The impact of cognitive decline on stroke rehabilitation

Useless.  Describes a problem, offers NO SOLUTION.  Obviously the mentors and senior researchers need retraining in the only goal in stroke. 100% RECOVERY.  Not this lazy crapola.

The impact of cognitive decline on stroke rehabilitation

Fătu Ana-Maria 1,
Pâslaru Ana Maria 1, 
Creangă-Zărnescu Valerica 1, 
Mihaela Lungu 1,2 ,
Verenca Mădălina Codruţa 1,3,
Ciubară Anamaria1,4
  Corresponding author: Creangă-Zărnescu Valerica, E-mail: zarnescu_vally@yahoo.com         
1. "Dunarea de Jos” University, Galati, Romania
2. Clinical Emergency Hospital "Sf. Apostol Andrei", Department Neurology,  Galati, Romania 
3. Clinical Emergency Hospital for Children "Sf.Ioan" , Department Rehabilitation , Galati, Romania 4. Psychiatry Hospital "Elisabeta Doamna", Galati, Romania

Abstract 

Introduction.
Stroke is a disease of great public importance, the second leading cause of death and the third leading cause of disability .The persistent and progressive decline of cognitive function in stroke survivors has a major impact on the patient's health and quality of life, with repercussions affecting the whole society. There is no cure for cognitive impairment or dementia, apart from the non-pharmacological treatment meaning the rehabilitation, which may be an important effective alternative.
Material and method.
We performed a retrospective study for a period of 6 months. The patient population consisted of 60 individuals. Their primary diagnosis was stroke and the secondary was dementia. Patient assessment was done by clinical, imagistic and psychiatric examination. In addition, an analysis of randomized controlled data trials from the literature, on cognitive rehabilitation had been performed.
Results and discussions.
The results show that 83,33% of patients were diagnosed with mixed dementia but 60% had this diagnosis before brain damage occured, with a Mini Mental State Examination under 20 points. The most common disorders of cognition were: fixation hypomnesia, temporal-spatial disorientation, impaired computing. Dementia patients have different rehabilitation needs and associate a lower functional result than those without cognitive impairments. For a rehabilitation benefit, patients should be able to recover their skills step by step and carry them over to the next session, which is difficult for people with severe memory problems. They have a low potential for progress and require a long time and many resources to advance with neurorehabilitation.(So what the fuck is your solution for these impaired cases? The goal is 100% recovery for all, not just your better cases.)
Conclusions.
The brain injury, such as stroke, causes damage of motor and cognitive functions with repercussion on quality of life. The cognitive decline associated with stroke is an important aspect of neurorehabilitation. Nevertheless is slightly neglected to the detriment of physical disability as there is a lack of recovery potential in these patients.

 Key words: dementia, stroke, cognitive, neurorehabilitation,

 Introduction 

Worldwide, cerebrovascular accidents are the second leading cause of death and the third leading cause of disability (1). In 2017, the Stroke Alliance for Europe (SAFE) with the European Stroke Organisation (ESO), launched a comprehensive overview of stroke in Europe and they showed that between 2015 and 2035 the number of strokes is expected to rise by 34% due to an ageing population (2).  The life expectancy of patients with stroke has increased due to the fast application of an advanced treatment, but the aging population increases the incidence of cognitive decline. Also, the sudden death of brain cells due to lack of oxygen when the blood flow to the brain is lost by blockage or rupture of an artery, is a major cause of dementia (3). Thus, the two entities are associated quite frequently, especially in the over-60 age group.  Current evidence suggests that 25-30% of stroke survivors develop immediate or delayed vascular cognitive disorders leading to dementia (4).  Therewith 10% of patients have a diagnosis of dementia prior to first stroke, one third of patients develop dementia after recurrent stroke and many others may have undiagnosed pre-stroke cognitive impairment (5). Patients with stroke who have cognitive impairments in addition to physical impairments have less recovery of physical function, more dependence in living after stroke (6), growth risk of mortality lower the quality of life.

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