The First Week

Dr Susanna Park from the Institute of Neurology, UK critically considers Stroke and the First Week

The focus of the March issue of JNNP is stroke, highlighting a range of research assessing risk factors, prognosis, treatment and management.

In this timely issue, Kauranen and colleagues1 present a study which emphasises the importance of cognitive function in the early stages after a stroke as a predictor of long term outcomes. In the study, 140 patients who experienced a first ever ischaemic stroke underwent a neurocognitive evaluation within the first week post-stroke. Before their stroke, all of the patients were engaged in full time employment. Six months later, the main predictor for a return to work was the number of cognitive deficits that were present in the first week.

Importantly, each additional cognitive deficit present in the first week doubled the likelihood of a patient being unable to return to employment at follow-up. This study stresses the role of cognition as an important predictor of long term outcomes post-stroke2, with previous studies indicating that cognitive status is also predictive of long-term functional status3 and quality of life4.

In the same issue of JNNP, El Hachioui and colleagues5 identified that the degree of aphasia one year following a stroke could be predicted within the first week by a combination of factors including phonology scores and stroke severity indices. These studies highlight the first week following stroke as a critical window not only for prognosis but also for rehabilitation and recovery.  Not only are early assessments of cognition and language invaluable for predicting long-term prognosis for stroke patients, but early interventions may be able to intervene in this time period to boost functional recovery and rehabilitative outcomes long-term.


Recovery post-stroke.  Wallaby great Michael Lynagh and his neurologist Dr Rob Henderson - discuss Noddies miraculous recovery post-stroke
Recovery post-stroke.
Wallaby great Michael Lynagh and his neurologist Dr Rob Henderson – discuss Noddy’s miraculous recovery post-stroke



1. Kauranen T, Turunen K, Laari S, Mustanoja S, Baumann P, Poutiainen E (2013) The severity of cognitive deficits predicts return to work after a first ever ischaemic stroke. JNNP 84: 316-321.

2. Arauz A. (2013) Return to work after stroke: the role of cognitive deficits. JNNP 84: 240.

3. Wagle J, Farner L, Flekkᴓy K, Bruun Wyller T, Sandvik L, Fure B, Stensrᴓd B, Engedal K (2011). Early post-stroke cognition in stroke rehabilitation patients predicts functional outcome at 13 months.  Dement Geriatr Cogn Disord 31: 379-387.

4. Nys GM, van  Zandvoort MJ, van der Worp HB, de Haan EH, de Kort  PL, Jansen BP, Kappelle LJ. (2006). Early cognitive impairment predicts long-term depressive symptoms and quality of life after stroke. J Neurol Sci 247: 149-56

5. El-Hachioui H, Lingsma HF, van de Sandt-Koenderman MWME, Dippel DWJ, Koudstaal PJ, Visch-Brink EG. (2013) Long-term prognosis of aphasia after stroke.  JNNP 84: 310-315.

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