Relationship of subjective and objective cognition with post-stroke mood differs between early and long-term stroke

Background: Depression and anxiety affects 1 in 3 stroke survivors. Performance on standardized objective cognitive tests and self-reported subjective cognitive complaints are associated with concurrent depression and anxiety, but it is unknown whether and how objective and subjective cognition relate to longer-term emotional outcomes. Method: N = 99 stroke survivors (M age = 68.9, SD = 13.1; Median NIHSS = 5) from the OX-CHRONIC cohort completed measures of depression and anxiety (Hospital Anxiety and Depression Scale; HADS), objective cognition (Oxford Cognitive Screen) and subjective cognitive complaints (Cognitive Failures Questionnaire) at 6-months (Time 1), at ~4.5 years (Time 2) and ~5.5 years (Time 3) post-stroke. The contribution of objective and subjective cognition to depression and anxiety was determined via mixed-effects models. Results: We found no evidence that age, stroke severity, years of education, and participant sex related to changes in HADS-Depression or HADS-Anxiety scores. Objective cognitive impairments at Time 1 (b = -0.79, p < .05) and increases in subjective cognitive complaints at Time 3 (b = 0.77, p < .05) related to increased HADS-Depression scores (Marginal R2 = 0.22). Only increases in subjective cognitive complaints at Time 3 (b = 0.96, p < .05) related to increased HADS-Anxiety scores (Marginal R2 = 0.20). When conducting models in reverse, HADS-Depression and HADS-Anxiety scores did not reciprocally explain changes in subjective cognitive complaints. Conclusions: Objective cognitive abilities are more strongly associated with depression at 6-months post-stroke, while subjective cognitive complaints are more relevant to both long-term post-stroke depression and anxiety. ### Competing Interest Statement ND is a developer of the Oxford Cognitive Screen but does not receive any remuneration from its use. ### Funding Statement This study was funded by a Priority Programme Grant from the Stroke Association (SA PPA 18/100032). ND (Advanced Fellowship NIHR302224) is funded by the National Institute for Health Research (NIHR). The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR, NHS or the UK Department of Health and Social Care. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The data use here was approved by the UK National Research Ethics Committees (Oxford Cognitive Screening Programme; Reference 14/LO/0648 & 18/SC/055; OX-CHRONIC Study; Reference 19/SC/0520) I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Study analysis code can be found at https://osf.io/6hdcs/. OX-CHRONIC study data has been deposited in full to Dementia Platforms UK where it can be accessed: https://portal.dementiasplatform.uk/