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Post-stroke depression, but not anxiety, is independently associated with executive and visuospatial function: A
Florine Ruthmann1, Etienne Allart2, Anne-Marie Mendyk Bordet1
1Université de Lille, Inserm, CHU Lille, LilNCog, Lille Neuroscience and Cognition, 59000, Lille, France.
Background:
Post-stroke anxiety and depression frequently co-occur, and whether each is independently associated with cognitive impairment remains unclear because most studies model one without adjusting for the other. In a five-year cohort, we tested whether anxiety and depression have distinct cognitive correlates and whether 6-month affective status predicted subsequent cognitive recovery.
Methods:
Patients from the STROKDEM cohort (n = 191) were assessed at 6, 12, 36, and 60 months post-stroke for anxiety, depression, and five cognitive domains (memory, executive functioning, attention, visuospatial functioning, and language). Two symmetric random-intercept linear mixed models regressed each affective score on the cognitive domains while adjusting for the other. Repeated-measures correlations, multiple imputation for attrition, and exploratory trajectory and prognostic models were also used.
Results:
After mutual adjustment and correction, depression was independently associated with executive and visuospatial function, whereas anxiety showed no independent cognitive correlate. Repeated-measures correlations confirmed this dissociation. The executive association and the absence of an anxiety correlate were robust to all sensitivity analyses, including multiple imputation for attrition, whereas the visuospatial association was attrition-sensitive. Exploratory associations between 6-month affect and cognitive recovery did not survive multiple imputation and were inconclusive.
Limitations:
Attrition was substantial and selective on baseline cognition; the persistent-anxiety subgroup was small; and psychiatric history, psychotropic medication, and cognitive reserve beyond education were unavailable.
Conclusions:
The cognitive burden of post-stroke affective disorders is carried by depression rather than anxiety. Screening for depression, rather than anxiety alone, may better identify stroke survivors at cognitive risk.