Cognitive impairment after stroke is common, and early diagnosis and treatment needed

By Sondra Forsyth

A recent scientific statement by the American Heart Association shows that over half of people who have had a stroke may have trouble thinking within a year after their stroke. Additionally, 1 out of 3 stroke survivors may have a higher risk of developing dementia within 5 years.

The American Heart Association has published a new scientific statement in the journal Stroke. This statement provides expert analysis of current research on the topic of cognitive impairment after stroke. The statement advises healthcare professionals to screen stroke survivors for cognitive impairment and provide comprehensive interdisciplinary care to support those affected. This guidance may be used to inform future guidelines on the topic.

Dr. Nada El Husseini, who led the writing committee for the scientific statement, said that cognitive impairment is a condition that stroke survivors often face but is not reported or diagnosed enough. She emphasized the importance of systematically evaluating stroke survivors for cognitive impairment to begin treatment as soon as possible when symptoms appear.

The American Heart Association’s 2023 Statistical Update states that around 9.4 million adults in America have had a stroke, which makes up about 3.6% of the adult population. Cognitive impairment may occur shortly after a stroke or even years later.

Nada El Husseini, M.D., M.H.Sc., FAHA, stated that cognitive impairment after stroke can vary from minor impairment to dementia and can impact many aspects of life such as memory, language, planning, attention, and a person’s ability to work, drive, or live independently.

The scientific statement talks about problems with thinking and memory after a stroke. There are two main types of strokes: one is caused by a blockage in a blood vessel going to the brain and the other happens when a blood vessel in the brain bursts. The first type of stroke is more common, while the second type is less common.

According to the statement:

• Many stroke survivors experience cognitive impairment within the first year after their stroke, with up to 60% of survivors affected. This impairment is most likely to occur within the first two weeks after a stroke.
• After a stroke, almost 40% of people experience cognitive impairment during the first year that doesn’t meet the criteria for dementia, but it still affects their quality of life.
• It’s possible for up to 20% of stroke survivors who experience mild cognitive impairment to fully recover their cognitive function. The best chance for recovery is within the first 6 months after a stroke.
• After a stroke, cognitive impairment is often linked to other conditions, such as physical disabilities, sleep disorders, changes in behavior and personality, depression, and other neuropsychological changes. These factors can all negatively impact a person’s quality of life.

Diagnosing and managing cognitive impairment after stroke

The scientific statement mentions that there is no universally accepted method for testing cognitive function after a stroke. However, there are some brief screening tests that can be used to identify cognitive impairment after a stroke. Two commonly used tests are the Mini-Mental State Examination and the Montreal Cognitive Assessment, which can both be completed in 30 minutes or less.

Detecting cognitive changes over time is important to help stroke survivors manage their condition better. Early detection of cognitive impairment is crucial for planning immediate care. If someone is having difficulty with activities related to memory, following instructions, or providing medical history, it might be an indication of cognitive impairment. Additional cognitive screening is necessary for those people. Neuropsychological screenings are recommended to evaluate brain function and to identify the cognitive strengths and weaknesses of individuals. It helps healthcare professionals provide better care to patients.

According to the scientific statement, healthcare professionals should provide guidance to stroke survivors and their caregivers regarding topics such as home safety, returning to work, and driving after a stroke. They should also connect stroke survivors and caregivers to community resources to provide social support.

To provide the best care for stroke survivors with cognitive impairment, different healthcare professionals such as physicians, occupational therapists, speech language therapists, neuropsychologists and nurses need to work together. They need to monitor the patient and offer care as needed. Cognitive rehabilitation and physical activity are also suggested to improve cognition after a stroke.

To prevent cognitive impairment from getting worse after a stroke, it’s important to prevent another stroke from occurring. This can be done by treating risk factors for stroke such as high blood pressure, high cholesterol, type 2 diabetes, and atrial fibrillation. Keeping blood pressure under control can lower the risk of having another stroke and also reduce the risk of mild cognitive impairment.

Future research needs

The scientific statement acknowledges that there are still unknowns about how cognitive impairment develops after a stroke, and how non-brain factors like infection, frailty, and social factors play a role. More research is needed to better understand cognitive screening after a stroke and to develop screening tools that take into account factors like age, culture, and language.

Dr. El Husseini highlights the urgent need for developing effective and culturally appropriate treatments for post-stroke cognitive impairment. Large clinical trials are necessary to assess the effectiveness of different techniques, medications, and lifestyle changes in improving cognitive function for diverse groups of patients.

This scientific statement was created by a group of volunteers representing different branches of the American Heart Association. The purpose of the statement is to increase awareness and knowledge about stroke and cognitive impairment. The statement provides information on what is currently known about the topic and what areas need further research. It is important to note that while the statement can inform healthcare decisions, it does not make specific treatment recommendations. The American Heart Association’s guidelines are used to provide official clinical practice recommendations.

Co-authors are Vice-Chair Irene L. Katzan, M.D., M.S., FAHA; Natalia S. Rost, M.D., M.P.H., FAHA; Margaret Lehman Blake, Ph.D., C.C.C.-S.L.P.; Eeeseung Byun, R.N., Ph.D.; Sarah T. Pendlebury, F.R.C.P., D.Phil.; Hugo J. Aparicio, M.D., M.P.H.; María J. Marquine, Ph.D.; Rebecca F. Gottesman, M.D., Ph.D., FAHA; and Eric E. Smith, M.D., M.P.H., FAHA. Authors’ disclosures are listed in the manuscript.

The Association receives funding primarily from individuals. Foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific Association programs and events. The Association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and biotech companies, device manufacturers and health insurance providers, and the Association’s overall financial information are available here.

About the American Heart Association

The American Heart Association is a relentless force for a world of longer, healthier lives. We are dedicated to ensuring equitable health in all communities. Through collaboration with numerous organizations, and powered by millions of volunteers, we fund innovative research, advocate for the public’s health and share lifesaving resources. The Dallas-based organization has been a leading source of health information for nearly a century. Connect with us on heart.org, Facebook, Twitter or by calling 1-800-AHA-USA1.