Can Stress and Depression Increase Risk for Subjective Cognitive Complaints After Stroke?

A physician speaking to a patient
A physician speaking to a patient
Psychological distress at 3 months after stroke may predict subjective cognitive complaints (SCC) at 12 months after the acute event.

Psychological distress at 3 months after stroke may predict subjective cognitive complaints (SCC) at 12 months after the acute event, according to study results published in the Journal of Stroke and Cerebrovascular Disease.

Previous studies reported that SCC are common after stroke and are associated with poor objective cognitive performance (OCP). However, most of the studies were limited due to cross-sectional designs and lack of assessment of changes in SCC over time. In the study the researchers explored changes in SCC during the first 12 months after stroke and possible predictors of SCC.

Checklist for Cognitive and Emotional consequences following stroke (CLCE) inventory (content component [CLCE-c] and worry component [CLCE-w]) was used to assess for SCC. Objective Cognitive Impairment (OCI)-index, previously used to quantify the association between OCP with SCC, was calculated using several tests, including the Mini Mental State Exam total score and standard neuropsychological tests. To determine predictors of change in SCC at 12 months post-stroke, multiple hierarchical linear regression analyses were performed.

Of 208 adults (mean age 64±7.9 years, 69.7% men) with a clinical diagnosis of ischemic or hemorrhagic stroke from the COMplaints After Stroke Study that had a first SCC assessment using the CLCE inventory at baseline (3 months), 155 (74.5%) were available for follow-up at 12 months with a second SCC assessment.  

At the group level, from the 3-month baseline assessment to 12-month follow-up, the CLCE-c scores remained stable. At the individual patient level, most patients (56.8%) had a stable CLCE-c score over time (CLCE changes of ≤1 point), and only 11 patients displayed clinically significant changes over time (8 worsened and 3 improved). A similar pattern was observed for the CLCE-w, with a change from 1.9±2.2 to 2.1±2.5 (P =.28) from 3 to 12 months.

As for predictors of SCC at follow-up, patients with SCC at 3 months after stroke were at increased risk for SCC at 12 months post-stroke (β =.54, P <.001). In addition, independent predictive values were found for perceived stress (for CLCE-c) and depression (for CLCE-w). SCC was not found to be predictive of future OCP. OCP and age at 3 months proved to be more important than SCC in predicting future OCP.

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The study had several limitations, according to the researchers, such as the inclusion of mostly mild stroke cases, no data on the locations of the lesions, and limited sample size.

“Our results suggest that interventions aimed at reducing perceived stress (maybe by developing adequate coping skills) and depressive symptoms in the first few months after stroke might reduce sustained SCC and improve well-being during the first year following stroke,” conclude the researchers.


van Rijsbergen MWA, Mark RE, Kop WJ, de Kort PLM, Sitskoorn MM. Course and predictors of subjective cognitive complaints during the first 12 months after stroke. J Stroke Cerebrovasc Dis. 2020;29(3):104588. doi:10.1016/j.jstrokecerebrovasdis.2019.104588