The relationship between early post-stroke cognition and longer term activities and participation: A systematic review

This systematic review examined whether early cognitive impairment after stroke is predictive of outcome within the "activity" and "participation" domains of the International Classification of Functioning, Disability and Health (ICF) at 6-12 months post-injury. Studies were included if cognitive functioning was assessed within 6 weeks of injury and outcome was measured at least 6 months post-injury. PsycINFO, MEDLINE, CINAHL and EMBASE databases were searched and 14 studies were identified. Studies were categorised according to whether "domain-general" or "domain-specific" cognitive assessment was undertaken and whether outcomes measured the ICF activities or participation domains, as determined by three independent raters using previous established linking rules. Quality of studies was assessed using a modified version of Downs and Black's Quality Index. Overall, early cognitive impairment predicted activities and participation 6-12 months post-stroke. This relationship was more consistent when domain-specific cognitive assessment was used. For the domain of activities, visuospatial perception/construction, visual memory, visual neglect, and attention/executive functioning predicted functioning 6-12 months post-stroke. Early domain-specific cognitive assessment may be clinically informative of longer term activities. For the domain of participation, further well-controlled studies are needed to determine the relationship with early post-stroke cognitive impairments.