Cognitive change following stroke and its impact on long-term care

Abstract

Aims/Background: The outcomes of cognitive assessments after stroke provide important information for the implementation of immediate specialist interventions. This study investigated the trajectory of cognitive changes in an acute stroke sample. This was done by examining the relationship between cognitive changes following stroke as determined by the Montreal Cognitive Assessment (MoCA) and patients' discharge locations (own home, home with social care package, and placement). Method: The data of 124 hospitalised patients with acute stroke was retrospectively analysed. Patients' age ranged from 51 to 96 years, 77 patients were women and 47 were men. Data of post-stroke cognitive outcomes as represented by the MoCA results and discharge location were collected. Results: Patients' MoCA Mean outcome was 12.12 and Standard Deviation 7.77. Significant differences were found between patients with low post-stroke cognitive functioning, requiring more intensive care after discharge (i.e. placement), and those with better cognition, who subsequently were discharged home. The MoCA subdomain ‘Concentration and Calculation’ was associated most with discharge location. The study outcomes can potentially improve the efficiency of very early interventions and hospital discharge plans for acute stroke patients.

Systematic review and meta-analysis of the effect of cognitive impairment on the risk of admission to long-term care after stroke

“…PSCI and admission to LTC PSCI was reported as significant predictor of LTC in 12 studies 22, 23,26,[28][29][30][31][32][34][35][36][37] , with three studies failing to find a significant association 21,24,25 .…”

“…A total of 1,219 unique records were identified and the full texts of 59 articles were reviewed (see Figure 1). The full texts of 30 articles were further examined in detail and 18 articles were selected for qualitative synthesis [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] . Of these, 12 provided sufficient information for inclusion in meta-analysis.…”

“…Of these, 12 provided sufficient information for inclusion in meta-analysis. 23 , the (MoCA) 24,32 , and the cognitive category of the Functional Independence Measure (FIM) 22, 25,30,31 . Of the three studies that examined dementia, one used DSM-IV criteria 20 , one used ICD-9 27 and one used Vascular Dementia criteria 21 .…”

“…Seven studies reported PSCI as a continuous predictor of LTC [22][23][24]26,30,32,37 . Of these, four studies 22,23,30,31 reported that lower levels of cognitive impairment (or better cognitive function) reduced odds of LTC.…”

“…This study was excluded from the metaanalysis as it assessed cognitive deficits (i.e., a higher score represented worse cognition), while other studies assessed cognitive function (a higher score represented better cognition), and pooling estimates was not feasible 26 . Another study did not report sufficient estimates to facilitate inclusion in a meta-analysis 32 .…”