Findings from an Asian post‐stroke cognitive impairment intervention programme

다국어 초록 (Multilingual Abstract)

Singapore sees more than 7,000 ischemic stroke cases yearly, with majority having physical and cognitive sequelae. Previous reports demonstrate that Post‐stroke cognitive impairment (PSCI) occurs in 37.3% of stroke patients at the National Neuroscience Institute (NNI, Singapore) within 6 months post‐stroke. The severity of rising PSCI rates prompted the implementation of the NNI Stroke Memory Rehabilitation Programme (SMaRT) for ischaemic stroke patients with mild physical impairments. This study aims to evaluate the outcomes of the SMaRT programme on PSCI and post‐stroke coping over a 6‐month period.
The SMaRT programme is a 8‐week group‐based post‐stroke cognitive rehabilitation programme focusing on healthy living habits, memory models, memory strategies and emotion regulation strategies. Patients with clinically diagnosed ischaemic strokes, mild functional and cognitive issues (modified Rankin Scale score≤3 and Mini Mental‐State Examination score≥20) were recruited from April 2018 to September 2020. Assessments were administered at baseline, 8 weeks and 6 months post‐SMaRT, measuring global cognition (Montreal Cognitive Assessment, Visual Cognitive Assessment Tool), visuospatial function/attention (Trail Making Test‐A), emotional coping (Geriatric Depression Scale‐15), daily functioning (Nottingham Extended Activities of Daily Living (NEADL)), subjective quality of life (Dementia Quality of Life (DemQOL)). Paired samples t‐tests compared scores between the three timepoints, adjusting for type I errors with Bonferroni correction.
137 subjects (N males=90 (65.7.%); mean age=63.49 years, SD=9.38, mean years of education=9.50, SD=3.79) underwent SMaRT. Comparing week‐8 to baseline, there was significant improvement in global cognition (MoCA, VCAT: p<.001), emotional coping (GDS, p<.001), daily functions (NEADL, p<.001), subjective quality of life (DemQOL: p=.008). Significant improvement was also observed comparing month‐6 to baseline scores in global cognition (MoCA, VCAT: p<.001), emotional coping (GDS, p<.001), daily functions (NEADL, p<.001), subjective quality of life (DemQOL: p<.001). In both analyses, decreasing trends in TMT‐A (seconds) were observed and approached significance.
The SMaRT programme is effective in mitigating post‐stroke cognitive impairment, particularly in global cognition. Additionally, SMaRT improved mood, daily functioning and subjective quality of life, suggesting its ability to instill positivity and confidence in stroke patients. These suggest a group‐based structured cognitive rehabilitation programme is likely to benefit stroke patients and reduces incidence of PSCI.