Which approach to measure cognitive functioning should be preferred when exploring the association between cognitive functioning and participation after stroke?

Figures & data

Table 1. Participant characteristics (n = 395).

	Study participants (n = 128)	Drop-outs (n = 267)	p values^b
Demographic factors
Sex (% male)	68.8	62.9	0.256
Age in years (at time of stroke)	63.7 ± 11.0	68.1 ± 13.1	0.001*
Marital status (% living together)	73.4	66.3	0.152
High education level (%)^a	28.1	25.8	0.624
Stroke-related factors
Ischemic stroke (%)	92.1	94.0	0.275
Stroke location
Left hemisphere (%)	33.9	43.1	0.165
Right hemisphere (%)	44.9	41.2
Vertebrobasilar stroke (%)	21.3	15.7
First stroke (%)	85.2	89.5	0.211
Discharge home after hospital stay (%)	75.8	67.8	0.104
Severity of stroke	2.7 ± 3.1	2.8 ± 3.3	0.647
No stroke symptoms (% NIHSS 0)	24.2	23.6	0.612
Minor stroke symptoms (% NIHSS 1-4)	57.0	55.4
Moderate stroke symptoms (% NIHSS 5-12)	17.2	18.4
Severe stroke symptoms (% NIHSS ≥ 13)	1.6	2.6
ADL 4 days after stroke	17.1 ± 4.6	16.7 ± 4.9	0.382
% ADL-dependent (BI ≤17)	31.3	34.5	0.527
Cognitive functioning 2 months after stroke
Cognitive functioning (MoCA)	24.5 ± 3.6	23.0 ± 4.1	0.001*
% cognitively impaired (MoCA ≤ 25)	58.2	72.4	0.007*

Note. Values are percentages or mean ± SD.

ADL, activities of daily living; BI, Barthel Index; MoCA, Montreal Cognitive Assessment; NIHSS, National Institutes of Health Stroke Scale.

^a Completed University of Professional Education and higher.

^b Comparison between “study participants” and “drop-outs”.

*p values are significant (p < 0.05).

Table 2. Scores on participation and cognitive tests (MoCA, CLCE-24-C and NTB) at three to four years after stroke.

			n	Mean (±SD)	Range	% impaired
USER-P-R			128	83.55 (±19.72)	13–100
SCC	CLCE-24-C		127	7.28 (±5.53)	0–23	89.0^b
OCP	MoCA		124	24.96 (±3.18)	15–30	45.3^c
	NTB	BNT^a	118	45.71 (±32.61)	5–100	2.5^d
		RBMT-I^a	112	36.14 (±8.91)	20–68	49.1^d
		RBMT-D^a	111	40.67 (±9.13)	23–80	25.2^d
		SDMT^a	111	46.67 (±10.92)	17–71	15.3^d
		TMT^a	106	51.01 (±9.81)	29–86	4.7^d
		VOSP	75	6.72 (±0.75)	3–8	20.0^e

Abbreviations: BNT, Boston Naming Test; CLCE-24-C, Checklist for Cognitive and Emotional Consequences – cognitive subscale; MoCA, Montreal Cognitive Assessment; NTB, Neuropsychological Test Battery; OCP, objective cognitive performance; RBMT-D, Rivermead Behavioral Memory Test – Delayed recall; RBMT-I, Rivermead Behavioral Memory Test – Immediate recall; SCC, subjective cognitive complaints; SD, standard deviation; SDMT, Symbol Digits Modalities Test; TMT, Trail Making Test; USER-P-R, Utrecht Scale for Evaluation of Rehabilitation-Participation Restrictions subscale; VOSP, Visual Object and Space Perception Test.

^at-scores, using age-matched (and, when available, education and gender) normative data.

^bImpairment defined as reported subjective cognitive complaints in at least one item of the CLCE-24-C.

^cImpairment defined as MoCA scores < 26.

^dImpairment defined as scores < 1.5 SD below the mean.

^eImpairment defined as VOSP scores < 7.

Table 3. Bivariate analyses: correlations between the neuropsychological tests, MoCA, CLCE-24-C and participation (n = 128) at three to four years after stroke.

			CLCE-24-C	MoCA	BNT	RBMT-I	RBMT-D	SDMT	TMT	VOSP
USER-P-R			−.51*	.24*	−.04	.14	.11	.36*	.20	.37*
SCC:	CLCE-24-C			−.27*	−0.08	−.25*	−.22	−.32*	−.26*	−.27
OCP:	MoCA				.07	.35*	.39*	.37*	.24	.26
	NTB:	BNT				.22*	.21	.16	.15	.06
		RBMT-I					.83*	.29*	.13	.10
		RBMT-D						.30*	.14	.15
		SDMT							.40*	.32*
		TMT								.29

Abbreviations: BNT, Boston Naming Test; CLCE-24-C, Checklist for Cognitive and Emotional Consequences – cognitive subscale; MoCA, Montreal Cognitive Assessment; NTB, Neuropsychological Test Battery; RBMT-D, Rivermead Behavioral Memory Test – Delayed recall; RBMT-I, Rivermead Behavioral Memory Test – Immediate recall; SDMT, Symbol Digits Modalities Test; TMT, Trail Making Test; USER-P-R, Utrecht Scale for Evaluation of Rehabilitation-Participation Restrictions subscale; USER-P-S, Utrecht Scale for Evaluation of Rehabilitation-Participation Satisfaction subscale; VOSP, Visual Object and Space Perception Test.

*p < .05.

Table 4. Multivariate analysis: associations between different combinations of cognitive measures (CLCE-24-C, MoCA and NTB) and participation three to four years after stroke.

			Model 1 (n = 75)			Model 2 (n = 124)			Model 3 (n = 75)			Model 4 (n = 75)
			NTB			MoCA and CLCE-24-C			NTB and CLCE-24-C			Backward model
			B	(95% CI)	β	B	(95% CI)	β	B	(95% CI)	β	B	(95% CI)	β
		Constant	−0.12	(−42.74–42.49)		74.56	(46.71–102.41)		25.11	(−18.41–68.64)		28.39	(−8.75–65.54)
SCC:	CLCE-24-C					−1.46	(−2.06–−0.86)	−0.41*	−1.18	(−1.96–−0.40)	−0.33*	−1.35	(−2.07–−0.64)	−0.38*
OCP:	MoCA					0.79	(−0.26–1.83)	0.13				^a
	NTB:	BNT	−0.06	(−0.20–0.07)	−0.10				−0.05	(−0.18–0.08)	−0.09	^a
		RBMT-I	0.31	(−0.70–1.32)	0.14				0.11	(−0.85–1.07)	0.05	^a
		RBMT-D	−0.13	(−1.11–0.84)	−0.06				−0.05	(−0.97–0.88)	−0.02	^a
		SDMT	0.47	(0.01–0.92)	0.26*				0.32	(−0.12–0.76)	0.18	^a
		TMT	0.05	(−0.42–0.52)	0.03				−0.03	(−0.47–0.42)	−0.01	^a
		VOSP	8.39	(2.18–14.60)	0.32*				7.99	(2.12–13.85)	0.30*	9.67	(4.37–14.97)	0.37*
		R^2	0.20			0.20			0.29			0.31

Abbreviations: 95% CI, 95% confidence interval; B, unstandardized regression coefficient; β, standardized regression coefficient; BNT, Boston Naming Test; CLCE-24-C, Checklist for Cognitive and Emotional Consequences - cognitive subscale; MoCA, Montreal Cognitive Assessment; NTB, Neuropsychological Test Battery; OCP, objective cognitive performance; RBMT-D, Rivermead Behavioral Memory Test – Delayed recall; RBMT-I, RBMT - Immediate recall; SCC, subjective cognitive complaints; SDMT, Symbol Digits Modalities Test; TMT, Trail Making Test; USER-P-R, Utrecht Scale for Evaluation of Rehabilitation-Participation Restrictions subscale; VOSP, Visual Object and Space Perception Test.

^a Variable removed in final backward analysis.

*p < .05.