Cognitive impairment is common 3 months after stroke and is independently associated with older age, ethnicity, lower social class, left hemispheric stroke, visual field defect, and urinary incontinence. It is associated with poor long-term outcomes, including survival and disability, up to 4 years after stroke. Because physical and cognitive impairments after stroke have independent prognostic implications, measures that evaluate both functions should be used in future studies of stroke outcome and in care of stroke patients.

Cognitive impairment remains highly prevalent up to three years after first stroke. Recovery from cognitive impairment is associated with smoking and possibly right hemisphere strokes, but compromised by visuospatial neglect. These associations require further clarification.

Objectives: to determine factors that independently predict health-related quality of life (HRQOL) 1 and 3 years after stroke. Methods: subjects numbering 397, from a population-based register of first-ever strokes were assessed for HRQOL using the Short Form 36 (SF36) 1 year after stroke. Physical (PHSS) and mental health (MHSS) summary scores were derived from the eight domains of HRQOL in the SF36. Multivariate stepwise regression analyses were conducted to determine independent predictors of these scores; β coefficients with 95% CI were obtained. β coefficient is the difference between average value of the variable (e.g. male) and average value under consideration (e.g. female). Demographic and stroke risk factors, neurological impairments and cognitive impairment (MMSE <24) were included in the models. Similar analyses were undertaken on 150 subjects 3 years post-stroke. Results: a year after stroke, independent predictors of the worst PHSS were of females (β coefficient −3.3 : 95% CI −5.7 to −0.8), manual workers (−3.2: −5.9 to −0.4), diabetes (−4.2: −7.7 to −0.8), right hemispheric lesions (−4.9: −8.7 to −1.2), urinary incontinence (−7.8: −11.6 to −4.1) and cognitive impairment (−2.7: −5.5 to −0.1); the worst MHSS were associated with being Asian (−11.8: −20.6 to −3.0), ischaemic heart disease (−2.7: −5.4 to −0.03), cognitive impairment (−3.04: −5.8 to −0.3). Subjects aged 65-75 years (5.4 : 2.5 to −8.4) had better MHSS than those <65 years. Three years post-stroke, independent predictors of worse PHSS were hypertension (−8.7: −13.5 to −3.9), urinary incontinence (−8.1: −15 to −1.1) and cognitive impairment (−8.3: −13.2 to −3.5). Conclusions: determinants of HRQOL vary both over time after stroke and whether physical or psychosocial aspects of HRQOL are being considered. This study provides valuable information on factors predicting long-term HRQOL, which can be taken into consideration in audits of clinical practice or in future interventional studies aiming to improve HRQOL after stroke.