Neurologists report infrequent cognitive, emotional screening after TIA, ischemic stroke

Nearly half of Dutch neurologists surveyed reported “sometimes or never” screening for emotional or cognitive problems following transient ischemic attack or ischemic stroke, according to research published in BMJ Open.

“After stroke, many patients experience cognitive and/or emotional problems, which affect their quality of life and participation,” Jos Slenders, of the neurology department at OLVG in Amsterdam, and colleagues wrote. “Therefore, national guidelines recommend screening and care for cognitive and emotional problems after stroke.”

Slenders and colleagues conducted a nationwide, cross-sectional online survey of 52 Dutch neurologists (women, 37%; median age, 45 years) between October 2018 and October 2019 about screening, information provision and follow-up care for cognitive and emotional problems after TIA and ischemic stroke.

Researchers asked 1 neurologist with stroke care experience per neurology department to complete the survey, which included 20 multiple choice questions about screening and follow-up care for cognitive and emotional consequences of TIA and ischemic stroke. They allowed survey forwarding within units.

Survey results demonstrated that 31 clinicians (59%) reported mostly or always conducting cognitive screening following TIA or ischemic stroke; (41%) sometimes or never screened for cognitive function. Neurologists described the most frequently used instruments for these assessments, which included the Montreal Cognitive Assessment (MoCA; 83%), the Mini-Mental State Examination (MMSE; 50%) and the Checklist for Cognitive and Emotional Consequences following Stroke (CLCE-24; 14%).

Regarding the prevalent use of the MMSE, the researchers noted that “two reviews have demonstrated that the MMSE is not sufficiently sensitive to the cognitive consequences of stroke, as it was originally designed to screen for the presence of dementia.” They recommended use of the MoCA instead.

For emotional screening, 29 participants (56%) said they mostly or always screened patients after TIA or ischemic stroke, while 23 reported sometimes or never screening for emotional problems. Thirty-one neurologists (63%) used validated screening tools, 27 (87%) of whom used the Hospital Anxiety Depression Scale.

Screening for cognitive problems occurred most commonly at hospital admission (n = 31; 62%), while 19 hospitals (38%) screened for emotional issues 4 to 8 weeks after the event. The researchers also reported that 14 hospitals (27%) screened multiples times for cognitive issues and 15% of hospitals screened multiple times for emotional issues.

Though a “satisfactory percentage” of neurologists responded, limitations included the survey design and a focus on neurologists’ and their teams’ perspectives. Moving forward, Slenders and colleagues emphasized increased guideline adherence.

“Fortunately, attention is increasingly being drawn to the cognitive and emotional consequences of stroke, and screening rates seem to be increasing,” they wrote. “Still, our results suggest that further improvement is possible and, in our opinion, desirable.”