Structured Multidomain Cognitive Rehabilitation for Stroke: Findings From an Observational Cohort Study

Abstract

BackgroundPersons with mild stroke experience minimal functional difficulties; nonetheless, they are at elevated risk for post-stroke cognitive impairment (PSCI) and cognitive decline. AimsWe report outcomes from an observational cohort study of a structured, multidomain intervention for persons with mild strokes. MethodsThe Stroke Memory RehabiliTation (SMaRT) program comprises weekly two-hour group sessions for six weeks on cognitive strategies, lifestyle and relaxation. Participants were recruited from a tertiary hospital between June 2018 to September 2019. They had MRI-confirmed ischemic strokes with mild functional difficulties (modified Rankin Scale score ≤3). Participants underwent assessments and questionnaires at baseline, 1-week post-program, 3 months post-program, and 6 months post-program. Results Participants (N=108, mean age=63.54±9.22, 31.5% female) demonstrated significant improvement in cognition, mood, activities of daily living (ADL) and quality of life (QOL) (ps<0.05) across timepoints. Participants performed significantly better at 6 months post-program compared to baseline on cognitive tests (MoCA 24.47±3.22 vs. 25.80±2.83, Beta=1.26, 95% CI(0.78,1.74)), p<.001; Visual Cognitive Assessment Test (22.74±3.98 vs. 24.76±3.68, Beta=2.04, 95% CI(1.44,2.65), p<.001); 87% of participants maintained or improved in performance. At 6 months post-program, participants reported greater functional independence (Nottingham Extended ADLs Questionnaire Beta=4.20, 95% CI(2.63,5.77), p<.001); fewer depressive symptoms (Geriatric Depression Scale Beta=-1.44, 95% CI(-1.94, -0.94), p<.001); and improved QOL (Dementia-QOL Questionnaire Beta=5.28, 95% CI(1.09, 2.57), p<.001). ConclusionsThe SMaRT program is a cost-effective, scalable, structured program for PSCI. Findings suggest its potential effectiveness in reducing cognitive decline and improving other domains of well-being, with carry-over benefits after 6 months.