Cognitive and emotional symptoms in patients with first-ever mild stroke: The syndrome of hidden impairments

J Rehabil Med. 2021 Jan 1;53(1):jrm00135. doi: 10.2340/16501977-2764.


Objective: To evaluate the prevalence of cognitive and emotional impairments one year after first-ever mild stroke in younger patients Design: Prospective, observational, cohort study.

Subjects: A consecutive sample of 117 previously cognitively healthy patients aged 18-70 years with mild stroke (National Institutes of Health Stroke Scale score ≤ 3) were included in 2 hospitals in Norway during a 2-year period.

Methods: At 12-month follow-up, patients were assessed using validated instruments for essential cognitive domains, fatigue, depression, anxiety, apathy and pathological laughter and crying.

Results: In total, 78 patients (67%) had difficulty with one or a combination of the cognitive domains psychomotor speed, attention, executive and visuospatial function, and memory. Furthermore, 50 patients (43%) had impairment in either one or a combination of the emotional measures for anxiety, depressive symptoms, fatigue, apathy or emotional lability. A total of 32 patients (28%) had both cognitive and emotional impairments. Only 21 patients (18%) scored within the reference range in all the cognitive and emotional tools.

Conclusion: Hidden impairments are common after first-ever mild stroke in younger patients. Stroke physicians should screen for hidden impairments using appropriate tools.

Keywords: anxiety; apathy; cognitive impairment; depression; fatigue; hidden impairments; mild stroke; younger patients.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Cognitive Dysfunction / psychology*
  • Cohort Studies
  • Depression / psychology
  • Emotions / physiology*
  • Fatigue / psychology
  • Female
  • Humans
  • Male
  • Middle Aged
  • Prevalence
  • Prospective Studies
  • Stroke / psychology*
  • Young Adult