In the United States, stroke is a prominent cause of both death and serious disability among adults. The 2023 Statistical Update from the American Heart Association reveals that approximately 9.4 million adults in the United States have reported experiencing a stroke, which accounts for approximately 3.6% of the adult population in the country.

Ischemic strokes account for about 87% of all strokes, while hemorrhagic strokes account for the remaining 13%.

According to a new scientific statement published in the journal Stroke by the American Heart Association, within a year after their stroke, more than half of stroke survivors may experience cognitive impairment, and 1 in 3 are at risk of developing dementia within five years.

“Cognitive impairment is an often under-reported and under-diagnosed — yet very common condition that stroke survivors frequently deal with,” points out Nada El Husseini, M.D., M.H.Sc., FAHA, chair of the scientific statement writing committee and an 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.”

Cognitive dysfunction can manifest shortly after a stroke or manifest years down the line.

“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,” explained El Husseini.

The following scientific statement pertains to cognitive dysfunction that occurs following a stroke. Ischemic strokes, which result from the obstruction of a blood vessel supplying blood to the brain, are responsible for 87% of all stroke cases. Hemorrhagic strokes, on the other hand, involve bleeding in the brain caused by the rupture of a weakened blood vessel, and they account for approximately 13% of all strokes.

The report revealed:

• Cognitive dysfunction is a prevalent occurrence in the initial year following a stroke, affecting up to 60% of individuals who have survived a stroke. This impairment is particularly pronounced within the first two weeks after the stroke.
• Within the first year after a stroke, approximately 40% of survivors experience cognitive difficulties that do not meet the diagnostic criteria for dementia. Nonetheless, these impairments significantly impact their overall quality of life.
• Around 20% of stroke survivors with mild cognitive impairment achieve complete cognitive recovery, with the highest likelihood of recovery observed within the initial 6 months after the stroke.
• Post-stroke cognitive impairment is frequently accompanied by other conditions, including physical disability, sleep disorders, behavioral and personality changes, depression, and various neuropsychological alterations. Each of these factors can contribute to a decreased quality of life for individuals affected by post-stroke cognitive impairment.

According to a scientific statement, there is currently no universally accepted standard for cognitive screening after a stroke. However, several brief screening tests that take 30 minutes or less are commonly used to identify cognitive impairment following a stroke. Two widely recognized tests for this purpose are the Mini-Mental State Examination and the Montreal Cognitive Assessment.

While it is crucial to detect cognitive changes early during the initial hospitalization for a stroke to ensure appropriate care planning, it is also important to assess cognitive function over time. Stroke survivors who encounter unexplained difficulties in cognitive-related daily activities, such as following care instructions or providing a reliable health history, may be considered for additional cognitive screening. In cases where cognitive impairment is identified, healthcare professionals are encouraged to evaluate an individual’s daily functioning through neuropsychological screenings. These screenings assess different areas of brain function that impact behavior and can provide a more comprehensive understanding of the individual’s cognitive strengths and weaknesses.

To prevent cognitive impairment from worsening after a stroke, it is crucial to take steps to prevent another stroke. This can be achieved by addressing risk factors such as high blood pressure, high cholesterol, Type 2 diabetes, and atrial fibrillation. Effective blood pressure control has been linked to a reduced risk of recurrent stroke and mild cognitive impairment.

Although the development of cognitive impairment after a stroke is not yet fully understood, there are additional factors beyond the brain that could contribute, such as infection, frailty, and social factors.

To determine the best approach for cognitive screening after a stroke, more research is necessary, according to the statement. This should include the development and utilization of screening tools that account for demographic, cultural, and linguistic factors when assessing “normal” function.

“Perhaps the most pressing need, however, is the development of effective and culturally relevant treatments for post-stroke cognitive impairment,” El Husseini added.

“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.”

Source: 10.1161/STR.0000000000000430

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