Predictors of Post-stroke Cognition Among Geriatric Patients: The Role of Demographics, Pre-stroke Cognition, and Trajectories of Depression

Abstract

Stroke is a prevalent disease among geriatric population, which tends to deteriorate cognitive ability and mental health. In such context, cognitive impairment and geriatric depression generate mutually deteriorating impacts on each other. Using the Health and Retirement Study, this study examined depression and cognition before, immediately after, and 2 years after the onset of stroke. Through latent growth mixture modeling, four different trajectories of depression were identified: resilience, recovery, emergent depression, and chronicity. We used demographics including gender, age, race, and ethnicity, activity of daily life, baseline cognition, and trajectories of depression to predict cognitive ability 2 years after the stroke. Both aforementioned demographic factors and pre-stroke cognition were predictive of post-stroke cognition, but the inclusion of depression trajectories further improved the predictive ability. Emergent depression and chronicity were two significant predictors of worse post-stroke cognition. This study showed the importance of considering a more specific trajectotrial interrelationship between depression and cognition in geriatric stroke patients.

Sex differences in post-stroke cognitive decline: A population-based longitudinal study of nationally representative data

“…Other variables used in our analysis include time-invariant covariates, such as age at baseline, sex, race / ethnicity and baseline level of education, and time-variant covariates, including participants' current marital status; participants' measure of depressive symptoms, obtained using the center for epidemiological studiesdepression (CES-D) score (higher scores indicating more depressive symptoms); and selfreported history of hypertension, diabetes, cancer, heart disease, and psychiatric conditions. These covariates have been shown to be associated with post stroke cognitive decline and have been typically controlled for in prior studies investigating association of stroke with cognitive decline [12,13,[21][22][23].…”

Biological, Psychiatric, Psychosocial, and Cognitive Factors of Poststroke Depression

“…The association between depression and cognitive difficulties in individuals with PSD is thought to reflect the effect of co-occurring brain damage (hippocampal damage leads to forgetfulness and emotion-regulation difficulties) or changes in environment (sadness with reduced opportunities leading to trouble with attention and forgetfulness) [ 30 ]. Recently, Kang [ 31 ] found that those with severe PSD were more forgetful. Indeed, mild levels of depression are not always associated with cognitive deficits, suggesting that the use of screeners to diagnose depression will be misleading when the diagnosis was mild sadness instead of clinical depression [ 31 ].…”

“…Recently, Kang [ 31 ] found that those with severe PSD were more forgetful. Indeed, mild levels of depression are not always associated with cognitive deficits, suggesting that the use of screeners to diagnose depression will be misleading when the diagnosis was mild sadness instead of clinical depression [ 31 ]. It is interesting to note that in our study there were higher rates of both memory and executive impairment in PSD compared to stroke patients without depression when evaluated in between-group analyses, but when used side by side in the regression analysis, the odds of PSD were significantly associated with memory loss and not executive difficulties.…”

Impact of Hope on Stroke Patients Receiving a Spiritual Care Program in Iran: A Randomized Controlled Trial

“…Long-term hopelessness affects stroke patients' mental and cognitive health. This situation is exacerbated by cognitive deterioration and depression (Jadidi et al, 2022 ; Kang, 2021 ). Compared to the study by Ge et al, our results are different.…”