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Research paper
The severity of cognitive deficits predicts return to work after a first-ever ischaemic stroke
  1. Tatu Kauranen1,2,
  2. Katri Turunen1,3,
  3. Siiri Laari1,3,
  4. Satu Mustanoja3,
  5. Peter Baumann2,
  6. Erja Poutiainen1,3
  1. 1University of Helsinki, Institute of Behavioral Sciences, Helsinki, Finland
  2. 2Department of Neurology and Clinical Neurophysiology, Lapland Central Hospital, Rovaniemi, Finland
  3. 3Helsinki University Central Hospital, Helsinki, Finland
  1. Correspondence to Tatu Kauranen, Department of Neurology, Lapland Central Hospital, P.O. Box 8041, FIN-96200 Rovaniemi, Helsinki, Finland; tatu.kauranen{at}


Background The inability of stroke patients to return to work contributes disproportionately to the socioeconomic impact of stroke and is best predicted by the severity of stroke. However, the role of cognitive deficits in stroke severity has not been scrutinised. We studied whether the initial cognitive severity of stroke, compared with other influential factors, predicts the inability to return to work after stroke.

Methods Consecutive patients aged 18–65 with a first-ever ischaemic stroke, working full time previously, were assessed neuropsychologically within the first weeks after stroke and at the 6-month follow-up. Similarly, 50 healthy demographic controls were assessed twice. The cognitive severity of stroke was operationalised as the number of initial cognitive deficits. Cognitive severity as a predictor of the inability to return to work was compared with demographic, occupational, neurological, radiological and functional data, vascular risk factors and mood state.

Results The mean age of the 140 patients assessed both initially and at follow-up was 52 years. They had a mean of 13 years of education and 59% were men. At 6 months, only 41% of the patients had returned to work despite the relatively minor neurological and functional impairments of the cohort. In our model, the number of early cognitive deficits (OR=2.252, CI 1.294 to 3.918) was the only significant predictor of the inability to return to work.

Conclusions The initial cognitive severity of stroke predicts the later inability to return to work. The benefits of neuropsychological assessments within the first weeks after stroke are emphasised.

  • Neuropsychology
  • cerebrovascular disease
  • stroke
  • cognition

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  • Funding The Social Insurance Institution of Finland (KELA) and Lapland Hospital District EVO-fund funded this study.

  • Competing interests None.

  • Ethics approval Provided by the ethics committee of Helsinki University Central Hospital.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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