Cognitive impairments and mood disruptions negatively impact instrumental activities of daily living performance in the first three months after a first stroke

Background: Cognition and mood play crucial roles in post-stroke recovery; however, the stroke literature is unclear as to how impairments in both domains influence performance of instrumental activities of daily living (IADL). Objective: (1) Evaluate the extent to which mood and cognition at two weeks post-stroke predict performance three months post-stroke. (2) Assess performance differences inpatients with impairments in both cognition and mood to patients with impairments in either cognition or mood. Methods: Inpatients with a first-ever ischemic or hemorrhagic stroke were assessed at 2 weeks (n=52) and at 3 months (n=41) post-stroke. Patients completed a battery of neuropsychological tests, self-report measures and performance-based tests. Cognitive impairments and mood disruptions were assessed at 2 weeks and three months and IADL performance, as assessed by the Executive Function Performance Test, was evaluated at three months. Results: Complete data from the 41 patients assessed at both time points were analyzed. Regression analysis showed that composite cognition and composite mood variables at two weeks post-stroke predicted 48% of the variance in IADL performance at three months (F-3,F-37=12.04; adjusted R-2=0.48, P<0.001). Statistically significant differences were found in performance scores for patients with a single impairment (M=7.86, SD=7.81) and for those with impairments in both mood and cognition (M=19.2, SD=13.2) (t(39) = -3.41, P=0.008). Conclusion: The results of this study suggest that cognitive and mood impairments at two weeks post-stroke are important predictors of performance in complex activities required for full independence at home and should be routinely assessed in stroke rehabilitation.