Review Article
Subjective Cognitive Complaints after Stroke: A Systematic Review

https://doi.org/10.1016/j.jstrokecerebrovasdis.2013.05.003Get rights and content

Background

Most studies to date have assessed poststroke cognitive impairment objectively, whereas less attention is paid to subjective cognitive complaints (SCC). We, therefore, systematically searched the literature to summarize and evaluate the current knowledge about poststroke SCC.

Methods

Articles were included in this review if the study evaluated SCC in adult stroke survivors, and the publication was an original empirical article from which the full text was available. There were no year or language restrictions.

Results

Twenty-six studies were found on poststroke SCC. There is a huge heterogeneity among these studies with respect to stroke sample, SCC definitions, and instruments used, but they all showed that SCC are very common after stroke. Other main findings are that SCC tend to increase over time and that there is moderate agreement between patients and their proxies on prevalence and severity of patients' SCC. Furthermore, SCC are inconsistently associated with current depressive symptoms and objective cognitive performances, whereas they may predict future emotional and cognitive functioning.

Conclusions

This review highlights that poststroke SCC are highly prevalent and that clinicians should take such complaints seriously. More research is, however, needed to gain further insight into poststroke SCC, to be able to accurately inform patients and relatives, and to develop adequate treatment programs. Based on the limitations of the studies to date, suggestions are made on how both future research and ultimately patient-centered care may be improved in stroke survivors.

Introduction

Cognitive impairment is common in both the acute and chronic phase after stroke and can be evaluated either objectively (using neuropsychological tests) or subjectively (using self-report measures or interviews). To date, most studies investigating poststroke cognition have focused on objective assessment, whereas subjective cognitive complaints (SCC), defined as whether individuals report cognitive difficulties and if so what these are and whether they are irritating and/or worrying for them, are too often ignored. Research on SCC in the general population has typically focused on memory complaints, whereas recent studies have begun to suggest that complaints about other cognitive domains (including attention, executive functioning, language, etc.) should also be assessed.1 The consensus in this field is that SCC are important to attend because they negatively affect daily functioning and quality of life, increase health care consumption, and may be an early indication of cognitive decline.1, 2, 3, 4 In this systematic review, we aim to summarize and evaluate what is currently known from the literature about SCC in stroke patients.

Section snippets

Search Strategy

A systematic literature search was conducted in MEDLINE, EMBASE, PsychINFO, Cochrane library databases, and ClinicalTrials.gov (last updated in April 2013) using key words and synonyms (see Appendix 1). Reference lists of all included articles were additionally hand searched for relevant publications. Research articles were included if they met the following criteria: (1) the study evaluated patient-reported SCC in adult (≥18 years) stroke survivors and (2) the publication was an original

Study Characteristics

Twenty-six studies in total were included (see Fig 1). They were published between 1987 and 2013. Twenty studies used a cross-sectional design, 4 were longitudinal, and 2 were randomized controlled trials. Five out of the 26 compared stroke patients with a nonstroke control group. There is a huge sample size range across the publications (12-1251), and the samples are quite heterogenic. Twelve studies, for example, included only first-ever stroke patients, 8 evaluated just subjects with a

Discussion

To the best of our knowledge, this is the first systematic review on poststroke SCC. A main finding is that there is large heterogeneity among the studies with respect to stroke sample, SCC definitions, and the instruments used. However, based on the studies included in this review, the following conclusions can be drawn: SCC are common after stroke, they tend to increase over time, and there is moderate agreement between patients and their proxies on prevalence and severity of patients' SCC.

Conclusions

This review highlights that SCC are very common after stroke and that clinicians should take such complaints seriously. On the other hand, it should also be noted that while some patients do not report SCC, OCP may be present and can detrimentally affect treatment success. More research is, however, needed to gain further insight into poststroke SCC, to be able to more accurately inform patients and relatives, and to develop adequate treatment programs. Focusing on what matters to individuals

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    Conflicts of interest: None declared.

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