Post-stroke cognitive impairment is associated with poorer return-to-work outcomes in working-aged stroke survivors: A systematic review.
Libby J Cunningham, Tadhg Stapleton, Killian Walsh et al.
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In 30 seconds
This systematic review examined how post-stroke cognitive impairment relates to return-to-work outcomes among working-aged stroke survivors and assessed cognitive measures used in the literature. It included 39 studies: 33 observational, five qualitative and one randomised trial. Across cohorts, reported cognitive impairment prevalence ranged from 17.5% at 28 days to 89% at 7 years, while return-to-work rates ranged from 7.5% to 100%. Despite substantial variation in assessment methods and timing, cognition was the factor most commonly associated with return-to-work outcomes, and impairment was linked to poorer outcomes even after milder stroke.
Key findings
- Cognitive impairment prevalence ranged from 17.5% at 28 days to 89% at 7 years across study cohorts.
- Return-to-work rates ranged from 7.5% to 100%, with no clear trends by time after stroke or stroke subtype.
- Cognition was the most commonly associated factor influencing return-to-work outcomes, followed by stroke severity, mood and functional status.
- Concentration, memory and processing speed impairments were most frequently reported.
Why it matters
Cognitive difficulties may affect employment after stroke even when the stroke is mild, yet their effects can be less visible than physical disability. The review also highlights inconsistent assessment practices and limited awareness among employers and clinicians. Recognising this evidence can help frame return-to-work assessment as involving cognitive as well as physical and functional outcomes.
What to keep in mind
Substantial heterogeneity in cognitive assessments, assessment timing and study designs required narrative synthesis, limiting direct comparison across studies. The evidence base included only one randomised trial.