Dual Impairment in Cognition and Physical Performance After Stroke: Prevalence, Pathogenesis and Prediction of Function
Bibliographic record
Abstract
Dual impairment of physical performance and cognition has been reported to increase the risk of dementia, falls, and functional dependency. However, this coexistence of impairments has to a little extent been explored in stroke populations; instead, these impairments have been studied, diagnosed, and treated as distinct entities. As a result, further knowledge is needed to delineate the underlying pathological mechanisms of dual impairment and their consequences for long-term function in stroke survivors.\nThe overall aim of this thesis was to investigate both the synergistic relationship between physical performance and cognition after stroke and the associations between functional outcomes and brain pathology. This thesis was based on data from baseline and 3- and 18-month follow-ups of the Norwegian Cognitive Impairment After Stroke (Nor-COAST) study, a prospective multicenter cohort study including 815 participants admitted to stroke units with acute stroke in five Norwegian hospitals between May 2015 and March 2017.\nPerformance-based assessments included the Montreal Cognitive Assessment (MoCA) and Short Physical Performance Battery (SPPB) at baseline and 3-month follow-up. In addition, executive function, memory, grip strength, and dual task cost were assessed at 3-month follow-up. Instrumental activities of daily living (IADL) were assessed at 3-and 18-month follow-up with the Nottingham Extended ADL (NEADL) questionnaire. Approximately half of the Nor-COAST participants were included in an MRI sub-study in which information was obtained on markers of cerebrovascular and neurodegenerative pathology, as well as on stroke lesion location and volume.\nResults from Paper 1 showed that every third participant in our sample showed impairment in either cognitive or physical function at 3 months post-stroke, with rates of concurrent impairment ranging from 10% to 23%, depending on which combination of assessments was applied. Impairments in physical performance and grip strength were associated with impaired global cognition, executive dysfunction, and impaired memory. Higher dual-task cost was only associated with executive dysfunction.\nIn Paper 2, combining measures of physical performance and cognition was found to be superior to assessing one domain exclusively in the prediction of change in IADL from 3 to 18 months post-stroke; however, cognition appeared to be a stronger predictor than physical performance when applied in combination within the same model. Overall, a stable level of IADL function was found among participants, but high scores on measures of both physical performance and cognition at 3 months post-stroke were associated with a statistically significant improvement in function over the ensuing 15 months.\nResults from Paper 3 showed that a larger stroke lesion volume was associated with dual impairment in cognition and physical performance at the time of stroke. Pre-existing pathology was found in two-thirds of the participants; however, associations with dual impairment were not significant when adjusting for age, whereas the association with stroke lesion volume remained significant. Participants with dual impairment were older, had poorer pre-stroke function, and suffered more severe stroke, on average, than participants with only one or no impaired domain.\nTo summarize, this thesis found that impairments in cognition and physical performance are observed in a substantial number of stroke patients, and that performance-based testing of dual impairment at 3 months post-stroke is useful for predicting IADL function at 18 months. These results contribute to increased knowledge of the interplay between post-stroke cognition and physical performance, their associations with brain pathology at the time of stroke, and their role in the prediction of long-term function. The\nidentification of dual impairments at 3 months post-stroke may be relevant for preventing functional decline and supports the adoption of a holistic treatment approach for this patient group. Further research is needed to refine the methods for identifying risk profiles and developing personalized rehabilitation that targets especially vulnerable populations following stroke.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".