Content » Vol 53, Issue 1

Original report

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

Georgios Vlachos, Hege Ihle-Hansen, Torgeir Bruun Wyller, Anne Brækhus, Margrete Mangset, Charlotta Hamre, Brynjar Fure
Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway. E-mail:
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.

Lay Abstract

Many patients with minimal or no apparent neurological deficits after stroke may experience cognitive and emotion-al symptoms. The quality of life and functioning of these patients may be reduced. Our research group studied 117 previously cognitively healthy patients aged 70 years or younger with mild stroke 12 months after the stroke event. They were assessed for cognitive and emotional impairments using validated tests for cognitive function, fatigue, depression, anxiety, and apathy. Only 21 patients (18%) scored within the normal range in these tests. In conclusion, “hidden impairments” are common among younger stroke patients. It is important for patients, their surroundi-ngs and stroke physicians to be aware that such difficulties can occur after even a mild stroke.


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