Review ArticleSubjective Cognitive Complaints after Stroke: A Systematic Review
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.