Concept Analysis of Post-Stroke Cognitive Function in Ischemic Stroke Patients: Implications for Nursing Practice

Muhammad Ardi; Salim Harris; I Made Kariasa; Bambang Wispriyono

doi:10.32382/medkes.v20i2.1574

Authors

Muhammad Ardi Postgraduate Program, Faculty of Nursing, Universitas Indonesia, Depok, Indonesia
Salim Harris Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia https://orcid.org/0000-0002-4271-2933
I Made Kariasa Faculty of Nursing, Universitas Indonesia, Depok, Indonesia https://orcid.org/0000-0003-1661-5782
Bambang Wispriyono Faculty of Public Health, Universitas Indonesia, Depok, Indonesia https://orcid.org/0009-0004-0271-5349

DOI:

https://doi.org/10.32382/medkes.v20i2.1574

Keywords:

Concept analysis, cognitive attributes, cognitive function, post-stroke recovery, ischemic stroke

Abstract

Ischemic stroke is a major cause of neurological disability, often resulting in cognitive impairment that impacts quality of life, functional status, and caregiver burden. However, there has been no systematic conceptual analysis explaining the attributes, antecedents, and consequences of cognitive function in ischemic stroke patients. Thi study aims to comprehensively analyze the concept of cognitive function in ischemic stroke patients, clarifying its definition, attributes, antecedents, consequences, and empirical references. This concept analysis followed the seven-steps approach by Walker and Avant. Literature search was conducted through PubMed, Scopus, and CINAHL with the following inclusion criteria: publications from 2020 to 2025, in English, focusing on post-stroke cognitive function. A total of 22 articles from various disciplines were analyzed. Empirical references were selected based on their relevance to cognitive attributes. Data were extracted and synthesized according to the attributes, antecedents, and consequences to form a conceptual definition. The six main attributes of cognitive function in ischemic stroke are: memory, executive function, attention, language, orientation, and visuospatial function. Antecedents include biological-structural factors (infarct location/size), sociodemographic factors (age, education), clinical factors (comorbidities, stroke severity), functional factors, and psychological factors. The consequences include a decline in quality of life, functional status, increased caregiver burden, and mortality. Instruments such as MoCA, MMSE, and biological biomarkers were identified as key empirical references. This conceptual analysis provides a strong theoretical foundation for nursing practice, emphasizing the importance of early detection and attribute-based multidisciplinary interventions to prevent further cognitive decline. This study has limitations, as variations in the assessment phase may affect the heterogeneity of cognitive impairment. Further research is recommended to validate this concept with clinical data, test the effectiveness of specifically designed interventions, and conduct longitudinal studies to monitor long-term cognitive function.

References

Pu L, Wang L, Zhang R, Zhao T, Jiang Y, Han L. Projected global trends in ischemic stroke incidence, deaths and disability-adjusted life years from 2020 to 2030. Stroke. 2023;54(5):1330-9.

Ministry of Health. Indonesia health survey (SKI) 2023 in numbers. Jakarta: Ministry of Health 2023.

Birle C, Slavoaca D, Balea M, Livint Popa L, Muresanu I, Stefanescu E, et al. Cognitive function: holarchy or holacracy? Neurol Sci. 2021;42(1):89-99.

Zhang C, Zhang X, Meng P, Gao H, Bai B, Li D. The association between serum uric acid and cognitive performance in patients with ischemic stroke is modified by estimated glomerular filtration rate. Sci Rep. 2023;13(1):7097.

Bender A, Beller S. Cognition and Cognitive Science. In: Stanlaw J, editor. The International Encyclopedia of Linguistic Anthropology. Hoboken (NJ): Wiley-Blackwell; 2020.

Pais R, Ruano L, O PC, Barros H. Global cognitive impairment prevalence and incidence in community dwelling older adults-a systematic review. Geriatrics (Basel). 2020;5(4).

Yan HY, Lin HR. Resilience in Stroke Patients: A Concept Analysis. Healthcare (Basel). 2022;10(11).

Gleeson L, Jagoe C. Recovery in the context of post-stroke aphasia: A concept analysis. Advances in Communication and Swallowing. 2023tim;26(1):25-35.

Dai Y, Shi H, Ji K, Han Y, De Ala M, Wang Q. Exercise preference in stroke survivors: a concept analysis. Front Neurol. 2024;15:1326649.

Walker LO, Avant KC. Strategies for theory construction in nursing. 5th ed. Harlow (England): Pearson Education Limited; 2014.

Barber P, Nestor SM, Wang M, Wu P, Ursenbach J, Munir A, et al. Hippocampal atrophy and cognitive function in transient ischemic attack and minor stroke patients over three years. Cereb Circ Cogn Behav. 2021;2:100019.

Cao S, Teng L, Gao M, Hu S, Xiao S, Chen C, et al. Nonlinear relationship between triglycerides and cognitive function after acute ischemic stroke among older adults. Heliyon. 2024;10(6):e27943.

Karimi E, Khorvash F, Arab A, Sepidarkish M, Saadatnia M, Amani R. The effects of royal jelly supplementation on oxidative stress, inflammatory mediators, mental health, cognitive function, quality of life, and clinical outcomes of patients with ischemic stroke: study protocol for a randomized controlled trial. BMC Nutr. 2023;9(1):32.

Li F, Kong X, Zhu H, Xu H, Wu B, Cao Y, et al. The moderating effect of cognitive reserve on cognitive function in patients with Acute Ischemic Stroke. Front Aging Neurosci. 2022;14:1011510.

Li H, Yang D, Liu S, Zhu Z, Shi M, Xu T, et al. Effects of early antihypertensive treatment on cognitive function in patients with acute ischemic stroke with different neurofilament light chain levels. J Stroke Cerebrovasc Dis. 2025;34(2):108206.

She R, Yan Z, Hao Y, Zhang Z, Du Y, Liang Y, et al. Comorbidity in patients with first-ever ischemic stroke: Disease patterns and their associations with cognitive and physical function. Front Aging Neurosci. 2022;14:887032.

Zhang Y, Song H, Wang J, Xi X, Cefalo P, Wood LJ, et al. Multiplex array analysis of serum cytokines offers minimal predictive value for cognitive function in the subacute phase after stroke. Front Neurol. 2022;13:886018.

Gu Z, Sun X, Wu C, Li B, Chen J, Wang W, et al. Lower 25-hydroxyvitamin D is associated with severer white matter hyperintensity and cognitive function in patients with non-disabling ischemic cerebrovascular events. J Stroke Cerebrovasc Dis. 2023;32(10).

Postoiu RL, Mocanu EM, Schek S, Lapadat M, Chipăruș CE, Onose G. Clinical and rehabilitative considerations in a complex case of spastic tetraplegia, mixed aphasia, secondary encephalopathy – post severe traumatic brain injury with hemorrhagic and ischemic lesions – with favorable late evolution and post-symptomatic status after SARS-COV-2 infection. Balneo PRM Res J. 2022;13(1).

Kliem E, Gjestad E, Ryum T, Olsen A, Thommessen B, Indredavik B, et al. The Relationship of Psychiatric Symptoms with Performance-Based and Self-Reported Cognitive Function after Ischemic Stroke. J Int Neuropsychol Soc. 2022;28(1):35-47.

Samuelsson H, Viken J, Redfors P, Holmegaard L, Blomstrand C, Jern C, et al. Cognitive function is an important determinant of employment amongst young ischaemic stroke survivors with good physical recovery. Eur J Neurol. 2021;28(11):3692-701.

Georgakis MK, Fang R, Düring M, Wollenweber FA, Bode FJ, Stösser S, et al. Cerebral small vessel disease burden and cognitive and functional outcomes after stroke: A multicenter prospective cohort study. Alzheimer's Dementia. 2023;19(4):1152-63.

Hua J, Zhou Y, Chen L, Tang X, Diao S, Fang Q. How do cardiovascular risk factors correlate with post-stroke cognitive function: Directly or indirectly through stroke severity? Frontiers in Neurology. 2022;13.

Lee M, Oh MS, Jung S, Lee JH, Kim CH, Jang MU, et al. Differential effects of body mass index on domain-specific cognitive outcomes after stroke. Sci Rep. 2021;11(1).

Niu S, Liu X, Wu Q, Ma J, Wu S, Zeng L, et al. Sleep Quality and Cognitive Function after Stroke: The Mediating Roles of Depression and Anxiety Symptoms. Int J Environ Res Public Health. 2023;20(3).

Schellekens MMI, Li H, Boot EM, Verhoeven JI, Ekker MS, Meijer FJA, et al. White matter integrity and cognitive performance in the subacute phase after ischemic stroke in young adults. NeuroImage Clin. 2025;45.

Zanin A, Reinholdsson M, Abzhandadze T. Association of cognitive function very early after stroke with subjective cognitive complaints after 3 months, a register-based study. PloS one. 2023;18.

Springer MV, Chen B, Whitney RT, Briceño EM, Gross AL, Aparicio HJ, et al. Age differences in the change in cognition after stroke. J Stroke Cerebrovasc Dis. 2024;33(12):108087.

Gjellesvik TI, Becker F, Tjonna AE, Indredavik B, Lundgaard E, Solbakken H, et al. Effects of High-Intensity Interval Training After Stroke (The HIIT Stroke Study) on Physical and Cognitive Function: A Multicenter Randomized Controlled Trial. Arch Phys Med Rehabil. 2021;102(9):1683-91.

Dharmasaroja PA. Temporal change in cognitive function in early recovery phase of the stroke. J Stroke Cerebrovasc Dis. 2021;30(10):106027.

Kotlęga D, Peda B, Palma J, Zembroń-łacny A, Gołab-Janowska M, Masztalewicz M, et al. Free fatty acids are associated with the cognitive functions in stroke survivors. Int J Environ Res Public Health,. 2021;18(12).

Kumkwan Y, Utriyaprasit K, Tankumpuan T, Lertmanorat Z, Mathayomchan B. Recovery after ischemic stroke: Effects of FuekFone home-based program on upper limb and cognitive function. Int J Nurs Sci. 2024;11(4):414-20.

Kumral E, Bayam FE, Özdemir HN. Cognitive and Behavioral Disorders in Patients with Precuneal Infarcts. Eur Neurol. 2021;84(3):157-67.

Alligood MR. Nursing theorists and their work. Eighth ed. St. Louis, Missouri: Elsevier Inc; 2014.

Biesbroek JM, Weaver NA, Aben HP, Kuijf HJ, Abrigo J, Bae HJ, et al. Network impact score is an independent predictor of post-stroke cognitive impairment: A multicenter cohort study in 2341 patients with acute ischemic stroke. NeuroImage Clinical. 2022;34:103018.

Huang Y, Wang Q, Zou P, He G, Zeng Y, Yang J. Prevalence and factors influencing cognitive impairment among the older adult stroke survivors: a cross-sectional study. Front Public Health. 2023;11:1254126.

Myooran J, Rahman F, Cordato D, Chróinín DN. Cognitive outcomes following ischaemic stroke: a narrative review. Aging Health Res. 2025;5(2).

Liao X, Zuo L, Dong Y, Pan Y, Yan H, Meng X, et al. Persisting cognitive impairment predicts functional dependence at 1 year after stroke and transient ischemic attack: a longitudinal, cohort study. BMC geriatrics. 2022;22(1).

Lim JS, Lee JJ, Woo CW. Post-stroke cognitive impairment: Pathophysiological insights into brain disconnectome from advanced neuroimaging analysis techniques. J Stroke. 2021;23(3):297-311.

Bao L, Wei J, Chen Z. The Impact of Progressive Rehabilitation Nursing on Physical Rehabilitation and Quality of Life in Patients with Cerebral Infarction. Altern Ther Health Med. 2024;30(3):62-7.

Elendu C, Amaechi DC, Elendu TC, Ibhiedu JO, Egbunu EO, Ndam AR, et al. Stroke and cognitive impairment: understanding the connection and managing symptoms. Ann Med Surg (Lond). 2023;85(12):6057-66.

Bonkhoff AK, Lim JS, Bae HJ, Weaver NA, Kuijf HJ, Biesbroek JM, et al. Generative lesion pattern decomposition of cognitive impairment after stroke. Brain Commun. 2021;3(2):fcab110.

Levine MD, Whitney PR, Ye PW, Briceño PE, Gross PA, Giordani PB, et al. Associations Between Stroke Type, Ischemic Stroke Subtypes, and Poststroke Cognitive Trajectories. Stroke. 2025;56:898-907.

Kaur M, Sharma S. Molecular mechanisms of cognitive impairment associated with stroke. Metab Brain Dis. 2022;37(2):279-87.

Seyedaghamiri F, Mahmoudi J, Hosseini L, Sadigh-Eteghad S, Farhoudi M. Possible engagement of nicotinic acetylcholine receptors in pathophysiology of brain ischemia-induced cognitive impairment. J Mol Neurosci. 2022;72(3):642-52.

Lee HY, Hyun SE, Oh BM. Rehabilitation for Impaired Attention in the Acute and Post-Acute Phase After Traumatic Brain Injury: A Narrative Review. Korean j neurotrauma. 2023;19(1):20-31.

Ghoreyshi Z, Nilipour R, Bayat N, Nejad SS, Mehrpour M, Azimi T. The incidence of aphasia, cognitive deficits, apraxia, dysarthria, and dysphagia in acute post stroke persian speaking adults. Indian J Otolaryngol Head Neck Surg. 2022;74(Suppl 3):5685-95.

Bogomolova K, van Merriënboer JJG, Sluimers JE, Donkers J, Wiggers T, Hovius SER, et al. The effect of a three-dimensional instructional video on performance of a spatially complex procedure in surgical residents in relation to their visual-spatial abilities. Am J Surg. 2021;222(4):739-45.

Budson AE, Solomon PR. Vascular Cognitive Impairment and Vascular Dementia. Memory Loss, Alzheimer's Disease and Dementia. third ed. Philadelphia: Elsevier Inc; 2022.

Zhang X, Bi X. Post-stroke cognitive impairment: A review focusing on molecular biomarkers. J Mol Neurosci. 2020;70(8):1244-54.