Cognitive status and quality of life of post-stroke patients: evidence from Serbia
Abstract
Background/Aim. Stroke is a major global health problem, and more than half of stroke patients suffer from cognitive impairments. The aim of this study was to assess the impact of secondary rehabilitation on cognitive status and to examine its correlation with quality of life in post-stroke patients. Methods. A total of 100 patients (average age 66.5 ± 7.3 years) participated in the study, of whom 50 were diagnosed with ischemic stroke (IS) and 50 with intracerebral hemorrhagic stroke (ICH). The Mini-Mental State Examination (MMSE) was utilized to assess cognitive status, while the European Quality of Life (EuroQol) 5-dimensional 3-level (EQ-5D-3L) questionnaire was employed to evaluate quality of life. Results. The MMSE test results showed significant differences at three months (p = 0.037) and six months (p = 0.009) of secondary rehabilitation compared to admission. For the EQ-5D-3L, significant differences were observed at the time of admission (p < 0.001), one month (p = 0.001), and six months (p = 0.007). In addition, the Wilcoxon signed-rank test showed a statistically significant improvement in both MMSE and EQ-5D-3L scores when comparing results from admission to those taken one month (p < 0.001), three months (p < 0.001), and six months (p < 0.001) after secondary rehabilitation for both IS and ICH. Conclusion. The results indicate a significant correlation between cognitive status and quality of life, measured at all four time points. Additionally, it was found that a longer duration of secondary rehabilitation leads to improved cognitive status and a higher quality of life for post-stroke patients.
References
Murphy SJ, Werring DJ. Stroke: causes and clinical features. Medicine (Abingdon) 2020; 48(9): 561–6.
Lindmark A, Eriksson M, Darehed D. Socioeconomic status and stroke severity: Understanding indirect effects via risk factors and stroke prevention using innovative statistical methods for mediation analysis. PLoS One 2022; 17(6): e0270533.
GBD 2019 Stroke Collaborators. Global, regional, and national burden of stroke and its risk factors, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol 2021; 20(10): 795–820.
Ojaghihaghighi S, Vahdati SS, Mikaeilpour A, Ramouz A. Com-parison of neurological clinical manifestation in patients with hemorrhagic and ischemic stroke. World J Emerg Med 2017; 8(1): 34–8.
Bisevac E, Lazovic M, Nikolic D, Mahmutovic E, Dolicanin Z, Ju-risic-Skevin A. Postacute Rehabilitation Impact on Functional Recovery Outcome and Quality of Life in Stroke Survivors: Six Month Follow-Up. Medicina (Kaunas) 2022; 58(9): 1185.
Elendu C, Amaechi DC, Elendu TC, Ibhiedu JO, Egbunu EO, Ndam AR, et al. Stroke and cognitive impairment: under-standing the connection and managing symptoms. Ann Med Surg (Lond) 2023; 85(12): 6057–66.
Bour A, Rasquin S, Boreas A, Limburg M, Verhey F. How pre-dictive is the MMSE for cognitive performance after stroke? J Neurol 2010; 257(4): 630–7.
Cerniauskaite M, Quintas R, Koutsogeorgou E, Meucci P, Sattin D, Leonardi M, et al. Quality-of-life and disability in patients with stroke. Am J Phys Med Rehabil 2012; 91(13 Suppl 1): S39–47.
World Medical Association. World Medical Association Declara-tion of Helsinki: ethical principles for medical research involv-ing human subjects. JAMA 2013; 310(20): 2191–4.
McCurley JL, Funes CJ, Zale EL, Lin A, Jacobo M, Jacobs JM, et al. Preventing Chronic Emotional Distress in Stroke Survivors and Their Informal Caregivers. Neurocrit Care 2019; 30(3): 581–9.
Bugarski V, Semnic M, Golubović Š. Quick assessment of cogni-tive status and presence of depressive symptoms in acute phase of stroke. Psihijatrija danas 2009; 41(1–2): 29–41. (Serbian)
Stojković Ivković M. Mild cognitive impairment: The importance of early revealing and treatment options. Sestrinska reč 2017; 21(74): 24–6. (Serbian)
EuroQol Group Association. European Quality of Life-EuroQol EQ-5D [Internet]. Netherlands: EuroQol; 2025 [updated 2025 April 1; cited 2025 July 22]. Available from: https://euroqol.org/register/obtain-eq-5d/available-versions/
Janus-Laszuk B, Mirowska-Guzel D, Sarzynska-Dlugosz I, Czlonkowska A. Effect of medical complications on the after-stroke rehabilitation outcome. NeuroRehabilitation 2017; 40(2): 223–32.
Isaac V, Stewart R, Krishnamoorthy ES. Caregiver burden and quality of life of older persons with stroke: A community hos-pital study in South India. J Appl Gerontol 2011; 30(5): 643–54.
Mori N, Otaka Y, Honaga K, Matsuura D, Kondo K, Liu M, et al. Factors associated with cognitive improvement in subacute stroke survivors. J Rehabil Med 2021; 53(8): jrm00220.
Barbosa PM, Ferreira LN, Cruz VT, Silva A, Szrek H. Healthcare, Clinical Factors and Rehabilitation Predicting Quality of Life in First-time Stroke Patients: A 12-month Longitudinal Study. J Stroke Cerebrovasc Dis 2022; 31(4): 106300.
Paolucci S. Advances in antidepressants for treating post-stroke depression. Expert Opin Pharmacother 2017; 18(10): 1011–7.
Schneider S, Taba N, Saapar M, Vibo R, Kõrv J. Determinants of Long-Term Health-Related Quality of Life in Young Ischemic Stroke Patients. J Stroke Cerebrovasc Dis 2021; 30(2): 105499.
Capo-Lugo CE, Askew RL, Muldoon K, Maas M, Liotta E, Prab-hakaran S, et al. Longer Time Before Acute Rehabilitation Therapy Worsens Disability After Intracerebral Hemorrhage. Arch Phys Med Rehabil 2020; 101(5): 870–6.
Katzan IL, Schuster A, Newey C, Uchino K, Lapin B. Patient-reported outcomes across cerebrovascular event types: More similar than different. Neurology 2018; 91(23): e2182–91.
Gialanella B, Santoro R, Ferlucci C. Predicting outcome after stroke: the role of basic activities of daily living predicting outcome after stroke. Eur J Phys Rehabil Med 2013; 49(5): 629–37.
Ginex V, Vanacore N, Lacorte E, Sozzi M, Pisani L, Corbo M, et al. General cognition predicts post-stroke recovery defined through minimal clinically important difference (MCID): a cohort study in an Italian rehabilitation clinic. Eur J Phys Re-habil Med 2015; 51(5): 597–606.
Liu H, Lou VWQ. Functional recovery of older stroke pa-tients discharged from hospital to home: The effects of cogni-tive status and different levels of therapy intensity. J Clin Nurs 2019; 28(1–2): 47–55.
Seo KD, Kang MJ, Kim GS, Lee JH, Suh SH, Lee KY. National Trends in Clinical Outcomes of Endovascular Therapy for Is-chemic Stroke in South Korea between 2008 and 2016. J Stroke 2020; 22(3): 412–5.
Portegies ML, Bos MJ, Koudstaal PJ, Hofman A, Tiemeier HW, Ikram MA. Anxiety and the Risk of Stroke: The Rotterdam Study. Stroke 2016; 47(4): 1120–3.
Dimunová L, Soósová MS, Kardosová K, Červený M, Belovičová M. Quality of life in post-stroke patients. Kontakt 2021; 23(3): 157–61.
Su Y, Dong J, Sun J, Zhang Y, Ma S, Li M, et al. Cognitive function assessed by Mini-mental state examination and risk of all-cause mortality: a community-based prospective cohort study. BMC Geriatr 2021; 21(1): 524.
Bo W, Lei M, Tao S, Jie LT, Qian L, Lin FQ, et al. Effects of combined intervention of physical exercise and cognitive training on cognitive function in stroke survivors with vascu-lar cognitive impairment: a randomized controlled trial. Clin Rehabil 2019; 33(1): 54–63.
Gamito P, Oliveira J, Coelho C, Morais D, Lopes P, Pacheco J, et al. Cognitive training on stroke patients via virtual reality-based serious games. Disabil Rehabil 2017; 39(4): 385–8.
Shin M, Sohn MK, Lee J, Kim DY, Lee SG, Shin YI, et al. Effect of cognitive reserve on risk of cognitive impairment and re-covery after stroke: the KOSCO study. Stroke 2020; 51(1): 99–107.
Alawieh A, Zhao J, Feng W. Factors affecting post-stroke mo-tor recovery: Implications on neurotherapy after brain injury. Behav Brain Res 2018; 340: 94–101.
Dhandapani M, Joseph J, Sharma S, Dabla S, Varkey BP, Nara-simha VL, et al. The Quality of Life of Stroke Survivors in the Indian Setting: A Systematic Review and Meta-Analysis. Ann Indian Acad Neurol 2022; 25(3): 376–82.