Screening for cognitive impairment in patients with acute stroke

Formal assessment of cognitive impairment is rare in acute stroke, yet. It was the goal to utilize easy-to-apply established screening tests to assess cognitive impairment from any cause in patients with acute ischemic stroke.

209 consecutive patients (69.8 +/- 13.3 years, mean +/- SD; 117 male, 92 female) admitted to an acute stroke unit, which serves as a community stroke center, and diagnosed as having acute cerebral ischemia from any cause were investigated within 24 h of stroke onset and in part followed up after 3 months. Orientation and aphasia were assessed with the ADAScog subscales orientation and aphasia, verbal memory with Buschke's Memory Impairment Screen, and concentration/working memory with a letter sorting test.

On admission, 74.6% were impaired on the Memory Impairment Screen, 77.0% on the letter sorting test, 45.0 and 24.9% on the ADAScog subscales aphasia and orientation. Results of the Memory Impairment Screen and letter sorting test were similar at the follow-up after 3 months.

Formal brief assessment of cognitive deficits with tests not requiring motor capabilities in unselected patients with an acute cerebral ischemic event reveals widespread deficits. This needs to be considered when obtaining informed consent from the patients and instructing them. Routine formalized screening may thus improve care for patients with acute stroke. Patients with impairment on admission should be followed up, diagnosed concerning preexisting or poststroke dementia with a more extensive workup and eventually treated.