Background
For
long-term stroke survivors, objective neuropsychological impairments
and subjective cognitive difficulties are common, and may contribute to
ongoing difficulties in community reintegration. However, subjective
cognitive complaints have been as much associated with low mood as with
actual cognitive performance.
Objective
The
objective of our study was to investigate the extent to which
subjective cognitive complaints predicted community reintegration
following a stroke, and whether this relationship would be mediated by
emotional status.
Methods
Using a cross-sectional design, patients with a primary diagnosis of stroke (n = 102;
age range 25–89 years) were recruited from the register of a
neurological rehabilitation service if they were at least 6 months
post-stroke and had been discharged home following the stroke.
Exclusions included history of dementia, co-morbid psychiatric or
neurological disorder, or significant aphasia. Assessments included the
Subjective Cognitive Complaints Questionnaire, the Community Integration
Questionnaire, and the Depression Anxiety and Stress Scale.
Results
Subjective
cognitive complaints were common, with moderate to high levels of
complaint most frequent for working memory (58.9%), and information
processing speed (53%). Subjective cognitive complaints were
significantly associated with social integration (r = −.23, p < .05).
However, examination of relationships using statistical mediation
revealed that depressive symptoms fully mediated the relationship
between subjective cognitive complaints and social integration.
Conclusions
Subjective
cognitive complaints are common in long-term outcome following stroke
and predict difficulty in community reintegration. However, this
relationship is mediated by variation in emotional status. Therefore,
addressing cognitive complaints through cognitive rehabilitation
programs that include components to improve mood (for example, building
self-efficacy or confidence) may also improve community reintegration
post-stroke.
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