Phase-specific relationships between cognitive function and life-space mobility in patients with ischemic stroke: implications for geriatric rehabilitation

Abstract

Based on the Chronic Illness Trajectory Framework (CITF), this study aims to explore the longitudinal trajectories and dynamic reciprocal relationships between cognitive function and life-space mobility in older patients with ischemic stroke (IS) during a 1-year post-discharge follow-up. A longitudinal observational study was conducted with 248 older patients with IS. Data were collected at 3 (T1), 6 (T2), 9 (T3), and 12 (T4) months post-discharge. Cognitive function and life-space mobility were assessed using the Montreal Cognitive Assessment (MoCA) and the Life-Space Assessment (LSA), respectively. Latent Growth Curve Models (LGCM) were utilized to outline developmental trajectories, and a Random-Intercept Cross-Lagged Panel Model (RI-CLPM) was constructed to analyze the dynamic relationships. LGCM revealed that cognitive function followed a “fast then slow” quadratic growth trajectory, whereas life-space mobility expansion followed a freely estimated, nonlinear growth pattern, with significant between-person differences in baseline level but not in the rate of change. The RI-CLPM demonstrated a strong, trait-like positive correlation between cognitive function and life-space mobility at the between-person level ( r = 0.822, P < 0.001). At the within-person level, a phase-specific, asymmetric reciprocal relationship was observed: mid-term cognitive function showed a positive temporal association with subsequent life-space mobility expansion (T2 to T3, β = 0.088, P = 0.031), whereas late-stage life-space mobility expansion showed a negative temporal association with subsequent cognitive function (T3 to T4, β= -0.146, P = 0.027). There is a phase-specific, reciprocal association between cognitive function and life-space mobility during rehabilitation in older IS patients. These findings point to a possible staged, two-component approach: enhancing cognitive training in the early-to-mid phases to promote life-space mobility expansion, while in the later phases, a negative temporal association between mobility expansion and subsequent cognitive scores suggests that mobility expansion may warrant careful monitoring. These results identify preliminary, hypothesis-generating candidate intervention targets rather than establishing a definitive phased intervention mechanism. As this was an observational study, the findings remain preliminary and require confirmation in future interventional research.