Stroke memory rehabilitation (SMaRT) programme for mild ischemic stroke: Preliminary findings

Abstract

Background There are 6000‐7000 stroke survivors yearly in Singapore with about 40% being at risk for post‐stroke cognitive impairment (PSCI). Stroke Memory Rehabilitation (SMaRT) programme was designed to reduce the incidence of PSCI, facilitate transition back to the community, improve the mood and quality of life of patients with mild ischemic strokes. We report the preliminary outcomes of the program. Method Participants who attended the programme from April 2018 to Dec 2019 were included in this study. Each patient attended 8 two‐hour sessions over 8 weeks, focusing on cognitive processes (episodic memory, executive function and visuospatial function); healthy lifestyle habits, relaxation techniques and goal setting. All patients were administered neuropsychological assessments and questionnaires pre‐programme, 8 weeks and 6 months post‐programme. Paired sample t‐tests were applied to evaluate the changes in scores over the four time points on each outcome measure, subject to Bonferroni correction for family‐wise errors. Result 156 participants (mean age=63.53 years, SD=9.63; mean education=9.95 years SD=4.18, 65.4 % male). Significant improvements in all outcome measures were observed from pre‐programme to all other time points. Cognitive scores significantly improved from pre to post‐programme and pre to 6 months post‐programme on the Montreal Cognitive Assessment (24.52 to 25.36; p<.001 and 25.05 to 25.98; p<.001 respectively); Visual Cognitive Assessment Test (VCAT) Score (22.67 to 24.14; p<.001 and 22.63 to 24.92; p<.001). Scores for Trail Making Test‐A only significantly shortened from pre‐ to 6 months post‐programme (52.00 to 45.52; p<.001). Depression levels significantly reduced on the Geriatric Depression Scale (4.01 to 3.29; p=.001 and 3.46 to 2.33; p<.001). Activities of daily living measured on the NEADL significantly improved (52.24 to 55.15; p<.001 and 52.48 to 56.27; p<.001). Quality of life (DemQOL) also significantly improved (88.77 to 91.88; p=.006 and 91.83 to 95.52; p<.001). Conclusion Preliminary findings demonstrate encouraging improvement in global cognition, executive function, quality of life, depression and activities of daily living from pre‐programme to 8 weeks and 6 months post‐programme. A multi‐approach structured cognitive rehabilitation programme for stroke survivors may thus be useful in preventing post‐stroke dementia.

Synergistic Impact of Visual and Cognitive Impairments on Health-Related Quality of Life in a Multiethnic Asian Population

“…As such, our finding of no significant changes in HRQoL resulting from VI or CI is not unexpected. Moreover, the lack of impact from VI or CI alone may also be due to increased accessibility to healthcare services, treatment, and rehabilitation that allow patients to receive timely and needed healthcare support [52, 53]. After performing stratification analyses by VI severity, we observed a significant VI-CI interaction for mild VI but not for moderate-severe VI.…”

“…As such, an integrated interventional program comprising early detection, diagnosis, treatment, and rehabilitation tailored toward older adults with comorbid VI-CI is needed. While Singapore has launched several rehabilitative initiatives targeted at patients with VI or CI only over the past decade, such as the low vision rehabilitation program and the stroke memory rehabilitation project [52, 53], additional effort is still needed to integrate these programs into tailored care and accommodate personalized interventions for individuals living with both VI and CI.…”