Cognitive and Physical Functioning in Young Adults with Stroke: A Comparative Cross-Sectional Study of Anxiety, Depression, and Stress

Abstract

Background: Stroke in young adults is an increasingly important public health concern because of its long-term impact on cognitive functioning, psychological well-being, and social participation. Understanding the interplay between cognitive impairment, psychological distress, and stroke severity is essential for optimizing post-stroke management. Objective: To compare cognitive function and symptoms of depression, anxiety, and stress between young adults with stroke and healthy controls and to investigate the associations of these outcomes with sociodemographic and disease-related characteristics. Methods: This cross-sectional case–control study was conducted at a university hospital in Türkiye between January and December 2025. A total of 160 participants, including 80 patients aged 18–<65 years with a clinical diagnosis of stroke and 80 healthy controls, were enrolled. Cognitive function was evaluated using the Mini-Mental State Examination (MMSE), neurological severity using the National Institutes of Health Stroke Scale (NIHSS), functional disability using the Modified Rankin Scale (mRS), and psychological symptoms using the Depression Anxiety Stress Scale-21 (DASS-21). Group differences were examined using multivariate general linear models, and Pearson correlation analyses were performed to evaluate associations between disease-specific characteristics and psychological and cognitive outcomes. Results: Across the study groups, the control group exhibited significantly higher levels of depression, anxiety, and stress than the stroke group. These between-group differences remained significant after adjustment for age, whereas the age-adjusted between-group difference in MMSE scores was not statistically significant. Age was not significantly associated with depression, anxiety, or stress scores but was significantly associated with MMSE performance. After adjustment for study group and age, the examined sociodemographic characteristics—gender, education level, employment status, income level, marital status, alcohol use, and smoking—showed no statistically significant main effects on depression, anxiety, stress, or MMSE scores. Although employment status showed a trend toward an association with anxiety, this finding did not reach statistical significance (p = 0.053). Higher NIHSS and mRS scores were significantly associated with higher depression, anxiety, and stress scores and lower MMSE scores (all p < 0.001). Conclusions: Psychological distress and cognitive performance demonstrated distinct patterns of association in young adults following stroke. Neurological severity and functional disability were consistently associated with both psychological distress and cognitive performance. After adjustment for study group and age, the examined sociodemographic characteristics showed no statistically significant main effects on depression, anxiety, stress, or MMSE scores. In contrast, age was significantly associated with MMSE performance but not with depression, anxiety, or stress. The unexpectedly higher levels of depression, anxiety, and stress observed among controls persisted after adjustment for age and warrant further investigation, particularly in relation to potential contextual, psychosocial, and recruitment-related factors. These findings highlight the importance of considering psychological, cognitive, neurological, and functional measures together when assessing young adults with stroke.

The authors' abstract, as published at the source. Neurology International, 2026 · DOI ↗