Circadian rest-activity rhythms associated with affect and cognition in stroke survivors: An ambulatory assessment study

Research Objectives: Rest-activity rhythm (RAR), a marker of circadian rhythm, is associated with health but is altered after stroke. This study aimed to examine the associations of RAR with affect and cognition in stroke survivors to determine if RAR may be a focus for intervention to improve affect and cognition outcomes.

Design: Prospective cohort study involving 7 days of ambulatory monitoring; participants completed 8 daily ecological momentary assessments (EMA) of their affect and cognitive complaints, wore an accelerometer, and completed the NIH Toolbox Cognition Battery. RAR measures were extracted using parametric and non-parametric approaches. Multivariable linear regression models were developed to identify RAR measures associated with affect and cognition, adjusting for age, sex, and race.

Setting: General community.

Participants: Forty community-dwelling survivors of stroke.

Interventions: Not applicable.

Main Outcome Measures: Independent variables include RAR measures of timing, activity level, rhythmicity, and fragmentation. Dependent variables include EMA measures of cognitive complaints, cheerful affect, and depressed affect and objective measures of fluid and crystallized cognition.

Results: Later onset of rest (estimate=.45; p=.008) and activity (estimate=.36; p=.041) were associated with greater depressed affect. In contrast, an earlier onset of rest (estimate=.42; p=.017) and activity (estimate=.39; p=.033) were associated with greater cheerful affect. Cheerful affect was also associated with higher relative amplitude of RAR (estimate=.39; p=.030). Higher intra-daily variability (estimate=.35; p=.042) and later onset of activity (estimate=.36; p = .048) were associated with higher levels of measured cognitive complaints. More robust/less erratic RAR were associated with higher levels of fluid cognition (estimate=.29; p=.036); intra-daily variability was positively associated with crystallized cognition (estimate=.39; p=.015).

Conclusions: We identified RAR measures associated with affect and cognition in stroke survivors. Future research should test if stabilizing RAR and promoting an earlier onset of rest and activity will reduce affective and cognitive impairment after stroke. This study also underscores the value of extending the focus of stroke rehabilitation from daytime waking behaviors to nighttime rest activity (i.e., a 24-hour approach).

Author(s) Disclosures: None disclosed.