Cognitive performance is associated with return to work after ischemic stroke in young adults: The ODYSSEY study

Mijntje Mi Schellekens; Esther M Boot; Jamie I Verhoeven; Merel S Ekker; Esmée Verburgt; Maikel Hm Immens; Anne Mertens; Mayte E van Alebeek; Paul Jam Brouwers; Renate M Arntz; Gert W van Dijk; Rob Ar Gons; Inge Wm van Uden; Tom den Heijer; Julia H van Tuijl; Karlijn F de Laat; Anouk Gw van Norden; Sarah E Vermeer; Marian Sg van Zagten; Robert J van Oostenbrugge; Marieke Jh Wermer; Paul J Nederkoorn; Frank G van Rooij; Ido R van den Wijngaard; Paul Lm de Kort; Frank-Erik de Leeuw; Roy Pc Kessels; Anil M Tuladhar

doi:10.1177/23969873251324400

Cognitive performance is associated with return to work after ischemic stroke in young adults: The ODYSSEY study

Mijntje Mi Schellekens, Esther M Boot, Jamie I Verhoeven, Merel S Ekker, Esmée Verburgt, Maikel Hm Immens, Anne Mertens, Mayte E van Alebeek, Paul Jam Brouwers, Renate M Arntz, Gert W van Dijk, Rob Ar Gons, Inge Wm van Uden, Tom den Heijer, Julia H van Tuijl, Karlijn F de Laat, Anouk Gw van Norden, Sarah E Vermeer, Marian Sg van Zagten, Robert J van OostenbruggeMarieke Jh Wermer, Paul J Nederkoorn, Frank G van Rooij, Ido R van den Wijngaard, Paul Lm de Kort, Frank-Erik de Leeuw, Roy Pc Kessels, Anil M Tuladhar^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

INTRODUCTION: Limited data exist on cognitive performance and return to work after ischemic stroke, especially in patients under 50 years. We investigated whether cognitive performance in the subacute phase after ischemic stroke in young adults was associated with unemployment and the inability to retain their jobs among those who returned to work. PATIENTS AND METHODS: We conducted a multicenter prospective cohort study between 2013 and 2021, enrolling patients aged 18-49 years with first-ever ischemic stroke. Cognitive assessments were performed within 6 months following the index event, covering seven cognitive domains. We categorized patients with cognitive impairment ( -score < -1.5 on a domain) and as no/mild or major vascular cognitive disorder (VCD; -score < -2.0 in one or more domains). Cognitive performance and other predefined characteristics were chosen to identify factors associated with unemployment and, among patients who returned to work, the inability to maintain employment. RESULTS: Of 525 patients (median age 44.3 [IQR 38.0-47.4] years; 243 women [46.3%]); median follow-up of 6.6 [IQR 4.5-8.2] years), 426 patients (81.1%) returned to work. Sixty-five patients (15.3%) were unable to maintain employment. In multivariable logistic regression analysis, major VCD (OR = 2.0; 95% CI 1.3-3.0; = 0.002) and cognitive impairment in processing speed (OR = 2.0; 95% CI 1.3-3.3; = 0.004) were associated with unemployment, but not with the inability to maintain employment. DISCUSSION AND CONCLUSION: In young patients after a first-ever ischemic stroke, major VCD and impaired processing speed in the subacute phase after stroke were independently associated with unemployment, but not with the inability to maintain employment.

Original language	English
Article number	23969873251324400
Number of pages	12
Journal	European Stroke Journal
DOIs	https://doi.org/10.1177/23969873251324400
Publication status	E-pub ahead of print - 12 Mar 2025

Keywords

Cognitive impairment
neuropsychological tests
return to work
stroke in young adults

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10.1177/23969873251324400

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11907581Licence: Other

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Schellekens, M. M., Boot, E. M., Verhoeven, J. I., Ekker, M. S., Verburgt, E., Immens, M. H., Mertens, A., van Alebeek, M. E., Brouwers, P. J., Arntz, R. M., van Dijk, G. W., Gons, R. A., van Uden, I. W., den Heijer, T., van Tuijl, J. H., de Laat, K. F., van Norden, A. G., Vermeer, S. E., van Zagten, M. S., ... Tuladhar, A. M. (2025). Cognitive performance is associated with return to work after ischemic stroke in young adults: The ODYSSEY study. European Stroke Journal, Article 23969873251324400. Advance online publication. https://doi.org/10.1177/23969873251324400

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title = "Cognitive performance is associated with return to work after ischemic stroke in young adults: The ODYSSEY study",

abstract = "INTRODUCTION: Limited data exist on cognitive performance and return to work after ischemic stroke, especially in patients under 50 years. We investigated whether cognitive performance in the subacute phase after ischemic stroke in young adults was associated with unemployment and the inability to retain their jobs among those who returned to work. PATIENTS AND METHODS: We conducted a multicenter prospective cohort study between 2013 and 2021, enrolling patients aged 18-49 years with first-ever ischemic stroke. Cognitive assessments were performed within 6 months following the index event, covering seven cognitive domains. We categorized patients with cognitive impairment ( -score < -1.5 on a domain) and as no/mild or major vascular cognitive disorder (VCD; -score < -2.0 in one or more domains). Cognitive performance and other predefined characteristics were chosen to identify factors associated with unemployment and, among patients who returned to work, the inability to maintain employment. RESULTS: Of 525 patients (median age 44.3 [IQR 38.0-47.4] years; 243 women [46.3%]); median follow-up of 6.6 [IQR 4.5-8.2] years), 426 patients (81.1%) returned to work. Sixty-five patients (15.3%) were unable to maintain employment. In multivariable logistic regression analysis, major VCD (OR = 2.0; 95% CI 1.3-3.0; = 0.002) and cognitive impairment in processing speed (OR = 2.0; 95% CI 1.3-3.3; = 0.004) were associated with unemployment, but not with the inability to maintain employment. DISCUSSION AND CONCLUSION: In young patients after a first-ever ischemic stroke, major VCD and impaired processing speed in the subacute phase after stroke were independently associated with unemployment, but not with the inability to maintain employment.",

keywords = "Cognitive impairment, neuropsychological tests, return to work, stroke in young adults",

author = "Schellekens, {Mijntje Mi} and Boot, {Esther M} and Verhoeven, {Jamie I} and Ekker, {Merel S} and Esm{\'e}e Verburgt and Immens, {Maikel Hm} and Anne Mertens and {van Alebeek}, {Mayte E} and Brouwers, {Paul Jam} and Arntz, {Renate M} and {van Dijk}, {Gert W} and Gons, {Rob Ar} and {van Uden}, {Inge Wm} and {den Heijer}, Tom and {van Tuijl}, {Julia H} and {de Laat}, {Karlijn F} and {van Norden}, {Anouk Gw} and Vermeer, {Sarah E} and {van Zagten}, {Marian Sg} and {van Oostenbrugge}, {Robert J} and Wermer, {Marieke Jh} and Nederkoorn, {Paul J} and {van Rooij}, {Frank G} and {van den Wijngaard}, {Ido R} and {de Kort}, {Paul Lm} and {de Leeuw}, Frank-Erik and Kessels, {Roy Pc} and Tuladhar, {Anil M}",

year = "2025",

month = mar,

day = "12",

doi = "10.1177/23969873251324400",

language = "English",

journal = "European Stroke Journal",

issn = "2396-9873",

publisher = "SAGE Publications Inc.",

}

Schellekens, MM, Boot, EM, Verhoeven, JI, Ekker, MS, Verburgt, E, Immens, MH, Mertens, A, van Alebeek, ME, Brouwers, PJ, Arntz, RM, van Dijk, GW, Gons, RA, van Uden, IW, den Heijer, T, van Tuijl, JH, de Laat, KF, van Norden, AG, Vermeer, SE, van Zagten, MS, van Oostenbrugge, RJ, Wermer, MJ, Nederkoorn, PJ, van Rooij, FG, van den Wijngaard, IR, de Kort, PL, de Leeuw, F-E, Kessels, RP & Tuladhar, AM 2025, 'Cognitive performance is associated with return to work after ischemic stroke in young adults: The ODYSSEY study', European Stroke Journal. https://doi.org/10.1177/23969873251324400

TY - JOUR

T1 - Cognitive performance is associated with return to work after ischemic stroke in young adults

T2 - The ODYSSEY study

AU - Schellekens, Mijntje Mi

AU - Boot, Esther M

AU - Verhoeven, Jamie I

AU - Ekker, Merel S

AU - Verburgt, Esmée

AU - Immens, Maikel Hm

AU - Mertens, Anne

AU - van Alebeek, Mayte E

AU - Brouwers, Paul Jam

AU - Arntz, Renate M

AU - van Dijk, Gert W

AU - Gons, Rob Ar

AU - van Uden, Inge Wm

AU - den Heijer, Tom

AU - van Tuijl, Julia H

AU - de Laat, Karlijn F

AU - van Norden, Anouk Gw

AU - Vermeer, Sarah E

AU - van Zagten, Marian Sg

AU - van Oostenbrugge, Robert J

AU - Wermer, Marieke Jh

AU - Nederkoorn, Paul J

AU - van Rooij, Frank G

AU - van den Wijngaard, Ido R

AU - de Kort, Paul Lm

AU - de Leeuw, Frank-Erik

AU - Kessels, Roy Pc

AU - Tuladhar, Anil M

PY - 2025/3/12

Y1 - 2025/3/12

N2 - INTRODUCTION: Limited data exist on cognitive performance and return to work after ischemic stroke, especially in patients under 50 years. We investigated whether cognitive performance in the subacute phase after ischemic stroke in young adults was associated with unemployment and the inability to retain their jobs among those who returned to work. PATIENTS AND METHODS: We conducted a multicenter prospective cohort study between 2013 and 2021, enrolling patients aged 18-49 years with first-ever ischemic stroke. Cognitive assessments were performed within 6 months following the index event, covering seven cognitive domains. We categorized patients with cognitive impairment ( -score < -1.5 on a domain) and as no/mild or major vascular cognitive disorder (VCD; -score < -2.0 in one or more domains). Cognitive performance and other predefined characteristics were chosen to identify factors associated with unemployment and, among patients who returned to work, the inability to maintain employment. RESULTS: Of 525 patients (median age 44.3 [IQR 38.0-47.4] years; 243 women [46.3%]); median follow-up of 6.6 [IQR 4.5-8.2] years), 426 patients (81.1%) returned to work. Sixty-five patients (15.3%) were unable to maintain employment. In multivariable logistic regression analysis, major VCD (OR = 2.0; 95% CI 1.3-3.0; = 0.002) and cognitive impairment in processing speed (OR = 2.0; 95% CI 1.3-3.3; = 0.004) were associated with unemployment, but not with the inability to maintain employment. DISCUSSION AND CONCLUSION: In young patients after a first-ever ischemic stroke, major VCD and impaired processing speed in the subacute phase after stroke were independently associated with unemployment, but not with the inability to maintain employment.

AB - INTRODUCTION: Limited data exist on cognitive performance and return to work after ischemic stroke, especially in patients under 50 years. We investigated whether cognitive performance in the subacute phase after ischemic stroke in young adults was associated with unemployment and the inability to retain their jobs among those who returned to work. PATIENTS AND METHODS: We conducted a multicenter prospective cohort study between 2013 and 2021, enrolling patients aged 18-49 years with first-ever ischemic stroke. Cognitive assessments were performed within 6 months following the index event, covering seven cognitive domains. We categorized patients with cognitive impairment ( -score < -1.5 on a domain) and as no/mild or major vascular cognitive disorder (VCD; -score < -2.0 in one or more domains). Cognitive performance and other predefined characteristics were chosen to identify factors associated with unemployment and, among patients who returned to work, the inability to maintain employment. RESULTS: Of 525 patients (median age 44.3 [IQR 38.0-47.4] years; 243 women [46.3%]); median follow-up of 6.6 [IQR 4.5-8.2] years), 426 patients (81.1%) returned to work. Sixty-five patients (15.3%) were unable to maintain employment. In multivariable logistic regression analysis, major VCD (OR = 2.0; 95% CI 1.3-3.0; = 0.002) and cognitive impairment in processing speed (OR = 2.0; 95% CI 1.3-3.3; = 0.004) were associated with unemployment, but not with the inability to maintain employment. DISCUSSION AND CONCLUSION: In young patients after a first-ever ischemic stroke, major VCD and impaired processing speed in the subacute phase after stroke were independently associated with unemployment, but not with the inability to maintain employment.

KW - Cognitive impairment

KW - neuropsychological tests

KW - return to work

KW - stroke in young adults

U2 - 10.1177/23969873251324400

DO - 10.1177/23969873251324400

M3 - Article

SN - 2396-9873

JO - European Stroke Journal

JF - European Stroke Journal

M1 - 23969873251324400

ER -

Cognitive performance is associated with return to work after ischemic stroke in young adults: The ODYSSEY study

Abstract

Keywords

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