Barriers to cognitive screening in acute stroke units

Abzhandadze, Tamar; Buvarp, Dongni; Lundgren‐Nilsson, Åsa; Sunnerhagen, Katharina S.

doi:10.1038/s41598-021-98853-5

Cited by 8 publications

(4 citation statements)

References 25 publications

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“…Furthermore, the MoCA is a generic assessment and a stroke specific instrument for cognitive screening may cover all stroke severities. Barriers to cognitive screening at a stroke unit are foremost mobility and communication problems 37 . A second limitation is the use of data from registers where variables are predefined, leaving variables of interest such as patients´ pre-stroke cognition, unaddressed.…”

Section: Discussionmentioning

confidence: 99%

A register-based study on associations between pre-stroke physical activity and cognition early after stroke (part of PAPSIGOT)

Reinholdsson

Abzhandadze

Palstam

et al. 2022

Sci Rep

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The objective was to investigate if pre-stroke physical activity is associated with intact cognition early after stroke. The study design was a cross-sectional, register-based study. The study sample included 1111 adults with first stroke (mild or moderate severity) admitted to three Swedish stroke units. The main outcome was cognition. The associations of pre-stroke physical activity, age, sex, smoking, diabetes, atrial fibrillation, previous TIA, statin treatment, hypertension treatment, reperfusion therapies, stroke severity, and education on the outcome cognition were analyzed using binary logistic regression. Physical activity was assessed within 48 h of admittance, and cognition was screened during stroke unit care. The results were: mean age 70 years, 40% women, 61% pre-stroke physically active, and 53% with post-stroke cognitive impairment. Patients with pre-stroke light or moderate physical activity have higher odds for intact cognition compared to inactive: odds ratio (95% confidence interval) 1.32 (0.97-1.80) and 2.04 (1.18-3.53), respectively. In addition to pre-stroke physical activity, people with younger age, a higher level of education, less severe stroke (more mild than moderate), being non-diabetic, and non-smoking have higher odds for intact cognition. In conclusion physical activity before stroke is associated with intact cognition in patients with mild and moderate stroke.

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Section: Discussionmentioning

confidence: 99%

A register-based study on associations between pre-stroke physical activity and cognition early after stroke (part of PAPSIGOT)

Reinholdsson

Abzhandadze

Palstam

et al. 2022

Sci Rep

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“…Although MoCA is a valid and reliable instrument for use in patients with stroke, some drawbacks should be mentioned. Namely, not all patients can undergo cognitive screening with MoCA (e.g., patients with aphasia, impaired motor function in dominant upper limb) and it lacks the sensitivity to identify inpatients on specific cognitive domains ( Demeyere et al, 2016 ; Abzhandadze et al, 2021 ). Another limitation of our study is the characteristics of our sample, as two out of three patients in our sample had a mild stroke and the majority of patients had normal or mildly impaired cognitive function, which probably affected the statistical power.…”

Section: Discussionmentioning

confidence: 99%

Very Early Cognitive Screening and Self-Reported Feeling of Fatigue Three Months After Stroke

Holmberg

Jondell

Abzhandadze

et al. 2021

Front. Hum. Neurosci.

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Stroke is a major cause of disability and the second leading cause of death worldwide. Post-stroke fatigue has been reported as one of the most limiting symptoms after a stroke. Early identification of risk factors for developing post-stroke fatigue is important for providing timely rehabilitation. A correlation has been found between fatigue and cognitive impairment after stroke, but 2 months after stroke at the earliest. In the present study, we examined whether cognitive function screening using the Montreal Cognitive Assessment (MoCA) very early after stroke could explain fatigue 3 months after stroke. A total of 311 stroke patients admitted to a comprehensive stroke unit in Sweden between 2011 and 2016 were included in this longitudinal study. Cognition was screened within 2 days after admission to the stroke unit. Data on self-reported feeling of fatigue were retrieved from Riksstroke’s 3-month follow-up form. The data were analyzed using binary logistic regression. We found that the cognitive function in an acute phase after stroke could not explain self-reported feeling of fatigue in a later stage. The correlation between cognitive impairment and fatigue that has been reported may be detectable no earlier than the subacute phase of stroke. As previous studies have shown that functional outcome, severity of stroke, and sex also correlate with fatigue after stroke, we controlled for these variables in our analysis. In line with previous studies, we found that female patients had higher odds of experiencing fatigue. This is something that health care professionals should be aware of when working with stroke patients.

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“…Moreover, although the MoCA is a feasible tool for cognition, not all patients undergo screening. There are several barriers to cognitive screening at acute stroke units, that can be related to patient characteristics as well as stuff- and organization-related factors [ 43 ], thus the high proportion of the patients who did not have cognitive screening performed at stroke units. Another limitation lies in the administration of the MoCA, as it was carried out by different assessors with different patients.…”

Section: Strength and Limitationsmentioning

confidence: 99%

Association of cognitive function very early after stroke with subjective cognitive complaints after 3 months, a register-based study

2023

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Objective Cognitive deficits are commonly observed after stroke and have been associated with the cognitive decline and development of dementia in later stages. This study aimed to investigate whether cognition screened at acute stroke units could explain subjective cognitive complaints 3 months after stroke and evaluate how the severity of stroke and age could influence this association. Methods In this register-based longitudinal study, data were retrieved from three Swedish registers between November 2014 and June 2019. Information on subjective cognitive complaints (SCC) was collected from the Riksstroke 3-month follow-up form, which were used to analyze the primary outcomes. Cognitive function screened using the Montreal Cognitive Assessment (MoCA) at acute stroke units was expressed as the primary independent variable. Results Of the 1977 patients included in the study, 58% were males, the median age was 73 years, and 63% had a minor stroke. A total of 60% of patients had impaired cognition at acute stroke units (MoCA score, <26), of whom 40.3% reported at least 1 cognitive problem after 3 months. In adjusted binary regression analysis models, patients with normal cognitive function had lower odds for SCCs. This pattern was observed regardless of age and in patients with a minor stroke. Conclusions Intact cognition early after stroke was related to decreased odds of subjective cognitive complaints at the 3-month follow-up. This study highlights the importance of both early cognitive screening after stroke and subjective cognitive complaints, which have been shown to be associated with cognitive decline. Furthermore, we suggest the importance of discussing cognitive function with patients during regular follow-up in primary care, usually 3 months after stroke.

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Barriers to cognitive screening in acute stroke units

Cited by 8 publications

References 25 publications

A register-based study on associations between pre-stroke physical activity and cognition early after stroke (part of PAPSIGOT)

A register-based study on associations between pre-stroke physical activity and cognition early after stroke (part of PAPSIGOT)

Very Early Cognitive Screening and Self-Reported Feeling of Fatigue Three Months After Stroke

Association of cognitive function very early after stroke with subjective cognitive complaints after 3 months, a register-based study

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