The importance of cognition to quality of life after stroke

Objective: Suffering a stroke typically has a negative impact on a person's quality of life. There is some evidence that post-stroke cognitive impairment is associated with poor quality of life, but the relative importance of deficits in different cognitive domains has not been established.

Methods: Patients with confirmed stroke were recruited in the acute hospital. A subgroup of patients completed 2 computerized cognitive tasks (simple and choice reaction time) within 2 weeks of stroke. The full cohort was followed up at 3 months with a comprehensive neuropsychological battery and then at 12 months with the Assessment of Quality of Life ('AQoL).

Results: Sixty patients participated in the study (mean age 72.1 years, SD 13.9), with a subgroup of 33 patients tested acutely (mean age 75.5 years, SD 11.9). Presence of cognitive impairment at 3 months was independently associated with lower quality of life at 12 months (p=0.021). Attention and visuospatial ability were the cognitive domains most closely associated with quality of life. Faster choice reaction time in the acute stage (mean 5.4 days post-stroke) was significantly associated with better quality of life at 12 months (p=0.003).

Conclusion: Cognition, particularly attention and visuospatial ability, is strongly associated with quality of life after stroke. It is possible that straightforward reaction time tasks are sensitive to the extent of brain damage, and might therefore be surrogate markers for quality of life.