Impact of early cognitive and psychological status on return to work after acute ischemic stroke

As young ischemic stroke (IS) incidence increases worldwide, helping IS survivors return to work (RTW) remains challenging. Post-stroke cognitive impairment (PSCI) and mood changes represent important hindrances to RTW. However, it remains uncertain whether early psycho-cognitive assessment during the acute admission can prognosticate RTW outcomes toward personalized rehabilitation regimens. Hence, we aimed to evaluate the relationship between early psycho-cognitive status and three-month RTW status in a cohort of working-age Asian IS survivors.

Consecutive IS patients previously in active employment admitted to a primary stroke center in Singapore from 1st January 2020 to 31st December 2022 were included. Psychocognitive status was assessed within 24-72 h of IS admission using the Montreal Cognitive Assessment (MoCA) and Patient Health Questionnaire-9 (PHQ-9). RTW was assessed at post-stroke three-months. Univariate and multivariate logistic regression was done to evaluate associations between psychocognitive status and RTW.

Overall, 322 IS survivors were included, with 33 (10.2%) patients experiencing post-stroke depression and 214 (66.5%) patients experiencing PSCI. 212 (65.8%) patients successfully RTW at post-stroke three-months. Only MoCA scores were significantly associated with RTW across univariable (OR = 1.10, 95% CI: 1.06-1.15, p < 0.001) and all multivariable analyses (OR = 1.07, 95% CI: 1.01-1.13, p = 0.014). Lower occupational skill levels and increased stroke severity were also associated with lower odds of RTW. MoCA scores remained significantly associated with RTW across all levels of adjustment in both sensitivity analyses.

Early MoCA scores at 24-72 h post-stroke may help identify high-risk patients for early interventions. Longitudinal cohort studies are needed to better characterize longer-term cognitive and return-to-work trajectories in acute ischemic stroke.