Abstract
BackgroundPost stroke cognitive difficulties are common but generally prioritised below other impairments. In the UK, clinical guidelines recommend a holistic review at six-months post-stroke including an assessment of cognitive function. In order to assist clinicians to provide better care for patients with post-stroke cognitive deficits and assist with service planning, our aim was to establish professional consensus on key actions at the six-month review.MethodsAn electronic Delphi survey was developed with ten potential actions for clinicians to prioritise across five different clinical scenarios describing patients with cognitive difficulties. Scenarios varied in terms of age of the stroke-survivor, stroke severity and use of dementia risk assessment. A panel of professional volunteers was obtained through the British Association of Stroke Physicians and the UK National Stroke Nursing Forum.ResultsForty-five stroke clinicians completed round one, with 21 participants completing round two. Priorities consistently supported by professionals included access to psychological services, screening for a mood disorder and ensuring multi-professional input. Direct access to specialist memory services was not generally supported unless a dementia risk assessment tool indicated that the individual was at high risk of dementia.ConclusionsAssessment of post-stroke cognitive deficits needs to be routinely considered during the six-month review. A formal risk assessment tool could be a way to streamline direct access to memory clinic services to ensure that individuals at-risk of dementia receive ongoing care.
Highlights
Post stroke cognitive difficulties are common but generally prioritised below other impairments
It is recommended that all stroke survivors receive a sixmonth review including a cognitive assessment, but there is no standardisation of content for general or specific patient groups
Direct access to memory clinics was approved if a risk assessment tool was used to identify individuals that were at high risk of developing dementia
Summary
Post stroke cognitive difficulties are common but generally prioritised below other impairments. In the UK, clinical guidelines recommend a holistic review at six-months post-stroke including an assessment of cognitive function. As part of longterm post-stroke care, the National Stroke strategy had previously recommended that all stroke survivors should have a six-month review [10] the clinician conducting these reviews can vary [11]. This was further emphasised in care guidelines produced by the National Institute for Health and Care Excellence [12]. They found that 77% of stroke survivors have problems with their memory with nearly 50% rating the support they received for memory problems and fatigue as poor [15]
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