International Journal of Current Research and Review
ISSN: 2231-2196 (Print)ISSN: 0975-5241 (Online)
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IJCRR - Vol 09 Issue 12, June, 2017

Pages: 27-31

Date of Publication: 24-Jun-2017


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Effect on Memory and Cognitive Function in Patients Suffering from Stroke - A Review

Author: Preeti Sangwan, Jaspreet Kaur, Annu Malik

Category: Healthcare

Abstract:We examined the evidence for widely held clinical beliefs about effect on memory and cognitive function after stroke, conducting narrative review. We sought to determine whether stroke patients experience problem with memory and cognitive function and which aspects of memory and cognitive functions are affected. The authentication for both memory and cognitive function dysfunction with relevance to stroke are mixed in this review. Various studies which are involved in this review are taken from google scholar, pubmed and springer link. The data is collected mainly through various research articles and reviews. Data collected from various epidemiological studies shows that global burden of stroke is high and India like other developing countries is in the centre of stroke outbreak. Correlation of memory and cognitive impairment is also included in this review. The data collected through various studies involving assessment scales provide significant evident of memory and cognitive impairment after stroke.

Keywords: Cognitive impairment, Epidemiology, Correlation, Consequences

Full Text:

Introduction:

“A stroke is a clinically defined syndrome of expeditiously developing symptoms and signs of focal loss of cerebral function with no obvious cause other than that of vascular origin, but the loss of function can at times be global. Symptoms last more than 24 hours or lead to death1. In daily life, besides physical handicaps the cognitive disorders can also come up with disability2. The risk factor for impaired cognitive functioning is cerebrovascular disease. If specifically hindered cognitive functions are considered, 50-70% of stroke patients are found to be affected depending on age3,4,5. Those patients who abide cognitively unmutilated after their index stroke, hospital-based and population-based studies have disclosed a remarkable risk for developing delayed dementia6,7. As a direct result of a stroke incident, twenty five percent of stroke left overs have dementia8,9,10.

Epidemiology:

The global load of stroke is high, incorporating of increasing incidence, disability, mortality, Adjusted Life- Years, and economic impact, particularly in low- and middle-income countries. According to World Heart Federation, 15 million people worldwide agonize a stroke every year11. Globally, it is estimated that stroke is the second prime cause of death above the age of 60 years, and the fifth prime cause of death in people aged 15 to 59 years old and it is considered less common below 40 years. According to the American Heart Association, collated to white people, black people have nearly twice the risk of a first –ever stroke and a much higher death rate from stroke. According to Taylor FC et al (2012), the estimated age-adjusted prevalence rate for stroke12, is as shown in figure 1.1.

The summarized data of Stroke Epidemiology, according to the ‘World Health Organisation-STEPS Stroke protocol’ during the first decade of the 21st century in Mumbai13, Trivandrum14 and Kolkata15, has shown in figure 1.3.

Stroke is also more likely to influence  people if they are obese, aged 55 or older, lack of exercise, drink excessively, have a personal or family history of stroke, stress and depression smoke or use illicit drugs, heart ailments such as recent Myocardial Infarction, atrial fibrillation and presence of blood fat molecules called apolipoproteins.

There are three chief kinds of stroke,16: 1) Ischemic stroke 2)  Hemorrhagic stroke 3) Transient ischemic attacks also referred to as mini-strokes.

Etiology:

Narrowing or blocking of arteries can lead to Ischemic Stroke in the brain. It is the most common type of stroke, resulting in around 85% of strokes. Blood clots can lead to these blockages. Bursting or leaking of blood vessels in and around the brain can lead to Hemorrhagic stroke.  Hypertension, trauma, blood-thinning medications and aneurysms are the conditions which can lead to rupturing of blood vessels. The most frequent form of hemorrhagic stroke is Intracerebral Hemorrhage and the second type of hemorrhagic stroke is Subarachnoid Hemorrhage. In Transient Ischemic Attack the flow of blood to the brain is only shortly interrupted.. They serve as deterrant signs for future stroke17.A study performed to assess ‘Evolution of cognitive dysfunction after stroke and risk factors for delayed progression’ concluded that cognition is rather stable for 2 years after stroke. Age, poly-pharmacy, previous cognitive decline and hypotension during admission are risk factors for its development18.

The symptoms of memory loss and vascular dementia involve slow movement and thinking, lack of attention and inability to do simple tasks. The symptoms of dementia after stroke can be masked by more evident post stroke conditions such as paralysis, depression, blindness. Other consequences of stroke are: Confusion, Headache, Numbness, trouble with seeing, trouble with walking, bladder or bowel control problems, depression, weakness or paralysis on one or both the sides of body, trouble controlling or expressing emotions. In order to remember the signs of stroke acronym F.A.S.T. is a way, which shows Face drooping; Arm weakness; Speech difficulty, if these symptoms seen then it is the time to call for emergency services19, 20.

Assessment Scales:

Various scales which can be used for assessment of memory and cognitive functioning in stroke patients are: Wechsler Memory scale- Revised21,22, Wechsler Adult Intelligence Scale –Revised 23 ,Mini Mental State Examination24,28, Scafold Objective Recognition Test 25,28 , Recognition Memory Test26,28 , FuldObject Memory Evaluation27.

Memory:

“Memory is the faculty of mind by which information is encoded, stored or retrieved”. Memory is essential to experience and related to limbic systems, it is the withholding of information over time for the determination of influencing future action. Usually, memory comprises sensory processor, short- term (or working) memory, and long term memory .Explicit and Implicit functions of memory are also understood as declarative and non-declarative systems. By information type, there are Topographic memory and Flashbulb memories. By temporal direction,  retrospective and prospective memory29.

Correlation with memory and cognitive function:

Hypo-perfusion and functional deactivation in neighboring and distant areas of brain are associated with cognitive dysfunction in the acute stage of stroke. Both pathological ups and downs of glucose concentrations may influence cognition30.A study performed by Glenn T. Stebbins et al, titled, ‘Gray Matter Atrophy in patients with Ischemic Stroke with cognitive impairment’ concluded that there is a central role for the thalamus and lesser role for other cortical regions in the development of cognitive impairment after ischemic stroke.31

General cerebral atrophy has also been related to the development of cognitive impairment after stroke31. Severe white matter hyper-intensities are related to global cognitive dysfunction. A study performed by Emma J. Burton et al, titled ‘White matter hyper-intensities are associated with impairment of memory, attention, and global cognitive performance in older stroke patients’ concluded that in older stroke patients, cognitive processing speed and performance on measures of attention are remarkably related to White Matter Hyper-intensity volume, particularly in frontal lobe regions, whereas memory dysfunction is related to the volume of temporal lobe White Matter Hyperintensity32.

Memory impairment has been reported to be one of the most common cognitive deficits experienced by leftovers of stroke 33.Awareness of the lateral asymmetry, termed “hemispheric specialization”, is critically important for understanding the nature of memory impairment following unilateral brain damage33. Memory deficit may be an important predictor for cognitive decline34.

Discussion:

Cognitive impairment occurs frequently after stroke, commonly involving memory, orientation, attention and language. Some studies which shows memory and cognition decline in stroke patients included which are: A study performed to evaluate the ‘Incidence and relationship of post-stroke dementia to the influence of pre-stroke cognitive decline’ concluded that the risk of Post-stroke dementia is high, and enhanced in patients with pre-stroke cognitive shrinkage, with about one-third of patients summiting the basis for Alzheimer Disease and two-thirds meeting the basis for Vascular Dementia. These inferences confirm that, in stroke patients, an underlying degenerative pathology may play a role in the evolution of Post-stroke dementia35. Another study performed in order to investigate ‘Cognitive impairment after stroke’ concluded that stroke-associated cognitive impairment is encircled by many issues with respect to prevalence, relevance heterogeneity and uniqueness. There is no consistent phenotype because strokes can rap any part of the brain. Moreover, it is difficult to establish a causal link between stroke and dementia, or to exclude the possibility that Alzheimer disease is responsible for the cognitive impairment36.

Another study  is performed to detect the ‘ Cognitive functioning after stroke’ concluded that few patients become demented after stroke, and most cognitive disturbances are in the field of mental speed and calculation37. Late emergence of Cognitive dysfunction following stroke also occurs in neonatal stroke in order to detect this a study performed by Robyn Westmacott et al, ‘Late emergence of cognitive deficits after Unilateral Neonatal Stroke’ concluded that the children with unilateral neonatal stroke, particularly males, are at increased risk for emerging deficits in higher-level cognitive skills during the school years38.

A combination of diffusion-weighted imaging, T1 and T2-weighted images has been used to determine tissue aberrations in Stroke patients39.Therapies or medicines almost never fully restore memory after stroke. However, many people do recover at the very least some memory instinctively after stroke20.A study performed by Fregni et al, reported that left prefrontal anodal stimulation for 10 minutes at 1 mA in healthy participants increased working memory performance40.A study performed ‘To investigate whether anodal trans-cranial direct current stimulation over the left dorsolateral prefrontal cortex affected the working memory performance of patients after a stroke’ concluded that the anodal trans-cranial direct current stimulation over the left dorsolateral prefrontal cortex was related to  increased  working memory interpretation  as indexed by the recognition accuracy in patients after a stroke41.Now- a- days, mnemonics either plays a little role in treatment program or is not used at all. Memory impaired patients benefit more from images generated by the experimenter than by those self-produced. These findings decrease the practical value of mnemonics because rehabilitation is focused at administering interventions to be used independently from therapy setting42.

A study performed to examine the ‘Prognosis of acute cognitive disorders post-stroke, and to evaluate which clinical factors estimate domain-specific cognitive recovery’ concluded that recovery in visual perception/construction (83%) and visual memory (78%) was the most common. Cognitive recovery is related to age, lesion volume, lesion location, preexistent ability and diabetes mellitus30.

Conclusion:

 Like other evolving  countries, India is in the centre of a stroke outbreak. There is an enormous burden of stroke with remarkable geographical variations. Through various studies involving various assessment scales also it is concluded that stroke can lead to various memory and cognitive dysfunctions. Stroke allied cognitive dysfunction is encircled by many difficulties with respect to  relevance, prevalence, heterogeneity and uniqueness.

Acknowledgement:

I hereby acknowledge my co-authors for constantly encouraging and supporting and helping me find my literature for this review article. Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors/ editors/ publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.

Source of funding: Nil

Conflict of interest: Nil

References:

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Dr. Pramod Kumar Manjhi joined Editor-in-Chief since July 2021 onwards

COPE guidelines for Reviewers

SCOPUS indexing: 2014, 2019 to 2021


Awards, Research and Publication incentive Schemes by IJCRR

Best Article Award: 

One article from every issue is selected for the ‘Best Article Award’. Authors of selected ‘Best Article’ are rewarded with a certificate. IJCRR Editorial Board members select one ‘Best Article’ from the published issue based on originality, novelty, social usefulness of the work. The corresponding author of selected ‘Best Article Award’ is communicated and information of award is displayed on IJCRR’s website. Drop a mail to editor@ijcrr.com for more details.

Women Researcher Award:

This award is instituted to encourage women researchers to publish her work in IJCRR. Women researcher, who intends to publish her research work in IJCRR as the first author is eligible to apply for this award. Editorial Board members decide on the selection of women researchers based on the originality, novelty, and social contribution of the research work. The corresponding author of the selected manuscript is communicated and information is displayed on IJCRR’s website. Under this award selected women, the author is eligible for publication incentives. Drop a mail to editor@ijcrr.com for more details.

Emerging Researcher Award:

‘Emerging Researcher Award’ is instituted to encourage student researchers to publish their work in IJCRR. Student researchers, who intend to publish their research or review work in IJCRR as the first author are eligible to apply for this award. Editorial Board members decide on the selection of student researchers for the said award based on originality, novelty, and social applicability of the research work. Under this award selected student researcher is eligible for publication incentives. Drop a mail to editor@ijcrr.com for more details.


Best Article Award

A Study by Amr Y. Zakaria et al. entitled "Single Nucleotide Polymorphisms of ATP-Binding Cassette Gene(ABCC3 rs4793665) affect High Dose Methotrexate-Induced Nephrotoxicity in Children with Osteosarcoma" is awarded Best Article for Vol 13 issue 19
A Study by Kholis Ernawati et al. entitled "The Utilization of Mobile-Based Information Technology in the Management of Dengue Fever in the Community Year 2019-2020: Systematic Review" is awarded Best Article for Vol 13 issue 18
A Study by Bhat Asifa et al. entitled "Efficacy of Modified Carbapenem Inactivation Method for Carbapenemase Detection and Comparative Evaluation with Polymerase Chain Reaction for the Identification of Carbapenemase Producing Klebsiella pneumonia Isolates" is awarded Best Article for Vol 13 issue 17
A Study by Gupta R. et al. entitled "A Clinical Study of Paediatric Tracheostomy: Our Experience in a Tertiary Care Hospital in North India" is awarded Best Article for Vol 13 issue 16
A Study by Chandran Anand et al. entitled "A Prospective Study on Assessment of Quality of Life of Patients Receiving Sorafenib for Hepatocellular Carcinoma" is awarded Best article for Vol 13 issue 15
A Study by Rosa PS et al. entitled "Emotional State Due to the Covid – 19 Pandemic in People Residing in a Vulnerable Area in North Lima" is awarded Best Article for Vol 13 issue 14
A Study by Suvarna Sunder J et al. entitled "Endodontic Revascularization of Necrotic Permanent Anterior Tooth with Platelet Rich Fibrin, Platelet Rich Plasma, and Blood Clot - A Comparative Study" is awarded Best Article for Vol 13 issue 13
A Study by Mona Isam Eldin Osman et al. entitled "Psychological Impact and Risk Factors of Sexual Abuse on Sudanese Children in Khartoum State" is awarded Best Article for Vol 13 issue 12
A Study by Khaw Ming Sheng & Sathiapriya Ramiah entitled "Web Based Suicide Prevention Application for Patients Suffering from Depression" is awarded Best Article for Vol 13 issue 11
A Study by Purushottam S. G. et al. entitled "Development of Fenofibrate Solid Dispersions for the Plausible Aqueous Solubility Augmentation of this BCS Class-II Drug" is awarded Best article for Vol 13 issue 10
A Study by Kumar S. et al. entitled "A Study on Clinical Spectrum, Laboratory Profile, Complications and Outcome of Pediatric Scrub Typhus Patients Admitted to an Intensive Care Unit from a Tertiary Care Hospital from Eastern India" is awarded Best Article for Vol 13 issue 09
A Study by Mardhiah Kamaruddin et al. entitled "The Pattern of Creatinine Clearance in Gestational and Chronic Hypertension Women from the Third Trimester to 12 Weeks Postpartum" is awarded Best Article for Vol 13 issue 08
A Study by Sarmila G. B. et al. entitled "Study to Compare the Efficacy of Orally Administered Melatonin and Clonidine for Attenuation of Hemodynamic Response During Laryngoscopy and Endotracheal Intubation in Gastrointestinal Surgeries" is awarded Best Article for Vol 13 issue 07
A Study by M. Muthu Uma Maheswari et al. entitled "A Study on C-reactive Protein and Liver Function Tests in Laboratory RT-PCR Positive Covid-19 Patients in a Tertiary Care Centre – A Retrospective Study" is awarded Best Article of Vol 13 issue 06 Special issue Modern approaches for diagnosis of COVID-19 and current status of awareness
A Study by Gainneos PD et al. entitled "A Comparative Evaluation of the Levels of Salivary IgA in HIV Affected Children and the Children of the General Population within the Age Group of 9 – 12 Years – A Cross-Sectional Study" is awarded Best Article of Vol 13 issue 05 Special issue on Recent Advances in Dentistry for better Oral Health
A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" is awarded Best Article of Vol 13 issue 06
A Study by Chen YY and Ghazali SRB entitled "Lifetime Trauma, posttraumatic stress disorder Symptoms and Early Adolescence Risk Factors for Poor Physical Health Outcome Among Malaysian Adolescents" is awarded Best Article of Vol 13 issue 04 Special issue on Current Updates in Plant Biology to Medicine to Healthcare Awareness in Malaysia
A Study by Kumari PM et al. entitled "Study to Evaluate the Adverse Drug Reactions in a Tertiary Care Teaching Hospital in Tamilnadu - A Cross-Sectional Study" is awarded Best Article for Vol 13 issue 05
A Study by Anu et al. entitled "Effectiveness of Cytological Scoring Systems for Evaluation of Breast Lesion Cytology with its Histopathological Correlation" is awarded Best Article of Vol 13 issue 04
A Study by Sharipov R. Kh. et al. entitled "Interaction of Correction of Lipid Peroxidation Disorders with Oxibral" is awarded Best Article of Vol 13 issue 03
A Study by Tarek Elwakil et al. entitled "Led Light Photobiomodulation Effect on Wound Healing Combined with Phenytoin in Mice Model" is awarded Best Article of Vol 13 issue 02
A Study by Mohita Ray et al. entitled "Accuracy of Intra-Operative Frozen Section Consultation of Gastrointestinal Biopsy Samples in Correlation with the Final Histopathological Diagnosis" is awarded Best Article for Vol 13 issue 01
A Study by Badritdinova MN et al. entitled "Peculiarities of a Pain in Patients with Ischemic Heart Disease in the Presence of Individual Combines of the Metabolic Syndrome" is awarded Best Article for Vol 12 issue 24
A Study by Sindhu Priya E S et al. entitled "Neuroprotective activity of Pyrazolone Derivatives Against Paraquat-induced Oxidative Stress and Locomotor Impairment in Drosophila melanogaster" is awarded Best Article for Vol 12 issue 23
A Study by Habiba Suhail et al. entitled "Effect of Majoon Murmakki in Dysmenorrhoea (Usre Tams): A Standard Controlled Clinical Study" is awarded Best Article for Vol 12 issue 22
A Study by Ghaffar UB et al. entitled "Correlation between Height and Foot Length in Saudi Population in Majmaah, Saudi Arabia" is awarded Best Article for Vol 12 issue 21
A Study by situs slot and Siti Sarah Binti Maidin entitled "Sleep Well: Mobile Application to Address Sleeping Problems" is awarded Best Article for Vol 12 issue 20
A Study by Avijit Singh et al. situs slot "Comparison of Post Operative Clinical Outcomes Between “Made in India” TTK Chitra Mechanical Heart Valve Versus St Jude Mechanical Heart Valve in Valve Replacement Surgery" is awarded Best Article for Vol 12 issue 19
A Study by Sonali Banerjee and Mary Mathews N. entitled "Exploring Quality of Life and Perceived Experiences Among Couples Undergoing Fertility Treatment in Western India: A Mixed Methodology" is awarded Best Article for Vol 12 issue 18
A Study by Jabbar Desai et al. entitled "Prevalence of Obstructive Airway Disease in Patients with Ischemic Heart Disease and Hypertension" is awarded Best Article for Vol 12 issue 17
A Study by Juna Byun et al. entitled "Study on Difference in Coronavirus-19 Related Anxiety between Face-to-face and Non-face-to-face Classes among University Students in South Korea" is awarded Best Article for Vol 12 issue 16
A Study by Sudha Ramachandra & Vinay Chavan entitled "Enhanced-Hybrid-Age Layered Population Structure (E-Hybrid-ALPS): A Genetic Algorithm with Adaptive Crossover for Molecular Docking Studies of Drug Discovery Process" is awarded Best article for Vol 12 issue 15
A Study by Varsha M. Shindhe et al. entitled "A Study on Effect of Smokeless Tobacco on Pulmonary Function Tests in Class IV Workers of USM-KLE (Universiti Sains Malaysia-Karnataka Lingayat Education Society) International Medical Programme, Belagavi" is awarded Best article of Vol 12 issue 14, July 2020
A study by Amruta Choudhary et al. entitled "Family Planning Knowledge, Attitude and Practice Among Women of Reproductive Age from Rural Area of Central India" is awarded Best Article for special issue "Modern Therapeutics Applications"
A study by Raunak Das entitled "Study of Cardiovascular Dysfunctions in Interstitial Lung Diseas epatients by Correlating the Levels of Serum NT PRO BNP and Microalbuminuria (Biomarkers of Cardiovascular Dysfunction) with Echocardiographic, Bronchoscopic and HighResolution Computed Tomography Findings of These ILD Patients" is awarded Best Article of Vol 12 issue 13 
A Study by Kannamani Ramasamy et al. entitled "COVID-19 Situation at Chennai City – Forecasting for the Better Pandemic Management" is awarded best article for  Vol 12 issue 12
A Study by Muhammet Lutfi SELCUK and Fatma situs slot entitled "Distinction of Gray and White Matter for Some Histological Staining Methods in New Zealand Rabbit's Brain" is awarded best article for  Vol 12 issue 11
A Study by Anamul Haq et al. entitled "Etiology of Abnormal Uterine Bleeding in Adolescents – Emphasis Upon Polycystic Ovarian Syndrome" is awarded best article for  Vol 12 issue 10
A Study by situs slot et al entitled "Estimation of Reference Interval of Serum Progesterone During Three Trimesters of Normal Pregnancy in a Tertiary Care Hospital of Kolkata" is awarded best article for  Vol 12 issue 09
A Study by Ilona Gracie De Souza & Pavan Kumar G. entitled "Effect of Releasing Myofascial Chain in Patients with Patellofemoral Pain Syndrome - A Randomized Clinical Trial" is awarded best article for  Vol 12 issue 08
A Study by Virendra Atam et. al. entitled "Clinical Profile and Short - Term Mortality Predictors in Acute Stroke with Emphasis on Stress Hyperglycemia and THRIVE Score : An Observational Study" is awarded best article for  Vol 12 issue 07
A Study by K. Krupashree et. al. entitled "Protective Effects of Picrorhizakurroa Against Fumonisin B1 Induced Hepatotoxicity in Mice" is awarded best article for issue Vol 10 issue 20
A study by Mithun K.P. et al "Larvicidal Activity of Crude Solanum Nigrum Leaf and Berries Extract Against Dengue Vector-Aedesaegypti" is awarded Best Article for Vol 10 issue 14 of IJCRR
A study by Asha Menon "Women in Child Care and Early Education: Truly Nontraditional Work" is awarded Best Article for Vol 10 issue 13
A study by Deep J. M. "Prevalence of Molar-Incisor Hypomineralization in 7-13 Years Old Children of Biratnagar, Nepal: A Cross Sectional Study" is awarded Best Article for Vol 10 issue 11 of IJCRR
A review by Chitra et al to analyse relation between Obesity and Type 2 diabetes is awarded 'Best Article' for Vol 10 issue 10 by IJCRR. 
A study by Karanpreet et al "Pregnancy Induced Hypertension: A Study on Its Multisystem Involvement" is given Best Paper Award for Vol 10 issue 09
Late to bed everyday? You may die early, get depression situs slot
Egg a day tied to lower risk of heart disease situs slot
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List of Awardees

A Study by Ese Anibor et al. "Evaluation of Temporomandibular Joint Disorders Among Delta State University Students in Abraka, Nigeria" from Vol 13 issue 16 received Emerging Researcher Award


A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" from Vol 13 issue 06 received Emerging Researcher Award


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International Journal of Current Research and Review (IJCRR) provides platform for researchers to publish and discuss their original research and review work. IJCRR can not be held responsible for views, opinions and written statements of researchers published in this journal

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