Cognitive function and improvement of balance after stroke in elderly people: the Gothenburg Cognitive Stroke Study in the Elderly

Abstract

Purpose. The ability to balance is no longer automatic after stroke in patients with motor impairment and needs to be relearned. Learning requires cognitive and executive abilities. It is well known that cognitive and executive impairments are common after stroke, but how these are related to balance has not yet been fully studied. We, therefore, wanted to explore the impact of pre-stroke cognitive impairment, global and selective cognitive and executive impairment in the early phase after stroke and at the 1-year follow-up on balance and on the improvement of balance during the first year after stroke.

Method. Seventy-four patients were included consecutively on admission following stroke to a geriatric stroke unit and followed prospectively for 1 year. Balance was assessed using the Berg Balance Scale on admission, on discharge and 1 year after stroke.

Results. Cognitive impairment before stroke, measured using the Cognitive Impairment Questionnaire, was found to lead to poor balance on discharge and 1 year after stroke. Patients with impaired logical deductive ability and executive function, measured using a neuropsychological test battery both in the early phase and 1 year after stroke, also had significantly poorer balance 1 year after stroke than patients with intact functions. Most importantly, only patients with intact cognitive function, before stroke, on admission and at the 1-year follow-up, significantly improved their balance after discharge.

Conclusions. Our results show that cognitive status, both before and after stroke, is important for balance and improvement of balance after stroke.

Keywords:

• Stroke
• postural balance
• cognition
• aged

Acknowledgements

The authors would like to thank the ward staff for data collection, Helle Wijk and Marie Cederfeldt for valuable support. This study was financially supported by the Vårdal Institute, the agreement concerning Research and Education of Doctors (ALF) at Sahlgrenska Academy, University of Gothenburg, the Health and Medical Care Committee of the Region Västra Götaland, Lion's foundation, the Swedish Order of St. John, the Lindh's foundation, the Swedish Stroke Association and the Swedish Association of Registered Physiotherapists (Gerontology and Geriatric Group, Neurology Group and the Renée Eander Foundation).