Impact of Cognitive Impairment on Functional Outcomes of Stroke Patients at a Tertiary Care Rehabilitation Institute.

Research Objectives: To assess the impact of cognitive impairment on the functional outcomes after institutional rehabilitation of stroke patients.

Design: prospective cohort of 85 stroke patients admitted for institutional rehabilitation followed for 3 months.

Setting: Inpatient rehabilitation facilities

Participants: All inpatient stroke rehabilitation patients except who had previous strokes, cognitive decline, or functional impairment prior to the current stroke and those who developed further new brain insults.

Interventions: Intensive inpatient rehabilitation care.

Main Outcome Measures: Cognition was assessed using Montreal Cognitive Assessment (MoCA) and Addenbrooke’s Cognitive Examination (ACE) to categorize as cognitively impaired and unimpaired groups. Functional improvement was measured by the change of Modified Barthel Index (MBI).

Results: Male to female ratio was approximately 3:2. Median (IQR) age was 65.00(53.50-70.00) years. Ischaemic strokes were 91.8% while 8.2% were haemorrhagic in type. Majority (85.9%) were educated up to ordinary and advanced level. 40% of patients were unemployed while higher managerial, intermediate, and routine and manual workers were 4.7%, 40% and 15.3% respectively. 98.8% of the participants had good family support and 30.6% of patients had financial restrain. The percentage of cognitive impairment in the sample was 34.1%-36.5%(MoCA < 22 = 34.1%, ACE < 86= 36.5%). NIHSS in cognitively impaired patients was high in comparison to the control group (NIHSS median in MoCA < 22/ACE < 86=9/9 and NIHSS median in MoCA ≥22 / ACE≥ 86 = 6/6). The median (IQR) change of MBI of the MoCA ≥22 and MoCA < 22 groups were 50.00(35.00-55.00) and 15.00(15.00-25.00) respectively (p < 0.001.) The respective values for ACE≥86 and ACE < 86 groups were 50.00(35.00-56.25) and 15.00(15.00-25.00) (p < 0.001). While age (p>0.05) was not significantly associated with MBI-change(r=0.156,p=0.155) a higher positive change of it was observed among females (median 45.00 versus 15.00, p=0.043)

Conclusions: Cognitively impaired stroke patients had poor recovery in their functional outcomes, compared to patients with normal cognition, despite being exposed to a similar inward rehabilitation therapy programme.

Author(s) Disclosures: None.