Cognitive Rehabilitation for Memory Deficits After Stroke
An Updated Review
Memory problems are common after a stroke, leading to difficulties in everyday life. Memory rehabilitation aims to help retrain lost functions or to teach patients strategies to compensate for them. Although some studies have reported positive outcomes after memory rehabilitation, reviews have provided inconclusive evidence for effectiveness.
This is an update of a Cochrane review first published in 2000 and subsequently updated in 2007.
The objective of this review1 was to determine whether participants who have received cognitive rehabilitation for memory problems after a stroke had better outcomes in relation to memory function, functional ability, mood, and quality of life, than those given no treatment or a placebo control.
For this update, we used a comprehensive electronic search strategy to identify studies in 16 databases, including the Cochrane Stroke Group Trials Register (last searched May 19, 2016), Cochrane Central Register of Controlled Trials (CENTRAL: 2016, Issue 5), and MEDLINE (2005 to March 7, 2016), in conjunction with handsearches of primary studies included.
We selected randomized controlled trials where cognitive rehabilitation was compared with a control condition. Studies with stroke patients were included, along with mixed etiology studies where separate stroke data were available.
Data Collection and Analysis
Two reviewers (H.C. and E.W.) selected trials, extracted data, and assessed trial quality, confirmed through group discussion. Authors of studies were contacted to obtain further information where required. Where there were sufficient numbers of similar outcomes, we performed meta-analyses.
This review included 13 trials involving 514 participants. There was a significant effect of treatment on subjective reports of memory in the short term (standard mean difference, 0.36; 95% confidence interval, 0.08–0.64; P=0.01, moderate quality of evidence), with small-to-moderate effect size (Figure). No significant effects of treatment were found in subjective reports in the long term or on performance on objective memory measures, mood, functional abilities, or quality of life.
Benefits were reported in the short term on subjective measures of memory; however, these did not persist in the long term. In addition, no benefits were reported in objective memory measures, mood, or daily functioning. There was insufficient evidence to support or refute the effectiveness of memory rehabilitation after stroke. This may be because of poor methodological quality of the included studies, inconsistencies in the choice of outcome measures, and small sample sizes. Furthermore, more robust trials of memory rehabilitation that use standardized activity or participatory level outcome measures are required.
Implications for Practice and Research
Because of the high prevalence of memory problems after a stroke and the diversity of interventions available to address these, it is important to understand the effectiveness of available interventions. Studies included in this review highlighted the broad range of interventions used in stroke care and the variety of measures used to evaluate their effectiveness. The results of this review indicated that there are some improvements to subjective reports of memory functioning in the short term but with unclear effects in the long term.
This article is based on a Cochrane Review published in The Cochrane Library 2016, issue 9 (see http://www.thecochranelibrary.com for information). Cochrane Reviews are regularly updated as new evidence emerges and in response to feedback, and the Cochrane Library should be consulted for the most recent version of the review.
Sources of Funding
External funding source for this study is National Institute for Health Research Cochrane Review Incentive Scheme 2015, United Kingdom.
- Received October 13, 2016.
- Revision received November 11, 2016.
- Accepted November 23, 2016.
- © 2016 American Heart Association, Inc.
- Das Nair R,
- Cogger H,
- Worthington E,
- Lincoln NB