Association Between Metacognition and Mood Symptoms Poststroke

Introduction: The link between metacognition and mood has been well established, particularly in other conditions with psychological comorbidity, however, there is no evidence regarding this association in the area of stroke. Aim: The aim of this study was to examine the association between metacognition, based on the Self-Regulatory Executive Function model, and mood symptoms in the acute phase after stroke. Methods: One hundred thirty patients were recruited to a prospective stroke study in Bahrain, and n = 64 were assessed for mood and cognition. A neuropsychological battery of cognitive assessments included the following measures: the Mini-Mental State Examination, the Trail Making Test (A+B), and the Metacognition Questionnaire 30 (MCQ-30) for metacognition. The Hospital Anxiety and Depression Scale assessed mood symptoms, and stroke severity was measured using the National Institute of Health Stroke Severity Scale. Results: Total MCQ-30 scores were significantly associated with both anxiety (r = .47, P = .001) and depression (r = .54, P <. 0001). The MCQ-30 subscales' cognitive confidence, cognitive self-consciousness, and uncontrollability/danger were the specific factors to be associated with mood symptoms (P < .01). Global cognition (r =.32, P < .01), but not executive function, was significantly associated with depression only. Metacognition remained a statistically significant correlate with depression ( = .42, P < .0001) and anxiety ( = .51, P < .0001) after adjusting for education and global cognition. Discussion: Metacognition is a better determinant of mood symptoms after stroke, especially in regions where illiteracy levels are high in older populations, in comparison to executive function and global cognition.