Abstract
Objectives
Many survivors of a mild ischemic stroke do not return to work or driving. Cognitive
testing is commonly done to assess long-term cognitive impairment after stroke. Inpatient
cognitive testing during the acute period of ischemic stroke may also be a predictor
for workforce reengagement and functional outcome.
Materials and methods
At our comprehensive stroke center, we prospectively enrolled previously working adults
< 65 years old who were diagnosed with first-ever ischemic stroke, had a prestroke
modified Rankin Scale (mRS) ≤ 1 and NIHSS ≤ 3. Testing performed within 1 week of
stroke included the Montreal Cognitive Assessment (MOCA), Clock Drawing Test (CDT),
Trail Making Tests A and B, Backward Digit Span Test, and Hospital Anxiety and Depression
Scale (HADS). Other data obtained included age, gender, years of education, occupation,
stroke location, stroke laterality, and presence of white matter disease on imaging.
Outcome measures assessed at 3 months, 6 months, and 12 months post-stroke included
return to work, return to driving, and mRS. In a logistic regression analysis, we
performed both univariate and multivariate analyses. Multivariate analysis was completed
on variables with p-value ≤ 0.05 in the univariate analysis.
Results
Of 39 total stroke patients enrolled and tested (median [IQR] age 55 [46–60] years;
77.5% male; 22.5% female), 36 completed 3-month follow up, of which 58% returned to
work, 78% returned to driving, and 72% had mRS of 0–1. In multivariate analysis, a
single point increase in the clock drawing task score increased the odds of return
to work by 3.79 (95% CI, 1.10–14.14) and return to driving by 6.74 (95% CI, 1.22–37.23)
at 3 months. MOCA and HADS were both associated with mRS ≤ 1. MOCA was associated
with return to work at 6 months and CDT was associated with return to work at 12 months.
Conclusion
Cognitive testing with CDT and MOCA in the acute period after ischemic stroke may
predict common patient goals post stroke, including return to work, driving, and independence.
These tools can potentially be used for prognosis and identifying those who may benefit
from further interventions.
Key Words
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Article info
Publication history
Published online: October 24, 2021
Accepted:
September 19,
2021
Received in revised form:
September 17,
2021
Received:
June 2,
2021
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2021.106132
Copyright
© 2021 Elsevier Inc. All rights reserved.
