Very early cognitive screening and return to work after stroke

ABSTRACT

Background: Stroke is a common cause of long-term disability worldwide, and an increasing number of persons affected by stroke are of working age. In addition to physical impairments, a majority of patients reportedly suffer cognitive impairments after stroke. Reduced cognitive function may hinder poststroke return to work (RTW); however, most studies of this relationship have assessed cognitive function months after the stroke.

Objectives: The current study aims to investigate the degree of post-stroke RTW, and whether very early cognitive function screening can predict RTW after a stroke.

Methods: This study included 145 persons treated for stroke at 18–63 years of age at a large university hospital in Sweden between 2011 and 2016. Data were retrieved from the GOTVED database. Within 36–48 h after hospital admission, cognitive function was screened using the Montreal Cognitive Assessment (MoCA). Full and partial RTW were assessed based on the Swedish Social Insurance Agency’s register. Logistic regression was performed to analyze the potential predictors of RTW at 6 months and 18 months.

Results: Neither global cognitive function nor executive function at 36–48 h after stroke predicted any degree of RTW at 6 or 18 months. Male sex, lower stroke severity, and not being on sick leave prior to stroke were significant predictors of RTW.

Conclusions: Screening for cognitive impairments at 36–48-h post stroke is apparently too early for predicting RTW, and thus cannot be the sole basis for discharge planning after stroke. Additional research is needed to further analyze cognitive function early after stroke and RTW.

KEYWORDS:

• Stroke
• Return to work
• cognition disorders
• rehabilitation
• young stroke

Acknowledgments

Thank you to the Riksstroke Collaboration http://www.riksstroke.org/eng/for providing data to the current study.

Disclosure

No potential conflict of interest was reported by the author(s).;Promobilia

Data availability statement

The data that supports the findings of this study are available from the authors (contact Professor Katharina S. Sunnerhagen, email: [email protected]) upon reasonable request. Due to Swedish regulations https://www.epn.se/en/start/regulations/, the data can only be used for what has been approved by the ethical board, and therefore the data used in the current study is not publicly available.

Additional information

Funding

This study was supported by grant from the Swedish Science Council [VR2012-3523 and VR2017-00946]; the Health & Medical Care Committee of the Regional Executive Board, Region Västra Götaland;King Gustaf V’s and Queen Victoria’s Freemasons’ Foundation;the Swedish state under the agreement between the Swedish government and the county councils, the ALF agreement [ALFGBG-718711];Agneta Prytz-Folke’s and Gösta Folke’s Foundation; the FRF foundation; the Swedish National Stroke Association