title: Cognitive function and improvement of balance after stroke in elderly people: the Gothenburg cognitive stroke study in the elderly.
abstract: OBJECTIVE
  The ability to balance is no longer automatic after stroke in patients with motor impairment and needs to be relearned. Learning requires cognitive and executive abilities. It is well known that cognitive and executive impairments are common after stroke, but how these are related to balance has not yet been fully studied. We, therefore, wanted to explore the impact of pre-stroke cognitive impairment, global and selective cognitive and executive impairment in the early phase after stroke and at the 1-year follow-up on balance and on the improvement of balance during the first year after stroke.
  
  
  METHODS
  Seventy-four patients were included consecutively on admission following stroke to a geriatric stroke unit and followed prospectively for 1 year. Balance was assessed using the Berg Balance Scale on admission, on discharge and 1 year after stroke.
  
  
  RESULTS
  Cognitive impairment before stroke, measured using the Cognitive Impairment Questionnaire, was found to lead to poor balance on discharge and 1 year after stroke. Patients with impaired logical deductive ability and executive function, measured using a neuropsychological test battery both in the early phase and 1 year after stroke, also had significantly poorer balance 1 year after stroke than patients with intact functions. Most importantly, only patients with intact cognitive function, before stroke, on admission and at the 1-year follow-up, significantly improved their balance after discharge.
  
  
  CONCLUSIONS
  Our results show that cognitive status, both before and after stroke, is important for balance and improvement of balance after stroke.
authors.affiliation: The Sahlgrenska Academy, University of Gothenburg, Institution of Medicine, Gothenburg, Sweden. ulrika.pahlman@vgregion.se
authors.forename: Ulrika
authors.initials: U
authors.lastname: Påhlman
authors.forename: Cristina
authors.initials: C
authors.lastname: Gutiérrez-Pérez
authors.forename: Marianne
authors.initials: M
authors.lastname: Sävborg
authors.forename: Elvi
authors.initials: E
authors.lastname: Knopp
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Tarkowski
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D003071:Cognition; D003072:Cognition Disorders / Q000150:complications / Q000523:psychology / Q000534:rehabilitation*; D056344:Executive Function; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D004856:Postural Balance; D011446:Prospective Studies; D012678:Sensation Disorders / Q000209:etiology / Q000534:rehabilitation*; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D020521:Stroke / Q000150:complications / Q000523:psychology*; D000071939:Stroke Rehabilitation; D011795:Surveys and Questionnaires; D013548:Sweden