Post-stroke depression, obstructive sleep apnea, and cognitive impairment: Rationale for, and barriers to, routine screening
| Autor: | Demetrios J. Sahlas, Jennifer Mandzia, Leanne K. Casaubon, Nathan Herrmann, Richard H. Swartz, Megan L Cayley, Brian J. Murray, Mark Bayley, Kevin E. Thorpe, Yael Perez, Michelle N. Sicard, Karen Lien, Dar Dowlatshahi, Krista L. Lanctôt, Gustavo Saposnik |
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| Rok vydání: | 2016 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment Psychological intervention Poison control 03 medical and health sciences 0302 clinical medicine Injury prevention medicine Humans Post-stroke depression Cognitive Dysfunction 030212 general & internal medicine Intensive care medicine Stroke Depression (differential diagnoses) Sleep Apnea Obstructive Rehabilitation Depression business.industry Stroke Rehabilitation medicine.disease Obstructive sleep apnea Neurology Physical therapy business 030217 neurology & neurosurgery |
| Zdroj: | International Journal of Stroke. 11:509-518 |
| ISSN: | 1747-4949 1747-4930 |
| DOI: | 10.1177/1747493016641968 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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