[Cognitive impairment after stroke--diagnosis and management]

Abstract

Background: An incidence of stroke is often followed by cognitive impairment. This review article presents an update about such impairment and emphasises diagnostical and therapeutical challenges.

Material and method: This article is based mainly on literature identified on Medline using the terms "cognitive impairment and stroke," "dementia and stroke," "vascular dementia" and "vascular cognitive impairment."

Results and interpretation: Cognitive impairment after stroke varies with respect to cerebral localisation and the magnitude of injured brain tissue, and may be classified according to neuropsychological profile and neuroanatomical damage. The cognitive domains affected are in particular executive functions, motor and psychomotor abilities (mapped by speeded tests) and attention. Executive function comprises planning, organising, conducting, assessing and controlling actions. The neuropathological basis for these cognitive domains is mainly located in frontal subcortical brain areas. Cognitive impairment can be identified using neuropsychological tests as verbal fluency (FAS) corresponding to executive function, digit span (psychomotor abilities) and finger-tapping (motor speed). The Mini Mental State Examination test is of limited diagnostic help, but is recommended due to the need of a global cognitive functioning measure. The treatment recommended comprises sound measures for secondary prevention of stroke directed towards vascular risk factors. Non-pharmaceutical intervention such as physical training, cognitive and social stimulation probably has a greater therapeutic potential than normally assumed.