UBC Theses and Dissertations
Exploring cognitive health in chronic stroke Bennett, Kimberly
Cognitive impairment is a common consequence of stroke that is largely overlooked in post-stroke care. To improve care for cognitive health in stroke, records of lived experience are needed to understand patient priorities. Post-stroke cognition is interrelated with other forms of post-stroke impairment. Specifically, executive performance is cross-sectionally related to mobility post-stroke but it is unknown if this relationship persists over time. This thesis examined: 1) the lived experience of cognitive changes post-stroke and 2) the relationship between executive performance and changes in mobility and balance over time in chronic stroke. Aim 1 was addressed through a qualitative study which captured the experience of post-stroke cognitive changes. This study showed that subjective post-stroke cognitive changes carried meaningful consequences for participants, and identified potential gaps in stroke care. Aim 2 was addressed in sub-analyses of data from a randomized control trial examining the effects of exercise and social and cognitive enrichment on cognition against a control (balance and tone exercises) in community-dwelling older adults (aged 55+ years) with chronic stroke (n=120). Four MANCOVA models were constructed wherein change in mobility was the dependent variable and executive performance and intraindividual variability at baseline were the independent variables; group allocation, age, sex, and education were included as covariates. Change in mobility was quantified through change scores calculated from baseline and 6-month performance on the Timed Up and Go test, the Short Physical Performance Battery and usual gait speed. Separate models were constructed for each independent variable: Digit Span test, Trail-Making Test Ratio, Stroop Colour Word test and intraindividual variability of the Stroop Colour Word test, using Pillai’s Trace. If a significant multivariate test was identified for any independent variable, the univariate F tests were examined. Given the known effect of two study groups: the control group and exercise training, on mobility, the 4 MANCOVA models were run within a sample of all 3 study groups (n=103/120), and a sample of the exercise and control groups (n=74/120). Future studies are needed to better understand whether executive performance or intraindividual variability predicts change in mobility and balance in chronic stroke.
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