European Stroke Organisation (ESO) and European Academy Neurology (EAN) Joint Guidelines on Post Stroke Cognitive Impairment.

Abstract

INTRODUCTION\nThe optimal management of post stroke cognitive impairment remains controversial. These joint European Stroke Organisation (ESO) and European Academy of Neurology (EAN) guidelines provide evidence-based recommendations to assist clinicians in decision making around prevention, diagnosis, treatment, and prognosis.\n\n\nMETHODS\nGuidelines were developed according to the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. The working group identified relevant clinical questions, performed systematic reviews, assessed the quality of the available evidence, and made specific recommendations. Expert consensus statements were provided where insufficient evidence was available to provide recommendations.\n\n\nRESULTS\nThere was limited randomised controlled trial evidence regarding single or multicomponent interventions to prevent post stroke cognitive decline. Lifestyle interventions and treating vascular risk factors have many health benefits but a cognitive effect is not proven. We found no evidence around routine cognitive screening following stroke but recognise the importance of targeted cognitive assessment. We described the accuracy of various cognitive screening tests but found no clearly superior approach to testing. There was insufficient evidence to make a recommendation for use of cholinesterase inhibitors, memantine nootropics or cognitive rehabilitation. There was limited evidence on the use of prediction tools for post stroke cognition. The association between post stroke cognitive impairment and acute structural brain imaging features was unclear, although the presence of substantial white matter hyperintensities of presumed vascular origin on MRI brain may help predict cognitive outcomes.\n\n\nCONCLUSIONS\nThese guidelines highlight fundamental areas where robust evidence is lacking. Further, definitive randomised controlled trials are needed, and we suggest priority areas for future research.