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European Stroke Organisation and European Academy of Neurology joint guidelines on post‐stroke cognitive impairment
Author(s) -
Quinn Terence J.,
Richard Edo,
Teuschl Yvonne,
Gattringer Thomas,
Hafdi Melanie,
O'Brien John T.,
Merriman Niamh,
Gillebert Celine,
Huygelier Hanne,
Verdelho Ana,
Schmidt Reinhold,
Ghaziani Emma,
Forchammer Hysse,
Pendlebury Sarah T.,
Bruffaerts Rose,
Mijajlovic Milija,
Drozdowska Bogna A.,
Ball Emily,
Markus Hugh S.
Publication year - 2021
Publication title -
european journal of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.881
H-Index - 124
eISSN - 1468-1331
pISSN - 1351-5101
DOI - 10.1111/ene.15068
Subject(s) - medicine , cognition , stroke (engine) , neurology , hyperintensity , randomized controlled trial , cognitive decline , montreal cognitive assessment , leukoaraiosis , psychological intervention , physical medicine and rehabilitation , evidence based medicine , physical therapy , psychiatry , dementia , cognitive impairment , alternative medicine , magnetic resonance imaging , disease , pathology , mechanical engineering , engineering , radiology
Background and purpose The optimal management of post‐stroke cognitive impairment (PSCI) remains controversial. These joint European Stroke Organisation (ESO) and European Academy of Neurology (EAN) guidelines provide evidence‐based recommendations to assist clinicians in decision making regarding prevention, diagnosis, treatment and prognosis. Methods Guidelines were developed according to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology. The working group identified relevant clinical questions, performed systematic reviews, assessed the quality of the available evidence, and made specific recommendations. Expert consensus statements were provided where insufficient evidence was available to provide recommendations. Results There was limited randomized controlled trial (RCT) evidence regarding single or multicomponent interventions to prevent post‐stroke cognitive decline. Lifestyle interventions and treating vascular risk factors have many health benefits, but a cognitive effect is not proven. We found no evidence regarding routine cognitive screening following stroke, but recognize the importance of targeted cognitive assessment. We describe the accuracy of various cognitive screening tests, but found no clearly superior approach to testing. There was insufficient evidence to make a recommendation for use of cholinesterase inhibitors, memantine nootropics or cognitive rehabilitation. There was limited evidence on the use of prediction tools for post‐stroke cognition. The association between PSCI and acute structural brain imaging features was unclear, although the presence of substantial white matter hyperintensities of presumed vascular origin on brain magnetic resonance imaging may help predict cognitive outcomes. Conclusions These guidelines highlight fundamental areas where robust evidence is lacking. Further definitive RCTs are needed, and we suggest priority areas for future research.