European Stroke Organisation and European Academy of Neurology joint guidelines on post-stroke cognitive impairment.
Authors
Richard, Edo
Gattringer, Thomas
Hafdi, Melanie
O'Brien, John T
Merriman, Niamh
Gillebert, Celine
Huyglier, Hanne
Verdelho, Ana
Schmidt, Reinhold
Ghaziani, Emma
Forchammer, Hysse
Pendlebury, Sarah T
Mijajlovic, Milija
Markus, Hugh S
Publication Date
2021-09Journal Title
Eur Stroke J
ISSN
2396-9873
Publisher
SAGE Publications
Volume
6
Issue
3
Pages
I-XXXVIII
Language
en
Type
Article
This Version
VoR
Metadata
Show full item recordCitation
Quinn, T. J., Richard, E., Teuschl, Y., Gattringer, T., Hafdi, M., O'Brien, J. T., Merriman, N., et al. (2021). European Stroke Organisation and European Academy of Neurology joint guidelines on post-stroke cognitive impairment.. Eur Stroke J, 6 (3), I-XXXVIII. https://doi.org/10.1177/23969873211042192
Abstract
The optimal management of post-stroke cognitive impairment remains controversial. These joint European Stroke Organisation (ESO) and European Academy of Neurology (EAN) guidelines provide evidence-based recommendations to assist clinicians in decision making around prevention, diagnosis, treatment and prognosis. These guidelines were developed according to ESO standard operating procedure and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology. The working group identified relevant clinical questions, performed systematic reviews and, where possible, meta-analyses of the literature, assessed the quality of the available evidence and made specific recommendations. Expert consensus statements were provided where insufficient evidence was available to provide recommendations based on the GRADE approach. There was limited randomised controlled trial evidence regarding single or multicomponent interventions to prevent post-stroke cognitive decline. Interventions to improve lifestyle and treat vascular risk factors may have many health benefits but a beneficial effect on cognition is not proven. We found no evidence around routine cognitive screening following stroke but recognise the importance of targeted cognitive assessment. We described the accuracy of various cognitive screening tests but found no clearly superior approach to testing. There was insufficient evidence to make a recommendation for use of cholinesterase inhibitors, memantine nootropics or cognitive rehabilitation. There was limited evidence on the use of prediction tools for post-stroke cognitive syndromes (cognitive impairment, dementia and delirium). The association between post-stroke cognitive impairment and most acute structural brain imaging features was unclear, although the presence of substantial white matter hyperintensities of presumed vascular origin on acute MRI brain may help predict cognitive outcomes. These guidelines have highlighted fundamental areas where robust evidence is lacking. Further, definitive randomised controlled trials are needed, and we suggest priority areas for future research.
Keywords
Guidelines, Cognition, dementia, diagnosis, guidelines, stroke, prognosis
Identifiers
10.1177_23969873211042192
External DOI: https://doi.org/10.1177/23969873211042192
This record's URL: https://www.repository.cam.ac.uk/handle/1810/330198
Rights
Embargo: ends 2021-10-08
Licence:
https://creativecommons.org/licenses/by/4.0/
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