Network analysis of the relationships between post-stroke activities of daily living, swallowing function, sleep quality, anxiety, depression, and cognitive performance in patients with acute ischemic stroke

Stroke is a major global health problem. Survivors often face lasting physical, cognitive, and emotional issues that reduce their quality of life. Common problems include difficulty with activities of daily living, swallowing, anxiety, depression, sleep disturbances, and cognitive decline. These symptoms frequently occur together and worsen each other, increasing the overall burden. Network analysis helps map how these symptoms are linked, identify key symptoms, and guide more effective, patient-centered rehabilitation. This cross-sectional study enrolled 1,012 patients with acute ischemic stroke (AIS) at a tertiary hospital in Guangdong Province, China, between February and November 2025. Symptoms were assessed across six domains: activities of daily living, sleep, depression, anxiety, cognition, and swallowing function. Network analysis was performed to examine symptom interconnections, identify core and bridging symptoms, and quantify their centrality within the network using metrics such as expected influence and bridge expected influence. The network analysis revealed the strongest pairwise associations between “Water swallowing test” and “Feeding”, “How satisfied/dissatisfied are you with your current sleep pattern?” and “Sleep disturbance”, “Problems with judgment” and “Anhedonia”, and “Sad mood” and “Nervousness”. Among the respective symptoms, the core symptoms based on expected influence were “Getting on and off the toilet”, “How noticeable to others do you think your sleeping problem is in terms of impairing the quality of your life?”, “Problems with judgment”, “Trouble concentrating”, and “Nervousness”. Notably, “Trouble concentrating” emerged as the primary bridging symptom connecting multiple symptom clusters. Network analysis revealed substantial interrelationships among physical, cognitive, and emotional symptoms in patients with AIS. “Trouble concentrating” showed the highest centrality and may represent a potentially important symptom warranting further longitudinal investigation. These findings support comprehensive multidimensional assessment in post-stroke care. Future longitudinal studies are needed to clarify the temporal relationships and clinical significance of the identified symptom network.