Is there a treatment for moderate cognitive impairment
Cognitive disorders after a stroke
Cognitive disorders can occur after a stroke (Illustration: PIRO4D | Pixabay)
In this article:
What are cognitive disorders?
Stroke patients often suffer from physical impairments such as paralysis of the legs or arms. However, a stroke can also result in cognitive problems such as memory and concentration disorders. Confusion and disorientation also occur.
These impairments can become severe for those affected Mood swings or even depressive moods to lead. Everyday life becomes a challenge for patients, and dependency on relatives or caregivers arises. The ignorant often label those affected as “mentally handicapped” and thus increase the suffering.
The collective term “cognitive disorders” encompasses impairments of information processing in the brain. The word cognition is derived from the Latin “cognoscere”, which means something like “recognize, experience or notice”.
Symptoms and severity of cognitive disorders
Symptoms of a cognitive impairment are essentially the restriction of perception, attention, the decline of memory or the ability to remember, the uncertainty in targeted action planning, the restriction of the ability to make judgments, the sensible problem solving and the ability to communicate.
One can therefore also say that with a cognitive disorder “the thinking” as such is disturbed. Cognitive disorders influence both everyday activities and social life, as well as professional performance. All of these restrictions often lead to a significant impairment of the quality of life.
Cognitive disorders after a stroke can occur in very different forms. Type and extent depend on the location and severity of the brain damage, age and previous state of health, especially with regard to cognitive performance.
Cognitive disorders have the potential for conflict
Cognitive disorders are noticed by those affected and by those around them and often lead to conflicts in the family or at work. So it is all the more important to encourage those affected and to educate all those involved so that these disorders are understood and treated with appropriate care.
“Mild cognitive impairment” (ICD-10: F06.7) describes cognitive disorders that go beyond age and level of education. Mostly it is memory disorders, impaired attention and concentration. But they do not represent a major handicap in everyday life.
Examples of cognitive limitations
- Attention and concentration disorders in the case of premature, mental fatigue and limited ability to remember, especially short-term memory. Patients very often complain that they forget more and more, often look for something, write down more or have to be reminded of an order several times. You are more easily distracted, get lost, and have difficulty concentrating on a task.
- Incorrect action planning, reduced ability to make judgments, difficult problem solving or limited ability to communicate. Patients report everyday problems with routine activities, such as cooking, planning and making purchases, making a bank transfer, or composing an email. This leads to impatience in the social environment, and reprimands are the result. Many patients also suffer from not being able to pronounce them if it takes too long to find a word. Or that they are simply not understood.
- Confusion and disorientation. Patients appear at a loss, speaking and acting are incoherent. You can no longer find your way in unfamiliar, sometimes even domestic, surroundings. This is known as a local disorientation. There are also uncertainties with regard to the temporal classification - naming the time of day, month, season and year. a temporal disorientation.
When is dementia suspected?
Cognitive impairments are the main characteristic of dementia (ICD-10: F03).
If the symptoms mentioned above are not the result of a stroke or another brain disease, incipient or advanced dementia should be considered.
Their cause and severity are then classified by means of neurological-psychiatric and neuropsychological examinations. Blood tests and apparatus-based examinations are also carried out, such as deriving brain waveforms (EEG), magnetic resonance imaging of the skull or ultrasound diagnostics on the arteries supplying the brain.
In addition, extensive tests are carried out with regard to brain performance. Examples are the “Montreal Cognitive Assessment” (MoCA) test, the “Mini-Mental-Status-Test” (MMST) or the “DemTect A + B” as early detection tests.
During these examinations, the spatial and temporal orientation, memory, attention and arithmetic, memory, reading, writing and visual-constructive skills are queried and evaluated or assessed.
Treatment: what can be done therapeutically?
Stroke patients with cognitive impairments can often achieve a significant improvement in brain performance and ability to act as part of neurological rehabilitation, inpatient or outpatient, through individually adapted and targeted therapies.
In particular, occupational therapy, often in collaboration with physiotherapy, and neuropsychological therapy are used here.
Exercises at home
The continuation of the professionally elaborated “training”, ie the learned and helpful exercises in a home environment, is of great importance. Also with help from family or friends.
Everyday exercises such as a Sudoku, a crossword puzzle from the newspaper or a memory game are ideal.
But also modern digital home training offers are helpful. They can be adapted to individual needs and actual performance.
Discuss with your doctor whether he can recommend a corresponding offer, such as RehaCom home training (https://hasomed.de/produkte/rehacom/).
Outlook and forecast
In the truest sense of the word: Don't let your head hang down
Stroke patients with cognitive disorders find it anything but easy to cope with everyday life. In addition, there is a lack of understanding by society due to a lack of education.
Stroke patients have a realistic chance of improving their quality of life and actively counteracting cognitive deficits.
Tips for patients
Finally, a few tips:
- Describe and discuss your problems with your doctor and therapist without shame and with the greatest possible openness
Clarify your environment
- Get psychiatric or psychological support if there are problems with your social environment or if you experience depressive disorders
- Integrate short exercises into your everyday life several times throughout the day
- Don't let your head down, you are not alone with your problem.
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Prof. Dr. med. Hans Joachim von Büdingen is a resident specialist in neurology and psychiatry at the Ravensburg Neurocenter. As chief physician, he headed the Department of Neurology and Clinical Neurophysiology at the St. Elisabeth Hospital in Ravensburg. The main focus of his work is the diagnosis and treatment of strokes. [more]
- Cognitive rehabilitation for memory deficits after stroke – Authors: the Nair R, Cogger H, Worthington E, Lincoln NB - publication: Cochrane Database of Systematic Reviews 2016, Issue 9. Art. No .: CD002293. - DOI: 10.1002 / 14651858.CD002293.pub3
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