global Burden of Disease Study. Lancet, 349(9061), 1269–1276.
35.
NysG. M. S., van ZandvoortM. J. E., de KortP. L. M., van der WorpH. B., JansenB. P. W., AlgraA., ... KappelleL. J. (2005). The prognostic value of domain-specific cognitive abilities in acute first-ever stroke. Neurology, 64(5), 821–827.
36.
O’SullivanM., MorrisR. G., & MarkusH. S. (2005). Brief cognitive assessment for patients with cerebral small vessel disease. Journal of Neurology, Neurosurgery, and Psychiatry, 76(8), 1140–1145.
37.
Oh-ParkM., HungC., ChenP., & BarrettA. M. (2014). Severity of spatial neglect during acute inpatient rehabilitation predicts community mobility post stroke. PM & R: The Journal of Injury, Function, and Rehabilitation, 6(8), 0–7.
38.
Organization, W. H. (2008). The Global Burden of Disease.
39.
OzdemirF., BirtaneM., TabatabaeiR., EkukluG., & KokinoS. (2001). Cognitive evaluation and functional outcome after stroke. American Journal of Physical Medicine & Rehabilitation/Association of Academic Physiatrists, 80(6), 410–415.
40.
PakerN., BugdaycD., TekdsD., KayaB., & DereC. (2010). Impact of cognitive impairment on functional outcome in stroke. Stroke Research and Treatment, 2010: 652612.
41.
ParkJ.-H.,
LeeG.,
LeeS.-U., & JungS. H. (2016). The Impact of Acute Phase Domain-Specific Cognitive Function on Post-stroke Functional Recovery. Annals of Rehabilitation Medicine, 40(2), 214–222.
42.
PatelM., CoshallC., RuddA. G., & WolfeC. D. A. (2003). Natural history of cognitive impairment after stroke and factors associated with its recovery. Clinical Rehabilitation, 17(2), 158–166.
43.
PohjasvaaraT., MäntyläR., YlikoskiR., KasteM., & ErkinjunttiT. (2003). Clinical features of MRI-defined subcortical vascular disease. Alzheimer Disease and Associated Disorders, 17(4), 236–242.
44.
RasquinS. M. C., LodderJ., PondsR. W. H. M., WinkensI., JollesJ., & VerheyF. R. J. (2004). Cognitive functioning after stroke: A one-year follow-up study. Dementia and Geriatric Cognitive Disorders, 18(2), 138–144.
45.
RománG. C., & RoyallD. R. (1999). Executive control function: A rational basis for the diagnosis of vascular dementia. Alzheimer Disease and Associated Disorders, 13(Suppl 3), S69–S80.
46.
SachdevP. S., BrodatyH., ValenzuelaM. J., LorentzL. M., & KoscheraA. (2004). Progression of cognitive impairment in stroke patients. Neurology, 63(9), 1618–1623.
47.
ThijsV. N., LansbergM. G., BeaulieuC., MarksM. P., MoseleyM. E., & AlbersG. W. (2000). Is early ischemic lesion volume on diffusion-weighted imaging an independent predictor of stroke outcome? A multivariable analysis. Stroke, 31(11), 2597–2602.
48.
van ZandvoortM. J. E., KesselsR. P. C., NysG. M. S., de HaanE. H. F., & KappelleL. J. (2005). Early neuropsychological evaluation in patients with ischaemic stroke provides valid information. Clinical Neurology and Neurosurgery, 107(5), 385–392.
49.
WagleJ., FarnerL., FlekkøyK., Bruun WyllerT., SandvikL., FureB., ... EngedalK. (2011). Early post-stroke cognition in stroke rehabilitation patients predicts functional outcome at 13 months. Dementia and Geriatric Cognitive Disorders, 31(5), 379–387.
50.
WeimarC., KönigI. R., KraywinkelK., ZieglerA., & DienerH. C. (2004). Age and National Institutes of Health Stroke Scale Score within 6 hours after onset are accurate predictors of outcome after cerebral ischemia: Development and external validation of prognostic models. Stroke; a Journal of Cerebral Circulation, 35(1), 158–162.
51.
ZweckerM., LevenkrohnS., FleisigY., ZeiligG., OhryA., & AdunskyA. (2002). Mini-mental state examination, cognitive FIM instrument, and the loewenstein occupational therapy cognitive assessment: Relation to functional outcome of stroke patients. Archives of Physical Medicine and Rehabilitation, 83(3), 342–345.
