Managing cognitive impairment following stroke: protocol for a systematic review of non-randomised controlled studies of psychological interventions

Abstract

IntroductionStroke is one of the primary causes of death and disability worldwide, leaving a considerable proportion of survivors with persistent cognitive and functional deficits. Despite the prevalence of poststroke cognitive impairment, there is no established treatment aimed at improving cognitive function following a stroke. Therefore, the aims of this systematic review are to identify psychological interventions intended to improve poststroke cognitive function and establish their efficacy.Methods and analysisA systematic review of non-randomised controlled studies that investigated the efficacy of psychological interventions aimed at improving cognitive function in stroke survivors will be conducted. Electronic searches will be performed in the PubMed, Embase and PsycINFO databases, the search dating from the beginning of the index to February 2017. Reference lists of all identified relevant articles will be reviewed to identify additional studies not previously identified by the electronic search. Potential grey literature will be reviewed using Google Scholar. Titles and abstracts will be assessed for eligibility by one reviewer, with a random sample of 50% independently double-screened by second reviewers. Any discrepancies will be resolved through discussion, with referral to a third reviewer where necessary. Risk of bias will be assessed with the Risk of Bias in Non-randomized Studies of Interventions tool. Meta-analyses will be performed if studies are sufficiently homogeneous. This review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The quality of the evidence regarding cognitive function will be assessed according to the Grading of Recommendations Assessment, Development and Evaluation.Ethics and disseminationThis systematic review will collect secondary data only and as such ethical approval is not required. Findings will be disseminated through presentations and peer-reviewed publication. This review will provide information on the effectiveness of psychological interventions for poststroke cognitive impairment, identifying which psychological interventions are effective for improving poststroke cognitive function.PROSPERO registration numberCRD42017069714.

Addressing cognitive impairment following stroke: systematic review and meta-analysis of non-randomised controlled studies of psychological interventions

“…This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement22 23 (see online supplementary table 1 in appendix A for PRISMA checklist). The review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) on 30 June 2017, and the full protocol was published 10…”

“…Funnel plots were inspected to identify outliers as potential sources of heterogeneity. A planned series of sub-group analyses based on intervention design features and population characteristics10 was not performed due to very low to null heterogeneity among study level cognitive outcomes following random effects analysis for both the controlled group design studies (I 2 =9.7%) and the one-group pre-post design studies (I 2 =0%), respectively. All analyses were performed using Stata version 14.…”

“…However, rehabilitation of post-stroke cognitive impairment has received far less attention. Despite the prevalence of cognitive impairment post-stroke, and the associated poorer outcomes for stroke survivors in terms of physical and psychological well-being, the efficacy of existing psychological interventions for the rehabilitation of cognitive impairment following stroke has yet to be established 10…”

Improving Cerebrovascular Function to Increase Neuronal Recovery in Neurodegeneration Associated to Cardiovascular Disease

“…Stroke is associated with the highest incidence of severe disability, of which neurological deficits are reported in 50% of all patients 6 months after a stroke event (Bordet et al, 2017;Merriman et al, 2018). Ischemic stroke leads to complete blood flow disruption, resulting in irreversible changes and cell death in the ischemic core and in parts of the surrounding area, the so-called penumbra.…”

How multi-infarct encephalopathy reflects on cognitive functioning after first ever ischemic stroke?

“…3,4 Post-stroke cognitive impairment is defined as any type of cognitive impairment developed 3 months after stroke. [10][11][12] The major determinants of cognitive dysfunctions in subacute stroke stage are considered age, education, the severity, number and location of stroke, the severity of acute stroke cognitive impairment and coexistence of depression and other forms of vascular dementia. 7,10,13,14 The impact of stroke on cognitive functioning is variable -some patients can show obvious decline, others can remain stable, or revert to baseline cognitive functioning.…”