Cognitive impairment in patients with cerebrovascular disease: A white paper from the links between stroke ESO Dementia Committee

Verdelho, Ana; Pavlovic, Aleksandra; Pantoni, Leonardo; Godefroy, Olivier; Duering, Marco; Charidimou, Andreas; Chabriat, Hugues; Biessels, Geert Jan

doi:10.1177/23969873211000258

Cited by 39 publications

(43 citation statements)

References 113 publications

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“…199 Although cognitive issues have not featured as prominantly in stroke Guidelines as may be expected based on their prevalance and importance, there have been some recent publications relevant to the field. The White Paper on cognitive impairment and cerebrovascular disease from ESO 202 complements the content of this Guideline. The White Paper emphasies the need to consider cognitive effects in all people living with stroke and highlights the importance of vascular secondary prevention.…”

Section: Discussionmentioning

confidence: 99%

“…11 ; advice on risk factor management, smoking cessation courses, physical activity, healthy diet, Cheng et al 12 ; cognitive and rehabilitation training). These trials recruited respectively 202,195, and 168 patients (n=565 in total), with a history of stroke. All participants were directly recruited after their initial diagnosis of stroke; two studies (Ihle-Hansen et al and Cheng et al) only included patients with a first ever stroke.…”

Section: Analysis Of Current Evidencementioning

confidence: 99%

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European Stroke Organisation and European Academy of Neurology joint guidelines on post-stroke cognitive impairment

Quinn

Richard

Teuschl

et al. 2021

European Stroke Journal

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Introduction: The optimal management of post stroke cognitive impairment remains controversial. These joint European Stroke Organisation (ESO) and European Academy of Neurology (EAN) guidelines provide evidence-based recommendations to assist clinicians in decision making around prevention, diagnosis, treatment, and prognosis. Methods: These guidelines were developed according to ESO standard operating procedure and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. The working group identified relevant clinical questions, performed systematic reviews and, where possible, meta-analyses of the literature, assessed the quality of the available evidence, and made specific recommendations. Expert consensus statements were provided where insufficient evidence was available to provide recommendations based on the GRADE approach. Results: There was limited randomised controlled trial evidence regarding single or multicomponent interventions to prevent post stroke cognitive decline. Interventions to improve lifestyle and treat vascular risk factors may have many health benefits but a beneficial effect on cognition is not proven. We found no evidence around routine cognitive screening following stroke but recognise the importance of targeted cognitive assessment. We described the accuracy of various cognitive screening tests but found no clearly superior approach to testing. There was insufficient evidence to make a recommendation for use of cholinesterase inhibitors, memantine or cognitive rehabilitation for post stroke dementia. We made a weak recommendation against using the nootropics actovegin and cerebrolysin, but quality of evidence was very low. There was limited evidence on the use of prediction tools for post stroke cognitive syndromes (cognitive impairment, dementia and delirium). The association between post stroke cognitive impairment and most acute structural brain imaging features was unclear. Conclusions: These guidelines have highlighted fundamental areas where robust evidence is lacking. Further randomised controlled trials are needed and we suggest priority areas for future research.

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Section: Discussionmentioning

confidence: 99%

Section: Analysis Of Current Evidencementioning

confidence: 99%

European Stroke Organisation and European Academy of Neurology joint guidelines on post-stroke cognitive impairment

Quinn

Richard

Teuschl

et al. 2021

European Stroke Journal

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“…145 We also refer to current hypertension, 32 diabetes, 137 or dementia guidelines 145 and white papers. 156,157 We expected that there could be limited evidence on ccSVD and clinical outcomes. Not only was the amount of evidence limited, but the quality of evidence was generally low reflecting primarily the small sample sizes and methodologies including randomisation procedures.…”

Section: Discussionmentioning

confidence: 99%

“… 145 We also refer to current hypertension, 32 diabetes, 137 or dementia guidelines 145 and white papers. 156 , 157 …”

Section: Discussionmentioning

confidence: 99%

ESO Guideline on covert cerebral small vessel disease

Wardlaw

Debette

Jokinen

et al. 2021

European Stroke Journal

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‘Covert’ cerebral small vessel disease (ccSVD) is common on neuroimaging in persons without overt neurological manifestations, and increases the risk of future stroke, cognitive impairment, dependency, and death. These European Stroke Organisation (ESO) guidelines provide evidence-based recommendations to assist with clinical decisions about management of ccSVD, specifically white matter hyperintensities and lacunes, to prevent adverse clinical outcomes. The guidelines were developed according to ESO standard operating procedures and Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. We prioritised the clinical outcomes of stroke, cognitive decline or dementia, dependency, death, mobility and mood disorders, and interventions of blood pressure lowering, antiplatelet drugs, lipid lowering, lifestyle modifications, glucose lowering and conventional treatments for dementia. We systematically reviewed the literature, assessed the evidence, formulated evidence-based recommendations where feasible, and expert consensus statements. We found little direct evidence, mostly of low quality. We recommend patients with ccSVD and hypertension to have their blood pressure well controlled; lower blood pressure targets may reduce ccSVD progression. We do not recommend antiplatelet drugs such as aspirin in ccSVD. We found little evidence on lipid lowering in ccSVD. Smoking cessation is a health priority. We recommend regular exercise which may benefit cognition, and a healthy diet, good sleep habits, avoiding obesity and stress for general health reasons. In ccSVD, we found no evidence for glucose control in the absence of diabetes or for conventional Alzheimer dementia treatments. Randomised controlled trials with clinical endpoints are a priority for ccSVD.

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“…For healthcare professionals, it can be difficult to perform time-consuming comprehensive cognitive assessments during the acute phase of stroke, as the patients need to undergo numerous medical examinations. Therefore, cognitive screening with short, validated screening instruments has been recommended for identifying patients with cognitive impairments and at need for further services and rehabilitation 7 , 8 .…”

Section: Introductionmentioning

confidence: 99%

Barriers to cognitive screening in acute stroke units

Abzhandadze

Buvarp

Lundgren‐Nilsson

et al. 2021

Sci Rep

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Cognitive impairment is common after stroke. However, not all patients with stroke undergo cognitive screening, despite recommendations. The aim of this retrospective, explorative study was to examine the barriers to cognitive screening in acute stroke units. Data were retrieved from two Swedish Stroke registries. The outcome variable was cognitive screening during the stay at acute stroke units. Forty-three candidate explanatory variables were considered for analysis, encompassing sociodemographic factors and stroke-related outcomes during the stay at acute stroke units. The Least Absolute Shrinkage and Selection Operator and decision-tree methods were used. Of the 1120 patients (56% male, mean age: 72 years, 50% with mild stroke), 44% did not undergo cognitive screening. Walking 10 m post-stroke was the most important attribute for decisions regarding cognitive screening. The classification accuracy, sensitivity, and specificity of the model were 70% (95% CI 63–75%), 71% (63–78%), and 67% (55–77%), respectively. Patient-related parameters that influenced cognitive screening with a valid and reliable screening instrument in acute stroke units included new stroke during the hospitalisation, aphasia at admission, mobility problems, impaired verbal output skills, and planned discharge to another care facility. The barriers to cognitive screening were both patient- and organisation-related, suggesting the need for patient-tailored cognitive screening tools as well as the implementation and systematic adherence to guidelines.

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Cognitive impairment in patients with cerebrovascular disease: A white paper from the links between stroke ESO Dementia Committee

Cited by 39 publications

References 113 publications

European Stroke Organisation and European Academy of Neurology joint guidelines on post-stroke cognitive impairment

European Stroke Organisation and European Academy of Neurology joint guidelines on post-stroke cognitive impairment

ESO Guideline on covert cerebral small vessel disease

Barriers to cognitive screening in acute stroke units

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