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Elena Nechaeva from Getty Images via Canvapro
Difficulty speaking, concentrating, or remembering things are common after a stroke. However, the impact varies greatly from one patient to another. For a long time, symptoms were assumed to be dependent on the location in the brain affected by the stroke. This new study shows that overall brain health and the patient’s level of education also play an important role.
The study is a large international collaboration, primarily between Oxford and KULeuven, with co-first authors Margaret Jane Moore and Hanne Huygelier (the former previously a DPhil candidate at Oxford, now based in Brisbane), and senior authors Professor Nele Demeyere (NDCN) and Céline Gillebert (KULeuven).
The researchers analysed data from 2172 patients in Belgium, Italy, and the United Kingdom, the majority of which comes from the Oxford Cognitive Screening programme at the John Radcliffe Hospital’s stroke unit, which has been coordinated by Prof Demeyere since 2012. All patients were assessed using the Oxford Cognitive Screen, a standardised test that maps language skills, memory, attention, numeracy, and other cognitive functions.
The study included patients with different types of strokes: both ischaemic (blood clot) and haemorrhagic (blood vessel rupture) strokes. The patients varied in age (as strokes affects both younger and older individuals), educational background, and health profiles.
Tailored recovery treatment
For a subset of patients, the severity of their cognitive symptoms was more closely linked to the overall brain condition prior to the stroke and to factors such as education. This so-called ‘cognitive reserve’ clearly provides protection. Patients who had built up more cognitive capacity before the stroke, for example through mentally stimulating activities, were more likely to experience less pronounced symptoms after several weeks.
Professor Céline Gillebert of KU Leuven and the Leuven Brain Institute says ‘These insights can pave the way for a more personalised approach to stroke recovery,’ says ‘The recovery approach should not solely be determined by the brain damage visible on an MRI scan, but also by who the patient was before the stroke. With our 13 symptom profiles, the recovery approach can be tailored much more precisely, and we can make symptoms visible that would otherwise sometimes remain invisible, allowing them to be treated.’
Professor Nele Demeyere says: 'Research in our group tries to bridge some of the silos of research that exist across cognitive neurosciences and clinical stroke research. Here, we bridge this gap and provide an elegant classification of cognitive profiles. Ultimately, unravelling the complexity of post stroke cognitive impairment will help our understanding of the clinical and real world impact for stroke patients, allowing future research to focus on more precise predictions of cognitive recovery and decline.'
Post Stroke Cognitive Impairment: more than a lesion-symptom model by H. Huygelier, C. Gillebert et al. was published in Imaging Neuroscience .