after stroke, 1 in 3 at risk of developing dementia within five years
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canadians suffer 108,707 strokes on an annual basis, or one every five minutes. getty
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more than half of people who survive a stroke experience cognitive impairment within a year of their medical emergency, according to a new scientific statement from the american heart association.
the statement, which was published in the journal stroke, reveals that around one in three people are at risk of developing dementia within the next five years. it calls for prompt screenings in the wake of a stroke to determine initial treatment, as well as ongoing cognitive assessment to monitor and address the needs of patients over time.
cognitive impairment “under-reported,under-diagnosed”
“cognitive impairment is an often under-reported and under-diagnosed yet very common condition that stroke survivors frequently deal with,” said nada el husseini, chair of the scientific statement writing committee and associate professor of neurology at duke university medical center in durham, north carolina. “stroke survivors should be systematically evaluated for cognitive impairment so that treatment may begin as soon as possible after signs appear.”
according to the heart & stroke foundation, a stroke occurs when something blocks the flow of blood to the brain, damaging cells in the area. canadians suffer 108,707 strokes on an annual basis, or one every five minutes. with the potential for a wide range of symptoms to emerge depending on the area and extent of damage, many canadians may not be receiving the care they need.
“cognitive impairment after stroke ranges from mild impairment to dementia and may affect many aspects of life, such as remembering, thinking, planning, language and attention, as well as a person’s ability to work, drive or live independently,” el husseini said.
this kind of impairment, according to the statement, is most likely to occur within the first two weeks after a stroke. up to 20 per cent of survivors who experience mild cognitive impairment recover fully, with the bulk of this progress occurring in the first six months. cognitive impairment is often tied to other conditions, including sleep disorders, depression and personality changes, that can take a steep toll on quality of life for patients.
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stroke survivors should be screened
although there is no universal standard for assessing cognition following a stroke, the statement recommends using brief screening tests, such as the mini-mental state examination and the montreal cognitive assessment. in addition to helping to facilitate immediate care planning, these screenings are vital in assessing cognitive changes over time. if impairment is detected, health-care professionals are encouraged to perform neuropsychological screenings that can pinpoint affected areas of the brain and provide a more detailed picture of a patient’s cognitive abilities.
health-care workers can then provide guidance and support for patients and their caregivers on a range of issues, including home safety, returning to work and finding social support in their communities. it also allows for collaboration among different health professionals, with the statement suggesting behavioural cognitive rehabilitation and physical therapy as effective ways to improve cognition.
the focus during this time should be on preventing another stroke by assessing and offering treatment for risk factors, such as high blood pressure, high cholesterol and atrial fibrillation.
with so many unanswered questions about how a stroke leads to cognitive decline, more research is needed to determine the most effective way to conduct initial screenings and find appropriate tools for assessing ‘normal’ function.
“perhaps the most pressing need is the development of effective and culturally relevant treatments for post-stroke cognitive impairment,” el husseini said. “we hope to see big enough clinical trials that assess various techniques, medications and lifestyle changes in diverse groups of patients that may help improve cognitive function.”
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dave yasvinski is a writer with healthing.ca
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