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Cognitive determinants of social functioning after a first-ever mild to moderate stroke at vocational age
  1. Marc Hommel (marc.hommel{at}ujf-grenoble.fr)
  1. INSERM CIC 003, University Hospital Grenoble, France
    1. Sandra Trabucco-Miguel (strabucco{at}chu-grenoble.fr)
    1. Stroke Unit, University Hospital - Joseph Fourier University, Grenoble, France
      1. Bernadette Naegele (bnaegele{at}chu-grenoble.fr)
      1. Research Center, Grenoble Institute of Neuroscience Unit UMR_S Inserm - UJF - CEA U 836 - GIN, France
        1. Nicolas Gonnet (ngonnet{at}chu-grenoble.fr)
        1. INSERM CIC 003, University Hospital Grenoble, France
          1. Assia Jaillard (assia.jaillard{at}ujf-grenoble.fr)
          1. Research Center, Grenoble Institute of Neuroscience Unit UMR_S Inserm - UJF - CEA U 836 - GIN, France

            Abstract

            Background and purpose: Social functioning is impaired in about two third of stroke patients in vocational age, even several months after a first-ever mild to moderate stroke. The known predictors of social functioning were initial stroke severity, anxiety and depression and the Mini Mental State Evaluation, suggesting that cognitive deficits contribute to post-stroke social dysfunctioning.

            Our aim was to evaluate whether cognitive domains correlated with social functioning and to determine the cognitive predictors of social dysfunctioning.

            Methods: We prospectively included 74 patients, 6 months after a first-ever stroke. NIHSS, modified Rankin scale, depression and anxiety were recorded. Social functioning was recorded using the Work and Social Adjustment Scale (WSAS). An extensive neuropsychological tests battery explored general cognitive functioning, episodic memory, instrumental functions, executive functions and working memory. Univariate comparisons assessed the relationships between the neuropsychological tests and the WSAS. Predicting factors of WSAS were determined using ordinal logistic regression.

            Results: Fifty two patients (70%; 95% CI 58 – 80%) complained of significant perturbation of functioning. In univariate comparisons, general cognitive functioning, memory, instrumental functions, executive functions and working memory significantly correlated with social functioning. Executive functions and working memory were the most affected domains. With multivariate modelling, the NIHSS at admission, Hospital Anxiety-Depression scale and Owen Spatial Working Memory test were independent predictors of WSAS.

            Conclusions: All cognitive domains were associated with social functioning, working memory being the main cognitive determinant. Our results suggest that cognitive impairment interfere with social dysfunctioning, resulting in alteration in quality of life.

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