national-clinical-guidelines-for-stroke-fourth-edition

National clinical guideline for stroke
6.39.1 Recommendations
A Any person after stroke who appears easily distracted or unable to concentrate should
have their attentional abilities (eg focused, sustained and divided) formally assessed.
B Any person with impaired attention should have cognitive demands reduced through:
● having shorter treatment sessions
● taking planned rests
● reducing background distractions
● avoiding work when tired.
C Any person with impaired attention should:
6.39.2 Sources
● be offered an attentional intervention (eg Time Pressure Management, Attention
Process Training, environmental manipulation), ideally in the context of a clinical
trial
● receive repeated practice of activities they are learning.
A–B Consensus
C Lincoln et al 2000; Winkens et al 2009; consensus
6.40 Memory
Subjective problems with memory are very common after stroke, and memory deficits
are often revealed on formal testing. Memory deficits can lead to longer hospital stays,
poorer functional outcomes, risks to personal safety, and can cause subjective distress to
patients and their families. Memory loss is a characteristic feature of dementia, which
affects about 20% of people 6 months after stroke. However, this section is not directly
concerned with the losses associated with diffuse cerebrovascular disease.
Evidence to recommendations
Since the previous edition of the National clinical guideline for stroke (2008), one RCT has
been published of sufficient quality to add to the current recommendations. Fish et al (2008)
provided some evidence for the benefits of electronic paging reminder systems, although the
effects were temporary, and from a small, crossover study of individuals who were younger
than the typical stroke patient, and most had subarachnoid haemorrhage. Interesting work
has been carried out on the impact of active music listening (Sarkamo et al 2010; Winkens et
al 2009), but further research needs to determine whether this is effective for memory
problems. Research is needed to establish both the clinical effectiveness (particularly at an
activity level) and the patient acceptability of different memory rehabilitation approaches,
recruiting larger, more representative, groups of stroke patients.
6.40.1 Recommendations
A Patients who complain of memory problems and those clinically considered to have
difficulty in learning and remembering should have their memory assessed using a
standardised measure such as the Rivermead Behavioural Memory Test (RBMT).
118 © Royal College of Physicians 2012