title: Executive function as a strong predictor of recovery from disability in patients with acute stroke: a preliminary study.
abstract: BACKGROUND
  Cognitive impairment impedes stroke rehabilitation. However, it is unclear whether cognitive impairment of specific domains or the degree of severity is more critical to functional recovery in patients with poststroke disability.
  
  
  METHODS
  We identified 182 patients who were disabled at 3 months after acute stroke, as defined by a modified Rankin Scale score of 2-5. At a single time point between 3 months and 1 year after onset, the following 4 cognitive domains were assessed: executive function, visuospatial ability, language, and memory. With respect to the severity of cognitive impairment, the patients were classified as having vascular dementia (VD), vascular cognitive impairment no dementia (VCIND), or normal cognition. The primary outcome was functional recovery between 3 months and 1 year after onset. To examine the association between cognitive status and functional recovery, multiple logistic regression with backward stepwise analysis was performed.
  
  
  RESULTS
  A total of 74 (40.7% of 182) patients demonstrated functional improvement at 1 year compared with 3 months. Patients with executive impairment demonstrated significantly less improvement in functional outcomes, with an adjusted odds ratio (OR) of .472 (95% confidence interval [CI], .245-.910). Patients with VD also demonstrated less functional recovery, with an adjusted OR of .289 (95% CI, .120-.700). The remaining 3 cognitive domains and VCIND were not significantly associated with functional recovery.
  
  
  CONCLUSIONS
  Executive function is a strong predictor of recovery from disability in patients with acute stroke. In addition, functional recovery is significantly hampered by cognitive impairment due to VD, but not VCIND.
authors.affiliation: Clinical Neuroscience Center and Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea; Department of Neurology, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Young Ho
authors.initials: YH
authors.lastname: Park
authors.affiliation: Department of Neurology, Kangwon National University Hospital, Chuncheon, Korea.
authors.forename: Jae-Won
authors.initials: JW
authors.lastname: Jang
authors.affiliation: Clinical Neuroscience Center and Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea; Department of Neurology, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: So Young
authors.initials: SY
authors.lastname: Park
authors.affiliation: Clinical Neuroscience Center and Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea; Department of Neurology, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Min Jeong
authors.initials: MJ
authors.lastname: Wang
authors.affiliation: Department of Neurology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea.
authors.forename: Jae-Sung
authors.initials: JS
authors.lastname: Lim
authors.affiliation: Clinical Neuroscience Center and Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea; Department of Neurology, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Min Jae
authors.initials: MJ
authors.lastname: Baek
authors.affiliation: Clinical Neuroscience Center and Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea; Department of Neurology, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Beom Joon
authors.initials: BJ
authors.lastname: Kim
authors.affiliation: Clinical Neuroscience Center and Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea; Department of Neurology, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Moon-Ku
authors.initials: MK
authors.lastname: Han
authors.affiliation: Clinical Neuroscience Center and Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea; Department of Neurology, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Hee-Joon
authors.initials: HJ
authors.lastname: Bae
authors.affiliation: Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Soyeon
authors.initials: S
authors.lastname: Ahn
authors.affiliation: Clinical Neuroscience Center and Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea; Department of Neurology, Seoul National University College of Medicine, Seoul, Korea. Electronic address: neuroksy@snu.ac.kr.
authors.forename: SangYun
authors.initials: S
authors.lastname: Kim
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D016009:Chi-Square Distribution; D003071:Cognition; D003072:Cognition Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D015140:Dementia, Vascular / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D004185:Disability Evaluation; D056344:Executive Function; D005260:Female; D006801:Humans; D007802:Language; D016015:Logistic Models; D008297:Male; D008568:Memory; D008875:Middle Aged; D015999:Multivariate Analysis; D009483:Neuropsychological Tests; D016017:Odds Ratio; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D020127:Recovery of Function; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013028:Space Perception; D020521:Stroke / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D000071939:Stroke Rehabilitation; D013997:Time Factors; D014796:Visual Perception
keywords: Cognition; functional outcome; recovery; stroke