Patients with neuropsychological disorders short after stroke have worse functional outcome: a systematic review and meta-analysis

Abstract

Purpose

To investigate if patients with neuropsychological disorders (neglect, aphasia, or cognitive dysfunction measured with the Mini-mental state examination) short after stroke have different functional outcome at follow-up compared to patients without these disorders.

Methods

Embase, Medline-Ovid, PsycINFO, Cochrane CENTRAL, Web of Science and Google Scholar were systematically searched for cohort studies up to 3 March 2019. PRISMA guidelines were followed. Functional outcome had to be measured with the Barthel Index or the Functional Independence Measure. If at least three studies studying the same neuropsychological disorder reported functional outcome at comparable follow-up, meta-analysis were performed and the quality of evidence was assessed using GRADE.

Results

The search resulted in 5398 unique articles and finally 27 articles were included. Pooled results show a standardized mean difference of −0.93 (95% confidence interval [−1.27 to −0.59]), indicating that the group with neglect short after stroke has significant lower functional outcome at follow-up. Regarding aphasia, the standardized mean difference was −0.50 (95% confidence interval [−0.72 to −0.28]). It appears in the limited articles available that patients with cognitive dysfunction have lower scores for functional outcome.

Conclusions

Patients with neglect or aphasia, especially aphasia with comprehension deficits, short after stroke have significant worse functional outcome.

Implications for rehabilitation

• Clinicians should perform an extensive screening for neglect, aphasia, and cognitive disorders to make sure to diagnose the different neuropsychological disorders correctly.

• When patients with neuropsychological disorders are referred for rehabilitation, it can be expected that they need a longer rehabilitation period or may never reach the same level of functioning.

• Clinicians should pay attention to instructions of training moments outside therapy and involve caregivers and patients family making these training moments more effective.

Keywords:

• Stroke
• neuropsychological disorder
• neglect
• aphasia
• functional outcome

Acknowledgements

The authors thank W. Bramer, Biomedical Information Specialist at Erasmus MC, Rotterdam, The Netherlands, for helping with the conduction of the search strategy.

Disclosure statement

The authors report no declarations of interest.