However, it is clear that for those with memory problems post-stroke, they have obstacles in accessing primary healthcare services ( 12). Compared to the general population, the incidence of dementia is nearly 50 times higher in the year after a major stroke ( 11). In fact, around 10% of individuals will develop dementia soon after their first stroke and around a third will be affected after recurrent stroke ( 10). Stroke is known to be a strong independent risk factor for dementia ( 9). In order for this to be achieved, there needs to be greater awareness of post-stroke cognitive changes particularly in primary care where these patients will be discharged to. The recent NHS Long Term Plan has specifically highlighted the need for stroke rehabilitation, which is better integrated into community care for the longer term ( 8). A previous survey by the Stroke Association found that 77% of stroke survivors have problems with memory yet nearly 50% of stroke-survivors reported that the support they received for their memory problems and fatigue was poor ( 7). Although there have been calls for stroke clinicians to have increased awareness of the cognitive consequences of stroke ( 6), even if this happens, services presently available to support patients and families are limited. Similarly, patients provide accounts of fragmented care ( 1), which could have a negative impact on the stroke-survivor and their families. In terms of current services, primary and secondary healthcare professionals have already identified a lack of clarity when managing stroke individuals with memory difficulties ( 5). Post-stroke cognitive deficits are common ( 4) and add to the challenges already faced by stroke-survivors. For some stroke-survivors the “unseen” emotional changes post-stroke can be more disabling than the physical impairments ( 3). However recovery in the community involves not only dealing with physical aspects, but the psychological and emotional impact of the stroke, to enable the individual to rebuild and restructure their world ( 2). Understanding the impact can enable more effective community and specialist support to be provided particularly if we were to also identify those who may then be at risk of a future dementia illness.įollowing a stroke and discharge from specialist services into the community, patients are expected to navigate through complex health systems and treatment regimens whilst recovering ( 1). Health professionals and services in the community need to recognize the burden of managing symptoms post-stroke for these individuals and their families. They identified several areas of impact: (1) impact on daily life (2) emotional impact and (3) compensating strategies implemented in response to impact.Ĭonclusion: Living with stroke combined with memory impairment can have negative effects on the stroke-survivor and their family once in the community. Five family carers and ten stroke-survivors were interviewed at six-months post-stroke, of these eight stroke-survivors and four family carers agreed to a 12-month follow-up interview. Results: Twenty-two interviews were conducted. Data collection and analysis were iterative all transcripts were anonymized. A topic guide was developed to explore participant's care experiences post-stroke when they have also presented with memory difficulties. Participants were invited to take part in an interview at around six and 12-months post-stroke. Methods: Semi-structured interviews were conducted with patients and family carers to gain an in-depth understanding of their experiences. The aim of this qualitative study was to report the impact of memory problems on the stroke-survivor and their family once they are living in the community. There is also good evidence that organized stroke care improves physical recovery but no equivalent evidence for the effectiveness of cognitive rehabilitation. There is often less focus on cognitive recovery post-stroke from clinical services perhaps because of the lack of awareness and evidence of these adaptations. Although a stroke-survivor may be physically capable of performing daily tasks, they and their families may have to learn to manage and adapt to their new memory deficits. Once in the community, stroke-survivors are looked after by their family doctors although there is evidence that these patients may struggle to access appropriate help in the community for these problems. 2Division of Psychiatry and Applied Psychology, Institute of Mental Health, School of Medicine, University of Nottingham, Innovation Park, Nottingham, United Kingdomīackground: Memory problems post-stroke are common and for some, these problems could then progress to a dementia illness. 1Population Health Sciences Institute, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, United Kingdom.Stephan 2 Louise Robinson 1 Catherine Exley 1
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