8th August 2024

Cognitive impairment

Chronic neurological conditions such as stroke can be life changing. Up to 75% of patients are left with some degree of cognitive impairment following a stroke. This may be global or in a specific domain. Two thirds of patients suffer from post-stroke fatigue at six months; no therapy has been proven beneficial for this.

Mood disorders

Up to a third of patients suffer from depression at some point following a stroke and a quarter from anxiety. Mood disturbance and emotional lability may be transient and related to the event, resolving as function and life return to normal. However, depression can negatively impact rehabilitation, reduce independence and functional outcomes and increase mortality.

• Detection: patients should routinely be assessed for mood and cognition disorders throughout follow up, with access to psychological services as part of the MDT.
• Pharmacotherapy: SSRIs are often first line pharmacological treatment in the management of depression but treatment should follow current guidance and be guided by patient discussion.

Communication disorders

Following a stroke, patients may be left with a degree of aphasia, alexia, acalculia or agraphia, impacting independence and quality of life. Key types of aphasia are:

Capacity

Following a stroke, patients may lose capacity to make certain decisions in the short or long-term. It is important that disorders of communication are not confused with lack of capacity. The MDT, particularly speech and language therapists (SLT), must be involved to assist with assessing capacity and help with decision making. This is to ensure all efforts are taken to provide the information in a way understandable to the patient and to understand responses which may not be verbal.