Executive function subdomains are associated with poststroke functional outcome and permanent institutionalization.

BACKGROUND: Impairment of executive functions (EFs) is a common cognitive symptom poststroke and affects independence in daily activities. Previous studies have often relied on brief cognitive tests not fully considering the wide spectrum of EF subdomains. We used a detailed assessment of EFs to examine which of the subdomains and tests have the strongest predictive value on poststroke functional outcome and institutionalization in long-term follow-up.

METHODS: A subsample of 62 patients from the Helsinki Stroke Aging Memory Study was evaluated with a battery of 7 neuropsychological EF tests 3 months poststroke and compared to 39 healthy control subjects. Functional impairment was evaluated with the modified Rankin Scale (mRS) and Instrumental Activities of Daily Living Scale (IADL) at 3 months, and with mRS at 15 months poststroke. Institutionalization was reviewed from the national registers of permanent hospital admissions in up to 21-year follow-up.

RESULTS: The stroke group performed poorer than the control group in multiple EFs tests. Tests of inhibition, set shifting, initiation, strategy formation, and processing speed were associated with mRS and IADL in stroke paitients. EF subdomain scores of inhibition, set shifting and processing speed were associated with functional outcome. In addition, inhibition was associated with the risk for earlier institutionalization.

CONCLUSIONS: EF was strongly associated with poststroke functional impairment. In follow-up, poor inhibition was related to earlier permanent institutionalization. Results suggest the prognostic value of EFs subdomains after stroke. This article is protected by copyright. All rights reserved.