Addressing post-stroke cognitive impairment through innovative application of health psychology principles
AbstractBackground: Cognitive impairment (CI) is a pervasive outcome of ischaemic stroke, with implications for stroke recovery, medication and rehabilitation adherence, and progression to dementia. Intervention for post-stroke cognitive impairment has received considerably less attention than rehabilitation for physical deficits. Through a series of studies conducted in the Republic of Ireland, the prevalence of post-stroke cognitive impairment and the absence of appropriate rehabilitation have been identified. Methods: Two national audits of acute and community stroke care (2008 and 2015) and a cohort study (ASPIRE-S) of 256 patients with acute ischaemic stroke followed up at 6 months (2011-2012) and being recalled at 5 years (2016-2017) will be described. Methods used include analysis of national hospital discharge data, qualitative interviews with healthcare professionals and surveys of patients with stroke and their carers. Findings: Cognitive impairment is reported in over half of patients six months post-stroke. It is identified as a common stroke outcome in national audits, with rehabilitation provision minimal to non-existent. While over 90% of Irish stroke patients interact with a stroke specialist nurse and 81% receive physiotherapy, 1.6% receive input from psychological services, with no recorded indication of rehabilitation provided for cognitive difficulties. Discussion: Findings of studies conducted in Ireland to date highlight a substantial unmet need for rehabilitation for cognitive impairment post-stroke. This issue is not unique to Ireland. These findings have led to the establishment of a research programme - the StrokeCog study - to develop an intervention for post-stroke cognitive impairment using principles of behavior change theory.
Copyright (c) 2017 A. Hickey, N.A. Merriman, E. Sexton, N. Donnelly, N. Pender, F. Horgan, M. Wren, K.E. Bennett, F. Doyle, D. Williams
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