Should Stroke Physicians Assess Cognition and Mood?

And what is the point of assessing cognition and mood? There are no protocols to address either. 
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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