AHA: Screening needed to assess common cognitive impairment after stroke
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Key takeaways:
- A new scientific statement recommends screenings to assess for cognitive impairment after a stroke.
- Up to 60% of stroke survivors will develop cognitive impairment within 1 year.
Cognitive impairment is common among stroke survivors and cognition screenings should be part of a person’s multidisciplinary follow-up care, according to a new scientific statement from the American Heart Association.
Poststroke cognitive impairment ranges in severity from mild to severe and occurs in up to 60% of stroke survivors in the first year after stroke, according to the statement. Up to 20% of people with mild cognitive impairment after stroke recover fully; however, improvement in cognitive impairment without return to levels before stroke is more frequent than complete recovery.
Data were derived from El Husseini N, et al. Stroke. 2023;doi:10.1161/STR.0000000000000430.
“Cognitive impairment is often underreported and underdiagnosed — yet very common —condition that stroke survivors frequently deal with,” Nada El Husseini, MD, MHSc, FAHA, associate professor of neurology at Duke University Medical Center and chair of the scientific statement writing committee, said in a press release. “Stroke survivors should be systematically evaluated for cognitive impairment so that treatment may begin as soon as possible after signs appear.”
Risk for dementia after stroke
El Husseini and colleagues conducted a literature review of randomized controlled trials, perspective and retrospective studies on the incidence and prevalence, natural history and management of poststroke cognitive impairment. Data show that poststroke cognitive impairment is common, especially in the first year, and ranges from mild to severe.
Although cognitive impairment is reversible in some cases early after stroke, up to one-third of individuals with stroke develop dementia within 5 years, according to the review.
The literature also notes differences in stroke outcomes by race.
“Racial differences in the frequency and severity of poststroke cognitive impairment have been reported,” the researchers wrote. “Stroke in Black patients results in a greater cognitive decline and is more frequently associated with dementia within 5 years of ischemic stroke compared with white patients, despite Black patients being younger at the time of the incident stroke.”
A person’s cognitive trajectory in the months after stroke might be affected by multiple factors, including the stroke location, preexisting cognitive impairment, small-vessel disease and comorbidities, socioeconomic status and demographic characteristics, as well as the intervention provided, according to the statement.
Screen all stroke patients for cognitive impairment
The researchers wrote that screening for associated comorbidities and interdisciplinary management are integral components in caring for people with poststroke cognitive impairment. Poststroke cognitive impairment often occurs in the presence of a variety of stroke-related deficits and other comorbid conditions, such as depression, adding complexity to both its diagnosis and its treatment, they wrote.
There is no “gold standard” cognitive screening after stroke; however, the AHA noted that some brief screening tests (30 minutes or less) widely used include the Mini-Mental State Examination and the Montreal Cognitive Assessment.
“The comprehensive management of patients with poststroke cognitive impairment should involve an interdisciplinary collaboration of the patient and their caregivers with health professionals, including neurologists, occupational therapists, speech therapists, nurses, neuropsychologists, gerontologists and primary care physicians,” the researchers wrote. “Given the prevalence of poststroke cognitive impairment and its association with poor health-related outcomes, the implementation of protocols to systematically evaluate and treat poststroke cognitive impairment based on locally available resources is warranted.”
El Husseini said more research is needed regarding best practice after a stroke.
“Perhaps the most pressing need, however, is the development of effective and culturally relevant treatments for poststroke cognitive impairment,” El Husseini said in the 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.”
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