Assessing the relationship of a neuropsychological model on concurrent function in acute stroke patients

Objective: Few studies have examined the relationship between cognition and function in stroke inpatients utilizing comprehensive methods. This study aimed to assess the relationship of a neuropsychological model, above and beyond a medical model, with concurrent functional status across multiple domains in the early stages of stroke recovery. Methods: Seventy-five acute stroke patients were administered a comprehensive neuropsychological assessment. Functional domains of ability, adjustment, and participation were assessed using the Mayo-Portland Adaptability Inventory - 4 (MPAI-4). Hierarchical linear regression was used to first account for a medical model comprised of neuroimaging results, co-morbid factors, and demographic information, followed by a neuropsychological model comprised of composite scores derived from neuropsychological tests of executive function, memory, visuospatial-constructional skills (VSC), and language. Results were examined for the sample as a whole, and after segregating the sample by stroke location using the Oxfordshire Community Stroke Project (OCSP) Classification System. Results: The neuropsychological model was significantly associated, above and beyond the medical model, with MPAI-4 Ability, Participation, and Total scores (all p-values < .05). The strength of association varied across functional domains, and was dependent on stroke location. Specifically, in anterior region strokes, executive function was significantly associated with MPAI-4 Total and Ability subscales (all p-values < .05). In posterior region strokes, VSC was significantly associated with MPAI-4 Adjustment, and memory was significantly associated with MPAI-4 Total (all p-values <.05). In the medical model, anterior region lesions resulted in greater maladjustment following stroke. Conclusion: Neuropsychological assessment contributes independently to the determination of functional status above and beyond medical and demographic variants of stroke patients in the early stages of recovery. There appears to be an intricate relationship between cognitive and functional domains which is dependent on stroke location. In addition, patients with anterior region strokes may benefit from a formulated intervention as part of their treatment plan due to greater difficulty with adjusting to the stroke.Arts and Sciences, Irving K. Barber School of (Okanagan)Psychology, Department of (Okanagan)Graduat