The prevalence of both motor deficit and cognitive impairment after stroke is high and persistent. Motor impairment, especially paresis, is often more obvious to both patients and their carers while cognitive problems can also have devastating effects on quality of life. The current review explores whether there might be a link between motor and cognitive impairment after stroke in the same patients. Electronic databases were searched systematically. Studies fulfilled the selection criteria when they were written in English and when both motor and cognitive deficit after stroke were evaluated and analyzed in the same patients, either with objective or subjective measures. 20 papers were included in this review. Measures of gait, balance and limb function were consistently correlated with aspects of attention and executive functioning in 9 studies. Correlations were robust when objective measures for specific functions were used, while results based on subjective or global measures tended to be more heterogeneous. Motor and cognitive impairment appear to be linked in stroke. Studies which assessed correlations between the two domains in the same patients (irrespective of time post stroke) found, on the whole, strong links between walking and balance tasks and the cognitive domains of attention and executive functioning. Whether the same mechanisms or neural pathways underlie these deficits or whether they are occurring simultaneously remains to be explored. Stroke often results in both motor impairment and cognitive deficit. Motor deficits are however typically more obvious than cognitive problems to patients and their carers and rehabilitation efforts often focus on attempting to improve limb function rather than on whether the patient has trouble planning their day for example. However, even when stroke is considered mild or patients show good recovery, cognitive deficits are common. In the first month post-stroke 49 to 91% of the patients suffer cognitive impairment in at least one cognitive domain. Frequently, these deficits are persistent, lasting for years. Since cognitive impairment can affect social, professional and vocational functioning, influence quality of life of both patients and family members and can affect rehabilitation success, it is important to assess both domains - motor and cognitive in the same patients. In neurological populations, a link between motor deficit and cognitive impairment has also been reported. In Parkinson’s disease different types of motor impairment were associated with specific cognitive deficits, including deficits in attention, mental flexibility, working memory, visuospatial function and memory. Furthermore, in Multiple Sclerosis measures of EF accounted for most of the variance in motor performance In three different reviews of the literature, links between gait and cognitive performance in both normal and demented populations were investigated; in both normal ageing and the most prevalent subtypes of dementia a close relationship between gait and cognition, more specifically attention and EF was found.The current review attempted to explore whether there is a link between motor deficit and cognitive impairment in the same stroke patients as well as to assess which aspects of these (global) domains are linked. Our goal is to determine if there is a specific relation or pattern between motor and cognitive deficit which will help us to advise clinicians as to which cognitive domains to assess after stroke.

With Regards,
Sara Giselle
Associate Managing Director