{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T23:51:07Z","timestamp":1785801067190,"version":"3.56.0"},"reference-count":44,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T00:00:00Z","timestamp":1761868800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"University of Medicine and Pharmacy of Craiova, Romania,"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>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\u201388) 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 &lt; 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 \u2265 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.<\/jats:p>","DOI":"10.3390\/jcm14217735","type":"journal-article","created":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T18:21:46Z","timestamp":1762194106000},"page":"7735","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Cognitive Impairment and Psychological Morbidity Among Stroke Survivors in Rehabilitation: A Cross-Sectional Analysis"],"prefix":"10.3390","volume":"14","author":[{"given":"Ana-Maria","family":"Bumbea","sequence":"first","affiliation":[{"name":"Department of Medical Rehabilitation, University of Medicine and Pharmacy of Craiova, 2 Petru Rares Str., 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela Gabriela","family":"Glavan","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, University of Medicine and Pharmacy of Craiova, 2 Petru Rares Str., 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramona-Constantina","family":"Vasile","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, University of Medicine and Pharmacy of Craiova, 2 Petru Rares Str., 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3070-2858","authenticated-orcid":false,"given":"Alexandra Daniela","family":"Rotaru-Zavaleanu","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, University of Medicine and Pharmacy of Craiova, 2 Petru Rares Str., 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrei","family":"Gre\u0219i\u021b\u0103","sequence":"additional","affiliation":[{"name":"Department of Physiology, University of Medicine and Pharmacy of Craiova, 2 Petru Rares Str., 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4509-885X","authenticated-orcid":false,"given":"Roxana","family":"Surugiu","sequence":"additional","affiliation":[{"name":"Department of Biochemistry, University of Medicine and Pharmacy of Craiova, 2 Petru Rares Str., 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sorin Nicolae","family":"Dinescu","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, University of Medicine and Pharmacy of Craiova, 2 Petru Rares Str., 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irina","family":"Burlacu","sequence":"additional","affiliation":[{"name":"Doctoral School, University of Medicine and Pharmacy of Craiova, 2 Petru Rares Str., 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madalina","family":"Aldea","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, University of Medicine and Pharmacy of Craiova, 2 Petru Rares Str., 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,31]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"6057","DOI":"10.1097\/MS9.0000000000001441","article-title":"Stroke and cognitive impairment: Understanding the connection and managing symptoms","volume":"85","author":"Elendu","year":"2023","journal-title":"Ann. Med. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Gao, H., Sai, Y., Shang, R., Zhong, X., Kong, L., Liu, J., and Wang, K. (2025). Post stroke depression: Pathogenesis and molecular mechanisms of natural product-based interventions. Front. Pharmacol., 16.","DOI":"10.3389\/fphar.2025.1595160"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"915","DOI":"10.1016\/j.bbadis.2016.01.015","article-title":"Stroke injury, cognitive impairment and vascular dementia","volume":"1862","author":"Kalaria","year":"2016","journal-title":"Biochim. Biophys. Acta"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"497","DOI":"10.15537\/smj.2025.46.5.20250080","article-title":"Identifying individuals at risk of post-stroke depression: Development and validation of a predictive model","volume":"46","author":"Alqahtani","year":"2025","journal-title":"Saudi Med. J."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Kuriakose, D., and Xiao, Z. (2020). Pathophysiology and treatment of stroke: Present status and future perspectives. Int. J. Mol. Sci., 21.","DOI":"10.3390\/ijms21207609"},{"key":"ref_6","first-page":"3238165","article-title":"Stroke in the 21","volume":"2018","author":"Donkor","year":"2018","journal-title":"Stroke Res. Treat."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"389","DOI":"10.26502\/fccm.92920399","article-title":"Epidemiology, pathophysiology, and current treatment strategies in stroke","volume":"8","author":"Ahmed","year":"2024","journal-title":"Cardiol. Cardiovasc. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"427","DOI":"10.3233\/JAD-160527","article-title":"Stroke, vascular dementia, and Alzheimer\u2019s disease: Molecular links","volume":"54","author":"Vijayan","year":"2016","journal-title":"J. Alzheimers Dis."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"803","DOI":"10.1038\/s41380-021-01361-1","article-title":"Age-related immune alterations and cerebrovascular inflammation","volume":"27","author":"Finger","year":"2022","journal-title":"Mol. Psychiatry"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"3822","DOI":"10.3390\/cimb44090262","article-title":"Effects of acute sepsis on cellular dynamics and amyloid formation in a mouse model of Alzheimer\u2019s disease","volume":"44","author":"Pirici","year":"2022","journal-title":"Curr. Issues Mol. Biol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1590\/1980-57642020dn14-020001","article-title":"Daily functioning and dementia","volume":"14","author":"Cipriani","year":"2020","journal-title":"Dement. Neuropsychol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"838","DOI":"10.1177\/17474930241279888","article-title":"Vascular cognitive impairment and dementia: Mechanisms, treatment, and future directions","volume":"19","author":"Mok","year":"2024","journal-title":"Int. J. Stroke"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"260","DOI":"10.3390\/gels11040260","article-title":"Post-stroke recovery: A review of hydrogel-based phytochemical delivery systems","volume":"11","author":"Musa","year":"2025","journal-title":"Gels"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1","DOI":"10.15280\/jlm.2020.10.1.1","article-title":"Relation of physical activity with depression: A short review","volume":"10","author":"Shaphe","year":"2020","journal-title":"J. Lifestyle Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2415","DOI":"10.37358\/RC.19.7.7352","article-title":"The relationship between the acute confusing state and the comorbidities of the elderly patient","volume":"70","author":"Albu","year":"2019","journal-title":"Rev. Chim."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"315","DOI":"10.62641\/aep.v53i2.1688","article-title":"The impact of post-stroke depression and physical fatigue on functional status","volume":"53","author":"Hu","year":"2025","journal-title":"Actas Esp. Psiquiatr."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Rotaru-Z\u0103v\u0103leanu, A.D., Dinescu, V.C., Aldea, M., and Gresita, A. (2024). Hydrogel-based therapies for ischemic and hemorrhagic stroke: A comprehensive review. Gels, 10.","DOI":"10.3390\/gels10070476"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1007\/s11940-019-0570-5","article-title":"Treatment of post-stroke depression","volume":"21","author":"Starkstein","year":"2019","journal-title":"Curr. Treat. Options Neurol."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Haupt, M., Gerner, S.T., B\u00e4hr, M., and Doeppner, T.R. (2023). Neuroprotective strategies for ischemic stroke\u2014Future perspectives. Int. J. Mol. Sci., 24.","DOI":"10.3390\/ijms24054334"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Li, X., He, Y., Wang, D., and Rezaei, M.J. (2024). Stroke rehabilitation: From diagnosis to therapy. Front. Neurol., 15.","DOI":"10.3389\/fneur.2024.1402729"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"103270","DOI":"10.5498\/wjp.v15.i6.103270","article-title":"Psychological interventions for post-stroke anxiety and depression: Current approaches and future perspectives","volume":"15","author":"Lei","year":"2025","journal-title":"World J. Psychiatry"},{"key":"ref_22","first-page":"9367942","article-title":"Stroke patients motivation influence on the effectiveness of occupational therapy","volume":"2018","author":"Savickas","year":"2018","journal-title":"Rehabil. Res. Pract."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Georgescu, O.S., Martin, L., T\u00e2rtea, G.C., Rotaru-Zavaleanu, A.-D., Dinescu, S.N., Vasile, R.C., Gresita, A., Gheorman, V., Aldea, M., and Dinescu, V.C. (2024). Alcohol consumption and cardiovascular disease: A narrative review of evolving perspectives and long-term implications. Life, 14.","DOI":"10.3390\/life14091134"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Asadauskas, A., Stieger, A., Luedi, M.M., and Andereggen, L. (2024). Advancements in modern treatment approaches for central post-stroke pain: A narrative review. J. Clin. Med., 13.","DOI":"10.3390\/jcm13185377"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e13232","DOI":"10.1111\/bpa.13232","article-title":"The post-stroke young adult brain has limited capacity to re-express the gene expression patterns seen during early postnatal brain development","volume":"34","author":"Ruscu","year":"2024","journal-title":"Brain Pathol."},{"key":"ref_26","first-page":"CD010783","article-title":"Mini-Mental State Examination (MMSE) for the detection of Alzheimer\u2019s disease and other dementias in people with mild cognitive impairment (MCI)","volume":"2015","author":"Smailagic","year":"2015","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1186\/1744-859X-7-4","article-title":"Hospital Anxiety and Depression Scale (HADS): Validation in a Greek general hospital sample","volume":"7","author":"Michopoulos","year":"2008","journal-title":"Ann. Gen. Psychiatry"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1046\/j.1525-1497.2001.016009606.x","article-title":"The PHQ-9: Validity of a brief depression severity measure","volume":"16","author":"Kroenke","year":"2001","journal-title":"J. Gen. Intern. Med."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Sobreiro, M.F.M., Terroni, L., Guajardo, V.D., Mattos, P.F., Leite, C.d.C., Amaro, E., Tinone, G., Iosifescu, D.V., and Fraguas, R. (2023). The impact of post-stroke depressive symptoms on cognitive performance in women and in men: A 4 month prospective study. Life, 13.","DOI":"10.3390\/life13071554"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Shewangizaw, S., Fekadu, W., Gebregzihabhier, Y., Mihretu, A., Sackley, C., and Alem, A. (2023). Impact of depression on stroke outcomes among stroke survivors: Systematic review and meta-analysis. PLoS ONE, 18.","DOI":"10.1371\/journal.pone.0294668"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1236","DOI":"10.1016\/j.jstrokecerebrovasdis.2019.01.010","article-title":"The influence of stroke location on cognitive and mood impairment: A voxel-based lesion-symptom mapping study","volume":"28","author":"Sagnier","year":"2019","journal-title":"J. Stroke Cerebrovasc. Dis."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Carandina, A., Lazzeri, G., Villa, D., Di Fonzo, A., Bonato, S., Montano, N., and Tobaldini, E. (2021). Targeting the autonomic nervous system for risk stratification, outcome prediction and neuromodulation in ischemic stroke. Int. J. Mol. Sci., 22.","DOI":"10.3390\/ijms22052357"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"W\u0142odarczyk, L., Cichon, N., Saluk-Bijak, J., Bijak, M., Majos, A., and Miller, E. (2022). Neuroimaging techniques as potential tools for assessment of angiogenesis and neuroplasticity processes after stroke and their clinical implications for rehabilitation and stroke recovery prognosis. J. Clin. Med., 11.","DOI":"10.3390\/jcm11092473"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Hama, S., Yamashita, H., Shigenobu, M., Watanabe, A., Hiramoto, K., Kurisu, K., Onoda, K., Nagata, S., and Yamawaki, S. (2020). Relationships between motor and cognitive functions and subsequent post-stroke mood disorders revealed by machine learning analysis. Sci. Rep., 10.","DOI":"10.1038\/s41598-020-76429-z"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1177\/15459683241300458","article-title":"Relationships between cognitive impairments and motor learning after stroke: A scoping review","volume":"39","author":"Rajda","year":"2025","journal-title":"Neurorehabil. Neural Repair"},{"key":"ref_36","first-page":"8198","article-title":"Robotic-assisted rehabilitation for balance in stroke patients (ROAR-S): Effects on cognitive, motor and functional outcomes","volume":"27","author":"Castelli","year":"2023","journal-title":"Eur. Rev. Med. Pharmacol. Sci."},{"key":"ref_37","first-page":"2020263","article-title":"Virtual reality technology for physical and cognitive function rehabilitation in people with multiple sclerosis","volume":"2024","author":"Kamari","year":"2024","journal-title":"Rehabil. Res. Pract."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Catania, V., Rundo, F., Panerai, S., and Ferri, R. (2023). Virtual reality for the rehabilitation of acquired cognitive disorders: A narrative review. Bioengineering, 11.","DOI":"10.3390\/bioengineering11010035"},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Maggio, M.G., Bonanno, L., Rizzo, A., Barbera, M., Benenati, A., Impellizzeri, F., Corallo, F., De Luca, R., Quartarone, A., and Calabr\u00f2, R.S. (2025). The role of virtual reality-based cognitive training in enhancing motivation and cognitive functions in individuals with chronic stroke. Sci. Rep., 15.","DOI":"10.1038\/s41598-025-08173-1"},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Al-Rajab, M., Lu, J., Amawi, S., Elmehalawy, N., Babillie, B., Alasmi, Y., Ibrahim, H.S., Ellahham, S., Sawsaa, A., and Al Zraiqat, S. (2025). A smart secure virtual reality immersive application for Alzheimer\u2019s and dementia patients. Sci. Rep., 15.","DOI":"10.1038\/s41598-025-14624-6"},{"key":"ref_41","first-page":"856","article-title":"Artificial intelligence for mental health care: Clinical applications, barriers, facilitators, and artificial wisdom","volume":"6","author":"Lee","year":"2021","journal-title":"Biol. Psychiatry Cogn. Neurosci. Neuroimaging"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"169","DOI":"10.31887\/DCNS.2020.22.2\/lvalmaggia","article-title":"Virtual reality as a clinical tool in mental health research and practice","volume":"22","author":"Bell","year":"2020","journal-title":"Dialogues Clin. Neurosci."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Siette, J., Campbell, C., Adam, P.J., and Harris, C.B. (2024). Exploring the usability of the virtual reality module LEAF CAF\u00c9: A qualitative think-aloud study. BMC Geriatr., 24.","DOI":"10.1186\/s12877-024-04767-y"},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Maleki Varnosfaderani, S., and Forouzanfar, M. (2024). The role of AI in hospitals and clinics: Transforming healthcare in the 21st century. Bioengineering, 11.","DOI":"10.3390\/bioengineering11040337"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/21\/7735\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T18:38:57Z","timestamp":1762195137000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/21\/7735"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,31]]},"references-count":44,"journal-issue":{"issue":"21","published-online":{"date-parts":[[2025,11]]}},"alternative-id":["jcm14217735"],"URL":"https:\/\/doi.org\/10.3390\/jcm14217735","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,31]]}}}