The impact of cognitive function deficits and their recovery on functional outcome in subjects affected by ischemic subacute stroke: results from the Italian multicenter longitudinal study CogniReMo

BACKGROUND: The recovery of independence in activities of daily living is a fundamental goal of rehabilitation programs in subjects af-fected by subacute stroke. Rehabilitation is focused both on motor and cognitive aspects, and some evidence has reported cognitive deficits as prognostic factors of motor recovery. However, rehabilitation is a dynamic process during which executive functions and motor functions should be improved.AIM: The aim of the study is to evaluate the relationships between impairments in cognitive functions and recovery of functional independence in stroke patients during the subacute phase. DESIGN: Multicenter observational study.SETTING: Intensive rehabilitation units. POPULATION: A sample of 319 stroke patients in subacute phase (70.6 & PLUSMN;11.6 years, 40.4% females), consecutively admitted from November 2019 to July 2021 at sixteen rehabilitation centers were enrolled in this observational, prospective and multicentric study with longitudinal as-sessments.METHODS: Cognitive and functional assessments were performed at hospital admission and discharge, including Oxford Cognitive Screen, modified Barthel Index, Functional Independent Measure, Fugl-Meyer assessment scale and National Institutes of Health Stroke Scale. RESULTS: A regression analysis identified five predictors (out of about 200 tested variables) of functional recovery related to four aspects as-sessed at admission: functional status (P<0.001), lower limb functioning (P=0.002), attention (P=0.011), and executive functions (P=0.017). Furthermore, patients who recovered deficits in executive functions had the same recovery of those without deficits, whereas those who main-tained deficits had a smaller recovery (P=0.019).CONCLUSIONS: The relationship between cognitive and motor deficits is increasingly highlighted and the recovery of executive functions deficits seems to contribute to motor recovery. CLINICAL REHABILITATION IMPACT: Our results suggest that the recovery of executive functions may promote the recovery of the func-tional outcome of the patient with subacute stroke. Future treatment protocols may benefit from paying more attention to the recovery of execu-tive functions.