Clinical Features, Diagnosis, and Treatment of Poststroke Cognitive Impairment

Poststroke Cognitive Impairment (PSCI) is becoming a major burden in our aging society, and its prognosis is poor, even compared with patients with Alzheimer’s disease. Executive dysfunction and working memory impairment are characteristic symptoms of PSCI. Additionally, poststroke apathy, which is a difficult neuropsychiatric sequela, often afflicts stroke survivors and is an important obstacle for rehabilitation. For PSCI detection, the Montreal Cognitive Assessment (MoCA) is superior to the Mini-Mental State Examination (MMSE) because the MoCA assesses a number of executive functions with visuoexecutive, abstraction, and conflicting instructions items. Additionally, the Apathy Scale is a useful tool for the early detection of poststroke apathy. Recently, the ASCO phenotypic classification of stroke has been proposed as a new classification system of stroke. The ASCO classification evaluates the etiology and mechanisms of ischemic stroke comprehensively and systematically. In addition, the risk factors for cognitive impairment, such as arterial sclerosis, leukoaraiosis, and atrial fibrillation, can be assessed simultaneously and graded with the ASCO classification. The total score of the ASCO classification correlates significantly with the total scores on the MoCA and MMSE. The ASCO classification is useful for assessing both the etiology of ischemic stroke and cognitive decline in stroke survivors. Both medication therapy, with agents such as acetylcholinesterase inhibitors, and cognitive rehabilitation therapy are considered effective treatments for patients with PSCI. In this review, the clinical features, diagnosis, and treatment of patients with PSCI are extensively described to aid in early detection and treatment, which will improve the prognosis of these patients.