March 18, 2013
Taking Action for the Management of Mood and Cognition Following Stroke
Taking Action in the areas of mood and cognition following stroke is critical. The occurrence of post-stroke depression and changes to cognition (vascular cognitive impairment), even if subtle, affect up to 30% to 60% of patients who have experienced a stroke within the first year after onset. Of equal concern is the large number of family members and informal caregivers who also may experience depressive symptoms in the post-stroke recovery phase. The first steps for healthcare professionals in Taking Action for mood and cognition are to understand the frequency of occurrence and build screening for the symptoms of depression and vascular cognitive impairment into regular workflows. Screening should occur through all stages and settings following a stroke, including in acute care, rehabilitation, prevention clinics and outpatient community settings (including primary care, home care and long-term care).
Taking Action to address mood and cognition issues involves healthcare providers, policy makers, patients, and caregivers. An essential component of Taking Action for mood and cognition issues is to have access to specially trained providers with expertise in mental health and cognition. Ideally, when screening is suggestive of a mood or cognition issue, patients and families should be referred to these clinical experts without delay to facilitate access to appropriate in-depth assessment and management, and to receive support and education for coping and self-management.
Recent reports on the quality of stroke services across Canada and within specific provinces have shown that there is inconsistent screening and monitoring of patients for post-stroke depression and vascular cognitive functioning issues, in both urban and rural settings. Delays in comprehensive assessment and management of mood and cognition issues may result in poor outcomes and slower recovery.
Highlights of the 2013 Update to the Management of Mood and Cognition Following Stroke
The 2013 update of the Mood and Cognition Chapter of the Canadian Best Practice Recommendations for Stroke Care reinforces the growing and changing body of research evidence available to better understand the mechanisms involved in post stroke depression and vascular cognitive impairment as well as optimal management. Active screening throughout the continuum of care is emphasized throughout this chapter.
The recommendations and evidence presented in this chapter are applicable to most adults who experience a stroke. This is because the current research evidence is strongest for patients between 40 years and 80 years of age. Given the current state of the evidence, care of each patient with stroke should be individualized to meet the needs of that patient, and therefore some modifications of the recommendations may be required in certain patient populations. These groups may include children with stroke (age newborn to 18 years), young adults who have experienced a stroke (age 19 to 44 years), and the elderly stroke population (over the age of 80 years). The evidence to support unique management needs for these groups is just starting to emerge. Where possible and appropriate, additional recommendations and comments have been included within the recommendations, and supporting sections to address specific considerations for these groups.
Highlights of the 2013 updates to the recommendations for the management of mood and cognition following stroke include:
- Increased guidance on management options for post stroke depression
- Revised definitions for vascular cognitive impairment
- Updates on medication use in vascular cognitive impairment
Management of Mood and Cognition, 2013 Update Resource Package Includes:
- Mood and Cognition Stroke Best Practice Recommendations
- Prevention of Stroke Educational Slide Decks
- Tables of Screening and Outcome Measurement Tools for Depression and Vascular Cognitive Impairment
- Tables describing the characteristics of commonly used medications for post stroke depression and vascular cognitive impairment
Development of the Canadian Best Practice Recommendations for Stroke Care
For detailed methodology on the development and dissemination of the Canadian Best Practice Recommendations for Stroke Care please refer to the stroke best practices website at http://www.strokebestpractices.ca/index.php/methods/.
The Canadian Stroke Network and the Heart and Stroke Foundation gratefully acknowledges the writing group leader Dr. Gail Eskes and all group members, the external reviewers, all of who volunteered their time and expertise to this project. This chapter was developed in collaboration with the Evidence Based Review in Stroke Rehabilitation group, including Dr. Robert Teasel, Katherine Salter, Norine Foley and Andrew McClure, and their efforts are greatly appreciated. We thank the Canadian Stroke Performance and Quality Committee for their work in updating and confirming the performance measures that accompany each recommendation. We acknowledge Elena Goubanova and Corrine Davies-Schinkel for their work on meeting coordination and project support; and, we thank Marie-France Saint-Cyr and Jan Carbon for their work on the French translations.
The development of these Canadian stroke care guidelines is funded in its entirety by the Canadian Stroke Network, which is in turn funded by the Networks of Centres of Excellence program. No funds for the development of these guidelines come from commercial interests, including pharmaceutical companies. All members of the recommendation writing groups and external reviewers are volunteers and do not receive any remuneration for participation in guideline development, updates and reviews.
Citing the Management of Mood and Cognition in Stroke Update 2013
Eskes G, Salter K, on behalf of the Mood and Cognition in Stroke Writing Group and the Evidence-Based Review in Stroke Rehabilitation Team. Chapter 7: Mood and Cognition in Stroke.
In Lindsay MP, Gubitz G, Bayley M, and Phillips S (Editors) on behalf of the Canadian Stroke Best Practices and Standards Advisory Committee. Canadian Best Practice Recommendations for Stroke Care: 2013; Ottawa, Ontario Canada: Canadian Stroke Network.
We invite comments, suggestions, and inquiries on the development and application of the Canadian Best Practice Recommendations for Stroke Care and ongoing updates.
Please forward comments to the Canadian Stroke Network’s Performance and Standards office at firstname.lastname@example.org