Skip to main content Accessibility help

Neuropsychological Outcome and its Predictors Across the First Year after Ischaemic Stroke

  • Suzanne Barker-Collo (a1), Rita Krishnamurthi (a2), Valery Feigin (a2), Amy Jones (a2), Alice Theadom (a2), P. Alan Barber (a3), Nicola Starkey (a4) (a5), Kathryn McPherson (a5), Elaine Rush (a6) and Derrick Bennett (a7)...


Background: Neuropsychological deficits occur in over half of the stroke survivors and are associated with the reduced functioning and a decline in quality of life. However, the trajectory of recovery and predictors of neuropsychological outcomes over the first year post stroke are poorly understood.

Method: Neuropsychological performance, assessed using the CNS-Vital signs, was examined at 1 month, 6 months and 12 months after ischaemic stroke (IS) in a sample drawn from a population-based study (N = 198).

Results: While mean scores across neuropsychological domains at each time-point fell in the average range, one in five individuals produced very low-range scores for verbal memory, attention and psychomotor speed. Significant improvements were seen for executive functioning, psychomotor speed and cognitive flexibility within 6 months post stroke, but no gains were noted from 6 to 12 months. Stroke-related neurological deficits and depression at baseline significantly contributed to the prediction of neuropsychological function at 12 month follow-up.

Conclusions: In a significant minority of IS survivors, focal deficits are evident in psychomotor speed, verbal memory, executive functions and attention. Significant improvements in these domains were only evident in the first 6 months post stroke. Initial stroke-related neurological deficits and concurrent depression may be the best predictors of later cognitive functioning.


Corresponding author

Address for correspondence: Suzanne Barker-Collo, School of Psychology, University of Auckland, Private Bag 92019, Auckland, New Zealand. E-mail:


Hide All
Aho, K., Harmsen, P., Hatano, S., Marquardsen, J., Smirnov, V.E., & Strasser, T. (1980). Cerebrovascular disease in the community: Results of a WHO collaborative study. Bulletin of the World Health Organisation, 58, 113130.
Barker-Collo, S., Feigin, V., Parag, V., Lawes, C., & Senior, H. (2010). Auckland stroke outcomes study. Part 2: Cognition and functional outcomes 5-years post-stroke. Neurology, 75(18), 16081616.
Barker-Collo, S.L., Feigin, V.L., Lawes, C.M.M., Parag, V., Senior, H., & Rodgers, A. (2009). Reducing attention deficits after stroke using attention process training. A randomised controlled trial. Stroke, 40(10), 32933298.
Barker-Collo, S., Starkey, N., Lawes, C., Feigin, V., Senior, H., & Parag, V. (2012). Neuropsychological profiles of 5-year ischemic stroke survivors by Oxfordshire stroke classification and hemisphere of lesion. Stroke, 43(1), 5055.
Bjelland, I., Dahl, A., Haug, T., & Neckelmann, D. (2002). The validity of the hospital anxiety and depression scale. An updated literature review. Journal of Psychosomatic Research, 52(2), 6977.
Brott, T., Adams, H.P. Jr, Olinger, C.P., Marler, J.R., Barsan, W.G., Biller, J., . . .Hertzberg, V. (1989). Measurements of acute cerebral infarction—A clinical examination scale. Stroke, 20, 864870.
Cumming, T.B., Blomstrand, C., Bernhardt, J., & Linden, T. (2010). The NIH stroke scale can establish cognitive function after stroke. Cardiovascular Diseases, 30(1), 714.
de Haan, E., Nys, G.M., & Van Zandvoort, M.J. (2006). Cognitive function following stroke and vascular cognitive impairment. Current Opinion in Neurology, 19(6), 559564.
Desmond, D., Moroney, J.T., Paik, M., Sano, J., Mohr, S., & Aboumatar, C. (2000). Frequency and clinical determinants of dementia after ischemic stroke. Neurology, 54(5), 11241131.
Desmond, D., Moroney, J.T., Sano, M., & Stern, Y. (2002). Incidence of dementia after ischemic stroke: Results of a longitudinal study. Stroke, 33(9), 22542260.
Dewey, H.M., Thrift, A.G., Mihalopoulos, C., Carter, R., Macdonell, R.A.L., McNeil, J.J., & Donnan, G.A. (2003). Lifetime cost of stroke subtypes in Australia: Findings from the North East Melbourne Stroke Incidence Study (NEMESIS). Stroke, 34(12), 25022507.
Douiri, A., Rudd, A.G., & Wolfe, C.D. (2013). Prevalence of poststroke cognitive impairment: South London stroke register 1995–2010. Stroke, 44(1), 138145.
Duncan, P.W., Lai, S.M., & Keighley, J. (2000). Defining post-stroke recovery: Implications for design and interpretation of drug trials. Neuropharmacology, 39(5), 835841.
Elliot, R. (1998). The neuropsychological profile of unipolar depression. Trends in Cognitive Sciences, 2(11), 447454.
Frankel, M.R., Morgenstern, L.B., Kwiatkowski, T., Lu, M., Tilley, B.C., Broderick, J.P., . . .Brott, T. (2000). Predicting prognosis after stroke: A placebo group analysis from the National Institute of Neurological Disorders and Stroke rt-PA stroke trial. Neurology, 55(7), 952959.
Gottesman, R.F., & Hillis, A.E. (2010). Predictors and assessment of cognitive dysfunction resulting from ischaemic stroke. Lancet Neurology, 9(9), 895905.
Granger, C., Dewis, L., Peters, N., Sherwood, C., & Barrett, J. (1979). Stroke rehabilitation: Analysis of repeated Barthel Index measures. Archives of Physical Medicine and Rehabilitation, 60, 1417.
Gualtieri, C., & Johnson, L. (2006). Reliability and validity of a computerized neurocognitive test barrey, CNS vital signs. Archives of Clinical Neuropsychology, 21(7), 623643.
Gualtieri, C., Johnson, L., & Benedict, K. (2004). Psychometric and clinical properties of a new, computerized neurocognitive assessment battery. Paper presented at the American Neuropsychiatric Association Annual Meeting, Bal Harbor, Florida.
Gustavsson, A., Svensson, M., & Jacobi, F. (2011). Cost of disorders of the brain in Europe 2010. European Neurophamacology, 21, 718779.
Hochstenbach, J.B., Anderson, P.G., van Limbeek, J., & Mulder, T.T. (2001). Is there a relation between neuropsychologic variables and quality of life after stroke?. Archives of Physical Medicine & Rehabilitation, 82(10), 13601366.
Hochstenbach, J., den Otter, R., & Mulder, T. (2003). Cognitive recovery after stroke: A 2-year follow-up. Archives of Physical Medicine and Rehabilitation, 84(10), 14991504.
Hsieh, Y.W., Wang, C.H., Wu, S.C., Chen, P.C., Sheu, C.F., & Hsieh, C.L. (2007). Establishing the minimal clinically important difference of the Barthel Index in stroke patients. Neurorehabiitation and Neural Repair, 21(3), 233238.
Hsueh, I.-P., Lin, J.-H., Jeng, J.-S., & Hsieh, C.-L. (2002). Comparison of the psychometric characteristics of the functional independence measure, 5 item Barthel Index, and 10 item Barthel Index in patients with stroke. Journal of Neurology, Neurosurgery, and Psychiatry, 73(2), 188190.
Huybrechts, K.F., & Caro, J.J. (2007). The Barthel Index and modified Rankin Scale as prognostic tools for long-term outcomes after stroke: A qualitative review of the literature. Current Medical Research and Opinion, 23(7), 16271636.
Hyndman, D., & Ashburn, A. (2003). People with stroke living in the community: Attention deficits, balance, ADL ability and falls. Disability & Rehabilitation, 25(15), 817822.
Krishnamurthi, R., Jones, A., Barber, P.A., Barker-Collo, S., McPherson, K., Bennett, D., . . .ARCOS IV Programme Group (2014). Methodology of a population-based stroke and TIA incidence and outcomes study: The Auckland Regional Community Stroke Study (ARCOS IV) 2011-2012. International Journal of Stroke, 9(1), 140147.
Kwakkel, G., Veerbeek, J.M., van Wegen, E.E., Nijland, R., Harmeling-van der Wel, B.C., & Dippel, D.W. (2010). Predictive value of the NIHSS for ADL outcome after ischemic hemispheric stroke: Does timing of early assessment matter?. Journal of Neurological Science, 294(1–2), 5761.
Lezak, M.D. (1995). Neuropsychological assessment (3rd ed.). New York, NY: Oxford University Press.
Lloyd-Jones, D., Adams, R.J., & Brown, T.M. (2010). AHA heart disease and stroke statistics—2010 update: A report from the American Heart Association. Circulation, 121, e46e215.
McDowd, J., Filion, D.L., Pohl, P.S., Richards, L.G., & Stiers, W. (2003). Attentional abilities and functional outcomes following stroke. Journals of Gerontology Series B – Psychological Sciences & Social Sciences, 58(1), 4553.
Muir, K.W., Weir, C.J., Murray, G.D., Povey, C., & Lees, K.R. (1996). Comparison of neurological scales and scoring systems for acute stroke prognosis. Stroke, 27(10), 18171820.
Mukherjee, D., & Patil, C.G. (2011). Epidemiology and the global burden of stroke. World Neurosurgery, 76(6), S85–S90.
Nys, G. (2005). The Neuropsychology of acute stroke: Characterisation and prognostic implications. PhD thesis, Department of Psychology, Utrecht University, Utrecht, Holland.
Nys, G., van Zandvoort, M.J., de Kort, H., Jansen, B., de Haan, E., & Kappelle, J.L. (2007). Cognitive disorders in acute stroke: Prevalence and clinical determinants. Cerebrovascular Diseases, 23(5–6), 408416.
Planton, M., Peiffer, S., Albucher, J.F., Barbeau, E.J., Tardy, J., Pastor, J., . . .Pariente, J.. (2012). Neuropsychological outcome after a first symptomatic ischaemic stroke with good recovery. European Journal of Neurology, 19(2), 212219.
Robertson, I.H., Ridgeway, V., Greenfield, E., & Parr, A. (1997). Motor recovery after stroke depends on intact sustained attention: A 2-year follow-up study. Neuropsychology, 11(2), 290295.
Schaapsmeerders, P., Maaijwee, N., van Dijk, E.J., Rutten-Jacobs, L., Arntz, R.M., Schoonderwaldt, H.C., . . .de Leeuw, F.-E. (2013). Long-term cognitive impairment after first-ever ischemic stroke in young adults. Stroke, 44(6), 16211628.
Scott, W. G., & Scott, H. (1994). Ischaemic stroke in: An economic study. Medical Journal, 107(989), 443446.
Stapleton, T., Ashburn, A., & Stack, E. (2001). A pilot study of attention deficits, balance control and falls in the subacute stage following stroke. Clinical Rehabilitation, 15(4), 437444.
Sun, J.H., Tan, L., & Yu, J.T. (2014). Post-stroke cognitive impairment: Epidemiology, mechanisms and management. Annals of Translational Medicine, 2(8), 8096.
Veiela, H.O.F. (1997). A preliminary profile of neuropsychological deficits associated with major depression. Journal of Clinical and Experimental Neuropsychology, 19(4), 587603.
Wolfe, C.D.A., Taub, N.A., Woodrow, E.J., & Burney, P.G.J. (1991). Assessment of scales of disability and handicap for stroke patients. Stroke, 22(10), 12421244.
Zigmond, A., & Snaith, R. (1983). The hospital anxiety and depression scale. . Acta Psychiatrica Scandinavica, 67(6), 361370.



Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed