Relationship of subjective and objective cognition with post-stroke mood differs between early and long-term stroke.

Abstract

Objective: Depression and anxiety affects approximately 1 in 3 stroke survivors. Performance on standardized objective cognitive tests and self-reported subjective cognitive symptoms are associated with concurrent depression and anxiety, but longitudinal data on whether and how objective and subjective cognition relate to emotional outcomes are lacking. Method: N = 99 stroke survivors (M age = 68.9, SD = 13.1; Median NIH Stroke Severity = 5) completed measures of depression and anxiety (Hospital Anxiety and Depression Scale; HADS), objective cognition (Oxford Cognitive Screen) and subjective cognitive symptoms (Cognitive Failures Questionnaire) at 6-months, 4.5, and 5.5 years post-stroke. The contribution of objective and subjective cognition to depression and anxiety was determined via mixed-effects models. Results: We found no evidence that age, stroke severity, years of education, and participant sex related to changes in HADS-Depression or HADS-Anxiety scores (Marginal R²=0.03 and 0.05, respectively). Objective cognitive impairments at 6-months and increases in subjective cognitive symptoms at 5.5 years significantly related to increased HADS-Depression scores (Marginal R²=0.22). Only increases in subjective cognitive symptoms at 5.5 years significantly related to increased HADS-Anxiety scores (Marginal R²=0.20). When conducting models in reverse, HADS-Depression and HADS-Anxiety scores did not reciprocally explain changes in subjective cognitive symptoms. Conclusions: Objective cognitive abilities are more strongly associated with depression at 6-months post-stroke, while subjective cognitive symptoms are more relevant to both long-term post-stroke depression and anxiety. There may be a unique unidirectional influence of subjective cognitive symptoms to post-stroke depression and anxiety.