Caregiver Psychosocial Factors & Stroke Survivor Cognitive Outcomes: A REGARDS-CARES Cohort Study

Objectives: Caring for an individual with cognitive impairment carries a physical, mental, and emotional toll. This manuscript examines the relationship between caregiver psychosocial measures and longitudinal cognitive outcomes of stroke survivors, as well as analyzing the psychosocial factors as moderators of stroke severity and cognition.

Methods: This analysis was conducted on caregiver and stroke survivor dyads (n = 157) that participated in the Caring for Adults Recovering from the Effects of Stroke (CARES) project, an ancillary study of the REasons for Geographic and Racial Differences in Stroke (REGARDS) national cohort study. Stroke severity at hospitalization discharge was included as the primary predictor of cognitive outcomes and caregiver psychosocial factors were included as additional predictors. Cognition was assessed biennially and measured the domains of learning, memory, and executive functioning. Individual mixed-effect models included each psychosocial factor and were covariate-adjusted for pre-stroke cognitive scores and demographic variables. Caregiver psychosocial factors included caregiver strain, depressive symptoms, life and leisure time satisfaction, and overall quality of life.

Results: Decreased caregiver strain (b = -0.230, 95% CI: -0.39 to -0.07; p = 0.006) and increased leisure time satisfaction (b = 0.045, 95% CI: 0.01 to 0.08; p = 0.005) were both found to be significant predictors, alongside stroke severity (b = -0.137, 95% CI: -0.22 to -0.05; p = 0.002), of better stroke survivor cognition overall. No variables were found to be moderating factors of the relationship between stroke severity and cognition.

Conclusions: Understanding the caregiver psychosocial factors that predict stroke outcomes will help clinicians to identify stroke survivor and caregiver dyads at higher risk for worst longitudinal cognitive outcomes following stroke.