Identification and care of patients at risk of post-stroke dementia

Abstract

Stroke can directly cause cognitive difficulties but also increases the risk of future dementia. There is often less focus on these consequences during standard care, which tends to concentrate on physical function. The seven publications described in this thesis focussed on four aims, which were to: a) describe the impact of cognitive difficulties post-stroke over time b) understand patient and professional views regarding current care for stroke-survivors with memory problems c) describe the acceptability and accuracy of dementia risk prediction models following stroke d) understand healthcare professional views about how to meet the cognitive needs of stroke-survivors. A mixed-methods approach was used to address these aims including: a) A systematic review of studies found there was a tendency towards cognitive decline, but this was not consistent as patients post-stroke can stabilise or even recover; b) Semi-structured interviews with i) stroke-survivors reporting memory difficulties and their family carers and ii) primary and secondary care professionals consistently reported clear gaps in care for stroke survivors with memory deficits; c) Harmonisation of international stroke cohorts to externally validate existing dementia risk prediction models which have not validated well in stroke populations. Further, in the qualitative interviews, patients, family carers and healthcare professionals identified challenges to their implementation; d) A national electronic-Delphi survey found that stroke clinicians believe assessment of post-stroke cognition needs better integration into services with clarification of when and where this should be done to streamline access. The gaps in current services mean that the support available to care for and identify those at greatest risk for dementia is lacking. Patients and carers should be offered information about the long-term cognitive consequences poststroke. If required, they should be encouraged to seek assistance in the community with the aim of being directly referred back into specialist services for assessment and intervention.