What percentage of patients with minor stroke require neuropsychological follow-up in the chronic phase of stroke?

From the Guidelines

Approximately 50% of patients with minor stroke require neuropsychological follow-up in the chronic phase of stroke. This significant proportion reflects the fact that even minor strokes can lead to persistent cognitive deficits, emotional changes, and functional limitations that may not be immediately apparent during acute care. These subtle impairments often become more evident as patients return to their daily activities and face cognitive demands. According to a recent study published in 2023 1, the prevalence of post-stroke cognitive impairment (PSCI) was found to be 59% at 3 months and 51% at 18 months in a cohort of mostly mild stroke patients. Another cohort study found that the overall frequency of 3-month PSCI was 47.3% in individuals with mild stroke 1. Neuropsychological follow-up typically involves comprehensive assessment of cognitive domains including attention, memory, executive function, language, and processing speed, along with evaluation of mood and adjustment. Early identification of these issues through follow-up at 3-6 months post-stroke allows for timely intervention with cognitive rehabilitation, compensatory strategies, and psychological support, potentially improving long-term outcomes and quality of life. The need for follow-up may be higher in patients with pre-existing cognitive vulnerabilities, older age, or strokes affecting regions associated with cognitive function. Key aspects to consider in neuropsychological follow-up include:

• Comprehensive cognitive assessment
• Evaluation of mood and adjustment
• Timely intervention with cognitive rehabilitation and compensatory strategies
• Consideration of pre-existing cognitive vulnerabilities and stroke location.

From the Research

Neuropsychological Follow-up in Minor Stroke Patients

• The provided studies do not directly address the percentage of patients with minor stroke who require neuropsychological follow-up in the chronic phase of stroke.
• However, study 2 highlights the importance of understanding the long-term impact of mini-stroke, including cognitive impairments, and the need for optimal care post-TIA/minor stroke.
• Study 3 discusses the prevalence of post-stroke cognitive impairment and the need for effective cognitive rehabilitation interventions, but does not provide specific information on the percentage of patients requiring neuropsychological follow-up.

Cognitive Impairment and Rehabilitation

• Studies 4, 5, and 6 investigate the use of selective serotonin reuptake inhibitors (SSRIs) for stroke recovery, including their effects on cognitive function and depression.
• These studies suggest that SSRIs may have a positive effect on cognitive recovery, but the evidence is not conclusive, and more research is needed to determine their effectiveness.
• Study 3 aims to compare the efficacy of cognitive rehabilitation interventions for patients with post-stroke cognitive impairment, but the results are not yet available.

Need for Further Research

• The available evidence highlights the need for further research on the long-term impact of minor stroke and the effectiveness of cognitive rehabilitation interventions.
• Study 2 emphasizes the importance of involving stakeholders in setting research priorities to increase the relevance of research and reduce research waste.
• More studies are needed to determine the percentage of patients with minor stroke who require neuropsychological follow-up and to develop effective interventions to improve their cognitive function and quality of life.