TY - JOUR
T1 - European Stroke Organisation and European Academy of Neurology joint guidelines on post-stroke cognitive impairment
AU - Quinn, Terence J.
AU - Richard, Edo
AU - Teuschl, Yvonne
AU - Gattringer, Thomas
AU - Hafdi, Melanie
AU - O'Brien, John T.
AU - Merriman, Niamh
AU - Gillebert, Celine
AU - Huygelier, Hanne
AU - Verdelho, Ana
AU - Schmidt, Reinhold
AU - Ghaziani, Emma
AU - Forchammer, Hysse
AU - Pendlebury, Sarah T.
AU - Bruffaerts, Rose
AU - Mijajlovic, Milija
AU - Drozdowska, Bogna A.
AU - Ball, Emily
AU - Markus, Hugh S.
N1 - Funding Information: The authors thank the Cochrane Dementia Group for assisting with search strategy and identification of papers. Dana Wong (La Trobe University, Australia) provided expert external review. Hana Mal? Rytter (Bispebjerg and Frederiksberg Hospital, Denmark), Maria Nordfang and Kristoffer Petterson (Rigshospitalet-Glostrup, Denmark) assisted with scope and focus of the cognitive rehabilitaton PICO. Publisher Copyright: © 2021 European Academy of Neurology and European Stroke Organisation
PY - 2021/12
Y1 - 2021/12
N2 - Background and purpose: The optimal management of post-stroke cognitive impairment (PSCI) 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 regarding prevention, diagnosis, treatment and prognosis. Methods: Guidelines were developed according to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology. The working group identified relevant clinical questions, performed systematic reviews, assessed the quality of the available evidence, and made specific recommendations. Expert consensus statements were provided where insufficient evidence was available to provide recommendations. Results: There was limited randomized controlled trial (RCT) evidence regarding single or multicomponent interventions to prevent post-stroke cognitive decline. Lifestyle interventions and treating vascular risk factors have many health benefits, but a cognitive effect is not proven. We found no evidence regarding routine cognitive screening following stroke, but recognize the importance of targeted cognitive assessment. We describe 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 cognition. The association between PSCI and acute structural brain imaging features was unclear, although the presence of substantial white matter hyperintensities of presumed vascular origin on brain magnetic resonance imaging may help predict cognitive outcomes. Conclusions: These guidelines highlight fundamental areas where robust evidence is lacking. Further definitive RCTs are needed, and we suggest priority areas for future research.
AB - Background and purpose: The optimal management of post-stroke cognitive impairment (PSCI) 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 regarding prevention, diagnosis, treatment and prognosis. Methods: Guidelines were developed according to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology. The working group identified relevant clinical questions, performed systematic reviews, assessed the quality of the available evidence, and made specific recommendations. Expert consensus statements were provided where insufficient evidence was available to provide recommendations. Results: There was limited randomized controlled trial (RCT) evidence regarding single or multicomponent interventions to prevent post-stroke cognitive decline. Lifestyle interventions and treating vascular risk factors have many health benefits, but a cognitive effect is not proven. We found no evidence regarding routine cognitive screening following stroke, but recognize the importance of targeted cognitive assessment. We describe 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 cognition. The association between PSCI and acute structural brain imaging features was unclear, although the presence of substantial white matter hyperintensities of presumed vascular origin on brain magnetic resonance imaging may help predict cognitive outcomes. Conclusions: These guidelines highlight fundamental areas where robust evidence is lacking. Further definitive RCTs are needed, and we suggest priority areas for future research.
KW - cognition
KW - dementia
KW - diagnosis
KW - guidelines
KW - prognosis
KW - stroke
UR - http://www.scopus.com/inward/record.url?scp=85114887054&partnerID=8YFLogxK
U2 - https://doi.org/10.1111/ene.15068
DO - https://doi.org/10.1111/ene.15068
M3 - Article
C2 - 34476868
SN - 1351-5101
VL - 28
SP - 3883
EP - 3920
JO - European journal of neurology
JF - European journal of neurology
IS - 12
ER -