More than half of people who survive a stroke experience cognitive decline within a year; Screening can help detect cognitive decline, according to a new scientific statement from the American Heart Association.
Highlights from the statement:
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More than half of people who survive a stroke may experience cognitive impairment within the first year after the stroke, and 1 in 3 are at risk of dementia within 5 years, according to a new scientific statement from the American Heart Association published today in Stroke , the peer-reviewed scientific professional journal of the American Stroke Association, a division of the American Heart Association.
A scientific statement from the American Heart Association is an expert analysis of current research and can be used as a basis for defining future guidelines. This new statement, “ Cognitive Impairment After Ischemic and Hemorrhagic Stroke ,” recommends post-stroke screening and a comprehensive, interdisciplinary care approach to support survivors. to a stroke and present cognitive impairment.
“Cognitive impairment is a very common, often underreported and underdiagnosed health problem that frequently affects stroke survivors,” said Nada El Husseini, MD, MHSc., FAHA, president. of the scientific statements writing committee and associate professor of Neurology at Duke University Medical Center in Durham, North Carolina. “In people who survive a stroke, cognitive impairment should be systematically evaluated, in order to start treatment as soon as possible when signs appear.”
According to the American Heart Association’s 2023 statistical update, an estimated 9.4 million American adults report having had a stroke; which represents 3.6% of the adult population of the United States. Cognitive impairment can occur early after a stroke or years later.
“Cognitive impairment after a stroke ranges from mild impairment to dementia, and can affect many aspects of life—for example, memory, thinking, planning, language, and attention—as well as “a person’s ability to work, drive or live independently,” said El Husseini.
This scientific statement refers to cognitive impairment following a stroke. Ischemic strokes, which are caused by a blockage in a blood vessel that supplies blood to the brain, account for 87% of all these episodes. Hemorrhagic strokes are bleeding in the brain that occur when a weakened blood vessel ruptures, and they account for approximately 13% of all strokes.
According to the statement:
Cognitive decline after a stroke is common during the first year after the event, occurring in up to 60% of people who survive a stroke. It most commonly occurs within the first two weeks after a stroke.
Approximately 40% of people who survive a stroke present, during the first year after the episode, cognitive impairment that does not meet the diagnostic criteria to be considered dementia, but that still affects their quality of life.
Up to 20% of stroke survivors who experience mild cognitive impairment fully recover cognitive function, and cognitive recovery is most likely to occur within the first six months after the event.
Cognitive impairment following a stroke is often associated with other health problems including physical disability, sleep disorders, behavioral and personality changes, depression, and other neuropsychological changes. All of them can contribute to a lower quality of life.
Diagnosis and management of cognitive impairment after a stroke
According to the scientific statement, there is no quality standard for cognitive evaluation after a stroke. However, there are some brief tests (30 minutes or less) that are widely used to identify cognitive decline after a stroke: the Mini-Mental State Examination and the Montreal Cognitive Assessment.
While early detection during the initial hospitalization for stroke is important for planning immediate care, it is also important to assess cognitive changes that manifest over time. Stroke survivors who experience unexplained difficulties with cognitive activities of daily living, following care-related instructions, or providing reliable information about their health history may be candidates for further cognitive testing. When cognitive impairment is detected, health care professionals are encouraged to evaluate the affected person’s daily functioning through neuropsychological testing, which looks at areas of brain function that affect behavior and can provide a more complete picture. of their cognitive strengths and weaknesses.
Health care professionals are encouraged to offer patients and their caregivers guidance on home safety and how to return to work and driving after a stroke, and to connect caregivers and stroke survivors. a stroke with community resources for social support.
Interdisciplinary collaboration between health care professionals, such as physicians, speech and language therapists, occupational therapists, neuropsychologists, and nursing professionals, is often needed to provide optimal care and management for people experiencing cognitive decline after a stroke. Additionally, the statement suggests that cognitive behavioral rehabilitation and physical activity may help improve cognitive functions after a stroke.
Preventing another stroke is a key consideration to prevent cognitive decline from worsening after the first episode. This includes treatments for stroke risk factors, such as high blood pressure, high cholesterol, type 2 diabetes, and atrial fibrillation. Controlling blood pressure is associated with a lower risk of recurrent stroke and mild cognitive impairment.
What are the research needs in the future?
There are still unknown questions about how cognitive decline occurs after a stroke, and what is the impact of non-brain-related factors, such as infections, weakness, and social factors. Further research is needed to determine best practices for cognitive assessment after stroke, including the development and use of assessment instruments that take demographic, cultural, and linguistic factors into account when determining “normal” functioning.
“Perhaps the most pressing need, however, is to develop effective, culturally sensitive treatments for post-stroke cognitive decline,” El Husseini said. “We hope to see clinical trials large enough to evaluate different techniques, medications and lifestyle changes in diverse groups of patients, which may help improve cognitive function.”
Co-authors of the paper are Vice President Irene L. Katzan, MD, MS, FAHA; Natalia S. Rost, MD, MPH, FAHA; Margaret Lehman Blake, Ph.D., CCC-SLP; Eeeseung Byun, R.N., Ph.D.; Sarah T. Pendlebury, FRCP, D.Phil.; Hugo J. Aparicio, MD, MPH; Maria J. Marquine, Ph.D.; Rebecca F. Gottesman, M.D., Ph.D., FAHA; and Eric E. Smith, MD, MPH, FAHA.
