Does early mobilisation after stroke affect cognition?

Getting stroke patients up and moving within 24 hours of their stroke does not affect cognition three months later, according to data from AVERT, a large international trial spanning 56 hospitals and eight countries.

Encouraging patients who have just had a stroke to mobilise, whether it be by sitting, standing, or walking, is recommended in various guidelines. However, there is a lack of strong evidence to say whether this is beneficial. AVERT sought to determine whether mobilising patients within 24 hours of stroke would improve function.

While the main trial focused on physical outcomes such as walking, Dr Toby Cumming and his team looked at the data to see if cognition was affected. The study found that ‘increasing out-of-bed activity in this early stage after stroke does not influence cognitive outcome at 3 months post-stroke. Performance on tasks that require attention, memory, planning and language was no different between the intervention and control groups.’

Researchers used the Montreal Cognitive Assessment (MoCA) to assess participants' cognition three months after their stroke. They found no difference between those who mobilised early and those who did not.

Dr Cumming hopes that the study will encourage other stroke researchers to start measuring cognition in their trials. ‘The effects of stroke are not just physical. Some consequences, like fatigue, mood disorders, and cognitive decline, are more hidden. These can have a massive impact on everyday life, yet less than 5% of all stroke research studies include a cognitive outcome measure.’

Dr Cumming believes that researchers may avoid measuring cognition because ‘historically, neuropsychological testing has been a little bit unwieldy. Full assessment can take an hour and a half, and you need to look at a mix of cognitive domains.’

But despite the difficulties, measuring cognition is worth the effort. ‘Given the importance of healthy cognition to the individual, it is vital that we find interventions to reduce post-stroke cognitive impairments. With our results, we have demonstrated the feasibility of including a cognitive outcome measure in a large, multi-centre, international trial. Hopefully this will open the way for other researchers to do the same.’

Read the original paper here.

Toby Cumming is a research fellow in the Stroke theme at the Florey. His research looks at how brain changes after stroke affect fatigue, cognitive function, depression and anxiety.