Questionnaire assessment of usual practice in mood and cognitive assessment in Scottish stroke units

PURPOSE: National and International guidelines recommend cognition and mood assessment for all stroke survivors. However, there is no consensus on preferred screening tool or method of assessment. We aimed to describe clinical practice in cognitive and mood assessment across Scottish stroke services. METHOD: We used a questionnaire based survey. After local piloting, we distributed the questionnaire using mixed methodologies (online and paper) across all Stroke Managed Clinical Networks in Scotland. We also distributed the questionnaire to specialist societies representing stroke physicians, nurses and allied health professionals and through the UK Stroke Forum delegate pack. RESULTS: We received 174 responses from nurses, physiotherapists, psychologists, occupational therapists and medical staff. Medical staff made up the largest group of respondents (61, 35%). Of the respondents 148 (85%) routinely assess cognition and 119 (72%) mood. A variety of tools were used (cognitive n = 45 tools; mood n = 17); Mini Mental State Examination (n = 103, 59% of respondents) and the Hospital Anxiety and Depression Scale (n = 76, 44%) were the most commonly employed tools. CONCLUSION: Response rate was modest but included all mainland Scottish regions with active stroke services. Although the majority of responders are assessing cognition and mood there is substantial heterogeneity in measures used and certain commonly used tools are not validated or appropriate for use in stroke. We suggest development of evidence based, standardised assessment protocols. IMPLICATIONS FOR REHABILITATION: Screening stroke survivor’s for cognitive and mood issues is recommended but there is little guidance on the preferred assessment strategy. Across Scottish stroke services there is a lack of consensus in assessment and management of cognition and mood post stroke. Sixty-two different cognitive/mood assessment tools were found to be in use across the country. Careful consideration must be given when inspecting assessment tools and use of caution when interpreting results.