Association of Depression and Anxiety With Cognitive Impairment 6 Months After Stroke
Owen A. Williams, Nele Demeyere
Abstract
<h3>Objective</h3> To investigate the associations between general cognitive impairment and domain-specific cognitive impairment with depression and anxiety at 6 months poststroke. <h3>Methods</h3> Participants were patients with confirmed acute stroke from the OCS-Care Study who were recruited on stroke wards in a multisite study and followed up at a 6-month poststroke assessment. Depression and anxiety symptoms were assessed by the Hospital Anxiety and Depression Scale subscales, with scores greater than 7 indicating possible mood disorders. General cognitive impairment at follow-up was assessed using the Montreal Cognitive Assessment (MoCA); stroke-specific cognitive domain impairments were assessed using the Oxford Cognitive Screen (OCS). Linear regression was used to examine the associations between cognition and depression/anxiety symptoms at 6 months, controlling for acute stroke severity and activities of daily living impairment, age, sex, education, and co-occurring poststroke depression/anxiety. <h3>Results</h3> A total of 437 participants (mean age, 69.28 years [SD 12.17], 226 male [51.72%]) were included in analyses. Six-month poststroke depression (n = 115, 26%) was associated with 6-month impairment on the MoCA (β = 0.96, standard error [SE] 0.31, <i>p</i> = 0.006) and all individual domains assessed by the OCS: spatial attention (β = 0.67, SE 0.33, <i>p</i> = 0.041), executive function (β = 1.37, SE 0.47, <i>p</i> = 0.004), language processing (β = 0.87, SE 0.38, <i>p</i> = 0.028), memory (β = 0.76, SE 0.37, <i>p</i> = 0.040), number processing (β = 1.13, SE 0.40, <i>p</i> = 0.005), and praxis (β = 1.16, SE 0.49, <i>p</i> = 0.028). Poststroke anxiety (n = 133, 30%) was associated with impairment on the MoCA (β = 1.47, SE 0.42, <i>p</i> = 0.001) and spatial attention (β = 1.25, SE 0.45, <i>p</i> = 0.006); these associations did not remain significant after controlling for co-occurring poststroke depression. <h3>Conclusion</h3> Domain-general and domain-specific poststroke cognitive impairment was found to be highly related to depressive symptomatology but not anxiety symptomatology.