The impact of cognitive function deficits and their recovery on functional outcome in subjects affected by ischemic subacute stroke: results from the Italian multicenter longitudinal study CogniReMo.
Mauro Mancuso, Marco Iosa, Laura Abbruzzese and 15 others
PMID 37184413WHAT IT FOUND
Patients who recovered executive function during rehab improved their independence as much as those who never had a deficit.
Those who kept the deficit improved significantly less. Screening for and targeting executive function may be key to functional recovery.
Key findings
01Recovery of executive function deficits during neurorehabilitation was associated with a level of effectiveness in improving Barthel Index scores not significantly different from patients who had no deficit at admission.
02Patients who had and maintained a deficit in executive functions showed significantly lower effectiveness of rehabilitation in terms of Barthel Index improvement.
03Higher admission Barthel Index, better attention performance, and lower limb motor function were significant predictors of a good functional outcome at discharge.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
As an observational study, it cannot prove that treating executive function causes better outcomes; it only shows an association. Patients received a bundle of conventional therapies (physiotherapy, occupational therapy, cognitive training), so the specific contribution of any single component to the observed recovery cannot be separated. There may have been differences in how the conventional cognitive and neuromotor therapy was administered across the sixteen centers. The study did not account for depression, personality changes, or behavioral impairments, which can influence rehabilitation participation and outcomes. The prediction model was not validated on an external dataset.
Declared interests
The authors declared no conflicts of interest with any financial organization regarding the material discussed in the manuscript.
The easy way to misread this
Do not assume that cognitive deficits are only a secondary issue to be managed. The study suggests that the recovery of executive function is closely tied to physical independence. However, because this was an observational study of mixed rehabilitation, it does not prove that specific cognitive exercises caused the functional gains.