Mapping the trajectory of acute mild-stroke cognitive recovery using serial computerised cognitive assessment

Alana Campbell; Louise Gustafsson; Rohan Grimley; Hannah Gullo; Ingrid Rosbergen; Mathew Summers

doi:10.1071/IB23042

RESEARCH ARTICLE (Open Access)

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Mapping the trajectory of acute mild-stroke cognitive recovery using serial computerised cognitive assessment

Alana Campbell

^A ^B ^* , Louise Gustafsson

^C , Rohan Grimley ^B ^D , Hannah Gullo ^A , Ingrid Rosbergen ^B ^E and Mathew Summers ^F

+ Author Affiliations

- Author Affiliations

^A The University of Queensland (School of Health and Rehabilitation Sciences), Brisbane, Queensland, Australia

^B Queensland Health (Sunshine Coast Hospital and Health Service), Sunshine Coast, Queensland, Australia

^C Griffith University (School of Health Sciences and Social Work), Brisbane, Queensland, Australia

^D Griffith University (School of Medicine), Sunshine Coast, Queensland, Australia

^E University of Applied Sciences, UAS, Leiden, The Netherlands

^F University of the Sunshine Coast (School of Health and Behavioural Sciences), Sunshine Coast, Queensland, Australia

^* Correspondence to: alana.campbell@health.qld.gov.au

Brain Impairment 24(3) 629-648 https://doi.org/10.1017/BrImp.2022.24

Submitted: 11 November 2021 Accepted: 15 September 2022 Published: 12 October 2022

© The Author(s), 2022. Published by Cambridge University Press on behalf of Australasian Society for the Study of Brain Impairment. This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Introduction:

Cognitive impairment is common post-stroke. There is a need to understand patterns of early cognitive recovery post-stroke to guide both clinical and research practice. The aim of the study was to map the trajectory of cognitive recovery during the first week to 90-days post-stroke using serial computerised assessment.

Method:

An observational cohort study recruited consecutive stroke patients admitted to a stroke unit within 48 hours of onset. Cognitive function was assessed using the computerised Cambridge Neuropsychological Test Automated Battery (CANTAB) daily for seven days, then 14, 30 and 90 days post-stroke. The CANTAB measured visual episodic memory and learning, information processing speed, visuo-spatial working memory, complex sustained attention and mental flexibility. Repeated measures MANOVA/ANOVA with Least Squares Difference post-hoc analyses were performed to ascertain significant change over time.

Result:

Forty-eight participants, mean age 73, primarily mild, ischaemic stroke, completed all assessment timepoints. There was a trajectory of early, global cognitive improvement, indicative of a post-stroke delirium, that largely stabilised between 6 and 14-days post-stroke. Change over time was examined within each cognitive test, with one measure stabilising by day 6 (Reaction Time) and others detecting improving performances up to 14 days post-stroke.

Conclusions:

Serial, computerised cognitive assessment can effectively map post-stroke cognitive recovery and revealed an early phase of global improvement over 14 days that is evidence for an acute post-stroke delirium. Resolution of post-stroke delirium in the second week following mild stroke indicates more extensive neuropsychological testing may be undertaken earlier than previously thought.

Keywords: Cognitive dysfunction, stroke, delirium, mild cognitive impairment, neuropsychological tests.

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