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

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 (Z-score < -1.5 on a domain) and as no/mild or major vascular cognitive disorder (VCD; Z-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; p = 0.002) and cognitive impairment in processing speed (OR = 2.0; 95% CI 1.3-3.3; p = 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.