Assessing Post-Stroke Psychology a Longitudinal Evaluation (APPLE)
Research type
Research Study
Full title
Improving our assessment and understanding of the short, medium and longer term neuropsychological consequences of stroke
IRAS ID
199099
Contact name
Terence J Quinn
Contact email
Sponsor organisation
NHS Greater Glasgow and Clyde
Duration of Study in the UK
3 years, 11 months, 26 days
Research summary
Research Summary
Problems of mood, thinking and memory are common after a stroke.
There has been limited research around these issues. This work aims to answer fundamental questions around who develops these problems and how they recover.The first step towards managing problems is recognition. Guidelines recommend assessing for emotional, thinking and memory problems in the first days following a stroke. However, there is no consensus on how to do this. At present researchers and clinicians are using a variety of different assessments. We will study various tests and assess if they are accurate; suitable for busy stroke units and acceptable to patients. This will allow us to give definitive recommendations on the tests best suited to stroke units.
We know very little about how mood, memory, thinking change after stroke. We will follow stroke survivors over 18 months testing mood, memory and thinking regularly and looking for patterns of recovery. We are particularly interested in factors that are associated with future problems of mood, thinking and memory. If we can predict who will develop problems we can use these findings to offer increased psychological follow-up and support to those at risk.
People with memory, thinking or mood problems after a stroke, may have had these problems prior to the stroke but never detected or assessed. Various questionnaire based tests that ask questions of family, friends or carers are available and have been used to describe previous psychological problems in older adults with dementia. We will describe if these tests also work in stroke and which works best.
Our research will improve how we look for and look after emotional, thinking and memory problems - helping clinical teams give the best care to individual patients; assisting policy makers in planning future stroke services and helping researchers plan future studies of treatments.
Summary of Results
Problems of mood, thinking and memory are common after a stroke, yet there has been limited research around these issues. I was supported by a Stroke Association / Chief Scientist Office Priority Program Award to develop research studies that aimed to answer fundamental questions around who will develop these problems and how they recover.
There were three main aspects to this work and I will describe each in turn.Psychological issues before the stroke: To understand the memory, thinking and mood issues that happen after a stroke, it is necessary to describe if these factors were an issue before the stroke. In the first of our studies, we interviewed patients admitted with stroke and their families. We used a structured questionnaire to look for evidence of depression, anxiety and dementia that were present before the stroke. We have detailed information on 137 stroke survivors and their care-givers. Our initial calculations suggest that around one third of people with stroke had issues with depression or anxiety before the stroke and around one-in-ten had memory and thinking problems before the stroke. We found that a simple questionnaire could give useful information on a person’s memory and thinking before their stroke. we hope that use of such questionnaires will become part of standard practice in stroke care.
Testing memory, thinking and mood in the early days after stroke: The first step towards managing problems is recognition. Guidelines recommend assessing for emotional, thinking and memory problems in the first days following a stroke. However, when we reviewed the international guidelines, we found that there was no consensus on how to assess for psychological issues following stroke. As a result, at present researchers and clinicians are using a variety of different assessments. We have completed a study looking at how brief tests of memory, thinking and mood perform in a busy stroke unit. We have collected information on over 300 people admitted with stroke. We found that short tests, used early after stroke, can give useful information on a person’s memory and thinking problems. However, we also found that test often need adapted to suit the needs of the stroke survivors and a ‘one size fits all’ approach would not work in acute stroke. We hope to use the project to offer guidance on the most appropriate test to use in an acute stroke unit setting.
The natural history of memory, thinking and mood problems: We know very little about how mood, memory, thinking change after stroke. So, we followed stroke survivors over 18 months testing mood, memory and thinking regularly and looking for patterns and predictors of recovery. At present we have no good methods for predicting a person’s recovery from stroke, particularly their psychological recovery. Many factors have been suggested as potentially identifying those who will make a good recovery and those who will develop problems but we are still not at a stage where we can use this information to give patients and families accurate estimates of recovery. We are still working with the information from this project, but already we are seeing that stroke survivors have differing patterns of recovery. Thankfully, most stroke survivors show recovery in their memory and thinking skills after initial problems following the stroke. There is the potential that we could predict those people who are most likely to have persisting issues based on early assessments following stroke. This would allow us to target psychological services and support to this group.
REC name
Scotland A: Adults with Incapacity only
REC reference
16/SS/0105
Date of REC Opinion
28 Jul 2016
REC opinion
Further Information Favourable Opinion