Introduction: Increasing attention is being paid to interventions for cognitive impairment (CI) post-stroke, including for CI that does not meet dementia criteria. The aim of this paper was to conduct a systematic review and meta-analysis of the prevalence of cognitive impairment no dementia (CIND) within one year post-stroke. Patients and methods: Pubmed, EMBASE and PsychInfo were searched for papers published in English in 1995-2017. Included studies were population or hospital-based cohort studies for first-ever/recurrent stroke, assessing CIND using standardised criteria at 1-12 months post-stroke. Abstracts were screened, followed by full text review of potentially relevant articles. Data were extracted using a standard form, and study quality was appraised using the Crowe Critical Appraisal Tool. A pooled prevalence of CIND with 95% confidence intervals (CI) was estimated using random-effects meta-analysis. Heterogeneity was measured using the I 2 statistic. Results: A total of 7000 abstracts were screened, followed by 1028 full text articles. Twenty-three articles were included in the systematic review, and 21 in the meta-analysis. The pooled CIND prevalence was 38% [95% CI ¼ 32-43%] (I 2 ¼92.5%, p < 0.01). Study quality emerged as one source of heterogeneity. The five studies with the highest quality scores had no heterogeneity (I 2 ¼0%, p ¼ 0.99), with a similar pooled prevalence (39%, 95%CI ¼ 35-42%). Other sources of heterogeneity were stroke type, inclusion of pre-stroke CI, and age at assessment time. Discussion and conclusion: Meta-analysis of available studies indicates that in the first year post-stroke, 4 in 10 patients display a level of cognitive impairment that does not meet the criteria for dementia.

Increasing longevity can be associated with increasing QoL as long as it is accompanied by reasonable levels of mental and physical health, high-quality relationships, and social participation. Even if physical health becomes poor, evidence suggests that QoL can often remain high as individuals find value and enjoyment in other dimensions of life.

BackgroundThis paper aimed to develop a short version of the 32-item Ageing Perceptions Questionnaire (APQ), a multi-dimensional measure based on Leventhal's self-regulation model. Ageing perceptions are a key area of interest for large-scale surveys of ageing populations. As these studies capture a broad range of health and social variables, included instruments need to be as concise as possible.MethodsData from the Irish Longitudinal Study of Ageing (TILDA), a representative sample of community-dwelling individuals aged 50+ (n = 6,718), was used to revise the scale. Items for exclusion were identified by examining conceptual content, descriptive statistics, and by detecting sources of poor model fit using confirmatory factor analysis (CFA). Potential combinations of dimensions were also tested using CFA. Finally, we identified any dimensions that could be excluded without limiting the conceptual coverage and coherence of the scale. Model modifications were done sequentially and with regard to theoretical considerations. Internal consistency and construct validity of the concise scale were compared with the longer version.ResultsInitially, 11 items were excluded on the basis of conceptual and empirical overlap with other items. CFA indicated that the negative-control and negative-consequences dimensions could be combined, allowing us to exclude a further item from this dimension. The 5-item timeline-cyclical dimension was also excluded, as it was less well-established conceptually and empirically than the other dimensions. The final 17-item, 5-dimension model was consistent with the original conceptual model and fit the data well (chi-sq = 1433.54, df(109), p < 0.01, RMSEA = 0.04, CFI = 0.97, TLI = 0.96).ConclusionsThe Brief-APQ (B-APQ) is a concise, multi-dimensional measure of ageing perceptions, which is psychometrically valid for use with the Irish population aged 50+. The concise version preserved the internal consistency and construct validity of the original. Its brevity makes it particularly suitable for use with large-scale adult population surveys. The psychometric analysis supports the application of the self-regulation model to ageing perceptions, but also the existence of distinct "physical decline" and "ongoing development" dimensions of perceptions.

We recommend the use of the single-factor model (CASP-R12) when assessing overall quality of life. The dimensions of control/autonomy and self-realisation/pleasure can be examined separately by researchers interested in those constructs. Researchers using structural equation modelling can use the well-fitting measurement model outlined here including adjustment for residual covariances.

ObjectiveCognitive impairment is a pervasive outcome of stroke, reported in over half of patients 6 months post-stroke and is associated with increased disability and a poorer quality of life. Despite the prevalence of post-stroke cognitive impairment, the efficacy of existing psychological interventions for the rehabilitation of cognitive impairment following stroke has yet to be established. The aim of this study is to identify psychological interventions from non-randomised studies that intended to improve post-stroke cognitive function and establish their efficacy.DesignSystematic review and meta-analysis of non-randomised studies of psychological interventions addressing post-stroke cognitive impairment.Data sourcesElectronic searches were performed in the Pubmed, EMBASE and PsycINFO databases, the search dating from inception to February 2017.Eligibility criteriaAll non-randomised controlled studies and quasi-randomised controlled trials examining psychological interventions to improve cognitive function following stroke were included, such as feasibility studies, pilot studies, experimental studies, and quasi-experimental studies. The primary outcome was cognitive function. The prespecified secondary outcomes were functional abilities in daily life and quality of life.MethodsThe current meta-analyses combined the findings of seven controlled studies, examining the efficacy of psychological interventions compared with treatment-as-usual controls or active controls, and 13 one-group pre–post studies.ResultsResults indicated an overall small effect on cognition across the controlled studies (Hedges' g=0.38, 95% CI=0.06 to 0.7) and a moderate effect on cognition across the one-group pre–post studies (Hedges' g=0.51, 95% CI=0.3 to 0.73). Specific cognitive domains, such as memory and attention also demonstrated a benefit of psychological interventions.ConclusionsThis review provides support for the potential of psychological interventions to improve overall cognitive function post-stroke. Limitations of the study, in terms of risk of bias and quality of included studies, and future research directions are explored.PROSPERO registration numberCRD42017069714.