Severity of Post-Stroke Cognitive Impairment Moderates the Relationship Between Cognitive Change and Emotional Distress in the Months Following Stroke

Depression and anxiety are common psychological consequences of stroke. Here, we investigated the relationships between cognitive change following stroke, awareness of cognitive impairments, and mood to further understanding of change processes influencing psychological outcomes post-stroke in line with the “Y-shaped” process model. Stroke patients (n = 143) were assessed at 3-weeks (T1) and 6-months (T2) post stroke and had completed the Oxford Cognitive Screen (T1 and T2), the Cognitive Failures Questionnaire (CFQ; T2), and the Hospital Anxiety and Depression Scale (HADS; T2). An ANCOVA controlling for disability relating to activities of daily living (ADL) revealed that awareness of cognitive impairment was significantly lower in participants with moderate-severe cognitive impairment. Regression analysis indicated that greater awareness of cognitive impairment and greater independence in ADL were associated with lower HADS scores at T2. Finally, cognitive improvement over time was associated with lower HADS scores at T2. This was moderated by acute cognitive impairment, suggesting that this effect was largest for those most cognitively impaired at T1. Together, predictors explained 36.9% variance in the model, whereby the interaction variable explained 2.2% variance. Targeting those most cognitively impaired post-stroke with cognitive rehabilitation may positively impact their long-term emotional adjustment.