Poststroke cognitive impairment is common following a stroke and cognitive screenings should be provided by stroke systems of care, according to a scientific statement by the American Heart Association published in the journal Stroke.

Poststroke cognitive impairment is known to be associated with poor health-related outcomes among survivors of stroke. In fact, it is frequently reported along with various stroke-associated deficits and such comorbidities as depression, thus rendering diagnosis and treatment more complex.

Recognizing that the implementation of protocols to assess and treat poststroke cognitive impairment according to locally available resources is needed, researchers sought to conduct a literature review of randomized controlled clinical trials, case-control studies, retrospective and prospective analyses, review articles, editorials, and clinical guidelines on the natural history, incidence and prevalence, diagnosis, and management of poststroke cognitive impairment.

The definition of poststroke cognitive impairment used in this review referred to “any severity of cognitive impairment, regardless of cause, noted after an overt stroke.”

The comprehensive management of patients with poststroke cognitive impairment should involve an interdisciplinary collaboration of the patient and their caregivers with health professionals …

Poststroke cognitive impairment that occurs following a stroke typically is observed in the first year and is reported in up to 60% of stroke survivors. Approximately 38% of these individuals have mild cognitive impairment, whereas 7% to 41% have dementia.

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Comorbidities that are reported among patients with poststroke cognitive impairment and dementia are known to be associated with diminished quality of life. These poststroke outcomes, along with their approximate incidence or prevalence within 12 months of stroke occurrence, include the following:

  • Poststroke cognitive impairment: 22% to 80%
  • Poststroke dementia: 7% to 41%
  • Sleep disorders: 50% to 60%
  • Fatigue: 45% to 55%
  • Physical/functional disability: 40% to 60%
  • Multimorbidity: >40%
  • Apathy: 30% to 40%
  • Depression: 30% to 35%
  • Anxiety: 20% to 25%

Risk factors for poststroke cognitive impairment include the following:

  • Older age
  • Race/ethnicity
  • Stroke severity
  • “Strategic” stroke location
  • Preexisting cognitive impairment
  • Recurrence of stroke
  • Vascular comorbidities
  • Concomitant neurodegenerative disease
  • Diabetes

Alternative diagnoses for poststroke cognitive impairment should be explored and managed accordingly:

  • Depression
  • Delirium
  • Infections
  • Metabolic disturbances
  • Polypharmacy and side effects of medications
  • Vision impairments
  • Hearing impairments
  • Prestroke cognitive decline

In some instances, cognitive impairment is reversible early after stroke occurrence; however, up to one-third of patients with stroke have been shown to develop dementia within 5 years.

Although the pathophysiology of poststroke cognitive impairment has not yet been fully elucidated, it is probably associated with an acute stroke — either ischemic or hemorrhagic — precipitating a number of pathologic events, frequently along with preexisting microvascular and neurodegenerative alterations. 

An unmet need exists for prospective studies designed to assess the trajectory of poststroke cognitive impairment and the role played by acute vascular events in an individual being predisposed to Alzheimer disease and associated dementias, along with high-quality, randomized clinical trials that are directed toward the management of this occurrence.

The researchers noted that “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.”

“Perhaps the most pressing need, however, is the development of effective and culturally relevant treatments for PSCI [poststroke cognitive impairment] through the conduct of adequately powered clinical trials of cognitive rehabilitative techniques, pharmaceutical agents, and lifestyle modifications in diverse groups of patients,” the researchers concluded.

Disclosure: Some of the study authors have declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. 

References:

Husseini N, Katzan IL, Rost NS, et al; American Heart Association Stroke Council; Council on Cardiovascular and Stroke Nursing; Council on Cardiovascular Radiology and Intervention; Council on Hypertension; and Council on Lifestyle and Cardiometabolic Health. Cognitive impairment after ischemic and hemorrhagic stroke: a scientific statement from the American Heart Association/American Stroke Association. Stroke. Published online May 1, 2023.  doi:10.1161/STR.0000000000000430