Early cognitive impairment predicts long-term depressive symptoms and quality of life after stroke.
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.
Nys
G M S
GM
Psychological Laboratory, Helmholtz Institute, Utrecht University, The Netherlands. g.nys@fss.uu.nl
van Zandvoort
M J E
MJ
van der Worp
H B
HB
de Haan
E H F
EH
de Kort
P L M
PL
Jansen
B P W
BP
Kappelle
L J
LJ
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