Moderating role of cognitive function in the relationship between stress and stroke recurrence: A Descriptive Study

Psychological stress is a recognized risk factor for stroke recurrence and is common in post-stroke nursing care. Cognitive impairment may limit patients' ability to manage stress, yet its moderating role in stroke recurrence remains unclear. This study examined whether cognitive function moderates the relationship between stress and stroke recurrence among stroke survivors, with implications for nursing assessment and secondary prevention.

A descriptive cross-sectional study was conducted among 84 stroke survivors with recurrent stroke recruited through convenience sampling. Sample size was estimated using G*Power assuming a medium effect size (Cohen's f² = 0.15), α = 0.05, and power = 0.90. Data were collected using a sociodemographic questionnaire, the International Stress Management Association (ISMA) questionnaire, and the Mini-Mental State Examination (MMSE). Data were analyzed using IBM SPSS Statistics version 30 with the PROCESS macro (version 4.2) and 5,000 bootstrap resamples.

Most participants had ischemic stroke (83.33%), mild cognitive impairment (35.71%), and moderate stress levels (72.62%). Psychological stress was positively associated with stroke recurrence (r = 0.240, p = 0.028), while cognitive function was negatively associated with recurrence (r = -0.270, p = 0.013). A significant interaction effect between stress and cognitive function was identified (β = -0.015, p = 0.040, 95% CI - 0.029 to -0.001), indicating that better cognitive function weakened the adverse effect of stress on stroke recurrence.

Cognitive function moderates the relationship between psychological stress and stroke recurrence. Routine assessment of stress and cognitive function may help nurses identify patients at higher risk and support targeted secondary prevention strategies.