Prevalence and Profile of Poststroke Subjective Cognitive Complaints

Prevalence and predictors of persistent cognitive and psychological symptoms in non-hospitalized post-COVID-19 patients seeking care at an outpatient post-COVID-19 clinic

Introduction

There is still much uncertainty about why some people develop persistent cognitive and mental health problems after SARS-CoV-2 infection and require additional care while others do not. In this study, we investigated the cognitive and psychological outcomes of non-hospitalized post-COVID-19 patients referred to an outpatient post-COVID-19 clinic for persistent symptoms more than 3 months after infection. Additionally, we aimed to explore the influence of demographic, physical, and personal factors on these outcomes.

Methods

This cross-sectional study was conducted at an outpatient post-COVID-19 clinic located at a prominent clinical teaching hospital in the Netherlands. Participants included non-hospitalized patients referred between 2020 and 2022, more than 3 months after SARS-CoV-2 infection, experiencing persistent symptoms. Main outcome measures included levels of anxiety and depression (Hospital Anxiety and Depression Scale), post-traumatic stress symptoms (PTSS) (Post-traumatic Stress Symptoms Checklist 14), and cognitive symptoms (Checklist for Cognitive and Emotional Consequences). Data analysis employed Spearman correlation and hierarchical multiple regression analyses.

Results

A total of 265 patients (61% female; mean age of 51.7 ± 13.7 years) were included in the study, with an average of 7.6 ± 4.5 months following SARS-CoV-2 infection. Among them, 104 patients (40%) reported high levels of anxiety, 111 patients (43%) showed high levels depressive symptoms, and 71 patients (31%) demonstrated high levels of PTSS. Additionally, 200 patients (79%) reported experiencing more than 2 cognitive symptoms. Bivariate analyses indicated associations between psychiatric history and increased cognitive and psychological symptoms. Multivariate analyses revealed positive associations between physical symptoms and cognitive and psychological symptoms, and catastrophizing thoughts were associated with higher anxiety levels (β = 0.217, p < 0.001). Conversely, positive refocusing was associated with lower depressive symptoms (β = -0.325, p < 0.001), PTSS (β = -0.290, p < 0.001), and cognitive symptoms (β = -0.220, p < 0.001).

Discussion

Among non-hospitalized COVID-19 patients seeking care for persistent symptoms, approximately one-third reported high levels of psychological symptoms, and more than three-quarter experienced cognitive symptoms. Physical symptoms, psychiatric history, and a tendency to catastrophize were identified as potential risk factors for persistent psychological and cognitive symptoms. Conversely, positive refocusing demonstrated a protective effect. These findings contribute to the understanding of long-term COVID-19 outcomes and emphasize the importance of integrating a biopsychosocial perspective into treatment approaches.

Cognitive complaints in patients with untreated obstructive sleep apnea versus patients with neurological and respiratory diseases: prevalence, severity and risk factors

PURPOSE

Little is known about cognitive complaints (self-reported problems in cognitive functioning) in patients with Obstructive Sleep Apnea (OSA). We compared the prevalence and severity of cognitive complaints in patients with untreated OSA to patients with neurological and respiratory diseases. We also studied risk factors for cognitive complaints across these diseases, including OSA.

METHODS

We used a convenience sample to compare untreated OSA patients (N = 86) to patients with stroke (N = 166), primary brain tumor (N = 197) and chronic obstructive pulmonary disease (COPD, N = 204) on cognitive complaints (Cognitive Failure Questionnaire, CFQ), anxiety and depression (Hospital Anxiety and Depression Scale, HADS) and cognitive impairments using neuropsychological tests. We combined all patient groups (OSA, stroke, brain tumor and COPD) and studied potential risk factors (demographic variables, anxiety, depression and cognitive impairments) for cognitive complaints across all patient groups using regression analysis.

RESULTS

The prevalence of cognitive complaints was higher in OSA patients and complaints of forgetfulness and distractibility were more severe compared to stroke and primary brain tumor patients, but similar to or lower than COPD patients. Regression analysis for the combined sample of all patient groups showed that cognitive complaints were most strongly associated with symptoms of anxiety and depression.

CONCLUSION

A high rate of OSA reported clinically significant cognitive complaints, comparable to other respiratory and neurological patients. Symptoms of anxiety and depression are important risk factors for cognitive complaints in patients with various neurological and respiratory diseases. Future studies should examine the relation between anxiety, depression and cognitive complaints in patients with OSA.

A Biopsychosocial Approach to Persistent Post-COVID-19 Fatigue and Cognitive Complaints: Results of the Prospective Multicenter NeNeSCo Study

OBJECTIVE

To evaluate whether psychological and social factors complement biomedical factors in understanding post-COVID-19 fatigue and cognitive complaints. Additionally, to incorporate objective (neuro-cognitive) and subjective (patient-reported) variables in identifying factors related to post-COVID-19 fatigue and cognitive complaints.

DESIGN

Prospective, multicenter cohort study.

SETTING

Six Dutch hospitals.

PARTICIPANTS

205 initially hospitalized (March-June 2020), confirmed patients with SARS-CoV-2, aged ≥18 years, physically able to visit the hospital, without prior cognitive deficit, magnetic resonance imaging (MRI) contraindication, or severe neurologic damage post-hospital discharge (N=205).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Nine months post-hospital discharge, a 3T MRI scan and cognitive testing were performed and patients completed questionnaires. Medical data were retrieved from medical dossiers. Hierarchical regression analyses were performed on fatigue severity (Fatigue Severity Scale; FSS) and cognitive complaints (Cognitive Consequences after Intensive Care Admission; CLC-IC; dichotomized into CLC-high/low). Variable blocks: (1) Demographic and premorbid factors (sex, age, education, comorbidities), (2) Illness severity (ICU/general ward, PROMIS physical functioning [PROMIS-PF]), (3) Neuro-cognitive factors (self-reported neurological symptoms, MRI abnormalities, cognitive performance), (4) Psychological and social factors (Hospital Anxiety and Depression Scale [HADS], Utrecht Coping List, Social Support List), and (5) Fatigue or cognitive complaints.

RESULTS

The final models explained 60% (FSS) and 48% (CLC-IC) variance, with most blocks (except neuro-cognitive factors for FSS) significantly contributing. Psychological and social factors accounted for 5% (FSS) and 11% (CLC-IC) unique variance. Higher FSS scores were associated with younger age (P=.01), lower PROMIS-PF (P<.001), higher HADS-Depression (P=.03), and CLC-high (P=.04). Greater odds of CLC-high were observed in individuals perceiving more social support (OR=1.07, P<.05).

CONCLUSIONS

Results show that psychological and social factors add to biomedical factors in explaining persistent post-COVID-19 fatigue and cognitive complaints. Objective neuro-cognitive factors were not associated with symptoms. Findings highlight the importance of multidomain treatment, including psychosocial care, which may not target biologically-rooted symptoms directly but may reduce associated distress.

Prevalence and trajectories of neuropsychological post-COVID-19 symptoms in initially hospitalized patients

OBJECTIVE

To investigate the prevalence and trajectories of post-COVID-19 neuropsychological symptoms.

DESIGN

Prospective longitudinal multicentre cohort study.

SUBJECTS

A total of 205 patients initially hospitalized with SARS-CoV-2 (COVID-19).

METHODS

Validated questionnaires were administered at 9 months (T1) and 15 months (T2) post-hospital discharge to assess fatigue, cognitive complaints, insomnia, anxiety, depression, and post-traumatic stress symptoms.

RESULTS

Analyses included 184 out of 205 patients. Approximately 50% experienced high cognitive complaints at T1 and T2, while severe fatigue affected 52.5% at T1 and 55.6% at T2. Clinically relevant insomnia scores were observed in 25% of patients at both time-points. Clinically relevant anxiety scores were present in 18.3% at T1 and 16.7% at T2, depression in 15.0% at T1 and 18.9% at T2, and PTSD in 12.4% at T1 and 11.8% at T2. Most symptoms remained stable, with 59.2% of patients experiencing at least 1 persistent symptom. In addition, 31.5% of patients developed delayed-onset symptoms.

CONCLUSION

Post-COVID-19 cognitive complaints and fatigue are highly prevalent and often persist. A subgroup develops delayed symptoms. Emotional distress is limited. Screening can help identify most patients experiencing long-term problems. Future research should determine risk factors for persistent and delayed onset symptoms.

Dual-task versus single-task gait rehabilitation after stroke: the protocol of the cognitive-motor synergy multicenter, randomized, controlled superiority trial (SYNCOMOT)

BACKGROUND

Gait disorders and cognitive impairments are prime causes of disability and institutionalization after stroke. We hypothesized that relative to single-task gait rehabilitation (ST GR), cognitive-motor dual-task (DT) GR initiated at the subacute stage would be associated with greater improvements in ST and DT gait, balance, and cognitive performance, personal autonomy, disability, and quality of life in the short, medium and long terms after stroke.

METHODS

This multicenter (n=12), two-arm, parallel-group, randomized (1:1), controlled clinical study is a superiority trial. With p<0.05, a power of 80%, and an expected loss to follow-up rate of 10%, the inclusion of 300 patients will be required to evidence a 0.1-m.s-1 gain in gait speed. Trial will include adult patients (18-90 years) in the subacute phase (0 to 6 months after a hemispheric stroke) and who are able to walk for 10 m (with or without a technical aid). Registered physiotherapists will deliver a standardized GR program (30 min three times a week, for 4 weeks). The GR program will comprise various DTs (phasic, executive function, praxis, memory, and spatial cognition tasks during gait) in the DT (experimental) group and gait exercises only in the ST (control) group. The primary outcome measure is gait speed 6 months after inclusion. The secondary outcomes are post-stroke impairments (National Institutes of Health Stroke Scale and the motor part of the Fugl-Meyer Assessment of the lower extremity), gait speed (10-m walking test), mobility and dynamic balance (timed up-and-go test), ST and DT cognitive function (the French adaptation of the harmonization standards neuropsychological battery, and eight cognitive-motor DTs), personal autonomy (functional independence measure), restrictions in participation (structured interview and the modified Rankin score), and health-related quality of life (on a visual analog scale). These variables will be assessed immediately after the end of the protocol (probing the short-term effect), 1 month thereafter (the medium-term effect), and 5 months thereafter (the long-term effect).

DISCUSSION

The main study limitation is the open design. The trial will focus on a new GR program applicable at various stages after stroke and during neurological disease.

TRIAL REGISTRATION

NCT03009773 . Registered on January 4, 2017.

Measurement properties of performance-based instruments to assess mental function during activity and participation in persons who have survived a stroke: A systematic review protocol

BACKGROUND

A frequent consequence of stroke is impaired mental function, which often affects the ability to perform activities and participate in life situation. In occupational therapy practice, performance-based instruments during activity and participation are often used. However, it is important to assess if the instruments used are valid, reliable and responsive.

OBJECTIVE

The objective of this systematic review is to investigate measurement properties of performance-based instruments to assess mental function during activity and participation in persons who have survived stroke.

MATERIAL AND METHODS

Systematic database searches of PubMed, EMBASE, CINAHL, PsycINFO, and OTseeker will be conducted. COSMIN Risk of Bias checklist will be used to evaluate methodological quality of the included articles. Measurement properties of the included studies will be rated against criteria for good measurement properties. The overall evidence of each measurement property per instrument is graded using a modified GRADE approach.

RESULTS

Results will be presented in text and tables.

CONCLUSIONS

Conclusion will be drawn up-on the overall evidence to give recommendations on the most suitable instrument.

SIGNIFICANCE

It is expected that findings of the review will provide evidence to guide professionals in the selection of a performance-based instruments to measure mental function in practice and research.

TRIAL REGISTRATION NUMBER

PROSPERO CRD42018086744.

Subacute cognitive impairment after first-ever transient ischemic attack or ischemic stroke in young adults: The ODYSSEY study

Introduction:

We aimed to investigate the prevalence of cognitive impairment in the subacute phase after transient ischemic attack (TIA) and ischemic stroke (IS), factors associated with a vascular cognitive disorder, and the prevalence of subjective cognitive complaints and their relation with objective cognitive performance.

Patients and methods:

In this multicenter prospective cohort study, we recruited patients with first-ever TIA and IS, aged 18–49 years, between 2013 and 2021 for cognitive assessment up to 6 months after index event. We calculated composite Z-scores for seven cognitive domains. We defined cognitive impairment as a composite Z-score < −1.5. We defined major vascular cognitive disorder as a Z-score < −2.0 in one or more cognitive domains.

Results:

Fifty three TIA and 545 IS patients completed cognitive assessment with mean time to assessment of 89.7 (SD 40.7) days. The median NIHSS at admission was 3 (interquartile range, 1–5). Cognitive impairment was common in five domains (up to 37%), with similar proportion in TIA and IS patients. Patients with major vascular cognitive disorder had a lower education level, higher NIHSS scores and more frequent lesions in the left frontotemporal lobe than without vascular cognitive disorder ( p < 0.05 FDR-corrected). Subjective memory and executive cognitive complaints were present in about two-thirds of the patients, but were weakly associated with objective cognitive performance (β: −0.32 and −0.21, respectively).

Discussion and conclusion:

In the subacute phase after TIA or stroke in young adults, cognitive impairment and subjective cognitive complaints are prevalent, but they are weakly associated with each other.

Can subjective cognitive complaints at three months post stroke predict alteration in information processing speed during the first year?

Cognitive impairment, particularly slowing of information processing speed (IPS), is prevalent after stroke. However, the link between subjective cognitive complaints (SCC) and cognitive deficit remains unclear. This study evaluated the link between SCC at three months post stroke and deficit as well as objective alterations in IPS in the first year post stroke. Patients (N = 200) and healthy controls (N = 105) took part in the COMPlaints After Stroke study (COMPAS). SCC, IPS and depression were evaluated at 3 months, 1 and 2 years post stroke. The Reliable Change Index was used to assess change in IPS in the first year post. Approximately one out of three patients showed deficit in IPS irrespective of time post stroke, while a change in IPS (N = 117) over time was relatively uncommon. SCC at three months post stroke did not predict change in IPS between three months and one year post stroke, where depressive symptoms did show a link. Cross sectional data showed a deficit in IPS in a substantial number of stroke patients irrespective of the point in time. Longitudinal data revealed a further decline in a small subgroup in the first year post stroke, which was not predicted by SCC at three months post stroke. The findings show that, irrespective of time post stroke and even when stroke is relatively mild, impairment in IPS is prevalent, but cannot be predicted by the complaints patients express. The link with depressive symptoms needs more exploration.

Long-term psychosocial outcome following mild traumatic brain injury and minor stroke: a direct longitudinal comparison

Background and purpose

Research suggests comparable long-term psychosocial outcomes following mild traumatic brain injury (mTBI) and minor stroke, but no direct comparison has been made. This study aimed to directly compare psychosocial outcome over time in persons with mTBI and minor stroke.

Methods

In this multicenter, prospective longitudinal cohort study, community-dwelling persons with mTBI (n = 182) and minor stroke (n = 48) were assessed at 6 weeks, 3, 6 and 12 months post-injury. Outcome measures included anxiety and depression symptoms (Hospital Anxiety and Depression Scale—HADS), cognitive problems in daily life (Checklist for Cognitive and Emotional Consequences of Stroke—CLCE-24) and quality of life (EuroQol-5D-5L—EQ-5D-5L). Multilevel growth curve modeling, controlled for demographic variables, was used to determine outcomes over time between groups. Proportions of persons reporting persistent psychosocial symptoms at 6 months post-injury were compared using Pearson’s Chi-squared tests.

Results

Improvements in outcomes were observed in the first 6 months and effects stabilized to 12 months post-injury in both groups. Minor stroke cases reported significantly higher levels of HADS anxiety and a significantly reduced increase in EQ-5D-5L utility scores than mTBI cases, but differences were small in absolute numbers. No significant differences were observed between groups regarding HADS depression and CLCE-24 cognition scores. Proportions of persons reporting persistent psychosocial symptoms were equal between groups.

Conclusions

Psychosocial outcome is largely comparable following mTBI and minor stroke. Specific attention should be paid to anxiety symptoms and cognitive problems in daily life for which uniform aftercare seems appropriate.

Which approach to measure cognitive functioning should be preferred when exploring the association between cognitive functioning and participation after stroke?

A variety of approaches are currently used to explore the relationship between cognitive functioning and participation after stroke. We aimed to gain insight into the preferred approach to measure cognitive functioning when exploring the association between cognitive functioning and participation in the long term after stroke. In this inception cohort study 128 individuals with stroke participated and were assessed at a single time point three to four years after the event. Participation was measured using the Restrictions subscale of the Utrecht Scale for Evaluation of Rehabilitation-Participation. Subjective cognitive complaints were assessed using the Cognition subscale of the Checklist for Cognitive and Emotional Consequences (CLCE-24-C). Objective cognitive performance was measured using the Montreal Cognitive Assessment (MoCA) and a neuropsychological test battery (NTB) testing multiple cognitive domains. Participation showed a strong correlation (r = 0.51) with the CLCE-24-C and moderate correlations with the domains of visuospatial perception (r = 0.37) and mental speed (r = 0.36). Backward linear regression analyses showed that participation restrictions were best explained by the combination of the CLCE-24-C and a test for visuospatial perception (R²= 0.31). Our findings suggest the use of a combination of subjective cognitive complaints and objective cognitive performance to explore the relationship between cognitive functioning and participation after stroke.

Systematic review of subjective memory measures to inform assessing memory limitations after stroke and stroke-related aphasia

AIM

Primary aims of this systematic review were to: (1) identify the range of subjective memory measures used in the stroke and stroke-related aphasia literature and (2) critically appraise their psychometric properties as well as (3) the methodological qualities of studies that included them, (4) investigate whether such measures provide an accurate reflection of memory impairments (i.e., in comparison to norms from age-matched, neurotypical participants), (5) document the representation of individuals with stroke-related aphasia, and (6) examine the extent to which subjective memory measures correlate with objective memory measures.

METHODS

Systematic review of the literature from 1970 to June 2019 using a comprehensive range of relevant search terms in EMBASE, Medline, PsychINFO, SCOPUS, and Web of Science. Eligibility criteria were for studies to include adults who had suffered of clinical stroke, to report a subjective memory measure that was completed by the stroke survivors, to be reported in a peer-reviewed journal, and to be published in English or Dutch. Quality appraisal was carried out for the included studies as well as the subjective memory measures they employed.

RESULTS

A total of 7,077 titles or abstracts were screened, with 41 studies included in the quantitative and qualitative synthesis. Twenty-six subjective memory measures were used in the included studies. The critical appraisal of their psychometric properties and the methodological quality of the included studies revealed significant shortcomings; for example, neurotypical participants were included in only 14 of the 41 studies. When statistical comparisons were made, different outcomes arose. Only eight studies statistically compared subjective with objective memory measures.

CONCLUSIONS

This literature domain currently provides an unclear picture as to how memory limitations affect participation in stroke and stroke-related aphasia.IMPLICATIONS FOR REHABILITATIONA broad range of subjective memory measures have been used to determine stroke survivors' perceptions of their everyday memory issues.Because of psychometric weaknesses such as inadequate reliability and cross-cultural validity among subjective memory measures, there remains a need to carefully review a given measure's properties to determine if it is appropriate for use with a given stroke survivor.Stroke survivors with aphasia have been infrequently included or inadequately described in studies of subjective memory measures, and thus how these individuals perceive their everyday memory abilities requires further investigation.Although the relationship between subjective and objective memory measures has been infrequently investigated by stroke researchers, both types of measures should be considered as they likely offer complementary rather than redundant information about stroke survivors' memory abilities.

Subjective cognitive functioning in patients with a meningioma: Its course and association with objective cognitive functioning and psychological symptoms

OBJECTIVE

Although meningioma patients show deficits in objective cognitive functioning (OCF) measured with neuropsychological tests, subjective cognitive functioning (SCF) has received little attention. We investigate SCF from pre- to postsurgery and its associations with OCF, psychological, sociodemographic, and clinical characteristics.

METHODS

SCF was measured using the Cognitive Failures Questionnaire (CFQ) 1 day before (T0) and 3 (T3) and 12 months (T12) after surgery. Patients' scores were compared with normative data and changes over time were assessed. The neuropsychological battery CNS Vital Signs and the Hospital Anxiety and Depression Scale were administered. Correlations of SCF with OCF, psychological, sociodemographic, and clinical characteristics were explored.

RESULTS

Patients reported significantly better SCF as compared with controls at T0 (N = 54) and T3 (N = 242), but not at T12 (N = 50). A significant decrease in group level SCF was observed from T0 to T12 (n = 24, P < .001). SCF was associated with anxiety at all time points (rs = -0.543 to -0.352) and with depression at T3 and T12 (r = -0.338 and -0.574), but not with OCF, sociodemographic, or clinical characteristics (rs = -0.202 to 0.288).

CONCLUSIONS

Meningioma patients experienced better SCF as compared with controls before and 3 months after surgery, which might be the result of phenomena related to disease and recovery. As the findings suggest that cognitive symptoms might increase later on, future studies should further investigate the course of SCF in meningioma patients. In clinical practice, measurements of SCF should be combined with those of OCF and psychological distress in order to determine whether and which interventions are needed.

Stroke Induces a BDNF-Dependent Improvement in Cognitive Flexibility in Aged Mice

Stroke remains a leading cause of disability worldwide. Recently, we have established an animal model of stroke that results in delayed impairment in spatial memory, allowing us to better investigate cognitive deficits. Young and aged brains show different recovery profiles after stroke; therefore, we assessed aged-related differences in poststroke cognition. As neurotrophic support diminishes with age, we also investigated the involvement of brain-derived neurotrophic factor (BDNF) in these differences. Young (3-6 months old) and aged (16-21 months old) mice were trained in operant touchscreen chambers to complete a visual pairwise discrimination (VD) task. Stroke or sham surgery was induced using the photothrombotic model to induce a bilateral prefrontal cortex stroke. Five days poststroke, an additional cohort of aged stroke animals were treated with intracerebral hydrogels loaded with the BDNF decoy, TrkB-Fc. Following treatment, animals underwent the reversal and rereversal task to identify stroke-induced cognitive deficits at days 17 and 37 poststroke, respectively. Assessment of sham animals using Cox regression and log-rank analyses showed aged mice exhibit an increased impairment on VD reversal and rereversal learning compared to young controls. Stroke to young mice revealed no impairment on either task. In contrast, stroke to aged mice facilitated a significant improvement in reversal learning, which was dampened in the presence of the BDNF decoy, TrkB-Fc. In addition, aged stroke control animals required significantly less consecutive days and correction trials to master the reversal task, relative to aged shams, an effect dampened by TrkB-Fc. Our findings support age-related differences in recovery of cognitive function after stroke. Interestingly, aged stroke animals outperformed their sham counterparts, suggesting reopening of a critical window for recovery that is being mediated by BDNF.

Participation and the Role of Neuropsychological Functioning in Myotonic Dystrophy Type 1

BACKGROUND

Myotonic Dystrophy type 1 (DM1) is primarily a neuromuscular disease but can also have neuropsychological consequences (i.e.cognitive, emotional and behavioural) which can influence daily living and societal participation. Not much is known about the level of participation of DM1 patients and their relatives and the factors influencing participation. This information can guide the development of rehabilitation programs and identify those at risk of long-term participation problems.

OBJECTIVE

To investigate the level of participation of DM1 patients and their partners and the determinants.

METHODS

Cross-sectional study using the Utrecht Scale for Evaluation of Rehabilitation-Participation. Determinants were demographic, disease related, and neuropsychological characteristics. Spearman correlations and backward multiple regression analyses were performed.

RESULTS

Of the 66 DM1 participants, 54% reported severe fatigue and 47% apathy. Experienced participation restrictions were most prevalent in housekeeping (74%), sports (68%) and outdoor activities (55%). Participants were relatively satisfied with their level of participation, but dissatisfaction occurred mostly in housekeeping (58%), outdoor activities (55%), and sports (54%). Age and apathy were significant predictors of frequency of (R2 = 10.4) and restrictions in participation in the multivariate model (R2 = 14.4). Emotional functioning was the only significant predictor of satisfaction with participation (R2 = 23.8).

CONCLUSIONS

A considerable number of DM1 patients have Central Nervous System-related problems such as fatigue and apathy in addition to neuromuscular restrictions. Risk factors for lower participation are age, apathy, and emotional problems. Physical as well as neuropsychological rehabilitation programs are recommended.

Psychological factors and subjective cognitive complaints after stroke: Beyond depression and anxiety

Subjective Cognitive Complaints (SCC) are common after stroke and adversely affect quality of life. In the present study, we determined the associations of depression, anxiety, perceived stress and fatigue with post-stroke SCC, and whether these associations were independent of objective cognitive functioning, stroke characteristics and individual differences in personality traits and coping styles. Using a cross-sectional design, SCC and psychological measures were obtained in 208 patients (mean 3.3 ± 0.5 months after stroke; 65.9% men; mean age 64.9 ± 12.4 years). SCC were assessed using the Checklist for Cognitive and Emotional consequences following stroke (CLCE) inventory. Validated questionnaires were used to measure depression and anxiety (Hospital Anxiety and Depression Scale), perceived stress (Perceived Stress Scale), fatigue (Fatigue Assessment Scale), personality traits (Eysenck Personality Questionnaire Revised Short Scale) and coping style (Utrecht Coping List). Multivariate hierarchical linear regression analyses were used to adjust for covariates. Depression (β = 0.35), anxiety (β = 0.38), perceived stress (β = 0.39), and fatigue (β = 0.39) were associated with CLCE scores, independent of demographic, cognitive performance and stroke-related covariates. After including personality traits and coping styles in the model, independent associations with CLCE scores were found for fatigue (β = 0.26, p = .003) and neuroticism (β = 0.21, p = .05). Interventions aimed at improving psychological resilience and increasing energy levels might be a worthwhile addition to stroke rehabilitation programmes by reducing SCC and improving quality of life.

The influence of computer-based cognitive flexibility training on subjective cognitive well-being after stroke: A multi-center randomized controlled trial

Background

Stroke can result in cognitive complaints that can have a large impact on quality of life long after its occurrence. A number of computer-based training programs have been developed with the aim to improve cognitive functioning. Most studies investigating their efficacy used only objective outcome measures, whereas a reduction of subjective cognitive complaints may be equally important for improving quality of life. A few studies used subjective outcome measures but were inconclusive, partly due to methodological shortcomings such as lack of proper active and passive control groups.

Objective

The aim of the current study was to investigate whether computer-based cognitive flexibility training can improve subjective cognitive functioning and quality of life after stroke.

Methods

We performed a randomized controlled double blind trial (RCT). Adults (30–80 years old) who had a stroke 3 months to 5 years ago, were randomly assigned to either an intervention group (n = 38), an active control group (i.e., mock training; n = 35), or a waiting list control group (n = 24). The intervention and mock training consisted of 58 half-hour sessions within 12 weeks. The primary subjective outcome measures were cognitive functioning (Cognitive Failure Questionnaire), executive functioning (Dysexecutive Functioning Questionnaire), quality of life (Short Form Health Survey), instrumental activities of daily living (IADL; Lawton & Brody IADL scale), and participation in society (Utrecht Scale for Evaluation of Rehabilitation-Participation). Secondary subjective outcome measures were recovery after stroke, depressive symptoms (Hospital Anxiety Depression Scale—depression subscale), fatigue (Checklist Individual Strength—Fatigue subscale), and subjective cognitive improvement (exit list). Finally, a proxy of the participant rated the training effects in subjective cognitive functioning, subjective executive functioning, and IADL.

Results and conclusions

All groups improved on the two measures of subjective cognitive functioning and subjective executive functioning, but not on the other measures. These cognitive and executive improvements remained stable 4 weeks after training completion. However, the intervention group did not improve more than the two control groups. This suggests that improvement was due to training-unspecific effects. The proxies did not report any improvements. We, therefore, conclude that the computer-based cognitive flexibility training did not improve subjective cognitive functioning or quality of life after stroke.

The role of objective cognitive dysfunction in subjective cognitive complaints after stroke

BACKGROUND AND PURPOSE

Objective cognitive performance (OCP) is often impaired in patients post-stroke but the consequences of OCP for patient-reported subjective cognitive complaints (SCC) are poorly understood. We performed a detailed analysis on the association between post-stroke OCP and SCC.

METHODS

Assessments of OCP and SCC were obtained in 208 patients 3 months after stroke. OCP was evaluated using conventional and ecologically valid neuropsychological tests. Levels of SCC were measured using the CheckList for Cognitive and Emotional (CLCE) consequences following stroke inventory. Multivariate hierarchical regression analyses were used to evaluate the association of OCP with CLCE scores adjusting for age, sex and intelligence quotient. Analyses were performed to examine the global extent of OCP dysfunction (based on the total number of impaired neuropsychological tests, i.e. objective cognitive impairment index) and for each OCP test separately using the raw neuropsychological (sub)test scores.

RESULTS

The objective cognitive impairment index for global OCP was positively correlated with the CLCE score (Spearman's rho = 0.22, P = 0.003), which remained significant in multivariate adjusted models (β = 0.25, P = 0.01). Results for the separate neuropsychological tests indicated that only one task (the ecologically valid Rivermead Behavioural Memory Test) was independently associated with the CLCE in multivariate adjusted models (β = -0.34, P < 0.001).

CONCLUSIONS

Objective neuropsychological test performance, as measured by the global dysfunction index or an ecologically valid memory task, was associated with SCC. These data suggest that cumulative deficits in multiple cognitive domains contribute to subjectively experienced poor cognitive abilities in daily life in patients post-stroke.

How Do Persons with Mild Acquired Cognitive Impairment Use Information and Communication Technology and E-Services? Results from a Swedish National Survey

Introduction

Mild acquired cognitive impairment is a term used to describe a sub-group of persons with mild cognitive impairment who are expected to reach a stable cognitive level over time. One tactic that can be considered for further developing treatment for this group is the use of information and communication technology and e-services. The purpose of this study was to investigate the current use of regular e-services and social media by this group as well as their user experiences.

Methods and Materials

Data were collected through a self-administered survey and analyzed using quantitative methods. The questionnaire included questions regarding the participants’ use of and experience with e-services. Categorization of e-services was based on and cross-validated with the International Classification of Functioning, Disability and Health (ICF). To estimate participants’ degree and type of impairment, the Cognitive Failure Questionnaire (CFQ), measuring cognitive difficulties in performing everyday tasks, was added.

Results

In total, 282 persons with acquired brain injury participated in the survey. The participants’ CFQ scores showed that they were suffering from mild to moderate cognitive impairments, most often acquired from traumatic brain injuries (40%). The majority (89%) used e-services in different categories whereof the most popular and essential ones were communication services (59%) and banking (39%) services. Participants with higher total CFQ scores (>58) used more e-services in most of the categories compared to participants with lower scores (<31). Although participants were interested in social media, they were annoyed by advertisements and the Internet speed in general. Some participants reported privacy concerns and addictive behavior. However, they mostly considered e-services to be trustworthy and supportive in different contexts. The usage of electronic devices decreased by age with the exception of electronic tablets that were used by older participants approximately as frequently as by other age groups.

Conclusions

Although persons with mild to moderate acquired brain injury used various e-services that are not customized for them, very few participants used self-care health services (apps) and readers (e-readers). Further studies are needed on utilizing these identified aspects for this group to support them with their chronic condition.