title: The severity of cognitive deficits predicts return to work after a first-ever ischaemic stroke.
abstract: BACKGROUND
  The inability of stroke patients to return to work contributes disproportionately to the socioeconomic impact of stroke and is best predicted by the severity of stroke. However, the role of cognitive deficits in stroke severity has not been scrutinised. We studied whether the initial cognitive severity of stroke, compared with other influential factors, predicts the inability to return to work after stroke.
  
  
  METHODS
  Consecutive patients aged 18--65 with a first-ever ischaemic stroke, working full time previously, were assessed neuropsychologically within the first weeks after stroke and at the 6-month follow-up. Similarly, 50 healthy demographic controls were assessed twice. The cognitive severity of stroke was operationalised as the number of initial cognitive deficits. Cognitive severity as a predictor of the inability to return to work was compared with demographic, occupational, neurological, radiological and functional data, vascular risk factors and mood state.
  
  
  RESULTS
  The mean age of the 140 patients assessed both initially and at follow-up was 52 years. They had a mean of 13 years of education and 59% were men. At 6 months, only 41% of the patients had returned to work despite the relatively minor neurological and functional impairments of the cohort. In our model, the number of early cognitive deficits (OR=2.252, CI 1.294 to 3.918) was the only significant predictor of the inability to return to work.
  
  
  CONCLUSIONS
  The initial cognitive severity of stroke predicts the later inability to return to work. The benefits of neuropsychological assessments within the first weeks after stroke are emphasised.
authors.affiliation: University of Helsinki, Institute of Behavioral Sciences, Helsinki, Finland. tatu.kauranen@lshp.fi
authors.forename: Tatu
authors.initials: T
authors.lastname: Kauranen
authors.forename: Katri
authors.initials: K
authors.lastname: Turunen
authors.forename: Siiri
authors.initials: S
authors.lastname: Laari
authors.forename: Satu
authors.initials: S
authors.lastname: Mustanoja
authors.forename: Peter
authors.initials: P
authors.lastname: Baumann
authors.forename: Erja
authors.initials: E
authors.lastname: Poutiainen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002545:Brain Ischemia / Q000150:complications / Q000523:psychology*; D016022:Case-Control Studies; D003072:Cognition Disorders / Q000150:complications / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests / Q000706:statistics & numerical data*; D009790:Occupations / Q000706:statistics & numerical data; D062707:Return to Work / Q000523:psychology*; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications / Q000523:psychology*