Journal
INTERNATIONAL JOURNAL OF STROKE
Volume 11, Issue 5, Pages 509-518Publisher
SAGE PUBLICATIONS LTD
DOI: 10.1177/1747493016641968
Keywords
Stroke; prevention; rehabilitation; depression; obstructive sleep apnea; cognitive impairment
Categories
Funding
- Heart and Stroke Foundation of Ontario [000392]
- Canadian Institutes of Health Research [1012404]
- New Investigator Award
- Henry J. Barnett Award from the Heart and Stroke Foundation of Canada
- HSF Canadian Partnership for Stroke Recovery
- Department of Medicine at Sunnybrook HSC
- University of Toronto
- Brill Chair in Neurology Sunnybrook HSC
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Stroke can cause neurological impairment ranging from mild to severe, but the impact of stroke extends beyond the initial brain injury to include a complex interplay of devastating comorbidities including: post-stroke depression, obstructive sleep apnea, and cognitive impairment (DOC). We reviewed the frequency, impact, and treatment options for each DOC condition. We then used the Ottawa Model of Research Use to examine gaps in care, understand the barriers to knowledge translation, identification, and addressing these important post-stroke comorbidities. Each of the DOC conditions is common and result in poorer recovery, greater functional impairment, increased stroke recurrence and mortality, even after accounting for traditional vascular risk factors. Despite the strong relationships between DOC comorbidities and these negative outcomes as well as recommendations for screening based on best practice recommendations from several countries, they are frequently not assessed. Barriers related to the nature of the screening tools (e.g., time consuming in high-volume clinics), practice environment (e.g., lack of human resources or space), as well as potential adopters (e.g., equipoise surrounding the benefits of treatment for these conditions) pose challenges to routine screening implementation. Simple, feasible approaches to routine screening coupled with appropriate, evidence-based treatment protocols are required to better identify and manage depression, obstructive sleep apnea, and cognitive impairment symptoms in stroke prevention clinic patients to reduce the impact of these important post-stroke comorbidities. These tools may in turn facilitate large-scale randomized controlled treatment trials of interventions for DOC conditions that may help to improve cardiovascular outcomes after stroke or TIA.
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