title: Post-stroke depression, obstructive sleep apnea, and cognitive impairment: Rationale for, and barriers to, routine screening.
abstract: Stroke can cause neurological impairment ranging from mild to severe, but the impact of stroke extends beyond the initial brain injury to include a complex interplay of devastating comorbidities including: post-stroke depression, obstructive sleep apnea, and cognitive impairment ("DOC"). We reviewed the frequency, impact, and treatment options for each DOC condition. We then used the Ottawa Model of Research Use to examine gaps in care, understand the barriers to knowledge translation, identification, and addressing these important post-stroke comorbidities. Each of the DOC conditions is common and result in poorer recovery, greater functional impairment, increased stroke recurrence and mortality, even after accounting for traditional vascular risk factors. Despite the strong relationships between DOC comorbidities and these negative outcomes as well as recommendations for screening based on best practice recommendations from several countries, they are frequently not assessed. Barriers related to the nature of the screening tools (e.g., time consuming in high-volume clinics), practice environment (e.g., lack of human resources or space), as well as potential adopters (e.g., equipoise surrounding the benefits of treatment for these conditions) pose challenges to routine screening implementation. Simple, feasible approaches to routine screening coupled with appropriate, evidence-based treatment protocols are required to better identify and manage depression, obstructive sleep apnea, and cognitive impairment symptoms in stroke prevention clinic patients to reduce the impact of these important post-stroke comorbidities. These tools may in turn facilitate large-scale randomized controlled treatment trials of interventions for DOC conditions that may help to improve cardiovascular outcomes after stroke or TIA.
authors.affiliation: University of Toronto, Toronto, Canada Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, Toronto, Canada Hurvitz Brain Sciences Research Program, Toronto, Canada Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Toronto, Canada University of Toronto Stroke Program, Toronto, Canada rick.swartz@sunnybrook.ca.
authors.forename: Richard H
authors.initials: RH
authors.lastname: Swartz
authors.affiliation: University of Toronto, Toronto, Canada Department of Medicine (Physiatry), University Health Network, Toronto Rehabilitation Institute, Toronto, Canada.
authors.forename: Mark
authors.initials: M
authors.lastname: Bayley
authors.affiliation: University of Toronto, Toronto, Canada Hurvitz Brain Sciences Research Program, Toronto, Canada Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada.
authors.forename: Krista L
authors.initials: KL
authors.lastname: Lanctôt
authors.affiliation: University of Toronto, Toronto, Canada Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, Toronto, Canada Hurvitz Brain Sciences Research Program, Toronto, Canada.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Murray
authors.affiliation: Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, Toronto, Canada.
authors.forename: Megan L
authors.initials: ML
authors.lastname: Cayley
authors.affiliation: Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, Toronto, Canada.
authors.forename: Karen
authors.initials: K
authors.lastname: Lien
authors.affiliation: Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, Toronto, Canada.
authors.forename: Michelle N
authors.initials: MN
authors.lastname: Sicard
authors.affiliation: University of Toronto, Toronto, Canada Dalla Lana School of Public Health, University of Toronto, Toronto, Canada St. Michael's Hospital, Applied Health Research Centre of the Li Ka Shing Knowledge Institute, Toronto, Canada.
authors.forename: Kevin E
authors.initials: KE
authors.lastname: Thorpe
authors.affiliation: University of Ottawa, Ottawa, Canada Department of Medicine (Neurology), Ottawa Hospital, Ottawa, Canada Ottawa Hospital Research Institute, Ottawa, Canada.
authors.forename: Dar
authors.initials: D
authors.lastname: Dowlatshahi
authors.affiliation: Western University, London, Canada Department of Clinical Neurological Sciences, London Health Sciences Centre, London, Canada.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Mandzia
authors.affiliation: University of Toronto, Toronto, Canada University of Toronto Stroke Program, Toronto, Canada Department of Medicine (Neurology), University Health Network, Toronto Western Hospital, Toronto, Canada.
authors.forename: Leanne K
authors.initials: LK
authors.lastname: Casaubon
authors.affiliation: University of Toronto, Toronto, Canada University of Toronto Stroke Program, Toronto, Canada Department of Medicine (Neurology), St. Michael's Hospital, Toronto, Canada.
authors.forename: Gustavo
authors.initials: G
authors.lastname: Saposnik
authors.affiliation: Department of Medicine (Neurology), Trillium Health Partners, Mississauga, Canada.
authors.forename: Yael
authors.initials: Y
authors.lastname: Perez
authors.affiliation: McMaster University, Hamilton, Canada Department of Medicine (Neurology), Hamilton Health Sciences, Hamilton, Canada Department of Medicine (Neurology), Hamilton General Hospital, Hamilton, Canada.
authors.forename: Demetrios J
authors.initials: DJ
authors.lastname: Sahlas
authors.affiliation: University of Toronto, Toronto, Canada Hurvitz Brain Sciences Research Program, Toronto, Canada Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada.
authors.forename: Nathan
authors.initials: N
authors.lastname: Herrmann
mesh_terms: D060825:Cognitive Dysfunction / Q000175:diagnosis* / Q000209:etiology* / Q000628:therapy; D003863:Depression / Q000175:diagnosis* / Q000209:etiology* / Q000628:therapy; D006801:Humans; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000209:etiology* / Q000628:therapy; D020521:Stroke / Q000150:complications* / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D000071939:Stroke Rehabilitation
keywords: Stroke; cognitive impairment; depression; obstructive sleep apnea; prevention; rehabilitation