Real-Time Associations Between Subjective Cognitive Concerns and Daily Activity Participation in Persons Aging With Stroke: Smartphone-Based Ecological Momentary Assessment Study.

Abstract

Background: Stroke is a leading cause of global disability in the aging population, with cognitive impairments playing a significant role. Prior research has shown that subjective cognitive concerns (SCCs) can predict later dementia and serve as an essential indicator for poststroke functional rehabilitation. The use of smartphone-based ecological momentary assessment (EMA) in real-world environments may help us understand how SCCs relate to daily functioning in individuals aging with stroke, thereby guiding cognitive rehabilitation and prevention efforts.

Objective: Our study aimed to use EMA to examine the real-time associations between SCCs and daily activity participation in persons aging with stroke.

Methods: This longitudinal observational study used smartphone-based EMA for real-time assessment of individual cognitive concerns and participation in various daily activities. EMA survey items, including SCCs (concentration and learning) and participation in daily activities (location, company, current activity, and self-appraisals of performance, help needed, satisfaction, and engagement), were collected 5 times per day for 2 weeks. Multilevel models were used to analyze the data.

Results: A total of 202 individuals with mild-to-moderate chronic stroke participated in the study (n=90, 44.6% female; n=89, 44.1% Black; n=182, 90.1% ischemic stroke; mean age 59.7, SD 11.7 years). SCCs were concurrently lower when participants engaged in activities of daily living (ADL; B=-0.04, 95% CI -0.07 to -0.01; P=.02), instrumental ADL (B=-0.05, 95% CI -0.07 to -0.02; P<.001), cognitively stimulating activities (B=-0.05, 95% CI -0.08 to -0.02; P<.001), and social activities (B=-0.05, 95% CI -0.08 to -0.02; P=.002); when participants were located in a friend's home (B=-0.10, 95% CI -0.17 to -0.02; P=.001); and when they spent time with family members (B=-0.07, 95% CI -0.10 to -0.04; P<.001), friends (B=-0.05, 95% CI -0.10 to -0.01; P=.01), and spouse or partners (B=-0.04, 95% CI -0.07 to -0.01; P=.02). Conversely, SCCs were higher when participants were in the hospital (B=0.39, 95% CI 0.25-0.53; P<.001). Additionally, greater SCCs were concurrently associated with worse ratings of performance (B=-0.05, 95% CI -0.06 to -0.05; P<.001), satisfaction (B=-0.05, 95% CI -0.06 to -0.05; P<.001), and activity engagement (B=-0.05, 95% CI -0.06 to -0.04; P<.001).

Conclusions: EMA provides an effective means of understanding the links between poststroke cognition and participation in daily activities. Our findings suggest that ADL, instrumental ADL, cognitively demanding activities, and socially engaging activities may lessen cognitive concerns among stroke survivors, implying that clinicians should schedule these activities to help reduce poststroke cognitive issues. Conversely, interventions that enhance cognition may increase participation in these challenging activities. Tracking cognition, everyday activity involvement, and their interactions in real-world settings could ultimately help develop rehabilitation and prevention strategies for individuals at risk of dementia due to stroke.