Assessment of subacute first-ever stroke patients: Use of cognitive tests, psychosocial measures and an examination of caregiver factors.

Dr Astrid Fernandes (). Assessment of subacute first-ever stroke patients: Use of cognitive tests, psychosocial measures and an examination of caregiver factors. Professional Doctorate, School of Psychology, The University of Queensland.

       
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Author Dr Astrid Fernandes
Thesis Title Assessment of subacute first-ever stroke patients: Use of cognitive tests, psychosocial measures and an examination of caregiver factors.
School, Centre or Institute School of Psychology
Institution The University of Queensland
Thesis type Professional Doctorate
Supervisor Dr Jeanie Sheffield
Total pages 211
Abstract/Summary Abstract Aims: (1) To examine the cognitive and psychosocial functioning of a cohort of subacute first-ever stroke patients assessed within 3 weeks of stroke onset and at 3 and 6 months post-stroke. (2) To compare their cognitive and psychological functioning to an age- and education-matched reference group. (3) To examine their quality of life (QOL) following discharge. Method: Seventeen first-ever ischaemic stroke patients (M = 67.1 years, SD = 9.51) were assessed with the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and other cognitive tests and psychosocial measures at a hospital following admission for stroke. The follow-up assessments were conducted at the patients’ homes. Results: At the subacute stage, around 74% of the patients were impaired in one or more domains of the RBANS. The most frequently affected domains were immediate memory, delayed memory, attention and visuospatial/constructional. At the follow-up assessments, around 58% of the patients were still impaired. Associations between the total scale score at Time 1 (T1) revealed strong significant correlations with immediate memory (r =.75), attention (r =.69), delayed memory (r =.69) and total scale score (r = .79) at T3. Compared with the reference group, the performance of stroke survivors was generally lower on all domains. At T1 there were statistically significant differences between the two groups on delayed memory and total scale score. At Time 2 (T2) statistically significant differences were noted on language, attention and total scale scores. On the psychological measures, more than 50% of the stroke patients had anxiety symptoms and around 29% had depressive symptoms at baseline and the prevalence of both symptoms decreased marginally over the two follow-up assessments. The prevalence of these symptoms was higher in stroke patients compared with the reference group at both assessments. The performance of stroke patients on the RAND 36-Item Survey 1.0 from T1 to Time 3 (T3) was generally much lower on all the subscales compared to Australian normative data. Physical functioning, role limitations due to physical problems, and social functioning were the most impaired dimensions at T1. Statistically significant increases between T1 and T2 were noted only in the social functioning domain. Conclusions: Findings suggest that cognitive impairments, anxiety and depression are frequent and often chronic consequences of stroke. These impairments may have a detrimental impact on stroke survivors’ QOL. Early cognitive testing of subacute stroke patients may have some predictive utility.
Keyword Stroke
Stroke assessment
Stroke Outcome
STROKE PATIENT
cognitive assessment
psychological assessment
caregiver
caregiver assessment
caregiver factors
psychosocial
psychosocial assessment
quality of life

 
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Created: Sun, 20 Feb 2011, 18:27:37 EST by Dr Astrid Fernandes