A newly designed intensive caregiver education program reduces cognitive impairment, anxiety, and depression in patients with acute ischemic stroke

Abstract

This study aimed to evaluate the effect of a newly designed intensive caregiver education program (ICEP) on reducing cognitive impairment, anxiety, and depression in acute ischemic stroke (AIS) patients. One hundred and ninety-six AIS patients were divided into ICEP group and Control group in a 1:1 ratio using blocked randomization method. In the ICEP group, the caregivers received ICEP, while in the Control group caregivers received usual education and guidance. All patients received conventional rehabilitation treatment. Cognitive impairment (assessed by Mini Mental State Examination (MMSE) score and Montreal Cognitive Assessment (MoCA) score), anxiety (assessed by Hospital Anxiety and Depression Scale (HADS)-A score and Self-rating Anxiety Scale (SAS) score), and depression (assessed by HADS-D score and Self-rating Depression Scale (SDS) score) were assessed at baseline (M0), 3 months (M3), 6 months (M6), and 12 months (M12). Cognitive impairment score at M12 and cognitive impairment score change (M12-M0) were increased, while cognitive impairment rate at M12 was reduced in the ICEP group compared with the Control group. Anxiety score change (M12-M0), anxiety score at M12, and anxiety rate at M12 were decreased in the ICEP group compared with the Control group. Depression score change (M12-M0), depression score at M12, and depression rate at M12 were lower in the ICEP group compared with the Control group. Further subgroup analysis based on baseline features also provided similar results. In conclusion, ICEP effectively reduced cognitive impairment, anxiety, and depression in AIS patients.

Figure 1. Study flow. ICEP: intensive caregiver education program; M0: baseline; M3: 3 months; M6: 6 months; M12: 12 months; MMSE: Mini Mental State Examination; MoCA: Montreal Cognitive Assessment; HADS-A: Hospital Anxiety and Depression Scale-Anxiety; HADS-D: Hospital Anxiety and Depression Scale-Depression; SAS: Zung Self-rating Anxiety Scale; SDS: Zung Self-rating Depression Scale.

Figure 2. Results of the Mini-Mental State Examination (MMSE) (A, B, C) and Montreal cognitive assessment (MoCA) (D, E, F) in patients with acute ischemic stroke who received the intensive caregiver education program (ICEP) and in Control patients. Data are reported as means±SD. *P<0.05 (t-test). NS: non-significant; M0: baseline; M3: 3 months; M6: 6 months; M12: 12 months.

Figure 3. Results of the Hospital Anxiety and Depression Scale-Anxiety (HADS)-A and the Zung Self-rating Anxiety Scale (SAS) in patients with acute ischemic stroke who received the intensive caregiver education program (ICEP) and in Control patients (A, B, E, F). Results on anxiety rate and severity are shown in C, D, G, and H. Data are reported as means±SD. *P<0.05 (t-test). NS, non-significant. M0: baseline; M3: 3 months; M6: 6 months; M12: 12 months.

Figure 4. Results of the Hospital Anxiety and Depression Scale-Depression (HADS)-D and the Zung Self-rating Depression Scale (SDS) in patients with acute ischemic stroke who received the intensive caregiver education program (ICEP) and in Control patients (A, B, E, F). Results on depression rate and severity are shown in C, D, G, and H. Data are reported as means±SD. *P<0.05 (t-test). NS: non-significant. M0: baseline; M3: 3 months; M6: 6 months; M12: 12 months.