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Review
. 2023 Nov 29;12(23):7413.
doi: 10.3390/jcm12237413.

Post-Stroke Brain Health Monitoring and Optimization: A Narrative Review

Eric L Stulberg  1 , Perminder S Sachdev  2   3 , Anne M Murray  4   5 , Steven C Cramer  6   7 , Farzaneh A Sorond  8 , Kamakshi Lakshminarayan  9 , Behnam Sabayan  9   10
Affiliations
Review

Post-Stroke Brain Health Monitoring and Optimization: A Narrative Review

Eric L Stulberg et al. J Clin Med. .

Abstract

Significant advancements have been made in recent years in the acute treatment and secondary prevention of stroke. However, a large proportion of stroke survivors will go on to have enduring physical, cognitive, and psychological disabilities from suboptimal post-stroke brain health. Impaired brain health following stroke thus warrants increased attention from clinicians and researchers alike. In this narrative review based on an open timeframe search of the PubMed, Scopus, and Web of Science databases, we define post-stroke brain health and appraise the body of research focused on modifiable vascular, lifestyle, and psychosocial factors for optimizing post-stroke brain health. In addition, we make clinical recommendations for the monitoring and management of post-stroke brain health at major post-stroke transition points centered on four key intertwined domains: cognition, psychosocial health, physical functioning, and global vascular health. Finally, we discuss potential future work in the field of post-stroke brain health, including the use of remote monitoring and interventions, neuromodulation, multi-morbidity interventions, enriched environments, and the need to address inequities in post-stroke brain health. As post-stroke brain health is a relatively new, rapidly evolving, and broad clinical and research field, this narrative review aims to identify and summarize the evidence base to help clinicians and researchers tailor their own approach to integrating post-stroke brain health into their practices.

Keywords: brain health; cognitive impairment; recovery; rehabilitation; stroke.

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Conflict of interest statement

Perminder S. Sachdev reported serving as a consultant for Biogen and Roche. Steven C. Cramer reported serving as a consultant for Abbvie, Constant Therapeutics, BrainQ, Myomo, MicroTransponder, Neurolutions, Panaxium, NeuExcell, Elevian, Helius, Omniscient, Brainsgate, Nervgen, Battelle, and TRCare. Farzaneh A. Sorond reported serving as a consultant for Stryker Neurovascular and has received research support from the National Institute of Neurological Disorders and Stroke within the National Institutes of Health. Kamakshi Lakshminarayan has served as an editorial advisory board member for the journal Stroke, has served as a consultant for Abbott Labs, and has received research support from the National Institutes of Health (grant numbers: R01 HL138332, 1K24AG078506, 5U24NS107269, 1U19NS115388). Eric L. Stulberg, Anne M. Murray, and Behnam Sabayan report no disclosures or conflicts of interest relevant to this article. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Figures

Figure 1
Figure 1
Domains of post-stroke brain health and examples of tools for domain-specific monitoring [25,27,28,32,33,34,35,36]. Key: MoCA = Montreal Cognitive Assessment; NINDS-CSN = National Institute of Neurological Disorders and Stroke—Canadian Stroke Network; PSCID = post-stroke cognitive impairment and dementia; DOC = depression, obstructive sleep apnea, cognition; PHQ-9 = Patient Health Questionnaire-9; CES-D = Center for Epidemiologic Studies Depression Scale; HDRS = Hamilton Depression Rating Scale; Hospital Anxiety and Depression Scale—Anxiety; BOA = Behavioral Outcomes of Anxiety Scale; GAI = Geriatric Anxiety Inventory; FAS = Fatigue Assessment Scale.
Figure 2
Figure 2
Stepwise approach to achieve and maintain post-stroke brain health.
See this image and copyright information in PMC

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