The relationship between early post-stroke cognition and longer term activities and participation: A systematic review

Mole, J; Demeyere, Nele · 2018 · OpenAlex-citations

DOI: 10.1080/09602011.2018.1464934

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Summary

This systematic review investigates whether early post-stroke cognitive impairment predicts long-term outcomes in the domains of “activities” and “participation,” as defined by the International Classification of Functioning, Disability and Health (ICF). The study was motivated by inconsistent findings in previous literature regarding the predictive value of early cognitive assessments, particularly those using brief, domain-general screening tools like the Mini-Mental State Examination. The authors sought to determine if domain-specific cognitive assessments offer more consistent predictions than domain-general ones and to identify which specific cognitive domains correlate with functional outcomes 6–12 months post-stroke. The researchers conducted a systematic search of PsycINFO, MEDLINE, CINAHL, and EMBASE databases, identifying 14 eligible studies published between 1970 and 2017. Inclusion criteria required quantitative research involving human participants over 18, with cognitive assessment conducted within six weeks of injury and outcome measurement at least six months post-injury. Outcome measures were coded by three independent raters using established linking rules to categorize them as either “activities” (e.g., self-care, mobility) or “participation” (e.g., employment, social life). Study quality was appraised using a modified Downs and Black Quality Index, with particular attention paid to whether studies controlled for confounding variables such as motor functioning, age, and education. The review found that early cognitive impairment generally predicted activities and participation at 6–12 months post-stroke, but this relationship was significantly more consistent when domain-specific cognitive assessments were used rather than domain-general screenings. In well-controlled studies, specific cognitive domains—visuospatial perception/construction, visual memory, unilateral visual neglect, and executive functioning—were identified as predictors of activity levels. While some uncontrolled studies suggested links between participation and domains like apraxia or attention, no well-controlled study adequately investigated the relationship between domain-specific cognition and participation. The authors noted that many included studies suffered from methodological limitations, including small sample sizes, lack of statistical power, and insufficient control for confounds. The findings suggest that early domain-specific cognitive assessment is clinically informative for predicting long-term activity limitations, potentially aiding in rehabilitation planning and care pathway decisions. The predominance of non-verbal cognitive domains as predictors may reflect the exclusion of aphasic patients in many studies, highlighting a need for more inclusive assessment tools. The authors conclude that while evidence supports the predictive value of specific cognitive impairments for activities, further well-controlled research is required to establish similar relationships for participation and to clarify why domain-general assessments yield inconsistent results.

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• cognitive impairment