Stress responses in stroke survivors: Associations with illness, physiological, and cognitive characteristics

Abstract

Introduction: Stroke survivors are not only subject to impairments in their functional capacities, but also psychological distresses associated with deterioration in their quality and standard of living. Salivary cortisol is a biomarker on objective stress response of the hypothalamic-pituitary-adrenal (HPA) axis. Little research has been done to explore the HPA axis activities and subjective stress response in stroke survivors and their potential relationships with various illness characteristics. Methods: The present study recruited a total of 43 stroke survivors (63% males, mean age = 55.2 years, SD = 7.7). Half of the sample suffered from ischemic stroke and the other half suffered from hemorrhagic stroke. Physiological assessments included ten salivary cortisol measures over two days, diastolic and systolic blood pressure, and heart rate measures. Subjective stress was assessed via Perceived Stress Scale. Impairment in functioning and cognitive functioning was assessed by Modified Rankin Scale and Montreal Cognitive Assessment (MoCA), respectively. Correlational analysis was used to examine the associations among the study variables. Results: The participants reported an average heart rate of 71.2 BPM (SD = 11.1) and the average mean arterial pressure was 94.1 mmHg (SD = 9.2). The mean MoCA score was 24.4 (SD = 5.8). The participants showed moderate levels of subjective perceived stress (Mean = 20.5, SD = 4.4). Males participants and survivors with hemorrhagic stroke showed steeper diurnal cortisol slopes (r = 0.29 – 0.39, p < 0.05). Participants with greater functional impairments perceived significantly higher levels of stress (r = 0.33, p = 0.03). No significant associations were found for the physiological markers (mean arterial pressure and heart rate) and cognitive functioning with diurnal cortisol slopes and subjective perceived stress. Conclusions: The present study contributed to an exploration of the linkage between neuroendocrine functioning and physiological indicators and cognitive functions among stroke survivors.