title: Early cognitive impairment predicts long-term depressive symptoms and quality of life after stroke.
abstract: OBJECTIVE
  The aim of the present study was to examine the predictive value of cognitive impairment in the acute phase after stroke as a risk factor for long-term (six to ten months after stroke) depressive symptoms (DS) and a reduced quality of life (QOL), independent of demographic and neurological predictors.
  
  
  METHODS
  We evaluated 143 patients within the first 3 weeks post-stroke. Predictor variables included domain-specific cognitive function, demographic data, vascular risk factors, lesion characteristics, and clinical factors. Predictor variables associated with long-term DS (Montgomery Asberg Depression Rating Scale >or=7) and QOL (Stroke-Specific Quality of Life Scale) were identified with multiple logistic and linear regression.
  
  
  RESULTS
  Long-term DS were independently predicted by cognitive impairment at baseline, DS at baseline, female sex, diabetes mellitus, and previous TIA(s). Cognitive impairment, increasing age, and functional dependence predicted a reduced QOL, whereas hypercholesterolaemia predicted a better QOL. Among all cognitive disorders, unilateral neglect was the greatest risk factor for DS after 6 months, whereas a disorder in visual perception and construction affected QOL the most.
  
  
  CONCLUSIONS
  Cognitive impairment and vascular risk factors are important predictors of long-term DS and QOL after stroke. The prognostic value of cognition suggests a reactive component in the development or continuation of long-term DS.
authors.affiliation: Psychological Laboratory, Helmholtz Institute, Utrecht University, The Netherlands. g.nys@fss.uu.nl
authors.forename: G M S
authors.initials: GM
authors.lastname: Nys
authors.forename: M J E
authors.initials: MJ
authors.lastname: van Zandvoort
authors.forename: H B
authors.initials: HB
authors.lastname: van der Worp
authors.forename: E H F
authors.initials: EH
authors.lastname: de Haan
authors.forename: P L M
authors.initials: PL
authors.lastname: de Kort
authors.forename: B P W
authors.initials: BP
authors.lastname: Jansen
authors.forename: L J
authors.initials: LJ
authors.lastname: Kappelle
mesh_terms: D000368:Aged; D003072:Cognition Disorders / Q000209:etiology*; D003710:Demography; D003863:Depression / Q000175:diagnosis* / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D011788:Quality of Life; D012307:Risk Factors; D012737:Sex Factors; D020521:Stroke / Q000150:complications / Q000503:physiopathology* / Q000523:psychology*; D014652:Vascular Diseases / Q000150:complications