Abstract Body: Introduction
Over 70% of patients experience post-stroke cognitive impairment (PSCI), which can lead to functional decline. Outpatient stroke clinics often lack a consistent and validated cognitive assessment protocol for follow-ups. This increases the risk of missed diagnosis of PSCI, which is often determined based on the subjective assessment of cognitive functioning by patients or caregivers. Our goal was to assess the practice of unstructured PSCI screening at our stroke clinic and test if a cognitive screening protocol would improve PSCI detection in follow-up patients.
Methods
We led a quality improvement project to identify root causes of the problem and plan interventions for introducing a feasible cognitive screening protocol. We performed a baseline chart review on 79 stroke patients seen at the clinic to assess documentation of discussion of cognitive symptoms during visits. We developed a pre-screening survey to assess educational level, post-stroke rehabilitation participation, and vascular risk factors. We enrolled 30 follow-up patients with either an ischemic or hemorrhagic stroke. An examiner conducted a short-form MoCA (MoCA-sf) test and a CLCE-24 questionnaire for subjective cognitive complaints (SCC) on each patient. We collected data from the electronic record on discharge mRS and NIHSS scores and measured time spent on screening to assess feasibility.
Results
In baseline chart review, 65% of 79 patients did not have any discussion of cognitive symptoms documented during their visit before our intervention. In our initial screening results, 53% of patients screened positive for cognitive impairment (<=12 MoCA-sf score). There was a moderately negative correlation between MoCA-sf scores and a history of hypertension (-0.48, p 0.007) and hyperlipidemia (-0.38, p 0.044). There was no statistically significant correlation between subjective cognitive complaints (CLCE-24 score) and MoCA-sf scores (-0.09, p 0.626) and only a weak correlation between MoCA-sf and discharge NIHSS (-0.26, p 0.251) and mRS scores (-0.29, p 0.207). The screening took 13 minutes on average to complete.
Conclusion
Relying on patient-initiated discussion, subjective cognitive complaints, or discharge functional status may lead to missed diagnosis of PSCI. The high prevalence of PSCI in follow-up patients confirms the need for an objective screening protocol like MoCA-sf in stroke clinics for diagnosing PSCI early, especially in patients with hypertension and hyperlipidemia.