Psychological factors and subjective cognitive complaints after stroke: Beyond depression and anxiety

Figures & data

Figure 1. Flowchart of the stroke study population. SCC: Subjective Cognitive Complaints.

Table 1. Characteristics of the stroke sample.

Characteristics	N = 208
Age (years)	64.9 ± 12.4
Males	137 (65.9%)
D-NART	95.4 ± 12.9
OCI- index score^a	5.9 ± 3.7
FAI	22.6 ± 7.8
NIHSS score at admission: median [Q1 – Q3]	3 [2–5]
First-ever stroke	187 (89.9%)
Stroke side
Left	78 (37.5%)
Right	104 (50.0%)
Not differentiated	26 (12.5%)
Length of hospital stay (days)	6.7 ± 5.9
Discharge destination
Home	179 (86.1%)
Clinical rehabilitation	29 (13.9%)

D-NART: Dutch version of the National Adult Reading Test; FAI:  Frenchay Activities Index; OCI-index:  Objective Cognitive Impairment; NIHSS:  National Institutes of Health Stroke Scale.

^aBased on 185 patients who completed the neuropsychological assessment.

Table 2. Associations between psychological factors and SCC (CLCE-content score).

Independent variables	Unadjusted	Model 1^a–d	Model 2^e
	Pearson’s r (p-value)	β value (p-value)	β value (p-value)
HADS – Depression	0.40 (<.001)**	0.35 (<.001)^a**	−0.07 (.53)
HADS – Anxiety	0.38 (<.001)**	0.38 (<.001)^b**	0.23 (.02)*
PSS-4 – Perceived stress	0.42 (<.001)**	0.39 (<.001)^c**	0.19 (.05)
FAS – Fatigue	0.45 (<.001)**	0.39 (<.001)^d**	0.27 (.002)**

CLCE: Checklist for Cognitive and Emotional consequences following stroke; HADS:  Hospital Anxiety and Depression Scale; PSS-4:  Perceived Stress Scale-short form; SCC: Subjective Cognitive Complaints; UCL:  Utrecht Coping List.

^a–dSeparate analyses for each of the four independent variables, adjusted for age, sex, intelligence quotient (IQ)-estimation, stroke severity, objective cognitive impairment and activities of daily living.

^eOne analysis with covariates in the first block and the independent variables being entered simultaneously in the second block.

*Significant result at p ≤ .05.

**Significant result at p ≤ .01.

Table 3. Model 3: full multivariate linear regression model examining background factors, distress-related psychological factors, personality traits and coping styles as related to SCC.

Independent variables	CLCE-content	CLCE-worry
	β value (p-value)	β value (p-value)
Age (years)	0.03 (.67)	−0.05 (.53)
Sex (male)	−0.03 (.67)	−0.03 (.69)
Pre-stroke IQ (D-NART)	0.14 (.12)	0.17 (.06)
NIHSS score at admission	−0.11 (.18)	−0.07 (.38)
OCI-index score	0.20 (.03)*	0.33 (.001)**
ADL (FAI)	−0.11 (.18)	−0.03 (.74)
HADS – Depression	−0.07 (.54)	−0.09 (.44)
HADS – Anxiety	0.12 (.28)	0.27 (.01)**
Stress (PSS-4)	0.13 (.19)	0.25 (.01)*
Fatigue (FAS)	0.26 (.003)**	0.16 (.07)
EPQ-RSS-neuroticism	0.21 (.05)*	No additive value

Multivariate models included demographics, stroke-related measures, objective cognitive performance index score, and the distress-related psychological measures (depression, anxiety, perceived stress and fatigue). Forward stepwise procedures were used to examine the additional role of personality factors and coping style.

CLCE:  Checklist for Cognitive and Emotional consequences following stroke; D-NART:  Dutch version of the National Adult Reading Test; EPQ-RSS:  Eysenck Personality Questionnaire Revised Short Scale; FAI:  Frenchay Activities Index; FAS: Fatigue Assessment Scale; HADS:  Hospital Anxiety and Depression Scale; NIHSS: National Institutes of Health Stroke Scale; OCI:  Objective Cognitive Impairment; PSS-4:  Perceived Stress Scale-short form ; UCL:  Utrecht Coping List.

*Significant result at p ≤ .05.

**Significant result at p ≤ .01.