Cognitive Recovery After Stroke: A Meta-analysis and Metaregression of Intervention and Cohort Studies

Saa, Juan Pablo; Tse, Tamara; Baum, Carolyn; Cumming, Toby; Josman, Naomi; Rose, Miranda; O'Keefe, Sophie; Sewell, Katherine; Nguyen, Vinh

doi:10.1177/15459683211017501

Cited by 12 publications

(9 citation statements)

References 70 publications

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“…Cognitive difficulties in the early post-stroke period are also independently associated with functional mobility in the chronic phase ( 7 ), possibly because impaired cognition interferes with attention to and control of motor movements ( 8 ), particularly when the difficulty of walking is high ( 9 ). Early, tailored cognitive interventions can alter the trajectory of recovery post-stroke ( 10 ). C-IADL measures may also be optimal for administration during acute inpatient rehabilitation because they are within the scope of practice of occupational therapists, and do not require specialty consultation with a neuropsychologist.…”

Section: Introductionmentioning

confidence: 99%

Impaired Performance on a Cognitively-Based Instrumental Activities of Daily Living Task, the 10-Item Weekly Calendar Planning Activity, in Individuals With Stroke Undergoing Acute Inpatient Rehabilitation

et al. 2021

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Performance-based, functionally relevant, and standardized measures of cognitive-instrumental activities of daily living (C-IADL) can complement neuropsychological tests of cognitive impairment and provide valuable clinical information to inform rehabilitation planning. Existing measures have been validated in the outpatient setting. Here, we sought to evaluate a 10-item, short-form of a C-IADL measure, Weekly Calendar Planning Activity (WCPA-10), in inpatients with stroke undergoing acute rehabilitation. The specific goal was to determine if the WCPA-10 could differentiate between stroke patients undergoing acute inpatient rehabilitation and healthy control individuals. We also explored whether the WCPA-10 would identify C-IADL limitations in stroke patients screened as having intact cognition. Seventy-seven stroke inpatients undergoing rehabilitation and 77 healthy control participants completed the WCPA-10, which involves entering a list of simulated, fictional appointments into a weekly schedule while keeping track of and adhering to multiple task rules and ignoring built-in obstacles and distractions. Compared to the control group, stroke patients had significantly worse accuracy, made more errors, used fewer cognitive strategies, followed fewer rules, took more time to complete the task, and were less efficient. 83% of stroke patients were less accurate than predicted by their age, and 64% used less strategies than their age prediction. Among 28 participants who screened as having “normal” cognitive function on the Montreal Cognitive Assessment, the majority had deficits on the WCPA-10. Our results provide initial support for use of a brief C-IADL assessment, WCPA-10, for individuals with stroke undergoing inpatient rehabilitation. They indicate that stroke patients have deficits in C-IADL accuracy, efficiency, and strategy use at this stage of stroke recovery. Results highlight the need to use performance based, functional cognitive assessments, even for those who perform well on cognitive screening tools.

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Section: Introductionmentioning

confidence: 99%

Impaired Performance on a Cognitively-Based Instrumental Activities of Daily Living Task, the 10-Item Weekly Calendar Planning Activity, in Individuals With Stroke Undergoing Acute Inpatient Rehabilitation

et al. 2021

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“…Aetiologic subtype of ischaemic stroke has been reported to associate not only with cognitive outcome 15 but also with other aspects of poststroke outcome such as persisting neurological deficits. 70 The study protocol presented here allows for subtyping of all ischaemic strokes according to two validated systems and subtype-specific analysis of outcome measures.…”

Section: Discussionmentioning

confidence: 99%

“… 7 9 A recent review on recovery reported the largest improvement in cognitive function 61–180 days (or 2–6 months) after stroke onset. 15 Knowledge about the long-term trajectory after 1 year is more uncertain, some report stability in cognitive function between 3 months and 2 years after stroke for the majority of cases, 16 while others found a decline at the group level. 17 There are also studies reporting that while some stroke survivors display no change in cognition or a decline, there are also stroke survivors who have improved cognitive function at long-term follow-ups.…”

Section: Introduction and Rationalementioning

confidence: 99%

FIND Stroke Recovery Study (FIND): rationale and protocol for a longitudinal observational cohort study of trajectories of recovery and biomarkers poststroke

et al. 2023

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IntroductionComprehensive studies mapping domain-specific trajectories of recovery after stroke and biomarkers reflecting these processes are scarce. We, therefore, initiated an exploratory prospective observational study of stroke cases with repeated evaluation, theFIND Stroke Recovery Study. We aim to capture trajectories of recovery from different impairments, including cognition, in combination with broad profiling of blood and imaging biomarkers of the recovery.Methods and analysisWe recruit individuals with first-ever stroke at the stroke unit at the Sahlgrenska University Hospital, Sweden, to FIND. The inclusion started early 2018 and we aim to enrol minimum 500 patients. Neurological and cognitive impairments across multiple domains are assessed using validated clinical assessment methods, advanced neuroimaging is performed and blood samples for biomarker measuring (protein, RNA and DNA) at inclusion and follow-up visits at 3 months, 6 months, 1 year, 2 years and 5 years poststroke. At baseline and at each follow-up visit, we also register clinical variables known to influence outcomes such as prestroke functioning, stroke severity, acute interventions, rehabilitation, other treatments, socioeconomic status, infections (including COVID-19) and other comorbidities. Recurrent stroke and other major vascular events are identified continuously in national registers.Ethics and disseminationFIND composes a unique stroke cohort with detailed phenotyping, repetitive assessments of outcomes across multiple neurological and cognitive domains and patient-reported outcomes as well as blood and imaging biomarker profiling. Ethical approval for the FIND study has been obtained from the Regional Ethics Review Board in Gothenburg and the Swedish Ethics Review Board. The results of this exploratory study will provide novel data on the time course of recovery and biomarkers after stroke. The description of this protocol will inform the stroke research community of our ongoing study and facilitate comparisons with other data sets.Trial registration numberThe protocol is registered athttp://www.clinicaltrials.gov, Study ID:NCT05708807.

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“…Otherwise, evidence from other studies showed that patients' function and dependence would improve over time [10,32]. In addition, several factors were known to affect the trend of survivors' functions and caregiver burden, including caring hours per day, type of rehabilitation, stroke severity, caregivers' age and caregivers' education level [6,13,32,40], and improvement of patient's function was associated with improvement of caregivers' burden.…”

Section: Discussionmentioning

confidence: 99%

“…As more studies have shown that the involvement of caregivers in rehabilitation may improve the outcome, support for caregivers may also be an essential consideration in developing a care plan for stroke survivors during hospital discharge [13][14][15].…”

Section: Introductionmentioning

confidence: 99%

Estimating the Burden Among Informal Caregivers of Stroke Survivors in East Coast Peninsular Malaysia: A Short-Term Longitudinal Study

Suliman¹,

Chen²,

Ibrahim³

et al. 2022

Preprint

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Taking care of stroke survivors can be taxing, however, it was understudied in Malaysia. This study aims to describe the burden of informal stroke caregivers within three months after hospital discharge. A longitudinal study design was conducted. Acute stroke survivors and their informal caregivers were recruited prior to hospital discharge, and the caregivers were interviewed by phone. Self-reported caregiver burdens were measured with Zarit Caregiver Burden Interview – Malay version (MZBI) and Caregiver Assessment of Function and Upset – Malay version (Malay-CAFU). The MZBI and Malay-CAFU scores were collected four times within three months. A total of 85 stroke survivors and 155 informal caregivers were recruited, with 58.1% of the caregivers were female. The stroke survivors had two caregivers on average. The mean (SD) scores for the three scales show a reduction, from 27.42 (12.73) in the first week to 17.77 (11.20) in the third month for MZBI, from 1.14 (0.94) to 0.62 (0.64) for instrumental activities of daily livings (IADL) of Malay-CAFU upset scale and 1.36 (1.00) to 0.78 (0.65) for activities of daily living (ADL) of Malay-CAFU upset scale in the same period. Stroke survivors may have several caregivers, usually their spouses or children. Within a short period, the caregiver’s burden was reduced. Early psychosocial support to alleviate the caregiver burden may be necessary.

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Cognitive Recovery After Stroke: A Meta-analysis and Metaregression of Intervention and Cohort Studies

Cited by 12 publications

References 70 publications

Impaired Performance on a Cognitively-Based Instrumental Activities of Daily Living Task, the 10-Item Weekly Calendar Planning Activity, in Individuals With Stroke Undergoing Acute Inpatient Rehabilitation

Impaired Performance on a Cognitively-Based Instrumental Activities of Daily Living Task, the 10-Item Weekly Calendar Planning Activity, in Individuals With Stroke Undergoing Acute Inpatient Rehabilitation

FIND Stroke Recovery Study (FIND): rationale and protocol for a longitudinal observational cohort study of trajectories of recovery and biomarkers poststroke

Estimating the Burden Among Informal Caregivers of Stroke Survivors in East Coast Peninsular Malaysia: A Short-Term Longitudinal Study

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