Saudi Stroke Standards

Psycho-social, emotional and cognitive support Purpose It is well recognized in the medical literature that people who have suffered stroke experience cognitive and neuropsychiatric issues. One of these issues is post stroke depression which was found to be associated with lesions in the left-side of the cortex, basal ganglia and lesions closer to the frontal lobe than on the left posterior or right frontal lesions. Beside this, other risk factors for depression have been identified such as non-fluent aphasia, significant motor deficit, age less than 60 years, female gender, and residency in nursing homes. The risk of post stroke depression is found to be between 20-79% from the first month up to 18 months post stroke. It has a negative impact on their physical wellbeing, their rehabilitation gains, functional recovery and social reintegration. It is imperative that stroke survivors, at various healthcare settings during their treatment journey, are screened and assessed to identify post stroke depression so they can receive appropriate and timely management. Furthermore, stroke can lead to behavioral and cognitive impairment which vary in severity from amnesia to dementia, with loss of mental capacity and inability to make decisions in life. Therefore, they will require assessment by expert professionals. Rationale  The risk of neuropsychiatric manifestation is high following stroke including a range of mood and cognitive disorders.  Post stroke depression has been reported between 20-79% starting after the first month and up to 18 after the stroke.  There are risk factors associated with post stroke neuropsychiatric problems.  Mood problems and cognitive impairment delay rehabilitation progress, reduce functional gain and they are a hindrance for social reintegration. Standards 1. All patients should be screened for post stoke cognitive and mental health issues along the care pathways from hospital to community setting. 2. Patients at high risk of mood, behavioral and cognitive problems need evaluation using validated measures, including patients with aphasia. 3. For patients with depression, severity of their depressive or cognitive symptoms need to be identified, as well as any potential risks and impact on their functional ability. These patients need to be referred to mental health for further evaluation and management. 4. Patients with severe cognitive impairment affecting their mental capacity require screening followed by expert professionals’ assessment to ensure their care & legal rights are met. 5. Patients and their care givers/ family should be given education and should also be provided with the information related to mood and cognitive problems post stroke, and the support available for them. QM