http://stroke.ahajournals.org/content/49/2/483?platform=hootsuite
Terence J. Quinn, Emma Elliott, Peter Langhorne
https://doi.org/10.1161/STROKEAHA.117.016994
Stroke. 2018;49:483-490
Originally published December 28, 2017
It
would seem intuitive that for a brain disease, such as stroke, the
examination of memory, thinking, and mood would be fundamental to the
clinical assessment. Yet in contemporary stroke practice, we have tended
to focus on the physical manifestations of stroke and
neuropsychological aspects have received little, if any, attention.1
Thankfully the landscape is changing, and there is an increasing
recognition of the importance of the psychological consequences of
stroke and a growing evidence base and standardization around
assessment.2–4
The stroke physician cannot be expected to take on the role of the
neuropsychology specialist, and there will always be cases where expert
input is required. However, a basic appreciation of how to approach
cognitive and mood assessment should now be mandatory for all working in
stroke care.
In this review, we discuss assessment of
cognitive function and mood. We have drawn on evidence from recent
research, particularly systematic review.3
We do not offer a comprehensive critique of all cognitive and mood
assessment tools. Rather, we suggest a framework for assessment that
emphasizes the need for differing approaches to testing at differing
points in the stroke pathway (Figure 1).
Figure 1.
Neuropsychological
assessment throughout the stroke pathway. Schematic illustrating a
potential approach to neuropsychological assessment at various stages in
the stroke pathway. The tests named are given as examples rather than
recommendations. Note how all elements are used to inform the clinical
diagnosis. Note also that the early assessments focus on prestroke
cognition, delirium, and stroke impairments rather than detailed
cognitive assessment. CAM-ICU indicates Confusion Assessment Method for
the Intensive Care Unit; CES-D, Centre for Epidemiologic Studies
Depression; E-ADL, Extended Activities of Daily Living; HR-QoL,
Health-Related Quality of Life; IQCODE, Informant Questionnaire for
Cognitive Decline in the Elderly; MoCA, Montreal Cognitive Assessment
(mini-MoCA, short form of …
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