Addressing post-stroke cognitive impairment through innovative application of health psychology principles

Abstract

Background: 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.