Emotion regulation, executive functioning and quality of life following stroke: a research portfolio

Abstract

Systematic review Executive dysfunction is commonly reported following stroke with most research in this area focused on frontal lobe lesions. A systematic review was carried out to evaluate the evidence of executive dysfunction following stroke as compared to control groups. It was found that executive functions are consistently impaired following stroke and is not limited to frontal lobe lesions. Processing speed, mental flexibility, attention and working memory impairments were found to be the most common executive functioning impairments following stroke. Given the impact executive dysfunction may have on successful rehabilitation, relationships, return to work and quality of life, a comprehensive assessment of such difficulties is important following stroke to aid in the development of appropriate and effective rehabilitation strategies. Future research should use larger samples and a wide range of measures to assess different aspects of executive functioning. Introduction Mood disorders and psychological distress are common following stroke, and depression and emotional lability have been studied extensively. There has, however, been little research into difficulties in emotion regulation following stroke and whether this is associated with emotional or cognitive difficulties. The current study investigated emotion regulation difficulties following stroke and their relationship with quality of life, executive functions, anxiety and depression. Method Fifty participants who had suffered a stroke and forty five age matched controls completed the Difficulties in Emotion Regulation Scale, the Hospital Anxiety and Depression Scale, the World Health Organization Quality of Life assessment – Brief version and the National Adult Reading Test. In addition individuals with stroke completed four measures of executive functioning – Color Trails Test, Verbal Fluency, Brixton Spatial Anticipation Test and the Hayling Sentence Completion Test. Results Individuals with stroke had significantly greater difficulties in emotion regulation compared to age matched controls and this was significantly associated with lower self reported quality of life and increased levels of both anxiety and depression. No significant associations were found between emotion regulation and executive functions or between executive dysfunction and lower self reported quality of life. Discussion The current study found evidence that individuals who have suffered a stroke have more difficulties in emotion regulation than an age matched control group. This is clinically important as emotion regulation difficulties are found in mood disorders and it may be that such difficulties precipitate and/or maintain depression following stroke. The absence of an association between difficulties in emotion regulation and executive functioning suggests that other factors may influence such difficulties, such as the trauma of having a stroke. Future research should explore emotion regulation difficulties further following stroke, particularly investigating whether the course of these difficulties changes over time and if they are linked to type of stroke or lesion location.