- 1School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- 2University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- 3School of Behavioural, Social and Legal Sciences, Örebro University, Örebro, Sweden
- 4School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
- 5Department of Prosthetics and Orthotics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
Purpose: The aim was to investigate the
associations between cognitive impairment and biopsychosocial factors
among older stroke survivors and predictors of poststroke return to
daily life.
Materials and methods: This cross-sectional study
involved 117 stroke survivors (61% men) with an average age of 77 years
(range 65–91). The participants completed two questionnaires
(Riksstroke and Short Form 36 questionnaires). The Montreal Cognitive
Assessment (MoCA) was used to assess cognitive abilities. The
International Classification of Functioning, Disability, and Health
(ICF) framework guided the selection of biopsychosocial variables. We
used Spearman’s correlation coefficient and multiple logistic regression
in the analyses.
Results: The average MoCA score was 21.7 points
(range: 4–30, SD 5.6). The need for assistance from relatives and
professionals, need for help with dressing and household chores,
reliance on others for mobility, and reading and balance problems were
correlated with more severe cognitive impairment (r = 0.20–0.33).
Cognitive impairment, fatigue, and balance issues predicted an
unfavorable return to daily life (odds ratio: 6.2–6.8).
Conclusion: The study indicated that cognitive
impairment is associated with difficulties in all ICF domains. Cognitive
impairment, fatigue, and balance issues are associated with an
unsuccessful return to daily life. Prioritizing these factors and
screening for cognitive impairment with objective assessment tools may
improve rehabilitation outcomes and enhance overall quality of life
poststroke.
Introduction
Stroke is a leading cause of long-term disability worldwide, impacting the lives of more than 100 million individuals (1, 2).
Stroke disrupts cerebral blood flow, causing tissue damage and
neurological deficits. The neuroplasticity enables the brain to adapt
and reorganize post-stroke, aiding recovery (3)
but a common consequence of stroke is poststroke cognitive impairment
(PSCI). PSCI is a broad term that includes conditions ranging from mild
cognitive impairment to dementia. Common disorders are problems with
memory, attention, executive abilities, language, visual processing, and
information management (4, 5). Usually, PSCI occurs within 3 months post-stroke, but can also develop over time (3). One year after stroke onset, one in four stroke survivors has PSCI (6, 7), and approximately seven of 10 stroke survivors will develop PSCI over time (8). PSCI often gives negative consequences on problem solving, organized planning and social interaction (9, 10),
which has a negative effect on individuals’ overall health and
well-being. There is a prioritized and ongoing global effort to
understand the complexity of PSCI and develop interventions to prevent
cognitive decline (11). PSCI predominantly affects the older population, which is growing globally (11, 12), making it a priority in stroke research (11).
An emerging issue in stroke research is investigating how cognitive
function is connected to other biopsychosocial factors to develop
personalized interventions (4).
Previous research has indicated that PSCI affects
several biopsychosocial aspects. It affects the overall recovery process
poststroke due to the negative impact on the body’s motor function
recovery (13).
PSCI makes it more challenging to participate in physical
rehabilitation; therefore, persons with PSCI are less physically active (14). Individuals with PSCI are also more prone to psychological deficits such as depression and fatigue (15, 16), which further affects their ability to engage in various leisure and social activities (17).
PSCI affects both basic and instrumental activities of daily living,
such as dressing, performing personal hygiene and household chores, and
cooking (18). It also impairs communication (19), participation in social activities and interactions with others (18, 20).
Despite extensive PSCI research, the understanding of how different
levels of PSCI affect biopsychosocial factors in older stroke survivors
is incomplete. There is also limited research exploring which factors
are associated with a successful return to daily life for older persons
with PSCI. Previous studies investigating factors associated with return
to daily life and leisure activities after stroke have shown that
cognitive ability, age, and mobility are important factors (21, 22). However, most related studies have focused on younger stroke survivors (23, 24).
This study adopted a biopsychosocial perspective and used the International Classification of Functioning, Disability and Health (ICF) model (25)
as a framework. This approach was chosen to capture the complexity of
the interaction between PSCI and daily life. The study aimed to
investigate (1) the associations between levels of cognitive impairment
and biopsychosocial factors and (2) how these factors are associated
with return to daily life. Through comprehensive insights into these
biopsychosocial factors, poststroke well-being and recovery can be
enhanced, allowing for tailored interventions for affected individuals.
More at link.
