Screening for emotional and cognitive problems after stroke

This thesis explored the screening for emotional and cognitive problems after stroke, with a particular focus on patients with minor strokes. First, it was demonstrated that patients discharged home after stroke, typically those with minor strokes, experience emotional and cognitive problems at a similar frequency to patients discharged to inpatient rehabilitation, who are generally those with major strokes. Furthermore, the research highlighted significant variability in the screening practices for emotional and cognitive problems at neurology departments across Dutch hospitals, likely due to the limited evidence supporting the efficacy of such screenings post-stroke.
Consequently, an intervention protocol for structured screening and care for emotional and cognitive problems in patients discharged home after stroke was developed and examined in the ECO-stroke trial. This multicenter, cluster-randomized controlled trial compared the intervention with usual care. While the intervention did not improve the primary outcome of participation, it yielded small benefits in the secondary outcomes, including symptoms of anxiety and quality of life. A cost-effectiveness analysis showed that the intervention could be cost-effective, as it led to reduced medical consumption. However, the trial’s robustness was limited by the small number of participating hospitals. Developments within the usual care group regarding emotional and cognitive care may have reduced the contrast between the groups, and a low referral rate to follow-up care may have compromised the intervention’s effectiveness.
In conclusion, this thesis supports the value of regular screening for emotional and cognitive problems post-stroke and provides a cost-effective, feasible approach for clinical implementation.