Cognitive rehabilitation interventions after stroke: protocol for a systematic review and meta-analysis of randomized controlled trials

Abstract

Background Stroke is the second leading cause of death worldwide, and 53.4% of stroke survivors suffer from post-stroke cognitive impairment. Post-stroke cognitive impairment can increase hospitalization rate and cost of care and decrease the quality of life of stroke patients. To date, multiple cognitive rehabilitation interventions have been tested in stroke populations with post-stroke cognitive impairment. However, the most efficacious intervention has not been established. This systematic review aims to compare the efficacy of cognitive rehabilitation interventions for patients with post-stroke cognitive impairment. Methods We will search MEDLINE, EMBASE, CENTRAL, PsycINFO, CINAHL, PubMed, and clinical trial registries to identify eligible randomized clinical trials with no restrictions in the date of publication and language. Studies conducted with patients aged 18 or over, with the presence of cognitive impairment after being diagnosed with stroke will be included. Studies will be restricted to randomized controlled trials comparing a cognitive rehabilitation intervention with another intervention. The primary outcome is any clinical changes in the general or specific cognitive domain (e.g., executive function, attention, memory, or perception). The secondary outcomes that will be collected include adverse effects (e.g., stroke, disability, or mortality) and quality of life. Two independent reviewers will assess articles to identify trials eligible for inclusion. Data extraction and risk of bias assessment of the included studies will also be done independently. Any discrepancies will be solved by discussion, or a third reviewer will be consulted if necessary. A meta-analysis will be carried out if appropriate. Discussion This systematic review for patients with post-stroke cognitive impairment will assess the efficacy of cognitive rehabilitation interventions. And our results will help clinical decision-making and support the development of clinical practice guidelines. Trial registration Systematic review registration: PROSPERO CRD42020173988

Resting-State Beta-Band Recovery Network Related to Cognitive Improvement After Stroke

“…Restoration interventions aim to regain the cognitive abilities of stroke patients, including domain-specific interventions and treatments for generalized cognitive impairment (10). The patients of our study received an integrated treatment based on the holistic-comprehensive model proposed by Ben-Yishay and Diller (41), which is consistent with the interventions suggested by some experts in post-stroke cognitive rehabilitation in terms of their global treatment approach.…”

“…In addition, if stroke is a central factor in the development of cognitive impairment, or if this depends on the severity, subtype, location, or its recurrence, it becomes essential to understand the brain mechanisms that produce both deficits and their recovery. There is agreement around the idea that cognitive rehabilitation interventions aim to improve the impaired brain functions in stroke patients, and that it must be related to the damaged anatomical substrate (10). Usually, rehabilitation facilitates the development of behavioral and cognitive strategies that have a positive impact on the structural and functional recovery of the brain (53,59).…”

“…These patients may have damage in general cognitive performance with important functional disability, which has been broadly reported in the scientific literature (7)(8)(9). Although stroke tends to impact on attention and executive function compared with its impact on memory, a malfunction in these cognitive domains could worsen the performance in other cognitive areas (3,4,6,10). In any case, it is important to highlight the role of non-pharmacological rehabilitation especially neuropsychological rehabilitation (NR) in order to improve cognitive abilities and daily functions (10,11).…”

“…Although stroke tends to impact on attention and executive function compared with its impact on memory, a malfunction in these cognitive domains could worsen the performance in other cognitive areas (3,4,6,10). In any case, it is important to highlight the role of non-pharmacological rehabilitation especially neuropsychological rehabilitation (NR) in order to improve cognitive abilities and daily functions (10,11). Neuropsychological rehabilitation is a systematic therapeutic activity oriented functionally based on the assessment and understanding of the cognitive deficits, emotional disturbances, disruptive behaviors, and functional disorders of patients (12,13), and includes interventions that might be compensatory, educational, or restorative (10).…”

Intensive care‐related cognitive impairment: A biopsychosocial overview

“…Although several factors have been explored as predictors (eg, level of education, illness severity, emotional distress, socioeconomic status), cognition has been shown to be one of the most prominent predictors of reduced or loss of employment 158 . Consequently, both restorative (eg, computer‐based cognitive training paradigms designed to modify brain structure and function) and compensatory (eg, applying environmental modifications to bypass cognitive and functional deficits) interventions have been shown to be effective at mitigating cognitive difficulties to varying degrees across several clinical populations 159‐162 …”