Objective:To test the hypothesis that cognitive demands influence motor performance during recovery from acute stroke, we tested acute stroke patients on two motor tasks with different cognitive demands and related task performance to cognitive impairment and neuroanatomic injury.Methods:We assessed the contralesional and ipsilesional upper extremities of a cohort of 50 patients with weakness after unilateral acute ischemic stroke at three timepoints with two tasks: the Box & Blocks Test, a task with greater cognitive demand, and Grip Strength, a simple and ballistic motor task. We compared performance on the two tasks, related motor performance to cognitive dysfunction, and used voxel-based lesion symptom mapping to determine neuroanatomical sites associated with motor performance.Results:Consistent across contralesional and ipsilesional upper extremities and most pronounced immediately post-stroke, Box & Blocks scores were significantly more impaired than Grip Strength scores. The presence of cognitive dysfunction significantly explained up to 33% of variance in Box & Blocks performance but was not associated with Grip Strength performance. While Grip Strength performance was associated with injury largely restricted to sensorimotor regions, Box & Blocks performance was associated with broad injury outside sensorimotor structures, particularly the dorsal anterior insula, a region known to be important for complex cognitive function.Conclusions:Altogether, these results suggest that cognitive demands influence upper extremity motor performance during recovery from acute stroke. Our findings emphasize the integrated nature of motor and cognitive systems and suggest that it is critical to consider cognitive demands during motor testing and neurorehabilitation after stroke.
Sleep Quality and Cognitive Dysfunction among Acute Stroke Patients from Coastal Areas of North Sulawesi, Indonesia