Working status is related to post stroke/TIA cognitive decline: data from the TABASCO study

J Stroke Cerebrovasc Dis. 2020 Sep;29(9):105019. doi: 10.1016/j.jstrokecerebrovasdis.2020.105019. Epub 2020 Jun 17.


Background and aims: Occupational status may influence physical and mental post-stroke outcomes. We aimed to evaluate the association between occupational status and type, or engagement in social and family activities, neuroimaging measures and cognitive decline (CD) in a prospective cohort of stroke patients.

Methods: We included 273 first-ever stroke survivors at working age. All patients underwent 3T MRI at admission, as well as clinical and cognitive assessments at admission, 6, 12 and 24 months thereafter.

Results: Ninty nine (36.3%) of the participants were unemployed prior to the stroke. Age, sex, work type, other comorbidities, stroke severity or location were not associated with return to work. Patients who returned to work (87.4%) had better cognitive results and less depressive symptoms than those who retired after the event. Pre-stroke unemployment was associated with diabetes mellitus, hypertension, dyslipidemia, depression, poorer cognitive scores and brain atrophy. During the follow-up, 11% developed CD. CD was more common among previously unemployed than employed participants (19.2% vs. 6.3%, p = 0.001). Multiple regression adjusted for risk factors, revealed that pre-stroke unemployment was an independent predictor of CD (HR, 3.0; 95% CI: 1.06-8.44). Furthermore, engagement in mentally stimulating jobs decreased the risk for CD.

Conclusions: Pre-stroke unemployment and post-stroke work disruption were each associated with depression and poorer cognitive performance up to two years post-stroke, as well as with brain atrophy at admission. Retirement after the stroke may increase the risk of developing CD. These results highlight the importance of continued employment in preserving cognitive abilities among stroke survivors.

Keywords: Brain atrophy; Occupational status; Post-stroke retirement; Work type.

Publication types

  • Comparative Study
  • Observational Study

MeSH terms

  • Aged
  • Cognition*
  • Cognitive Dysfunction / diagnostic imaging
  • Cognitive Dysfunction / etiology*
  • Cognitive Dysfunction / physiopathology
  • Cognitive Dysfunction / psychology
  • Depression / etiology
  • Depression / physiopathology
  • Depression / psychology
  • Family Relations
  • Female
  • Health Status
  • Humans
  • Ischemic Attack, Transient / complications*
  • Ischemic Attack, Transient / diagnostic imaging
  • Ischemic Attack, Transient / physiopathology
  • Ischemic Attack, Transient / psychology
  • Magnetic Resonance Imaging
  • Male
  • Mental Health
  • Middle Aged
  • Neuroimaging
  • Prospective Studies
  • Retirement*
  • Return to Work*
  • Risk Assessment
  • Risk Factors
  • Social Behavior
  • Stroke / complications*
  • Stroke / diagnostic imaging
  • Stroke / physiopathology
  • Stroke / psychology
  • Time Factors
  • Unemployment*