Post-Stroke Cognitive Impairment

Elayne Ansara, PharmD, BCPS, BCPP
CPNP Programming Committee

Every year 795,000 Americans suffer a stroke, which totals costs of $34 billion related to health care services, medication, and missed work days. According to the Center for Disease Control, stroke is the leading cause of long-term disability. The Guidelines for Adult Stroke Rehabilitation and Recovery have identified cognitive impairment as affecting over one-third of stroke survivors at both three and twelve months, which results in “poor long-term survival, higher disability, and greater institutionalization rates.” The cognitive domains typically affected include memory, orientation, language, and attention. Screening for cognitive deficits is recommended for all post-stroke patients with neuropsychological testing indicated if cognitive deficits are initially detected. Along with cognitive rehabilitation, several medications have been used to treat post-stroke deficits, although the literature base is limited. Possible pharmacologic agents could include methylphenidate, modafinil, atomoxetine, anticholinesterase inhibits, and antidepressants. Other nonpharmacologic modalities such as a structured exercise program have been implicated as beneficial to capitalize on the increased neuroplasticity in the acute post-stroke phase. Given the complexity of managing post-stroke patients, psychiatric and neurologic pharmacists can play a unique role in helping to care for these patients.

At the CPNP Annual Meeting in Salt Lake City, Dr. Deborah Levine will present on the evidence-based treatments for post-stroke cognitive impairment. Specific learning objectives include:

1. Explain the significance of post-stroke cognitive impairment to the patient, the caregiver(s), and the health care system.
2. Identify patients in whom post-stroke cognitive deficits may be present and when neuropsychological testing is recommended.
3. Describe the evidence supporting guideline recommendations for the treatment of post-stroke cognitive deficits.
4. Apply knowledge of treatment recommendations to the care of patients and appropriate patient education.

Dr. Levine is an Associate Professor of Medicine in the Division of General Medicine and Department of Internal Medicine at the University of Michigan Medical School. Some of her research examines the cognitive outcomes after stroke, seeking to understand the predictors and long-term trajectory of cognitive decline after stroke. Dr. Levine will present on this topic on Tuesday, April 9^th at the 2019 CPNP Annual Meeting in Salt Lake City, Utah.

References

AHA/ASA Guideline. The guidelines for adult stroke rehabilitation and recovery. Stroke. 2016;47(6):e98-169