Assessing Prevalence and Predictors of Impaired Executive Functioning in Four-year Stroke Survivors

Stroke is a cerebrovascular accident which may result in long-lasting consequences in the physical, emotional and cognitive wellbeing of a survivor’s life. Impaired executive function (EF) is a common form of cognitive impairment following a stroke which often results in the inability to sustain attention, initiate action, control emotions and motor coordination. These types of deficits can significantly impact a stroke survivor’s day-to-day living and quality of life. To date, there is a lack of data which examines the long-term effects of stroke on EF. The current study aimed to understand the predictors and prevalence of EF in four-year stroke survivors. The current four-year follow-up study used a quantitative methodology. The sample (n=132) comprised of previously collected data, obtained from a sub-cohort drawn from a large population-based study, the fourth Auckland Regional Stroke Outcome Study (ARCOS-IV). Baseline data (at time of stroke or within two weeks) was obtained to examine factors which were associated with long-term impaired EF, four years following a stroke. EF was measured using the Comprehensive Trail Making Test (CTMT) at the four-year timepoint. A mean score of < 43 was indicative of impaired EF. Multivariate linear and logistic models were used to identify baseline predictors (reported as Odds Ratio [OR] with 95% confidence intervals [CI]) of impaired EF). Four years after the stroke, nearly half (48.5%) of the stroke survivors experienced impaired EF (indicated by a score of <43 in the CTMT). Factors such as age, unemployment, a posterior circulation infarct (POCI), stroke in the non-frontal region, stroke in middle cerebral artery (MCA), having a history of previous stroke, history of hypertension, history of coronary artery disease, impaired baseline cognitive function (Montreal Cognitive Assessment [MoCA] scores ≤26) and lower quality of life (EuroQol Quality of Life Scale [EQ-5D] utility scores