Challenges for Diagnostic Clarity for Post-stroke Cognitive Impairment and Behavioural Issues in Middle-Income Countries: Case Studies From Malaysia

Yap, Kwong H., Warren, Narelle, Allotey, Pascale and Reidpath, Daniel, (2021). Challenges for Diagnostic Clarity for Post-stroke Cognitive Impairment and Behavioural Issues in Middle-Income Countries: Case Studies From Malaysia. Frontiers in Neurology, 1-8

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  • Sub-type Journal article
    Author Yap, Kwong H.
    Warren, Narelle
    Allotey, Pascale
    Reidpath, Daniel
    Title Challenges for Diagnostic Clarity for Post-stroke Cognitive Impairment and Behavioural Issues in Middle-Income Countries: Case Studies From Malaysia
    Appearing in Frontiers in Neurology
    Publication Date 2021-06-02
    Place of Publication Lausanne
    Publisher Frontiers Media S.A.
    Start page 1
    End page 8
    Language eng
    Abstract Following stroke, individuals require ongoing screening, diagnosis and monitoring for cognitive impairment. Services and policies around these vary widely between settings, and reports from many countries highlight persistent under-diagnosis of cognitive impairment in the months and years after stroke. Missed and delayed diagnosis of post-stroke cognitive impairment, including dementia, are important factors in shaping the experiences of people so affected and their family members, especially in low- and middle-income countries. Drawing upon ethnographic research conducted in Malaysia, this article draws upon three case studies to examine the continued health-seeking behaviour after the appearance of salient cognitive and behavioural symptoms that occurred after stroke. Findings highlight the challenges in getting formal diagnostic clarity for cognitive and behavioural symptoms in a rural setting within a middle-income country. No study participants sought help for memory or cognitive problems, partly due to limited lay awareness of cognitive impairment but more significantly due to health service factors. Despite their elevated risk for dementia, participants were not monitored for cognitive impairment during any follow-up care in various health facilities. Furthermore, caregivers' attempts to seek help when behavioural issues became untenable were met with multiple health system barriers. The journey was complicated by the meanings attached to the reactions towards cognitive symptoms at the community level. We suggest that strategies seek to increase the awareness of post-stroke cognitive and behavioural symptoms, and incorporate clear treatment pathways into the long-term care plans of community-dwelling stroke survivors.
    UNBIS Thesaurus CASE STUDIES
    MALAYSIA
    MIDDLE-INCOME COUNTRIES
    Keyword Diagnostic challenges
    Post-stoke cognitive impairment
    Behavioural issues
    Copyright Holder The Authors
    Copyright Year 2021
    Copyright type Creative commons
    DOI 10.3389/fneur.2021.628876
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    Created: Fri, 31 Dec 2021, 18:53:04 JST by Radhika Das on behalf of UNU IIGH