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Mood, Cognition & Fatigue

Mood, Cognition and Fatigue following Stroke Module Overview

Working Together with Stroke Survivors and their Caregivers to Achieve Optimal Outcomes is an imperative within the areas of mood, cognition and fatigue following stroke. 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, and the timing of symptoms may vary from within a few weeks to a year or more after the stroke has occurred.

The primary underpinnings of this chapter on cognitive and mood changes after stroke require individuals with stroke, their families and healthcare team members to work together to identify risk areas, agree on goals for treatment and recovery, and implement appropriate management strategies. This theme applies across the system of care, and emphasizes the participation of individuals with stroke, their families and caregivers, healthcare providers, and the broader community.

The first steps for healthcare professionals in Working Together for mood and cognition are to understand the frequency of occurrence and build screening for the symptoms of depression, vascular cognitive impairment, and post-stroke fatigue into regular workflows. Achieving optimal outcomes for stroke survivors and their families requires ongoing screening and assessment for mood and cognitive changes. 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).

Working Together involves healthcare providers, policy makers, individuals with stroke, their families and caregivers, and the public. It should ensure timely access to clinicians with expertise in treating these issues, and ongoing monitoring of the effects of treatment and goal attainment. 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. Continuity of care and strong communication among healthcare professionals, and between members of the healthcare team and the patient and their family are critical to smooth transitions between care settings and for ensuring that issues related to mood, cognition and fatigue do not fall through the cracks.

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.

Notable Changes in the Mood, Cognition and Fatigue Following Stroke 2015 Update

The 2015 update of the Canadian Stroke Best Practice Recommendations Mood, Cognition and Fatigue module reinforces the growing and changing body of research evidence available to guide screening, assessment and management of these conditions following stroke. A coordinated and organized approach to screening and assessment as well as appropriate management is emphasized throughout this chapter.

In some areas, the research evidence is weaker or just starting to emerge. For some of these topics, the writing group was able to provide preliminary guidance based on expert opinion and current clinical practices.

Highlights of the moderate and significant updates as well as new additions to the Mood, Cognition and Fatigue module recommendations for 2015 include:

  • Updated recommendations on the timing of screening for depression and VCI
  • New literature incorporated which suggests that prophylactic antidepressant medication can be effective in some stroke patients.
  • New comparison table of selected antidepressants for management of post-stroke depression;
  • New information on cognitive rehabilitation strategies for patients with vascular cognitive impairment;
  • Updated comparison table of assessment tools for screening for vascular cognitive impairment
  • Addition of post-stroke fatigue recommendations to this module (previously included in Transitions of Care following Stroke module)

Guideline Development Methodology:

The detailed methodology and explanations for each of these steps in the development and dissemination of the Canadian Stroke Best Practice Recommendations is available in the Canadian Stroke Best Practice Recommendations Overview and Methodology manual available on the Canadian stroke best practices website at http://www.strokebestpractices.ca/wp-content/uploads/2014/08/CSBPR2014_Overview_Methodology_ENG.pdf

Citing the Mood, Cognition and Fatigue following Stroke 2015 Module

Eskes G, Lanctot K on behalf of the Mood, Cognition and Fatigue following Stroke Writing Group. Mood, Cognition and Fatigue following Stroke Module 2015. In Lindsay MP, Gubitz G, Bayley M, and Smith EE (Editors), on behalf of the Canadian Stroke Best Practices and Advisory Committee. Canadian Stroke Best Practice Recommendations, 2015; Ottawa, Ontario Canada: Heart and Stroke Foundation.

Comments

We invite comments, suggestions, and inquiries on the development and application of the Canadian Stroke Best Practice Recommendations.

Please forward comments to the Heart and Stroke Foundation’s Stroke Team at strokebestpractices@hsf.ca

Mood, Cognition and Fatigue Following Stroke Module Contents: