Executive function deficits in acute stroke.
OBJECTIVE
To establish the frequency of executive dysfunction during acute hospitalization for stroke and to examine the relationship of that dysfunction to stroke severity and premorbid characteristics.


METHODS
Inception cohort study.


METHODS
Inpatient wards at a Veterans Affairs hospital.


METHODS
Consecutive sample of inpatients with radiologically or neurologically confirmed stroke. Final sample included 47 patients screened for aphasia and capable of neuropsychologic testing. Two nonstroke inpatient control samples (n=10 each) with either transient ischemic attack (TIA) or multiple stroke risk factors were administered the same research procedure and tests.


METHODS
Not applicable.


METHODS
Composite cognitive impairment ratio (CIR), calculated from 8 scores indicative of executive function on 6 neuropsychologic tests by dividing number of tests completed into the number of scores falling below cutoff point, defined as 1.5 standard deviations below normative population mean.


RESULTS
Stroke patients had a mean CIR of .61, compared with .48 for TIAs and .44 for stroke-risk-only. Analysis of variance revealed that CIRs of stroke-risk-only patients but not TIAs were lower than those of the stroke patients (P=.02). Impairment frequencies were at least 50% for stroke patients on most test scores. The Symbol Digit Modalities Test (75% impairment) and a design fluency measure distinguished stroke from nonstroke patients. CIR was not related to stroke severity in the stroke patient sample, but was related to estimated premorbid intelligence.


CONCLUSIONS
Executive function deficits are common in stroke patients. The data suggest that limitations in information processing due to these deficits may require environmental and procedural accommodations to increase rehabilitation benefit.
Zinn
Sandra
S
Research and Development, Veterans Affairs Medical Center, Durham, NC 27705, USA. sandra.zinn@duke.edu
Bosworth
Hayden B
HB
Hoenig
Helen M
HM
Swartzwelder
H Scott
HS
D000203:Activities of Daily Living; D000368:Aged; D000704:Analysis of Variance; D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D006760:Hospitalization; D006801:Humans; D007360:Intelligence; D002546:Ischemic Attack, Transient / Q000150:complications; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications*