Prevalence and factors associated with comorbid cognitive impairment and depression among Stroke patients attending Mulago National Referral Hospital, Neurology Clinic : a cross-sectional study

Abstract

Introduction: Individuals with stroke suffer from both cognitive impairment and depression at varying degrees, with these two conditions negatively affecting quality of life and delaying improvement during rehabilitation. Frequency of co-occurrence of these conditions is likely to be high given their high individual prevalence. There is paucity of data on the comorbidity of cognitive impairment and depression after stroke especially in the sub-Saharan context. Objectives: This study determined the prevalence and factors associated with comorbid cognitive impairment and depression among stroke patients at Mulago National Referral Hospital in Uganda. Methods: This was a quantitative cross-sectional study conducted from October 2024 to January 2025. It included participants aged ≥18 years with a confirmed stroke status recruited by consecutive sampling. The Mini-Mental State Exam (MMSE) was used to collect data on cognitive function while the Patient Health Questionnaire 9 (PHQ-9) was used to assess for depression. The Barthel Index assessed functionality based on activities of daily living. Cognitive impairment was based on a MMSE cut off score of ≤23 while depression was based on a PHQ-9 cut off score of ≥10. Data were analysed with Stata version 15.1 with the association between comorbid cognitive impairment and depression with the independent variables being determined using logistic regression. Results: The study recruited 173 participants with a mean age of 53.4 years (SD = 13.8) majority of whom were males 80 (58.0%), unemployed 90 (65.2%), and married 122 (70.5%). Comorbid cognitive impairment and depression was found in 25 participants representing 14.5%). After adjusting for age and sex, diabetes mellitus (OR = 4.8, CI 1.680 – 13.550, p = 0.003) was found to be significantly associated with comorbid cognitive impairment and depression. Conclusion: Comorbidity of cognitive impairment and depression is common among stroke patients at Mulago National Referral Hospital, affecting nearly 15% of survivors. The strong association of diabetes mellitus highlights the need for routine screening and integrated management of cognitive and mood disorders, particularly among stroke survivors with metabolic comorbidities. Early identification and multidisciplinary intervention may improve recovery and overall quality of life in this population.