Cognitive determinants of social functioning after a first ever mild to moderate stroke at vocational age

Social functioning is impaired in approximately two-thirds of stroke patients of vocational age, even several months after a first ever mild to moderate stroke. The known predictors of social functioning are initial stroke severity, anxiety and depression, and the Mini-Mental State Evaluation, suggesting that cognitive deficits contribute to post-stroke social dysfunctioning. The aim of this study was to evaluate whether cognitive domains correlated with social functioning and to determine the cognitive predictors of social dysfunctioning.

74 patients were prospectively included 6 months after a first ever stroke. National Institutes of Health Stroke Scale (NIHSS), modified Rankin scale, depression and anxiety were recorded. Social functioning was recorded using the Work and Social Adjustment Scale (WSAS). An extensive neuropsychological test battery explored general cognitive functioning, episodic memory, instrumental functions, executive functions and working memory. Univariate comparisons assessed the relationships between the neuropsychological tests and scores on the WSAS. Predicting factors for WSAS were determined using ordinal logistic regression.

52 patients (70%; 95% confidence interval 58% to 80%) complained of significant perturbations in work and social functioning. In univariate comparisons, general cognitive functioning, memory, instrumental functions, executive functions and working memory significantly correlated with social functioning. Working memory was the most affected domain. With multivariate modelling, the NIHSS at admission, Hospital Anxiety Depression scale and Owen's Spatial Working Memory test were independent predictors of WSAS.

All cognitive domains were associated with social functioning, working memory being the main cognitive determinant. Our results suggest that cognitive impairment impacts on social dysfunctioning, which is known to be a component of quality of life.