Stroke Severity, Caregiver Feedback, and Cognition in the REGARDS-CARES Study

Area of Science:

• Neurology
• Neuroscience
• Rehabilitation Medicine

Background:

• Cognitive impairment is a frequent and significant consequence of stroke, affecting up to 60% of survivors.
• Stroke severity, determined by lesion volume and location, is a primary determinant of post-stroke cognitive deficits.
• Existing research highlights the need to explore various indicators of stroke severity and functional recovery in relation to cognitive outcomes.

Purpose of the Study:

• To investigate the association between two established stroke severity scales and caregiver-reported post-stroke functioning with longitudinal cognitive outcomes.
• To determine the predictive value of different stroke severity measures on cognitive trajectories in stroke survivors.
• To assess the role of caregiver-reported functional impairments in predicting cognitive decline after stroke.

Main Methods:

• The study analyzed data from 157 caregiver-stroke survivor dyads within the CARES project, an ancillary study of the REGARDS cohort.
• Glasgow Outcome Scale and modified Rankin Scale scores at discharge were used as stroke severity predictors.
• Cognitive function was assessed biennially for up to 5 years using a telephone battery measuring learning, memory, and executive function, controlling for prestroke cognition and demographics.

Main Results:

• Both the Glasgow Outcome Scale and modified Rankin Scale scores significantly predicted longitudinal cognitive scores.
• Caregiver-reported problems and impairments at 9 months post-stroke also significantly predicted cognitive outcomes.
• In a combined model, only caregiver-reported problems remained a significant predictor of cognitive function over time.

Conclusions:

• Caregiver feedback is a vital component in predicting the cognitive consequences following a stroke.
• These findings underscore the clinical utility of incorporating caregiver perspectives into the assessment and management of post-stroke cognitive impairment.
• Integrating caregiver-reported functioning offers a valuable, independent predictor of long-term cognitive health in stroke survivors.