Cognitive Impairment and Psychological Morbidity Among Stroke Survivors in Rehabilitation: A Cross-Sectional Analysis

Bumbea, Ana-Maria; Glavan, Daniela Gabriela; Vasile, Ramona-Constantina; Rotaru-Zavaleanu, Alexandra Daniela; Greșiță, Andrei; Surugiu, Roxana; Dinescu, Sorin Nicolae; Burlacu, Irina; Aldea, Madalina

doi:10.3390/jcm14217735

Open AccessArticle

Cognitive Impairment and Psychological Morbidity Among Stroke Survivors in Rehabilitation: A Cross-Sectional Analysis

by

Ana-Maria Bumbea

^1,†,

Daniela Gabriela Glavan

^2,†,

Ramona-Constantina Vasile

^3,*,

Alexandra Daniela Rotaru-Zavaleanu

^3,*

,

Andrei Greșiță

⁴,

Roxana Surugiu

⁵

,

Sorin Nicolae Dinescu

³,

Irina Burlacu

⁶ and

Madalina Aldea

²

¹

Department of Medical Rehabilitation, University of Medicine and Pharmacy of Craiova, 2 Petru Rares Str., 200349 Craiova, Romania

²

Department of Psychiatry, University of Medicine and Pharmacy of Craiova, 2 Petru Rares Str., 200349 Craiova, Romania

³

Department of Epidemiology, University of Medicine and Pharmacy of Craiova, 2 Petru Rares Str., 200349 Craiova, Romania

⁴

Department of Physiology, University of Medicine and Pharmacy of Craiova, 2 Petru Rares Str., 200349 Craiova, Romania

⁵

Department of Biochemistry, University of Medicine and Pharmacy of Craiova, 2 Petru Rares Str., 200349 Craiova, Romania

⁶

Doctoral School, University of Medicine and Pharmacy of Craiova, 2 Petru Rares Str., 200349 Craiova, Romania

^*

Authors to whom correspondence should be addressed.

^†

These authors contributed equally to this work.

J. Clin. Med. 2025, 14(21), 7735; https://doi.org/10.3390/jcm14217735

Submission received: 23 September 2025 / Revised: 21 October 2025 / Accepted: 28 October 2025 / Published: 31 October 2025

(This article belongs to the Section Mental Health)

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Abstract

Background: Stroke represents a leading cause of disability worldwide and is frequently associated with cognitive impairment, anxiety, and post-stroke depression (PSD), all of which can hinder rehabilitation and reduce quality of life. This study aimed to evaluate the correlations between cognitive function, depression, and anxiety in stroke survivors. Methods: A total of 71 patients (41 female, 30 male; mean age 68.1 years, range 42–88) were assessed during rehabilitation using the Mini-Mental State Examination (MMSE), the Hospital Anxiety and Depression Scale (HADS), and the Patient Health Questionnaire-9 (PHQ-9). Stroke type and comorbidities, including hypertension, chronic ischemic heart disease, atrial fibrillation, and type II diabetes, were also recorded. Results: As expected, most patients experienced ischemic strokes (73.1%), while 16.9% had hemorrhagic strokes. Comorbidities were highly prevalent, particularly hypertension (63 patients) and chronic ischemic heart disease (60 patients). Cognitive impairment (MMSE < 24) was observed in 28.2% of participants. Emotional assessment showed a mean HADS score of 11.55, with 36.6% of patients classified as having moderate to severe depression (PHQ-9 ≥ 10). Hemorrhagic stroke patients reported slightly higher PHQ-9 scores (8.4 compared to 8.2), while ischemic patients had higher HADS scores (11.8 compared to 9.8). A strong correlation was found between PHQ-9 and HADS (r = 0.90), while MMSE scores showed weak associations with emotional outcomes. Conclusions: Cognitive and affective disturbances are common during stroke rehabilitation, with depression and anxiety strongly interrelated but only weakly linked to cognitive decline. These findings emphasize the need for integrated screening and mental health support in rehabilitation programs. Future studies may explore technology-assisted tools, including virtual reality, to enhance patient engagement and recovery.

Keywords: stroke rehabilitation; post-stroke depression; anxiety; cognitive impairment; MMSE; HADS; PHQ-9; ischemic stroke; hemorrhagic stroke; mental health

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MDPI and ACS Style

Bumbea, A.-M.; Glavan, D.G.; Vasile, R.-C.; Rotaru-Zavaleanu, A.D.; Greșiță, A.; Surugiu, R.; Dinescu, S.N.; Burlacu, I.; Aldea, M. Cognitive Impairment and Psychological Morbidity Among Stroke Survivors in Rehabilitation: A Cross-Sectional Analysis. J. Clin. Med. 2025, 14, 7735. https://doi.org/10.3390/jcm14217735

AMA Style

Bumbea A-M, Glavan DG, Vasile R-C, Rotaru-Zavaleanu AD, Greșiță A, Surugiu R, Dinescu SN, Burlacu I, Aldea M. Cognitive Impairment and Psychological Morbidity Among Stroke Survivors in Rehabilitation: A Cross-Sectional Analysis. Journal of Clinical Medicine. 2025; 14(21):7735. https://doi.org/10.3390/jcm14217735

Chicago/Turabian Style

Bumbea, Ana-Maria, Daniela Gabriela Glavan, Ramona-Constantina Vasile, Alexandra Daniela Rotaru-Zavaleanu, Andrei Greșiță, Roxana Surugiu, Sorin Nicolae Dinescu, Irina Burlacu, and Madalina Aldea. 2025. "Cognitive Impairment and Psychological Morbidity Among Stroke Survivors in Rehabilitation: A Cross-Sectional Analysis" Journal of Clinical Medicine 14, no. 21: 7735. https://doi.org/10.3390/jcm14217735

APA Style

Bumbea, A.-M., Glavan, D. G., Vasile, R.-C., Rotaru-Zavaleanu, A. D., Greșiță, A., Surugiu, R., Dinescu, S. N., Burlacu, I., & Aldea, M. (2025). Cognitive Impairment and Psychological Morbidity Among Stroke Survivors in Rehabilitation: A Cross-Sectional Analysis. Journal of Clinical Medicine, 14(21), 7735. https://doi.org/10.3390/jcm14217735

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Cognitive Impairment and Psychological Morbidity Among Stroke Survivors in Rehabilitation: A Cross-Sectional Analysis

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