European Stroke Organisation and European Academy of Neurology Joint Guidelines on Post-stroke Cognitive Impairment
European Journal of Neurology
Quinn, T. J., Richard, E., et al. (2021).
European Journal of Neurology, 28(12), 3883-3920.
This evidence-based guideline provides recommendations for the prevention, diagnosis, and treatment of individuals with post-stroke cognitive impairment. This summary highlights recommendations within the scope of speech-language pathology.
European Stroke Organisation; European Academy of Neurology
<div>"Cognitive training could be considered following stroke as part of a broader rehabilitation package. However, based on the current available literature, there is no evidence that cognitive training, as a single intervention, has a clinically meaningful or sustained benefit for prevention of cognitive decline or dementia following stroke" (Very low quality of evidence, No recommendation; p. 3891). Cognitive rehabilitation, particularly personalized compensatory strategies related to functional tasks, may be beneficial; however, research on efficacy is limited (Very low quality of evidence, No recommendation).</div>
<div>"Cognitive screening should be considered as part of the comprehensive assessment of stroke survivors. However, there are insufficient data to make recommendations around the timing, the content or the potential benefits of cognitive screening to the patient, their caregivers, and to healthcare systems" (Very low quality of evidence, No recommendation; p. 3894).</div>
<div>In acute and post-acute stroke settings, cognition should be screened using one of the following tools: the Montreal Cognitive Assessment (MoCA), Folstein's Mini-Mental State Examination (MMSE), or the Addenbrookes Cognitive Examination (ACE). These tools should not replace comprehensive clinical assessment (Low to very low quality of evidence, Weak for intervention recommendation). For the MoCA, "we suggest that a revised (lower) threshold be considered for stroke populations" (Low quality of evidence, Weak for intervention recommendation; p. 3896). While the Oxford Cognitive Screen (OCS) demonstrates some advantages related to ease of completion and feasibility for stroke patients, there is insufficient evidence to recommend its use as a cognitive screening tool (Very low quality of evidence, No recommendation). Clinicians using these tools should be trained in their administration. Individuals who score positively should undergo additional comprehensive cognitive assessment. All test results should be provided to the multidisciplinary stroke team (Expert consensus statement).</div>
<div>"In post-acute stroke settings, telephone-based screening of cognition can be considered. Telephone-based cognitive screening is not a substitute for comprehensive clinical assessment" (Very low quality of evidence, Weak for intervention recommendation; p. 3901). Clinicians utilizing telephone-based cognitive screening tests should be trained in their administration. Individuals who score positively should undergo additional comprehensive cognitive assessment. All test results should be provided to the multidisciplinary stroke team (Expert consensus statement).</div>
