Cognitive predictors of a performance-based measure of instrumental activities of daily living following stroke

ABSTRACT

Background

To inform cognitive interventions that target functional capacity for individuals who have survived stroke, an evaluation of predictors of daily functioning is necessary. The current literature is limited regarding identifying the associations between objective cognitive functioning and objective performance of Instrumental Activities of Daily Living (IADLs).

Objectives

To investigate the relationship between objectively measured cognitive domains/executive functions and performance on an objective measure of IADLs following a stroke.

Methods

Cross-sectional examination of 52 participants who have survived strokes and completed assessments of immediate memory, visuospatial/constructional skills, language, attention, delayed memory, executive functions (i.e., inhibition and flexibility, concept-formation and problem-solving, abstract thinking, deductive thinking, and verbal abstraction), and a performance-based measure of IADLs (UCSD Performance-based Skills Assessment; UPSA).

Results

Results indicated significant correlations between the UPSA and immediate memory, visuospatial/constructional skills, language, delayed memory, and executive functions (i.e., concept formation and problem-solving, flexibility of thinking, and verbal abstraction). A hierarchical multiple regression, controlling for age, severity of stroke, side of stroke, and depressive symptoms and including the cognitive measures individually significantly associated with the UPSA, explained approximately 62% of the variance in overall UPSA performance. This regression demonstrated that only language significantly predicted UPSA total score, in the context of multiple variables.

Conclusions

Cognitive functioning is significantly associated with IADL functioning post-stroke, and considering multiple domains of cognitive functioning together largely explains the performance of IADLs.

KEYWORDS:

• Stroke
• cognition
• neuropsychological performance
• functioning
• activities of daily living

Disclosure of interest

The authors report no conflict of interest.

Data availability statement

The data that support the findings of this study are available on request from the corresponding author, DT. The data are not publicly available due to their containing information that could compromise the privacy of research participants.

Additional information

Funding

Funding for this project was provided by a UMKC faculty start-up award. Writing of this manuscript was supported by the VA Center of Excellence for Stress and Mental Health (CESAMH) and the Office of Academic Affiliations, CESAMH Advanced Fellowship Program in Mental Illness Research and Treatment, Department of Veterans Affairs.