Management of Cognitive Impairment After Stroke

Purpose of Review In this review, we present the reader with the latest diagnostic and therapeutic approaches in the management of patients with post-stroke cognitive impairment (PSCI). We discuss the most commonly utilized and validated neuropsychological assessments and neuroimaging diagnostic assessment tools. We also provide a critical appraisal of the pharmacological treatment approaches of PSCI, in addition to highlighting the latest emerging non-pharmacological and technological advances in cognitive rehabilitation techniques. Recent Findings Advanced MRI techniques and newer PET tracers are being utilized heavily in research into cognitive impairment. Non-invasive brain stimulation (NIBS), computer-based cognitive training (CBCT), and virtual reality (VR)-based rehabilitation are playing an increasing role in recent trials of cognitive rehabilitation techniques of PSCI patients. In approaching patients with PSCI, neuropsychological assessment and neuroimaging should be undertaken to aid in the diagnosis and classification of underlying pathological processes. Aggressive vascular risk factor modification, in addition to the use of cholinesterase inhibitors, is the recommended pharmacological treatment approach in these patients. This should be accompanied by encouraging exercise and prescribing conventional cognitive rehabilitation, while attempting to incorporate newer technological treatment modalities such as NIBS, CBCT, and VR. We identified a significant need for future research into treatment modalities aimed at PSCI and vascular dementia (VaD).