Relationship of subjective and objective cognition with post-stroke mood differs between early and long-term stroke.

Depression and anxiety affects approximately 1 in 3 stroke survivors. Performance on standardized objective cognitive tests and self-reported subjective cognitive symptoms are associated with concurrent depression and anxiety, but longitudinal data on whether and how objective and subjective cognition relate to emotional outcomes are lacking.  99 stroke survivors ( age = 68.9,  = 13.1; Median NIH Stroke Severity = 5) completed measures of depression and anxiety (Hospital Anxiety and Depression Scale; HADS), objective cognition (Oxford Cognitive Screen) and subjective cognitive symptoms (Cognitive Failures Questionnaire) at 6-months, 4.5, and 5.5 years post-stroke. The contribution of objective and subjective cognition to depression and anxiety was determined mixed-effects models. We found no evidence that age, stroke severity, years of education, and participant sex related to changes in HADS-Depression or HADS-Anxiety scores (Marginal =0.03 and 0.05, respectively). Objective cognitive impairments at 6-months and increases in subjective cognitive symptoms at 5.5 years significantly related to increased HADS-Depression scores (Marginal =0.22). Only increases in subjective cognitive symptoms at 5.5 years significantly related to increased HADS-Anxiety scores (Marginal =0.20). When conducting models in reverse, HADS-Depression and HADS-Anxiety scores did not reciprocally explain changes in subjective cognitive symptoms. Objective cognitive abilities are more strongly associated with depression at 6-months post-stroke, while subjective cognitive symptoms are more relevant to both long-term post-stroke depression and anxiety. There may be a unique unidirectional influence of subjective cognitive symptoms to post-stroke depression and anxiety.