Baseline Function and Rehabilitation Are as Important as Stroke Severity as Long-term Predictors of Cognitive Performance Post-stroke.
Sophia G Girgenti, Autumn O Brunson, Elisabeth B Marsh
PMID 36634330WHAT IT FOUND
After minor stroke, cognition often improved over 12 months, but verbal memory stayed low and recovery varied by domain.
Pre-stroke function and rehabilitation were linked to later improvement, not stroke severity alone.
Key findings
01At one month, 46% had MoCA scores below 26; at six months 38% were impaired, and by 12 months nearly 50% showed some impairment.
02Verbal memory scores improved from 30.6 to 35.1 but stayed below the normal average of 50, while spatial memory scores rose from 20.7 to 48.3.
03Ninety-four percent improved in global cognition between 1 and 12 months, but only 57% improved between 6 and 12 months; pre-stroke function was significantly associated with overall improvement, while stroke severity, one-month MoCA, and rehabilitation trended toward importance.
STILL TO COME
How it was doneWhat they foundWhat it means for OTs
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What it does not show
The analysis included 46 of 133 enrolled patients, so it is a small single-center study. Nine patients were missing 6-month data because of COVID-19 clinic limits. Because the sample was small, some predictors were only trends, not significant results. Baseline cognition before stroke was unknown, so norms were used to judge recovery. Repeated testing could have produced practice effects, although alternate forms were used when possible. Rehabilitation was not standardized and was outpatient only, so the study cannot separate rehabilitation type, amount, or timing. Patients with aphasia, neglect, non-native English, prior dementia, prior stroke, or major psychiatric or neurological conditions were excluded, so results may not apply to those groups.
Declared interests
The authors report no disclosures related to this work. The article is listed as NIH extramural and non-U.S. government research support.
The easy way to misread this
Do not read the observed cognitive improvements as proof that rehabilitation or a specific therapy works. Patients were followed over time, not assigned to treatment groups, therapy was individualized and outpatient only, and only 57% improved between 6 and 12 months.