Impact of anxiety on verbal and visuospatial working memory in patients with acute stroke without severe cognitive impairment

Working memory is the most impaired cognitive domain in the acute phase of stroke. In a context where anxiety is highly prevalent, close attention must be paid to anxiety which could mimic mild to moderate working memory impairments. This is the first study to assess the contribution of state anxiety (the currently experienced level of anxiety) to the working memory (verbal, visuospatial) in patients with first-ever acute stroke without severe cognitive impairment.28 patients with first-ever acute stroke and 41 matched control subjects were exposed to a neutral condition and an anxiogenic condition in which verbal (VWM) and visuospatial working memory (VSWM) performance and state anxiety were assessed. State anxiety was assessed before the beginning of the experiment (baseline), after the neutral condition and after the anxiogenic condition.The mean state anxiety score was higher in patients than in controls in the neutral (z = 1.9, p<0.05) and anxiogenic (z = 2, p<0.05) conditions despite a similar level at baseline. Multiple regression analyses with a dummy variable 'group' (patients vs controls) showed that increased state anxiety in patients contributed significantly more to both reduced VWM (β = -0.93, p<0.05) and VSWM (β = -1, p<0.05) performance between the neutral and anxiogenic conditions compared to controls.In a stressful context, the contribution of state anxiety to reduced working memory performance is more pronounced in patients with acute stroke than in controls. These results are of particular relevance for clinicians assessing patients in the acute phase of stroke in which anxiety is highly prevalent.