Chapter 7 - Expert Consensus on the Management of Cognitive Impairment after Stroke 2021

Speaker - Dr. Song Haiqing

Song Haiqing
Chief Physician, Xuanwu Hospital, Capital Medical University
Deputy Director of Neurology

Live Broadcast Excerpts

Good evening, I'm Song Haiqing from Xuanwu Hospital of Capital Medical University. I am very glad to share with you the expert Consensus 2021 on the management of cognitive impairment after stroke in about one hour tonight. I look forward to explaining relevant concepts clearly and gaining some unique perspectives in the process of Q&A interaction with you, and the questions generated will supplement our future research work.

The concept of post-stroke cognitive impairment was formally proposed less than ten years ago, and it was only included in the guidelines of Western countries in 2016. Our country is still in the stage of dissemination of concepts, and we are gradually exploring the management system in some mature units. I believe it will become a very important hot issue in the future.

01 Overview of cognitive impairment after stroke

First of all, as a neurologist, I can clearly understand that the disease burden caused by stroke among many diseases of the nervous system is the first in the world. In China, through the verification of epidemiological data, we can find that its stroke incidence rate is one of the highest in the world. The lifetime incidence rate of adults in our country is about 40%, ranking in the forefront of the world. The burden of high morbidity on our society, our patients and their families is very heavy, and the dysfunction caused by stroke limits the ability of patients to return to society.

Post-stroke cognitive impairment (PSCI) is a clinical syndrome characterized by cognitive impairment that occurs after a stroke event and persists up to six months. Due to early recovery from post-stroke delirium and transient cognitive impairment, the diagnosis of PSCI is often determined by a cognitive assessment 3-6 months after stroke.

From a neurological point of view, we know that different types of stroke will increase the cognitive impairment after stroke, it will cause local brain function damage, if the local is affected by cognition, then it will inevitably appear cognitive problems. In addition, once cognitive impairment occurs, it increases the risk of death in post-stroke patients.

Therefore, from the overall conceptual understanding, we can see that post-stroke cognitive impairment brings a heavy burden to society, families and patients, and it causes difficulties in patients' rehabilitation from many aspects, including psychological problems, decline in physical function and damage to social function. Because the ultimate goal of stroke treatment is to enable patients to return to society, and the occurrence of cognitive impairment after stroke leads to a significant decline in patients' ability to return to society and work ability, resulting in a special disability.

02 Guidelines for cognitive impairment after stroke

Canada first issued the "Guidelines for the Treatment of Emotional Cognitive Fatigue after Stroke" in 2015, which emphasizes that the treatment and intervention of patients with vascular cognitive impairment (VCI) after stroke should take into account all aspects of factors, including the following five aspects:

• Emphasize that management should be patient-centered and respect the value and dignity of patients, families and caregivers;
• Intervention goals and measures should take into account the advantages and shortcomings of cognitive and communication skills, and need to be fully evaluated to achieve the strong purpose of intervention;
• The patient's communication or cognitive rehabilitation must be supported by the family, and the patient is encouraged to participate in goal setting and functional reconstruction;
• Interventions should be individualized and based on good evidence-based medical evidence, with a long-term plan of activities and goals to promote rehabilitation;
• If moderate dementia is reached, more attention should be paid to patient education and caregiver support in addition to cognitive recovery.

What really made our understanding of post-stroke cognitive impairment a big step forward was the first "Guidelines for Adult Stroke Rehabilitation and Recovery" published by the American Heart Association (AHA) and Stroke Association (ASA) on May 4, 2016. This guideline provides recommendations for systemic interventions for various brain dysfunctions after stroke. The guideline recommends that stroke patients should receive more cognitive function training and activities, and puts high importance on the recovery of cognitive function after stroke, all of which are first-level recommendations and level A evidence. The guidelines recommend that all stroke patients should be screened for cognitive impairment before discharge, a first-level recommendation, and level-b evidence. The need for interventions to be individualized and staged was also emphasized. Let everyone not only care about the traditional treatment goals, but also pay attention to the cognitive function of patients in an all-round way.

Some experts in our country have also realized that the threat of stroke disease to patients is not only hemiplegia or death, but also that the non-physical dysfunction of patients is as important as the physical dysfunction. In 2017, we started to have the “Expert Consensus on the Management of Cognitive Impairment after Stroke”, and then we have a content that can be followed at the management level for some concepts. Then, with the promotion and promotion of academic organizations, we have some corresponding consensus on the prevention and treatment of cognitive impairment after stroke, the management and screening of stroke patients in outpatient clinics. This year, the relevant experts in 2021 together updated some unclear concepts and unclear management measures in 2017, and we have this “Expert Consensus on the Management of Cognitive Impairment after Stroke 2021”.

Note: The above content is part of the text without changing the original meaning from the speakers. To watch the full live video (in Chinese), please go to Live Broadcast Entrance.