Cognitive assessment after stroke: A qualitative study of patients’ experiences

Abstract

ObjectivesClinical guidelines recommend early cognitive assessment after stroke to inform rehabilitation and discharge decisions. However, little is known about stroke survivors’ experiences of the cognitive assessment process. This qualitative study aimed to explore patients’ experiences of poststroke cognitive assessments.DesignStroke survivors were purposively sampled in an iterative process through a pool of research volunteers who had previously taken part in the Oxford Cognitive Screen Recovery study. Stroke survivors and their family caregivers were invited to participate in a semistructured interview steered by a topic guide. Interviews were audio recorded, transcribed and analysed using reflexive thematic analysis. Demographic, clinical and cognitive data were acquired from patients’ previous research data.SettingStroke survivors were originally recruited from the acute inpatient unit at Oxford University Hospital (John Radcliffe), UK. Participants were interviewed after discharge either at their homes or via telephone or videocall.ParticipantsTwenty-six stroke survivors and eleven caregivers participated in semi-structured interviews.ResultsWe identified three key phases of the cognitive assessment process and themes pertaining to each phase. The phases (numbered) and themes (lettered) were as follows: (1) before the cognitive assessment: (A) lack of explanation, (B) considering the assessment useless; (2) during the cognitive assessment: varied emotional responses, moderated by (D) perception of the purpose behind cognitive assessment, (E) perception of cognitive impairment, (F) confidence in cognitive abilities, (G) assessment administration style and (3) after the cognitive assessment: (H) feedback can impact self-confidence and self-efficacy, (I) vague feedback and clinical jargon are unhelpful.ConclusionsStroke survivors require clear explanations about the purpose and outcomes of poststroke cognitive assessments, including constructive feedback, to promote engagement with the process and protect their psychological wellbeing.

Domain-specific cognitive impairment 6 months after stroke: The value of early cognitive screening

“… IQR: interquartile range; CCI: Charlson Comorbidity Index; NIHSS: National Institute of Health Stroke Scale. CCI scored based on ICD-10 scoring scheme through hospital records. Population data inclusive of these patients (Oxford Vascular Study) 22 indicate the predominant ethnicity (>90%) was White British. a Vascular supply is a crude characterization of primary territory affected. b NIHSS recorded for n = 320 (74%) due to not being recorded before 2014. c Premorbid modified Rankin Scale (mRS) reported for n = 248 (58%). d Barthel index was reported for n = 141 (33%). e Dependence was categorized as requiring formal support. …”

“… CCI scored based on ICD-10 scoring scheme through hospital records. Population data inclusive of these patients (Oxford Vascular Study) 22 indicate the predominant ethnicity (>90%) was White British. …”

“…However, persistent impairments were also found across all domains, particularly memory and language deficits. Each post-stroke cognitive profile is unique and highlighting different strengths and weaknesses in performance early allows for more accurate information to be communicated to the patient, 22 more tailored discharge care packages and appropriate allocation of rehabilitation resources.…”

Feasibility, comprehensibility and acceptability of the VISION-Cog, a novel tool to assess cognitive impairment in visually impaired older adults: a cross-sectional pilot study in Singapore

“…15 We also aimed to balance other demographic characteristics within each group, including age, sex and language. 16 Participant recruitment, test administration and test revision were conducted iteratively until the VISION-Cog met the criteria of feasibility, comprehensibility and acceptability. 15 16 The study was performed at the Singapore Eye Research Institute research clinic located at the Singapore National Eye Centre.…”