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Acute post-stroke cognitive test performance predicts one-year functional independence
Preprint   Open access

Acute post-stroke cognitive test performance predicts one-year functional independence

Alan Romanowski, Kathleen Langbehn, Maurizio Corbetta, Daniel Tranel, Aaron D Boes and Mark Bowren
medRxiv : the preprint server for health sciences
Cold Spring Harbor Laboratory
12/15/2025
DOI: 10.64898/2025.12.13.25342206
PMCID: PMC12723970
PMID: 41445648
url
https://doi.org/10.64898/2025.12.13.25342206View
Preprint (Author's original)This preprint has not been evaluated by subject experts through peer review. Preprints may undergo extensive changes and/or become peer-reviewed journal articles. Open Access

Abstract

General cognitive ability (g), a latent variable derived from cognitive data, can predict life outcomes (e.g., educational attainment and occupational success) among neurologically healthy individuals. The value of g for predicting post-stroke functional outcomes is unknown. We addressed this gap here. We derived g using exploratory structural equation modeling of 15 neuropsychological tests administered to 112 patients with stroke, 69 of whom also had functional outcome data (42 men; mean age = 53.23 years (SD = 10.54)). We used logistic regressions to compare g and individual tests in terms of their ability to predict the Functional Assessment Measure (FAM) and the Functional Independence Measure (FIM; motor and cognitive subscales) at 12 months post-stroke. g was a statistically significant predictor of FAM ( = 6.86, = 0.013) and the cognitive ( = 11.48, = 0.002) but not motor FIM subscale ( = 0.93, = 0.154). Individual tests varied widely in terms of predictive utility ( range: 0.07-21.03), with the most robust predictors being measures of visuospatial functions. Acute measures of cognition, including g, can predict functional independence 12 months after stroke. g and visuospatial ability measures were the most robust predictors. General cognitive ability (or, g) is composite score based on scores on performance-based tests of cognition. In neurologically healthy people, g can predict long-term life outcomes. The value of g measured acutely after stroke for predicting functional outcomes one year later is unknown. We evaluated the utility of g for predicting post-stroke functional outcomes. A g factor based on neuropsychological test data collected from acute stroke patients was a statistically significant predictor of cognitive and psychosocial functional outcomes one year later. Lower g after stroke was linked to higher chance of needing functional assistance. When neuropsychological test data are collected in the acute post-stroke period, it may be possible to derive a g factor score based on those data. Our findings suggest that this g factor score could help clinicians tailor treatment strategies to a patient's expected long-term functional outcomes.

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