Apraxia as a Predictor of Poststroke Recovery: Insights From the Birmingham Cognitive Screening Program.

Abstract

Limb apraxia is common after stroke and may affect long-term activities of daily living. This study investigates whether early subacute limb praxis scores predict long-term activities of daily living outcomes over and above other cognitive deficits. This longitudinal observational study analyzed data from the BCoS (Birmingham Cognitive Screen) cohort, conducted between 2010 and 2015 across multiple stroke centers in the United Kingdom. Two-hundred-fifty-six first-ever computed tomography confirmed stroke survivors (56.3% men; mean±SD age=68.3±11.4 y) were assessed <1 month poststroke (subacute) and >9 months (chronic). BCoS cohort comprises 34 cognitive tasks and 4 assess limb praxis. Scores were rescaled to 0 to 100. Functional outcome was the 20-point Barthel index (BI). Stepwise multiple linear regression with 4-fold internal cross-validation tested whether subacute cognitive and praxis performance predicted chronic BI, adjusting for baseline BI, and other cognitive domains. Mean BI improved from 13.3±5.5 to 17.3±3.9. Higher subacute limb praxis scores predicted better chronic activities of daily living: gesture production β=-0.0555 (<i>P</i>=0.0008), gesture recognition β=-0.0349 (<i>P</i>=0.017), meaningless gesture imitation β=0.0338 (<i>P</i>=0.0047). The full model explained 60% of BI variance and outperformed a model without praxis measures (ΔR²=0.04; ANOVA <i>P</i><0.001). Detailed early limb praxis testing adds independent prognostic value for long-term activities of daily living and should be incorporated into routine poststroke assessments to target rehabilitation.