Stroke is one of the leading causes of disability and mortality worldwide. It entails motor sequelae and neuropsychiatric complications such as cognitive impairment and depression, significantly impacting quality of life and functional recovery.
ObjectiveTo analyse cognitive status, functionality, and the level of depressive symptomatology in patients who have experienced ischemic stroke or transient ischemic attack.
MethodsAn analytical, observational, and prospective study was conducted at the Neurology and Neurosurgery Unit of the Lucus Augusti University Hospital. A sample of 36 patients diagnosed with ischemic stroke or transient ischemic attack was included. Patients were evaluated at 2 time points: hospital discharge and 3 months post-discharge. The main variables were cognitive status, depressive symptomatology, and functional dependence, assessed using the Mini-Mental State Examination, the Beck Depression Scale, and the Barthel Index.
ResultsThe sample consisted of 36 patients (83.3% with ischemic stroke), with a mean age of 69.17 ± 11.71 years and 27.8% women. The mean scores at discharge and 3 months were as follows: depression (8.03 ± 9.63 and 6.08 ± 6.83), cognitive status (26.7 ± 3.62 and 28.31 ± 2), and functional dependence (95.14 ± 13 at both time points). Depressive symptomatology decreased significantly from discharge to the three-month follow-up (P = .04). Significant correlations were identified between depressive symptomatology at discharge and at 3 months (P = .04), as well as with cognitive impairment at discharge (P = .01). Cognitive status showed relation between the 2 time points (P = .02) and was correlated with depressive symptomatology at 3 months (P = .03) and cognitive status at 3 months (P = .01). Functional independence demonstrated correlations with depressive symptomatology at discharge (P = .01) and at 3 months (P = .01), as well as with cognitive status at discharge (P = .05) and at 3 months (P = .02).
ConclusionThe analysis suggests improvements in cognitive status and reductions in depressive symptomatology from discharge to the three-month follow-up. Significant correlations between functional dependence, cognitive status, and depressive symptomatology underscore the interrelationship of these factors in recovery. These findings highlight the importance of a comprehensive evaluation encompassing functional, cognitive, and emotional aspects to optimize functional recovery in stroke patients.
El ictus es una de las principales causas de discapacidad y mortalidad en el mundo, conlleva secuelas motoras y complicaciones neuropsiquiátricas como el deterioro cognitivo y la depresión, afectando la calidad de vida y la recuperación funcional.
ObjetivoAnalizar la funcionalidad, el estado cognitivo y el nivel de sintomatología de depresión en pacientes que han sufrido ictus isquémico o accidente isquémico transitorio.
MetodologíaEstudio analítico, observacional y prospectivo realizado en la Unidad de Neurología y Neurocirugía en el Hospital Universitario Lucus Augusti. Se incluyó una muestra de 36 pacientes diagnosticados de ictus o accidente isquémico transitorio, evaluados en 2 momentos: al alta hospitalaria y a los 3 meses. Las variables principales fueron el estado cognitivo, la sintomatología depresiva y la dependencia funcional, medidas mediante el Mini Examen de Estado Mental, la Escala de Depresión de Beck y el Índice de Barthel.
ResultadosLa muestra incluyó a 36 pacientes (83,3% con ictus isquémico), con una media de edad de 69,17 ± 11,71 años y un 27,8% mujeres. Las puntuaciones medias al alta y a los 3 meses fueron: depresión (8,03 ± 9,63 y 6,08 ± -6,83), estado cognitivo (26,7 ± 3,62 y 28,31 ± 2) y dependencia funcional (95,14 ± 13 en ambos momentos). La sintomatología depresiva disminuyó desde el alta hasta los 3 meses de seguimiento (p = 0,04). Se identificaron correlaciones significativas entre la sintomatología depresiva al alta y a los 3 meses (p = 0,04) y con el deterioro cognitivo al alta (p = 0,01). El estado cognitivo mejoró significativamente entre ambos momentos (p = 0,01). Se correlacionó con la sintomatología depresiva a los 3 meses (p = 0,03) y con el estado cognitivo a los 3 meses (p = 0,01). La independencia funcional presentó correlaciones significativas con la sintomatología depresiva al alta (p = 0,01) y a los 3 meses (p = 0,01), así como con el estado cognitivo al alta (p = 0,05) y a los 3 meses (p = 0,02).
ConclusiónEl análisis sugiere mejoras en el estado cognitivo y disminución de la sintomatología depresiva desde el alta hasta los 3 meses de seguimiento. Las correlaciones significativas entre dependencia funcional, estado cognitivo y sintomatología depresiva resaltan la interrelación de estos factores en la recuperación. Estos resultados destacan la importancia de una evaluación integral que contemple aspectos funcionales, cognitivos y emocionales para optimizar la recuperación funcional en pacientes con ictus.
Stroke is a cerebrovascular disease caused by an interruption of blood flow to an area of the brain. This interruption, whether temporary or permanent, prevents the neurons in that area from receiving the necessary oxygen supply, leading to neuronal death and serious consequences.1 Based on the mechanism of vascular disruption, two types are distinguished: ischemic, which accounts for 80% of cases, and haemorrhagic.2
Ischemic stroke originates from the obstruction of an artery that supplies blood to part of the brain. This reduces blood flow, preventing neurons from receiving the oxygen and glucose necessary for their function, and inducing neuronal death. The main triggering factors are the formation of thrombi, frequently associated with atherosclerotic plaques in the cerebral arteries, or the arrival of emboli from the heart. Ischemic strokes can be classified as transient ischemic attack (TIA) or cerebral infarction, the former lasting less than 24 h and the latter longer.1,2
The prognosis for a stroke patient is time-dependent; early diagnosis and intervention improve the prognosis and reduce long-term sequelae. In Spain, the Stroke Code prioritises early recognition and immediate transfer to a hospital with a Stroke Unit.1–3 Epidemiologically, stroke is one of the leading causes of disability and death worldwide. According to the World Health Organization (WHO), more than 12 million new cases occur annually.4 In Spain, the Cerebrovascular Diseases Study Group of the Spanish Society of Neurology (GEECV-SEN) estimates that 40,000 deaths occur annually and that a stroke occurs every 6 min in the country.4–7 Current effective treatments for ischemic stroke include the administration of intravenous or intra-arterial arteplase (rt-PA) or mechanical thrombectomy.8,9
Traditionally, stroke sequelae have focused on motor and sensory aspects, but significant neuropsychiatric complications also exist, such as cognitive impairment and post-stroke depression (PSD). These conditions are common but underdiagnosed, despite their impact on patients' autonomy and quality of life.10,11
PSD affects approximately one-third of stroke survivors, with an estimated prevalence between 25% and 50%, depending on the diagnostic criteria used and the time elapsed since the stroke. According to the DSM-5-TR, it is defined as a major depressive episode that occurs after a stroke, with affective, cognitive, and somatic symptoms. Its diagnosis is complex due to the overlap of symptoms between stroke and depression, such as difficulty concentrating or decreased appetite. PSD is associated with poorer rehabilitation, lower quality of life, and a higher risk of cardiovascular recurrence, as well as increased mortality and healthcare costs.10–13
In the Spanish context, several studies have analysed the relationship between stroke, cognition, and depression, highlighting risk factors and long-term consequences. Lopez-Espuela et al.14 identified a post-stroke depression prevalence of 42.2% at 6 months, underscoring the influence of variables such as initial neurological severity and functional status on the development of depressive symptoms. Reverté-Villarroya et al.15 explored vascular risk factors in ischemic stroke survivors in Catalonia, emphasizing the importance of comprehensive care that addresses both the physical and emotional aspects of patients. These findings reinforce the need for multidisciplinary strategies to improve quality of life and reduce cognitive and emotional sequelae after stroke.
Furthermore, post-stroke cognitive impairment, also known as vascular cognitive impairment, has an aetiology directly linked to cerebrovascular lesions. It affects 60% of stroke survivors and is most prevalent during the first year after a stroke. One-third of patients with post-stroke cognitive impairment develop dementia over time.16
The relevance of this study lies in the need to address the physical, psychological, cognitive, and functional sequelae of stroke, especially given the increase in stroke survivors due to clinical and technological advances.3
As stroke mortality decreases, the number of patients living with sequelae increases, reinforcing the need to implement best practice guidelines that include the early detection of complications such as depression and post-stroke cognitive impairment.3 Early diagnosis and treatment are essential to improve long-term outcomes.3,6,7
In this context, the Registered Nurses' Association of Ontario (RNAO) developed the "Nursing Best Practice Guidelines.Stroke assessment through continuous care," which includes effective, evidence-based interventions for the care of post-stroke patients.17 In Spain, the Lugo, A Mariña, and Monforte de Lemos Health Area implemented this guide at the Lucus Augusti University Hospital (HULA) in 2018, achieving quality levels above 80%. In 2024, new recommendations related to the assessment of cognitive status and depressive symptoms were included.
For all the reasons mentioned above, the overall objective of this study was to analyse cognitive status, functionality, and the level of depressive symptoms in patients who have suffered an ischemic stroke or TIA. The specific objectives were: to correlate cognitive status with depressive symptoms and functionality; to relate depressive symptoms to cognitive status and functionality; to correlate functionality with cognitive status; and to assess the risk of aspiration pneumonia, the presence of pressure ulcers, swallowing ability, blood pressure, temperature, glucose levels, and pain levels.
Material and methodsStudy designThis was a prospective observational study conducted during the first quarter of 2025 in patients treated at the Neurology and Neurosurgery Unit of the HULA (University Hospital of Lugo).
Population, sample, and inclusion criteriaFor this study, the target population was selected as patients with a clinical diagnosis of ischemic stroke or TIA in the Lugo, A Mariña, and Monforte de Lemos health area.
All patients who met the inclusion criteria and were seen during the first quarter of 2025, from admission to their 3-month follow-up visit, were consecutively included.
The inclusion criteria were: diagnosis of ischemic stroke or TIA and aged ≥ 18 years. The exclusion criteria were: intracranial haemorrhage, pregnancy, and cognitive impairment.
Justification and sample size calculationAccording to the Stroke Atlas of Galicia published by the Spanish Society of Neurology in 2018, the province of Lugo, with a population of 327,946 inhabitants, has an estimated annual incidence of 614 new stroke cases per 100,000 inhabitants, of which 80% are ischemic (approximately 492 cases).1,6 To ensure that the study results were representative of the Lugo population, a minimum sample size of 96 patients was calculated, considering a 95% confidence interval and a 10% margin of error. The following formula was used for the calculation:18
The study was based on convenience sampling, selecting accessible and available patients at the Neurology and Neurosurgery Unit of the HULA (University Hospital of Lugo), which explains the high participation rate (>97%). However, the final sample included 36 patients due to logistical and time constraints. This reduction was justified by the length of the inclusion period, patient availability, and operational capacity limitations of the service during the pilot study.
VariablesSocio-demographic: age (<65 years, 65−80 years, >80 years); sex (male, female); date of ischemic event (mm/yyyy).
Clinical data: stroke type (ischemic, TIA); treatment modality (receiving rt-PA, receiving mechanical thrombectomy, or not receiving antithrombotic treatment); number of falls; pain level (visual analogue scale); presence of pressure ulcers during admission (yes/no); swallowing assessment (viscosity test: yes/no); and presence of aspiration pneumonia (yes/no). vital signs: temperature (°C); blood pressure (mmHg); heart rate (bpm); blood glucose (mg/dL); cognitive status assessment at admission (NIHSS); cognitive status at discharge and at 3 months (MEC); assessment of depressive symptoms at discharge and at 3 months (BDI), and functional status assessment at discharge and at 3 months (Barthel Index).
ToolsNational Institutes Health Stroke ScaleThe NIHSS assesses stroke severity and its neurological effects. It consists of 11 items that assess the level of consciousness, sensory-motor impairment, language, and vision, assigning scores according to the degree of impairment. The total score ranges from 0 (normal function) to 42 (maximum impairment). In this study, it was used to classify stroke severity in patients. According to the scale's categorisation, a score of 0 points is considered asymptomatic, a score of 1 indicates minimal impairment; a score between 2 and 5 indicates mild impairment; a score between 6 and 15 indicates moderate impairment; a score between 16 and 20 points indicates significant impairment; and a score > 20 points indicates severe impairment. The NIHSS demonstrates excellent retrospective reliability (ICC = .95) and inter-rater reliability (ICC = .93), making it a key tool in clinical protocols for assessing stroke severity.19
Beck Depression Inventory (BDI)The BDI measures the severity of depressive symptoms using 21 items that assess depression-related experiences in recent weeks. The total scale score ranges from 0 to 63, with 14 points considered the threshold for clinically significant depression. Administering this tool takes approximately 10 min. Based on the score obtained, symptoms are classified into four categories: no depression (0−13 points), mild depression (14−19 points), moderate depression (20−28 points), and severe depression (29−63 points). The BDI adapted for the Spanish population shows high internal consistency, with a Cronbach's alpha coefficient of .83.20
Mini-Mental State Examination (MMSE)The MMSE assesses cognitive impairment in areas such as orientation, memory, calculation, language, and graphic constructional praxis. The maximum score on the scale is 30 points, indicating the absence of cognitive impairment, while a score below 23 points suggests cognitive impairment. Test administration takes approximately 5 min. The scoring categories are as follows: no cognitive impairment (30−27 points), doubtful cognitive status (26−25 points), mild to moderate cognitive impairment (24−10 points), moderate to severe cognitive impairment (9−6 points), and severe cognitive impairment (<6 points). In this study, it was used to detect cognitive problems in patients. The Spanish-adapted version (MEC) shows internal consistency with Cronbach's alpha between 0.78 and 0.82 for the different domains evaluated.21
Barthel IndexThe Barthel Index measures functional independence in basic activities of daily living (ADL). It assesses 10 activities, assigning scores that range from 0 (total dependence) to 100 (total independence). In this study, the Barthel Index was used to assess patient functionality. Its interpretation was as follows: 100 points = independence, ≤ 60 = mild dependence, 40–55 = moderate dependence, 20–35 = severe dependence, and 5–20 = total dependence. The Barthel Index, with a Cronbach's alpha of .87–.89 and inter-rater reliability (ICC = .88), is widely used to measure functional independence in basic activities of daily living in the Spanish population.22,23
Data collectionThe data extracted for this research were completed by the principal investigator and were only accessible to them and the project team. No one outside the research team was allowed to make changes to this data. The data were collected at three specific points in time: upon patient admission (neurological assessment using the NIHSS), upon discharge from the Neurology Unit, and at the three-month follow-up visit.
For the discharge and three-month assessments, the following instruments were used: the MEC to assess cognitive status, the Barthel Index to evaluate functional status, and the BDI to assess depressive symptoms. The scales were administered by trained nurses, and the data were recorded in a data collection form specifically designed for this study. The information was stored anonymously and reviewed to ensure its quality and consistency.
Confidentiality of data and ethical considerationsThis study is part of a project being carried out by HULA in collaboration with the Investén Group of the Carlos III Health Institute. This project has been underway since 2018, and the current phase began in the first quarter of 2025, following approval from the ethics committee of Santiago-Lugo (Registration Code 2024-472).
The Project has adhered to the ethical principles established in the World Medical Association's Declaration of Helsinki (2024) and applicable Spanish regulations, such as Organic Law 3/2018 on the Protection of Personal Data and Guarantee of Digital Rights, Law 41/2002 regulating patient autonomy, and Law 3/2005 on access to electronic health records.
Patient confidentiality and anonymity were guaranteed through coding and the anonymisation of clinical data in the database. Only the principal investigator was able to associate data with an identified or identifiable individual, and the resulting database contained no personal information. At the end of the study, the data will be destroyed or stored in anonymised form as established in the informed consent form. The centre responsible for data processing is HULA.
Data analysisA descriptive analysis was performed using measures of central tendency (mean [M]) and dispersion (standard deviation [SD]) for quantitative variables, and frequencies and percentages for qualitative variables.
The Shapiro-Wilk test was initially applied to assess the normality of the distribution of quantitative variables. Since all quantitative variables exhibited a non-parametric distribution, the Kruskal–Wallis’ test (to compare more than two groups), the Mann–Whitney U test (to analyse pairwise differences), and Spearman's rank correlation coefficient (to assess the strength and direction of associations between quantitative variables) were used.
Additionally, a multivariable regression analysis was performed to control for potential confounding factors, such as sex and age.
The analyses were performed using the PASW statistical package (version 23.0; SPSS Inc., Chicago, Illinois, USA), considering a two-tailed significance level of p < .05.
ResultsThe sample for this study consisted of 36 patients diagnosed with stroke or TIA at HULA.
Socio-demographic characteristicsAgeThe sample was analysed according to age, with a mean of 69.17 ± 11.71 years (minimum 41, maximum 89). After categorising this variable, the frequencies were as follows: <65 years, 33.3%; 65–80 years, 44.4%; and ≥80 years, 22.2%. The most predominant age group was 65–80 years.
A significant relationship was found between age and rt-PA treatment (p = .02). Looking at the different age groups, of the 27.8% of patients treated with rt-PA in the sample, it was observed that in the <65 age group, 16.7% received antithrombotic treatment, while in the 65–80 age group, 50% received this treatment. In the oldest age group (>80), all patients received rt-PA treatment.
The logistic regression model showed that categorised age is a significant predictor of cognitive status at 3 months (χ² = 7.84, df = 2, p = .02). In the <65 age group, none of the patients presented cognitive impairment, while in the 65−80 age group, 12.5% obtained scores reflecting mild impairment. In the >80 age group, 37.5% presented mild-to-moderate cognitive impairment according to the Mini-Mental State Examination (MMSE). Furthermore, the logistic regression indicated that older patients have a higher probability of presenting significant cognitive impairment (Exp(B) = 9.80, 95% CI: 1.08–88.99). No significant associations were found between categorised age and the other variables analysed.
Although information on the cognitive status prior to the event is unavailable (a common limitation in current studies), NIHSS values offer an indirect estimation of the severity of the initial neurological and cognitive impairment in these patients.
In the elderly patients aged 80 years (n = 8), the NIHSS results showed a mean of 2.88 ± 5.44, with 25th, 50th, and 75th percentiles corresponding to .1 and 2.75, respectively. When categorising the NIHSS, 50% of the patients had scores ≤1, indicating mild impairment, while 37.5% had scores of 3, suggesting moderate impairment, and 12.5% reached a score of 5, reflecting more severe impairment.
SexThe distribution was 72.2% male versus 27.8% female.
A significant relationship was found between sex and functional status at discharge and at 3 months (p = .04). In both measurements, 60% of the women scored 100 points (total independence), while 20% scored ≤ 60 (mild dependence), and the remaining 20% scored between 40 and 55 points (moderate dependence). Regarding the men, 88.5% scored the full 100 points, indicating total independence. However, the remaining 11.5% scored ≤ 60 points, representing mild dependence.
A significant association was found between sex and functional status at admission and at 3 months (U = 90, Z = −2.05, p = .04, and U = 90, Z = −2.05, p = .04, respectively).
Regarding cognitive status at 3 months, a trend toward significance was observed (χ² = 3.67, df = 1, p = 0.06). In the logistic regression analysis, sex showed a relationship with cognitive status at 3 months, with women presenting a higher probability of significant cognitive impairment (Exp(B) = 9.95, 95% CI: .76–130.63).
The NIHSS scores were analysed, revealing notable differences between the sexes. In the male group, the mean NIHSS score was 2.27 ± 3.04 points, with 25th, 50th, and 75th percentile scores corresponding to .1 and 3, respectively. This generally reflects less severe strokes in this group. While in the women's group the mean NIHSS score was significantly higher (6.30 ± 6.93), with 25th, 50th, and 75th percentiles of .75, 4, and 11.5, respectively.
Regarding the categories, it was observed that in women, 60% had an NIHSS score ≥ 3, while the remaining 40% had scores ≤ 2. In contrast, in men, only 25% had an NIHSS score ≥ 3, while 75% had scores ≤ 2.
This indicates greater stroke severity in the women in the sample. No significant associations were found between sex and the other variables.
Clinical characteristics and treatmentEighty-three point three per cent of the patients had suffered an ischemic stroke, while 16.7% had a TIA. During hospitalisation, adverse events were infrequent: 91% experienced no pain (VAS), no patients developed pressure ulcers or aspiration pneumonia, and only 2.8% suffered a fall. Regarding the treatment received, 27.8% of patients were treated with rt-PA and 5.6% were candidates for mechanical thrombectomy (Table 1).
Frequency table and measures of central tendency and dispersion for the characteristics of the variables studied.
| n | % | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| Age, years | Mean | SD | P25 | P50 | P75 | LL | UL | ||
| 6916 | 11.71 | 60.25 | 68.5 | 78 | 41 | 89 | |||
| <65 | 12 | 33.3 | |||||||
| 65−80 | 16 | 44.4 | |||||||
| > 80 | 8 | 22.2 | |||||||
| Sex | Man | 26 | 72.2 | ||||||
| Woman | 10 | 27.7 | |||||||
| Type of stroke | Ischemic | 30 | 83.3 | ||||||
| TIA | 6 | 16.7 | |||||||
| rt-PA | No | 26 | 72.2 | ||||||
| Yes | 10 | 27.8 | |||||||
| Thrombectomy | No | 34 | 94.4 | ||||||
| Yes | 2 | 5.6 | |||||||
| UPP | No | 36 | 100 | ||||||
| Yes | 0 | 0 | |||||||
| Dysphagia test | No | 0 | 0 | ||||||
| Yes | 36 | 100 | |||||||
| Dysphagia | No | 36 | 100 | ||||||
| Yes | 0 | 0 | |||||||
| Pneumonia | No | 36 | 100 | ||||||
| Yes | 0 | 0 | |||||||
| Falls | No | 35 | 97,2 | ||||||
| Yes | 1 | 2.8 | |||||||
| Pain | 0 | 33 | 91.7 | ||||||
| 1 | 0 | 0 | |||||||
| 2 | 1 | 2.8 | |||||||
| 3 | 1 | 2.8 | |||||||
| 4 | 0 | 0 | |||||||
| 5 | 1 | 2.8 | |||||||
| 6 | 1 | 2.8 | |||||||
| 7 | 0 | 0 | |||||||
| 8 | 0 | 0 | |||||||
| 9 | 0 | 0 | |||||||
| 10 | 0 | 0 | |||||||
| NIHSS on admission | Mean | SD | P25 | P50 | P75 | LL | UL | ||
| 3389 | 4.723 | 0 | 2 | 4 | 0 | 20 | |||
| 0 | 12 | 33.3 | |||||||
| 1 | 5 | 13.9 | |||||||
| 2−5 | 11 | 30.6 | |||||||
| 6−15 | 0 | 0 | |||||||
| 16−20 | 2 | 5.6 | |||||||
| > 20 | 0 | 0 | |||||||
| Barthel discharge | Mean | SD | P25 | P50 | P75 | LL | UL | ||
| 95,139 | 13.01 | 100 | 100 | 100 | 50 | 100 | |||
| 100 | 29 | 80.6 | |||||||
| ≤ 60 | 5 | 13.9 | |||||||
| 40−55 | 2 | 5.6 | |||||||
| 20−35 | 0 | 0 | |||||||
| < 20 | 0 | 0 | |||||||
| Barthel at 3 months | Mean | SD | P25 | P50 | P75 | LL | UL | ||
| 95.139 | 13.01 | 100 | 100 | 100 | 50 | 100 | |||
| 100 | 29 | 80.6 | |||||||
| ≤ 60 | 5 | 13.9 | |||||||
| 40−55 | 2 | 5.6 | |||||||
| 20−35 | 0 | 0 | |||||||
| < 20 | 0 | 0 | |||||||
| BDI discharge | Mean | SD | P25 | P50 | P75 | LL | UL | ||
| 8.028 | 9.632 | 2 | 5 | 9 | 0 | 37 | |||
| 0−13 | 30 | 83 | |||||||
| 14−19 | 0 | 0 | |||||||
| 20−28 | 4 | 11 | |||||||
| 29−63 | 2 | 5.6 | |||||||
| BDI at 3 months | Mean | SD | P25 | P50 | P75 | LL | UL | ||
| 6.083 | 6.826 | 1 | 3.5 | 10.75 | 0 | 23 | |||
| 0−13 | 31 | 86.1 | |||||||
| 14−19 | 2 | 5.6 | |||||||
| 20−28 | 3 | 8.3 | |||||||
| 29−63 | 0 | 0 | |||||||
| Mini-Mental at discharge | Mean | SD | P25 | P50 | P75 | LL | UL | ||
| 26.694 | 3.624 | 24.5 | 28 | 29 | 17 | 30 | |||
| 27−30 | 25 | 69.4 | |||||||
| 25−26 | 2 | 5.6 | |||||||
| 10−24 | 0 | 0 | |||||||
| 6−9 | 0 | 0 | |||||||
| < 6 | 0 | 0 | |||||||
| Mini-Mental at3 months | Mean | SD | P25 | P50 | P75 | LL | UL | ||
| 28.306 | 1.997 | 27 | 29 | 30 | 23 | 30 | |||
| 27−30 | 31 | 86.1 | |||||||
| 25−26 | 2 | 5.6 | |||||||
| 10−24 | 3 | 8.3 | |||||||
| 6−9 | 0 | 0 | |||||||
| < 6 | 0 | 0 | |||||||
| Temperature | Mean | SD | P25 | P50 | P75 | LL | UL | ||
| 36.33 | .43 | 36 | 36.3 | 36.7 | 35.5 | 37.2 | |||
| Systolic blood pressure | Mean | SD | P25 | P50 | P75 | LL | UL | ||
| 149,78 | 25.98 | 127.5 | 149.5 | 164.75 | 102 | 218 | |||
| Diastolic blood pressure | Mean | SD | P25 | P50 | P75 | LL | UL | ||
| 80,06 | 13.79 | 70 | 79.5 | 89.75 | 54 | 114 | |||
| Mean blood pressure | Mean | SD | P25 | P50 | P75 | LL | UL | ||
| 114.92 | 17.61 | 103.25 | 111 | 129 | 78 | 154 | |||
| Heart rate | Mean | SD | P25 | P50 | P75 | LL | UL | ||
| 69,61 | 14.27 | 58.5 | 65.5 | 78.5 | 48 | 110 | |||
| Blood sugar | Mean | SD | P25 | P50 | P75 | LL | UL | ||
| 105.25 | 16.55 | 93.25 | 102.5 | 114.25 | 80 | ||||
LL: lower limit; n: sample (n = 36); P25, P50, P75: percents; %: frequency; SD: standard deviation; UL: upper limit.
Table 2 shows the results obtained for the correlation between cognitive status at discharge and treatment with rt-PA (p = .05) and between cognitive status at discharge and treatment with thrombectomy (p = .04). It was observed that among those patients who did not receive rt-PA treatment, the majority (66.7%) were in the category of cognitive status without cognitive impairment in the cognitive status assessment performed at discharge. Similarly, the majority (73.5%) of patients who did not undergo thrombectomy were in the no-cognitive-impairment category.
Relationship between the first Mini-Mental State Examination and the application of rt-PA and thrombectomy.
Cognitive status was assessed at admission using the NIHSS scale. It was observed that 66.8% of patients presented some level of cognitive impairment at admission. At discharge (MEC scale), 30.6% presented some level of impairment, while at 3 months this frequency decreased to 14.2%, indicating cognitive improvement.
Table 3 shows that cognitive status at admission was significantly related to functional status at discharge (p = .01) and at 3 months (p = .01). Notably, in the group of patients who were independent at discharge and at 3 months, the majority (41.4%) were classified as asymptomatic in the cognitive status assessment at admission.
Correlations between cognitive status at admission with: functionality at discharge, functionality at 3 months, high depressive symptoms, depressive symptoms at consultation, cognitive status at discharge, cognitive status at consultation.
| Cognitive status on admission n (%) | p Value | |||||||
|---|---|---|---|---|---|---|---|---|
| Asymptomatic | Minimum deficit | Mild deficit | Mod deficit | Major deficit | Severe deficit | |||
| Func. On discharge | Independence | 12 (41.4) | 5 (17.2) | 9 (31) | 3 (10.3) | 0 (0) | 0 (0) | .005a |
| Mild dependence | 0 (0) | 0 (0) | 2 (40) | 2 (40) | 1 (20) | 0 (0) | ||
| Moderate dependence | 0 (0) | 0 (0) | 0 (0) | 1 (50) | 1 (50) | 0 (0) | ||
| Severe-total dependence | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | ||
| Func. At 3 months | Independence | 12 (41.4) | 5 (17.2) | 9 (31) | 3 (10.3) | 0 (0) | 0 (0) | .014 |
| Mild dependence | 0 (0) | 0 (0) | 2 (40) | 2 (40) | 1 (20) | 0 (0) | ||
| Moderate dependence | 0 (0) | 0 (0) | 0 (0) | 1 (50) | 1 (50) | 0 (0) | ||
| Severe-total dependence | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | ||
| Depressive symptoms on discharge | Minimum range | 10 (33.3) | 5 (16.7) | 11 (36.7) | 3 (10) | 1 (3.3) | 0 (0) | .035 |
| Mild depression | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | ||
| Moderate depression | 2 (50) | 0 (0) | 0 (0) | 2 (50) | 0 (0) | 0 (0) | ||
| Severe depression | 0 (0) | 0 (0) | 0 (0) | 1 (50) | 1 (50) | 0 (0) | ||
| Depressive symptoms at 3 months | Minimum range | 12 (38.7) | 4 (12.9) | 11 (35.5) | 3 (9.7) | 1 (3.2) | 0 (0) | .027 |
| Mild depression | 0 (0) | 1 (50) | 0 (0) | 1 (50) | 0 (0) | 0 (0) | ||
| Moderate depression | 0 (0) | 0 (0) | 0 (0) | 2 (66,7) | 1 (33,3) | 0 (0) | ||
| Severe depression | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | ||
| Cognitive status at discharge | No impairment | 9 (36) | 4 (16) | 9 (36) | 3 (12) | 0 (0) | 0 (0) | .003 |
| Questionable status | 0 (0) | 1 (50) | 0 (0) | 1 (50) | 0 (0) | 0 (0) | ||
| Mild-moderate dependence | 3 (33.3) | 0 (0) | 2 (22.2) | 2 (22.2) | 2 (22.2) | 0 (0) | ||
| Moderate-severe dependence | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | ||
| Cognitive status at 3 months | No impairment | 9 (29) | 5 (16.1) | 11 (35.5) | 5 (16.1) | 1 (3.2) | 0 (0) | .018 |
| Questionable status | 1 (50) | 0 (0) | 0 (0) | 1 (50) | 0 (0) | 0 (0) | ||
| Mild-moderate dependence | 2 (66.7) | 0 (0) | 0 (0) | 0 (0) | 1 (33.3) | 0 (0) | ||
| Moderate-severe dependence | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | ||
Similarly, cognitive status at admission was significantly related to depression symptoms at discharge (p = .04). In the group of patients with minimal depressive symptoms, the majority (36.7%) were classified as having mild cognitive impairment at admission. Furthermore, a significant relationship was found with depressive symptoms at 3 months (p = .03). It was observed that, in the group of patients with minimal depressive symptoms, the majority (38.7%) were asymptomatic at admission in terms of cognitive status.
Cognitive status at admission was significantly related to cognitive status at discharge (p = .01). Notably, within the group of patients without cognitive impairment at discharge, the majority were asymptomatic (36%) or had mild cognitive impairment (36%) at admission. Similarly, a relationship was also found with cognitive status at 3 months (p = .02), and it was observed that, in the group of patients without cognitive impairment at discharge, the majority (35.5%) had mild cognitive impairment at admission.
FunctionalityRegarding functionality, the results were the same in both the Barthel Index assessment at discharge and the assessment at 3 months. The results reveal that the majority of patients (80.6%) were fully independent in both measurements.
With respect to functionality at discharge, it was significantly related to functionality at 3 months (p = .01). It was observed that all individuals who were independent at discharge remained in the independent group at 3 months. However, this also occurred with those who were in the mild and moderate dependency groups at discharge (Table 4A). Functionality at discharge was also related to depressive symptoms at discharge (p = .01) and to depressive symptoms at 3 months (p = .01).
Similarly, a relationship was found with cognitive status at discharge (p = .01), observing that in the group of patients who were in the no cognitive impairment category at discharge, the majority (88%) were independent at discharge. A significant relationship was also found with cognitive status at 3 months (p = .01), showing the same trend as at discharge: in the group of patients who were in the no cognitive impairment category at 3 months, the majority (83.9%) were independent at discharge.
Table 4B shows that functionality at 3 months had a significant relationship with depressive symptoms at discharge (p = .01). Within the group of patients with minimal depression at discharge, the majority (86.2%) were in the functionally independent group at 3 months. It was also related to depressive symptoms at 3 months (p = .01), notably showing that, in the group of patients with minimal depression at 3 months, the majority (93.1%) were in the functionally independent group at 3 months. Functionality at 3 months was related to cognitive status at discharge (p = .05) and to cognitive status at 3 months (p = .02). In both cases, it was observed that the group of patients without cognitive impairment were in the functionally independent category at discharge and at 3 months (88% and 83.9%, respectively).
Correlations between functionality at discharge with: functionality at 3 months, high depressive symptoms, depressive symptoms at consultation, high cognitive status, cognitive status at consultation (A). Correlations between functionality at 3 months with: high depressive symptoms, depressive symptoms at consultation, high cognitive status, cognitive status at consultation (B). Correlations between high depressive symptoms with: depressive symptoms at consultation, high cognitive status (C) and correlations between high cognitive status with: depressive symptoms, cognitive status at consultation (D).
| A | Functionality at discharge, n (%) | |||||
|---|---|---|---|---|---|---|
| Independence | Slight dependence | Mod. dependence | Severe and total dependence | p | ||
| Functionality at 3 months | Independence | 29 (100) | 0 (0) | 0 (0) | 0 (0) | .001a |
| Mild dependence | 0 (0) | 5 (100) | 0 (0) | 0 (0) | ||
| Moderate dependence | 0 (0) | 0 (0) | 2 (100) | 0 (0) | ||
| Severe and total dependence | 0 (0) | 0 (0) | 0 (0) | 0 (0) | ||
| Depressive symptoms at discharge | Minimum range | 25 (83.33) | 4 (13,33) | 1 (3.33) | 0 (0) | .001 |
| Mild depression | 0 (0) | 0 (0) | 0 (0) | 0 (0) | ||
| Moderate depression | 3 (75) | 1 (25) | 0 (0) | 0 (0) | ||
| Severe depression | 29 (8.56) | 5 (13.89) | 2 (5.55) | 0 (0) | ||
| Depressive symptoms at 3 months | Minimum range | 27 (93.1) | 1 (3.4) | 1 (3.4) | 0 (0) | .001 |
| Mild depression | 3 (60) | 1 (20) | 1 (20) | 0 (0) | ||
| Moderate depression | 1 (50) | 0 (0) | 1 (50) | 0 (0) | ||
| Severe depression | 0 (0) | 0 (0) | 0 (0) | 0 (0) | ||
| Cognitive status at discharge | No impairment | 22 (88) | 2 (8) | 1 (4) | 0 (0) | .013 |
| Questionable status | 1 (50) | 1 (50) | 0 (0) | 0 (0) | ||
| Mild-moderate dependence | 6 (66.7) | 2 (22.2) | 1 (11.1) | 0 (0) | ||
| Moderate to severe impairment | 0 (0) | 0 (0) | 0 (0) | 0 (0) | ||
| Cognitive status at 3 months | No impairment | 26 (83.9) | 4 (12.9) | 1 (3) | 0 (0) | .012 |
| Doubtful status | 1 (50) | 1 (50) | 0 (0) | 0 (0) | ||
| Mild to moderate impairment | 2 (66.7) | 0 (0) | 1 (33.3) | 0 (0) | ||
| Moderate to severe impairment | 0 (0) | 0 (0) | 0 (0) | 0 (0) | ||
| B | Functionality at 3 months, n (%) | |||||
|---|---|---|---|---|---|---|
| Independence | Slight dependence | Mod. dependence | Severe-total dependence | |||
| Depressive symptoms at discharge | Minimum range | 25 (86.2) | 0 (0) | 3 (10.3) | 1 (3.4) | .001 |
| Depressive symptoms at 3 months | Mild depression | 4 (80) | 0 (0) | 1 (20) | 0 (0) | |
| Moderate depression | 1 (50) | 0 (0) | 0 (0) | 1 (50) | ||
| Severe depression | 0 (0) | 0 (0) | 0 (0) | 0 (0) | ||
| Cognitive status at discharge | Minimum range | 27 (93.1) | 1 (3.4) | 1 (3.4) | 0 (0) | .001 |
| Depressive symptoms at discharge | Mild depression | 3 (60) | 1 (20) | 1 (20) | 0 (0) | |
| Moderate depression | 1 (50) | 0 (0) | 1 (50) | 0 (0) | ||
| Severe depression | 0 (0) | 0 (0) | 0 (0) | 0 (0) | ||
| Depressive symptoms at 3 months | No impairment | 22 (88) | 2 (8) | 1 (4) | 0 (0) | .047 |
| Doubtful status | 1 (50) | 1 (50) | 0 (0) | 0 (0) | ||
| Mild-moderate impairment | 6 (66.7) | 2 (22.2) | 1 (11.1) | 0 (0) | ||
| Moderate-severe impairment | 0 (0) | 0 (0) | 0 (0) | 0 (0) | ||
| Cognitive status at discharge | No impairment | 26 (83.9) | 4 (12.9) | 1 (3.2) | 0 (0) | .022 |
| Questionable status | 1 (50) | 1 (50) | 0 (0) | 0 (0) | ||
| Mild-moderate impairment | 2 (66.7) | 0 (0) | 1 (33.3) | 0 (0) | ||
| Moderate-severe impairment | 0 (0) | 0 (0) | 0 (0) | 0 (0) | ||
| C | Depression symptoms at discharge n (%) | |||||
|---|---|---|---|---|---|---|
| Minimum range | Mild depression | Moderate depression | Major depression | |||
| Depressive symptoms at 3 months | Minimum range | 28 (90.3) | 0 (0) | 3 (9.7) | 0 (0) | .044a |
| Mild depression | 2 (100) | 0 (0) | 0 (0) | 0 (0) | ||
| Moderate depression | 0 (0) | 0 (0) | 1 (33.3) | 2 (66.7) | ||
| Severe depression | 0 (0) | 0 (0) | 0 (0) | 0 (0) | ||
| Depressive symptoms at 3 months | No impairment | 28 (90.3) | 0 (0) | 2 (6.5) | 1 (3.2) | .0001 |
| Questionable status | 0 (0) | 0 (0) | 2 (100) | 0 (0) | ||
| Mild-moderate dependence | 2 (66.7) | 0 (0) | 0 (0) | 1 (33.3) | ||
| Moderate-severe dependence | 0 (0) | 0 (0) | 0 (0) | 0 (0) | ||
| D | Cognitive status at discharge, n (%) | |||||
|---|---|---|---|---|---|---|
| No impairment | Questionable status | Mild-moderate impairment | Mod-severe impairment | |||
| Depressive symptoms at 3 months | Minimum range | 23 (74.2) | 1 (3.2) | 7 (22.6) | 0 (0) | .026 |
| Mild depression | 1 (50) | 1 (50) | 0 (0) | 0 (0) | ||
| Moderate depression | 1 (33.3) | 0 (0) | 2 (66.7) | 0 (0) | ||
| Severe depression | 0 (0) | 0 (0) | 0 (0) | 0 (0) | ||
| Cognitive status at 3 months | No impairment | 25 (80.6) | 2 (6.5) | 4 (12.9) | 0 (0) | .002* |
| Questionable status | 0 (0) | 0 (0) | 2 (100) | 0 (0) | ||
| Mild-moderate severity | 0 (0) | 0 (0) | 3 (100) | 0 (0) | ||
| Moderate-severe severity | 0 (0) | 0 (0) | 0 (0) | 0 (0) | ||
In the initial assessment, 83% of patients scored <13 points on the BDI scale, positioning them in the minimum range of depressive symptoms. At the 3-month follow-up, 86.1% scored <13 points, showing a significant decrease in depressive symptoms from hospitalisation to follow-up (p = .04).
Regarding depressive symptoms at discharge, correlations can be observed in Table 4. A significant relationship was established with depressive symptoms at 3 months (p = .04), notably showing that the majority of patients (90.3%) who presented with a minimum range of depressive symptoms at 3 months were already in that group at discharge. A significant relationship was also observed with cognitive impairment at discharge (p = .01), noting that the majority of patients who did not present with cognitive impairment at discharge (90.3%) were in the lowest range for depression at discharge.
Table 4D shows that cognitive status at discharge was significantly related to depressive symptoms at 3 months (p = .03). Notably, the majority (74.2%) of patients who did not present with cognitive impairment at discharge fell into the lowest range category for depressive symptoms at 3 months. Furthermore, cognitive status at discharge was also related to cognitive status at 3 months (p = .01). It was observed that the majority (80.6%) of patients who were in the group without cognitive impairment at discharge remained in that same category in the cognitive status assessment at 3 months.
Spearman’s correlationsThe strength and direction of the association were also studied (Table 5).
Spearman’s correlations.
| Cognitive status at admission | Func. At discharge | Func at consultation | Depression at discharge | Depression at consultation | Cognitive status at discharge | Cognitive status at consultation | ||
|---|---|---|---|---|---|---|---|---|
| Func. At discharge | Rho | –.511b | 1000 | |||||
| p Value | .001 | |||||||
| Func. At consultation | Rho | –.511b | 1000** | 1.00 | ||||
| p Value | .001 | |||||||
| Depression at discharge | Rho | .430b | –.378* | –.378a | 1000 | |||
| p Value | .009 | .023 | .023 | |||||
| Depression at consultation | Rho | .529b | –.380* | –.380a | .716b | 1000 | ||
| p Value | .001 | .022 | .022 | .000 | ||||
| Cognitive status at discharge | Rho | –.196 | .215 | .215 | –.112 | –,136 | 1000 | |
| p Value | .251 | .209 | .209 | .514 | .430 | |||
| Cognitive status at consultation | Rho | –.180 | 0.226 | .226 | –.252 | –.232 | .818b | 1000 |
| p Value | .293 | .185 | 0.185 | .139 | .174 | .000 |
Cognitive status at admission showed a moderate negative correlation with functional status at discharge (p = .01, rho = .51). It also showed a moderate negative correlation with functional status at 3 months (p = .01, rho = .51). However, it showed a moderate positive correlation with depressive symptoms at discharge (p = .09, rho = .43). Similarly, it showed a moderate positive correlation with depressive symptoms at 3 months (p = .01; rho = .53).
Functionality at discharge showed a perfect positive correlation with functional status at 3 months. However, it showed a moderate negative correlation with depressive symptoms at discharge (p = .02, rho = .38). Similarly, depressive symptoms at 3 months showed a moderate negative correlation (p = .02, rho = .38). Functional status at 3 months, however, showed a moderate negative correlation with depressive symptoms at discharge (p = .02, rho = .38), and also with depressive symptoms at 3 months (p = .02, rho = .38).
Depressive symptoms at discharge showed a very strong positive correlation with depressive symptoms at 3 months (p = .01, rho = .72). Finally, cognitive status at discharge showed a very high positive correlation with cognitive status at 3 months (p = .01, rho = .82).
DiscussionThis study conducted a comprehensive assessment that included cognitive, emotional, and functional variables, leading to the identification of correlations relevant to the clinical management of patients. Significant correlations were identified between cognitive status at admission, functionality, and subsequent depressive symptoms in patients with ischemic stroke or TIA. The results highlight that initial cognitive impairment predicts both reduced functionality and greater depressive symptoms during follow-up. Furthermore, it was observed that loss of functionality is associated with a greater risk of depressive symptoms. These findings underscore the importance of a comprehensive assessment in the acute and subacute phases of stroke. These sequelae, such as post-stroke depression (PSD), are frequently underdiagnosed in the acute phase, highlighting the need to implement early detection tools and systematic follow-up protocols.5
The sample for this study consisted of 36 patients, with a mean age of 69.17 ± 11.71 years and a male predominance. These characteristics are similar to those reported in previous research, such as that by Sajobi et al.,24 although other studies, such as that by Sánchez Silverio et al.,25 show a more equitable distribution by sex and a lower mean age. These differences may reflect variations in the inclusion criteria and the population contexts of each study.
The majority of patients in the sample were functionally independent at discharge and at 3 months, suggesting that moderate or severe stroke cases were less frequent, in line with previous studies that highlight that most ischemic strokes treated early show a favourable functional recovery.24,25 However, the data from this study indicate that the women in the sample had a worse functional recovery as measured by the Barthel Index and experienced greater stroke severity according to NIHSS scores. This greater severity could be a determining factor in the observed differences in functionality between the sexes, due to the influence of the initial NIHSS score on long-term functional outcomes.26 Furthermore, women tend to have poorer functional outcomes after a stroke, which could be related to biological and social factors that affect both initial severity and subsequent recovery.15 These findings highlight the need to address gender differences in post-stroke care and rehabilitation to improve functional outcomes in women.
Although more than half of the patients aged 80 years or older presented with mild impairment, another 40% suffered moderate impairment. Age proved to be a determining factor in cognitive status at 3 months, showing that older patients tended to present with more pronounced cognitive decline. Sánchez Silverio et al.25 reported a direct relationship between advanced age and a greater degree of functional dependence and cognitive impairment after a stroke. Other research has highlighted that aging is associated with greater vulnerability to post-stroke cognitive deficits, possibly due to the decrease in cognitive reserve and the greater prevalence of comorbidities in this population.16,26 These results underscore the need to design specific interventions that take into account demographic characteristics, such as age, to optimize functional and cognitive recovery in older patients.15
The lack of data on cognitive status prior to the ischemic event represents a significant limitation in this and other similar studies. However, recent research suggests that the NIHSS can be used as a tool to estimate baseline cognitive status by reviewing medical history and other neurological parameters. One study demonstrated that retrospective analysis of the NIHSS along with clinical data can provide reasonable predictions of baseline cognitive status in post-stroke patients.27 Incorporating this approach into future studies could help overcome this limitation and improve our understanding of the factors influencing cognitive recovery, reinforcing the need for special attention in this age group.
Regarding cognitive status, in this study it was assessed three times, the first time upon the patient's arrival at the hospital using the NIHSS scale. The mean score was mild cognitive impairment. The results of cognitive status in this study, assessed using the NIHSS and Mini-Mental State Examination, reflect an initial mild deficit and progressive recovery toward the absence of cognitive impairment at follow-up. This evolution differs from studies such as that by Bermello López et al.,6 where moderate deficits were reported, which could be related to differences in the severity of the cases included. Subsequent mean assessments, performed at discharge and at 3 months, indicated questionable cognitive status/no cognitive impairment, respectively. These results were similar to those of the study by Sánchez Silverio et al.,25 which determined a mean of 24.9 ± 4.1 points (questionable cognitive status).
The results obtained indicated a better neurological status in the study sample, with significantly lower cognitive scores compared to the Citeds studies. The inclusion of patients with TIA, who do not usually present with neurological sequelae, may have affected the results. If patients with TIA were excluded from the analysis, higher proportions of cognitive deficits might be shown.
Functionality, assessed using the Barthel Index, showed mild levels of independence/dependence at both discharge and 3 months. Compared to previous studies such as those by Sánchez Silverio et al.25 and Pego Pérez et al.,28 where the mean scores were 78.84 ± 24.42 and 78.1 ± 14 points, respectively, this study shows improved functionality. This could be related to the inclusion of patients with TIA, who tend to have less functional impairment than those with ischemic stroke.
Depressive symptoms in this study remained at minimal levels both at discharge and during follow-up. These results are consistent with those reported by Park et al.,10 although it should be noted that early measurements in acute and subacute phases may underestimate the prevalence of post-traumatic depression (PTD), which tends to become more evident in later stages. This highlights the importance of long-term follow-up to identify and treat emotional complications in post-stroke patients.
Lopez-Espuela et al.14 identified a 42.2% prevalence of depression in post-stroke patients (n = 173) assessed using the Hamilton Depression Rating Scale (HDS) at 6 months post-stroke. This study found significant associations between depression and variables such as a prior diagnosis of depression, the modified Rankin Scale score at discharge, and length of hospital stay. Furthermore, they emphasized the impact of left-sided stroke location and degree of disability at discharge as key predictors, which complements the evidence presented in our analysis.14
Li et al.29 identified a 25% prevalence of depression in patients with ischemic stroke (n = 499), using the HAMD scale, and found that neurological deficits assessed by the NIHSS (p < .01) and limitations in daily activities measured by the ADL scale (p = .01) were significant predictors of depression. Furthermore, Carnés-Vendrell et al.30 reported a cross-sectional prevalence of 25% of depression in patients with minor stroke or transient ischemic attack, highlighting a bidirectional association between depressive symptoms and cognitive impairment.
A 2025 meta-analysis of predictive models for post-stroke cognitive impairment identified advanced age (OR = 1.85; 95% CI: 1.23–2.78; p < .01) and stroke severity (OR = 2.12; 95% CI: 1.45–3.10; p < .01) as key risk factors.31 Furthermore, Carnés-Vendrell et al.30 highlighted that the interaction between cognitive impairment and depression can negatively influence functional recovery, underscoring the need to assess these parameters when designing therapeutic strategies.
A significant correlation was identified between cognitive impairment at admission and subsequent functionality, demonstrating that a greater cognitive deficit predicts a worse functional prognosis. This finding is consistent with the study by Bermello López et al.,6 which highlighted the usefulness of the NIHSS as a predictor of functionality at 3 months post-stroke. This reinforces the importance of performing early cognitive assessments to anticipate and plan rehabilitation strategies.
Functionality was associated with depressive symptoms, with patients exhibiting lower functional status having higher scores on the BDI. This finding aligns with the study by Carnés-Vendrell et al.,30 which identified functional impairment as a risk factor for post-traumatic dementia (PTD). This underscores the need for comprehensive interventions that address both functional recovery and emotional well-being.
The results obtained highlight the importance of a holistic approach to managing patients with stroke or TIA, including physical, neurological, cognitive, and emotional assessments. This approach allows for the prevention and early detection of neuropsychiatric complications such as cognitive impairment and PTD, promoting more effective and patient-cantered care. Consensus documents emphasize the importance of early detection and timely treatment of PTD to improve functional outcomes and quality of life for patients.11,32 Furthermore, they underscore the need to develop and implement standardised protocols that ensure this holistic approach in both inpatient and outpatient follow-up. In this context, the RNAO is a leader in developing guidelines that promote comprehensive patient care with the aim of reducing variability in care and improving health outcomes.12,17
To advance the comprehensive management of post-stroke patients, it is essential to standardise care through nursing best practice guidelines that evaluate the influence of interventions on patient outcomes. Furthermore, it is necessary to expand data collection, especially during the stabilisation phase, to address aspects that are often overlooked in studies focused on the acute and subacute phases.
To ensure the applicability of the findings, it is essential to replicate these types of studies in larger and more representative samples. This will allow for the validation of results and the adaptation of interventions to diverse clinical and population contexts, optimising the management of patients with stroke or TIA.
For future research, it would be interesting to consider excluding patients with TIA, given that their complete recovery may bias the results toward better cognitive and functional states. Alternatively, an independent samples analysis considering this variable could be considered to verify whether there is any relationship or bias in the results associated with the inclusion of these patients. Furthermore, it would be useful to include a more detailed analysis of stroke severity in the sample and how this variable relates to cognitive and functional outcomes, allowing for a more precise comparison with other studies.
LimitationsThis study has several limitations that should be considered when interpreting the results. First, the small sample size (36 patients) limits the generalisability of the conclusions to a broader population, especially considering the heterogeneity of stroke and TIA patients. Second, the lack of long-term follow-up prevents the evaluation of the evolution of the variables studied beyond the subacute phase, which could provide crucial information on functional and emotional stabilisation in later stages. In addition, although multiple clinical and emotional variables were included, other potentially relevant factors, such as social support, comorbidities, or access to rehabilitation resources, which could influence the results, were not assessed. Finally, the observational design of the study does not allow for establishing definitive causal relationships between the variables analysed.
ConclusionsIschemic stroke was the predominant event in the sample, with a higher incidence in men and in the 65−80 age group. These data are consistent with previous research and highlight the need to adapt preventive and management strategies according to population characteristics. Patient functionality remained stable from discharge to follow-up, indicating a favourable recovery in most cases.
However, it was observed that greater cognitive impairment at admission and discharge predicts a worse functional prognosis and a greater risk of post-stroke depression. These findings underscore the importance of integrating early cognitive assessments and tools for the detection and management of depressive symptoms into clinical protocols, promoting comprehensive care from the acute phase to outpatient follow-up.
The authors have no conflict of interests to declare.
