Investigating cognitive impairment, biopsychosocial barriers, and predictors of return to daily life among older stroke survivors

 With nothing here on how to improve cognitive impairment; useless!

Investigating cognitive impairment, biopsychosocial barriers, and predictors of return to daily life among older stroke survivors

Alexandra Björck^1*Marie Matérne^2,3Mialinn Arvidsson Lindvall^2,4Gustav Jarl^2,5

• ¹School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
• ²University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
• ³School of Behavioural, Social and Legal Sciences, Örebro University, Örebro, Sweden
• ⁴School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
• ⁵Department of Prosthetics and Orthotics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden

Purpose: The aim was to investigate the associations between cognitive impairment and biopsychosocial factors among older stroke survivors and predictors of poststroke return to daily life.

Materials and methods: This cross-sectional study involved 117 stroke survivors (61% men) with an average age of 77 years (range 65–91). The participants completed two questionnaires (Riksstroke and Short Form 36 questionnaires). The Montreal Cognitive Assessment (MoCA) was used to assess cognitive abilities. The International Classification of Functioning, Disability, and Health (ICF) framework guided the selection of biopsychosocial variables. We used Spearman’s correlation coefficient and multiple logistic regression in the analyses.

Results: The average MoCA score was 21.7 points (range: 4–30, SD 5.6). The need for assistance from relatives and professionals, need for help with dressing and household chores, reliance on others for mobility, and reading and balance problems were correlated with more severe cognitive impairment (r = 0.20–0.33). Cognitive impairment, fatigue, and balance issues predicted an unfavorable return to daily life (odds ratio: 6.2–6.8).

Conclusion: The study indicated that cognitive impairment is associated with difficulties in all ICF domains. Cognitive impairment, fatigue, and balance issues are associated with an unsuccessful return to daily life. Prioritizing these factors and screening for cognitive impairment with objective assessment tools may improve rehabilitation outcomes and enhance overall quality of life poststroke.

Introduction

Stroke is a leading cause of long-term disability worldwide, impacting the lives of more than 100 million individuals (1, 2). Stroke disrupts cerebral blood flow, causing tissue damage and neurological deficits. The neuroplasticity enables the brain to adapt and reorganize post-stroke, aiding recovery (3) but a common consequence of stroke is poststroke cognitive impairment (PSCI). PSCI is a broad term that includes conditions ranging from mild cognitive impairment to dementia. Common disorders are problems with memory, attention, executive abilities, language, visual processing, and information management (4, 5). Usually, PSCI occurs within 3 months post-stroke, but can also develop over time (3). One year after stroke onset, one in four stroke survivors has PSCI (6, 7), and approximately seven of 10 stroke survivors will develop PSCI over time (8). PSCI often gives negative consequences on problem solving, organized planning and social interaction (9, 10), which has a negative effect on individuals’ overall health and well-being. There is a prioritized and ongoing global effort to understand the complexity of PSCI and develop interventions to prevent cognitive decline (11). PSCI predominantly affects the older population, which is growing globally (11, 12), making it a priority in stroke research (11). An emerging issue in stroke research is investigating how cognitive function is connected to other biopsychosocial factors to develop personalized interventions (4).

Previous research has indicated that PSCI affects several biopsychosocial aspects. It affects the overall recovery process poststroke due to the negative impact on the body’s motor function recovery (13). PSCI makes it more challenging to participate in physical rehabilitation; therefore, persons with PSCI are less physically active (14). Individuals with PSCI are also more prone to psychological deficits such as depression and fatigue (15, 16), which further affects their ability to engage in various leisure and social activities (17). PSCI affects both basic and instrumental activities of daily living, such as dressing, performing personal hygiene and household chores, and cooking (18). It also impairs communication (19), participation in social activities and interactions with others (18, 20). Despite extensive PSCI research, the understanding of how different levels of PSCI affect biopsychosocial factors in older stroke survivors is incomplete. There is also limited research exploring which factors are associated with a successful return to daily life for older persons with PSCI. Previous studies investigating factors associated with return to daily life and leisure activities after stroke have shown that cognitive ability, age, and mobility are important factors (21, 22). However, most related studies have focused on younger stroke survivors (23, 24).

This study adopted a biopsychosocial perspective and used the International Classification of Functioning, Disability and Health (ICF) model (25) as a framework. This approach was chosen to capture the complexity of the interaction between PSCI and daily life. The study aimed to investigate (1) the associations between levels of cognitive impairment and biopsychosocial factors and (2) how these factors are associated with return to daily life. Through comprehensive insights into these biopsychosocial factors, poststroke well-being and recovery can be enhanced, allowing for tailored interventions for affected individuals.

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