1. Screening

2. By building screening for symptoms of VCI into regular workflows or practice, health care providers are participating in Taking Action to address cognition. Clinicians must bear in mind that although screening can provide highly useful information, it must not be confused with assessment.

3. Who to Screen? All patients with vascular risk factors and with clinically evident stroke or TIA should be considered at a greater risk for VCI, especially in patients with cognitive, perceptual or functional changes that are clinically evident or reported during history taking. Vascular risk factors include: hypertension, diabetes, transient ischemic attack or clinical stroke, neuroimaging findings of covert stroke or white matter disease, hypertension-associated damage to other target organs, atrial fibrillation, other cardiac disease, and/or sleep apnea should be considered for VCI screening. Eskes G, Salter K, on behalf of the Mood and Cognition in Stroke Writing Group and the Evidenced-Based Review in Stroke RehabilitationTeam Chapter 7: Mood and Cognition in Stroke. In Lindsay MP, Gubitz G, Bayley M, and Phillips S (Editors) on behalf of the Canadian Stroke Best Practices Standards Advisory Committee. Canadian Best Practice Recommendations for Stroke Care: 2013; Ottawa, Ontario Canada: Canadian Stroke Network

4. When to Screen Cognitive Screening should occur through all stages and settings following a stroke, including: acute care, rehabilitation, prevention clinics, outpatient and community settings, including primary care, home care and long term care.

5. When to Screen Assessment (we are talking about assessment in this paragraph) All patients considered at high risk for cognitive impairment should be assessed periodically throughout the stages of care as indicated by the severity of clinical presentation, history and/or imaging abnormalities to identify cognitive, perceptual deficits, depression, delirium and/or changes in function [Evidence Level C]

6. When to Screen –cont’d Stages of care may include: During presentation to emergency when cognitive, perceptual or functional concerns are noted; During acute care stay, particularly if cognitive, perceptual or functional concerns, or evidence of delirium is noted; Throughout rehabilitation within inpatient, outpatient, and home-based settings, according to client progress; Following hospital discharge from the emergency department or inpatient setting to an outpatient or community-based healthcare setting.

7. When to Screen –cont’d While assessment at different stages of care is important for guiding diagnosis and management, it is also important to be aware of the potential impact of multiple assessments on both the validity of the results as well as on the patient (e.g., test fatigue, practice effects) [Evidence Level B].