Potential challenges to harmonize post-stroke cognitive assessment and its prognostic value: a narrative review

Abstract

With advances in scientific and clinical knowledge, stroke has evolved from a major cause of death to a chronic condition affecting the daily lives of sufferers, their relatives, and society. Post-stroke cognitive impairment (PSCI) is common even among individuals with good neurological recovery. When deciding on interventions aimed to improve the life quality of post-stroke patients, identifying those at high risk of cognitive decline proves crucial. Given the complexity of PSCI assessment, this narrative review discusses the feasibility of developing standardized criteria for selecting cognitive instruments. Potential approaches for establishing harmonized procedures for post-stroke cognitive assessment are presented depending on how the cognitive impairment is defined, the cognitive domains examined, the methods used to generalize cognitive data by components/domains, and their normalization against standardized normative samples. The prognostic value of cognitive assessment to identify patients at high risk of PSCI, functional dependence, and poor survival is also discussed. Implementing harmonized criteria for assessing the cognitive status of stroke patients could reduce the now considerable heterogeneity between studies and serve as a reliable basis for determining the prevalence and predicting the occurrence/aggravation of PSCI.

Keywords: ACE-R, Addenbrooke's Cognitive Examination-Revised;; AUC, area under the curve;; CI, confidence interval;; DSM-5, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition;; HR, hazard ratio;; ICH, intracerebral hemorrhage;; IST, Isaacs Set Test;; MCI, mild cognitive impairment;; MMSE, Mini-Mental State Examination;; MoCA, Montreal Cognitive Assessment;; NIHSS, National Institutes of Health Stroke Scale;; NPV, negative predictive value;; OCS, Oxford Cognitive Screen;; OR, odds ratio;; PPV, positive predictive value;; PSCI; PSCI, post-stroke cognitive impairment;; SD, standard deviation;; TIA, transient ischemic attack;; VASCOG, Vascular Behavioral and Cognitive Disorders;; VCD,vascular cognitive disorders; cognitive assessment; harmonized criteria; mRS, modified Rankin scale;; prognosis; stroke.

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Article selection flowchart

Figure 2

Post-stroke cognitive assessment. The recommended criteria for harmonizing cognitive assessment are represented in gray rectangles. DSM-5, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition; NPV, negative predictive value; PPV, positive predictive value; PSCI, post-stroke cognitive impairment; VASCOG, Vascular Behavioral and Cognitive Disorders.

Figure 3

Prognostic value of Montreal Cognitive Assessment. MoCA, Montreal Cognitive Assessment; PSCI, post-stroke cognitive impairment