Global cognition, executive function, and metacognition in a stroke population
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Post-stroke cognitive impairment is associated with poor long-term outcomes and increased functional dependency. The overall study aim was to explore the relationships between global cognition, executive function and metacognition in a stroke population, to examine correlates and potential predictors of cognitive impairment and to determine the relationship between cognitive impairment and stroke in a Bahraini stroke sample in comparison to an age- and sex- matched control group. A sample of 130 stroke patients (case group) were recruited from the largest medical complex in Bahrain and 55 control participants from the non-stroke general population were recruited from two primary local health centres in the country. General demographic data, clinical assessment and neuropsychological battery of cognitive assessments was conducted on participants. The study found that individuals not affected by stroke have proportional risk factors to a stroke population in Bahrain. Approximately 48% of the stroke sample group had some degree of cognitive impairment with greater stroke severity being more significantly associated with worse overall cognitive impairment. Poorer performance on global cognition was correlated with executive dysfunction and more functional dependency. Stroke patients with higher levels of cognitive impairment were more likely to report lower cognitive self-consciousness levels, indicating an impairment in their metacognitive thought processes. Similarly, participants who performed poorly in the memory components of cognitive testing tended to subjectively report higher confidence in their memory skills, indicating an impairment in metamemory. Though no significant correlations were reported between total Metacognitive Questionnaire-30 scores and executive function and global cognition, the Metacognitive Questionnaire-30 was shown to be a good predictor of anxiety and depression post-stroke. The development of a tool that can consolidate both subjective and global objective assessment and thereby measure the full breadth of metacognitive function is necessary and may have important implications for future rehabilitation.