AHA Backs Screening for Cognitive Impairment After Stroke

2 May 2023 • Screening for cognitive impairment should be part of multidisciplinary care for stroke survivors, the American Heart Association (AHA) says in a new scientific statement published on May 1. It's the first to specifically focus on the cognitive impairment resulting from an overt stroke (ischemic or hemorrhagic).

The scientific statement aimed to critically appraise the literature on the prevalence, diagnosis, and management of poststroke cognitive impairment (PSCI) and provide a framework for clinical care while highlighting gaps that merit further study.

'Actionable' Considerations for Care

  • PSCI, ranging from mild to severe, occurs in up to 60% of stroke survivors in the first year after stroke; yet, it is often underreported and underdiagnosed, the writing group notes.
  • Up to 20% of stroke survivors who experience mild cognitive impairment fully recover cognitive function, and cognitive recovery is most likely within the first 6 months after a stroke.
  • However, improvement in cognitive impairment without return to pre-stroke levels is more frequent than is complete recovery.
  • As many as 1 in 3 stroke survivors may develop dementia within 5 years of stroke.
  • The writing group also notes that PSCI is often associated with other conditions, including physical disability, sleep disorders, behavioral and personality changes, depression, and other neuropsychological changes — each of which may contribute to lower quality of life.
  • Currently, there is no "gold standard" for cognitive screening following stroke
  • The statement also highlights the importance of assessing cognitive changes over time after stroke. Stroke survivors who experience unexplained difficulties with cognitive-related activities of daily living, following care instructions, or providing a reliable health history may be candidates for additional cognitive screening.

"Perhaps the most pressing need, however, is the development of effective and culturally relevant treatments for post-stroke cognitive impairment," Nada El Husseini, MD, MHSc, chair of the scientific statement writing group said in a news release. "We hope to see big enough clinical trials that assess various techniques, medications and lifestyle changes in diverse groups of patients that may help improve cognitive function," she added.

Source: AHA Journal | Read full story

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