HONOLULU—Attention and visuospatial ability three months after stroke may be strong predictors of patients’ long-term quality of life. Mental processing speed in the acute stage, particularly choice reaction time, also may be associated with quality of life at 12 months after stroke, according to research presented at the 2013 International Stroke Conference.
“It is possible that straightforward reaction time tasks are sensitive to the extent of brain damage after stroke,” said Toby Cumming, PhD, postdoctoral research fellow at the Florey Institute of Neuroscience and Mental Health in Melbourne. “As a surrogate marker of general brain status and network interruption, reaction time is reflected in quality of life.”
Assessing Cognitive Outcomes and Quality of Life After Stroke
Recently, two large studies with more than three years of follow-up showed that processing speed and visuomotor speed are independently associated with long-term functional outcome after stroke. Prompted in part by these data, Dr. Cumming and colleagues enrolled 60 patients in a study that assessed cognitive outcomes and quality of life during the first year after stroke. Eligible patients had ischemic stroke or intracerebral hemorrhage, and patients who had impairments that precluded cognitive testing were excluded from the study.
The researchers tested simple reaction time and choice reaction time in a subgroup of 33 patients in the acute stage of stroke (mean 5.4 days after stroke onset). The tests were drawn from the CogState computerized battery, and each test took approximately three minutes to complete.
Investigators assessed all patients with a full neuropsychologic exam and the Hospital Anxiety and Depression Scale at three months after stroke. Patients were given the Assessment of Quality of Life at 12 months after stroke. Dr. Cumming’s group used correlation and regression models to identify the factors associated with quality of life at 12 months after stroke.
Executive Function May Not Predict Quality of Life
About 81% of patients had an infarct, and 19% had a hemorrhage. Forty-four of the 60 patients were male. Subjects’ mean age was 72, and mean stroke severity, as measured by NIH Stroke Scale score, was 5.8.
Older age was independently related to lower quality of life at 12 months. Of the cognitive domains assessed at three months, attention and visuospatial ability were most closely related to quality of life at 12 months, with moderate correlations of 0.51 and 0.50, respectively. Executive function, language, and memory also were associated with quality of life, but not as strongly.
Data from the acute stage testing indicated that faster simple and choice reaction times were related to greater quality of life at 12 months, with correlations of 0.47 and 0.67, respectively. “It is unlikely that acute reaction time is simply a proxy for stroke severity, as no correlation with NIH Stroke Scale score was identified,” said Dr. Cumming.
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Barker-Collo S, Feigin VL, Parag V, et al. Auckland Stroke Outcomes Study. Part 2: Cognition and functional outcomes 5 years poststroke. Neurology. 2010;75(18):1608-1616.
Cumming TB, Brodtmann A, Darby D, Bernhardt J. Cutting a long story short: reaction times in acute stroke are associated with longer term cognitive outcomes. J Neurol Sci. 2012;322(1-2):102-106.