Following advice, Ray notified the DVLA of the stroke and is waiting to hear whether he will need to have a driving assessment.
He is currently using Access to Work scheme to enable him and his daughter to get to school (Get help from Access to Work (Easy Read) (publishing.service.gov.uk)).
Driving assessments focus on skills such as attention, visuospatial perception, speed of processing, memory, sequencing and coordination, and other executive functioning skills, including insight.
These cognitive domains were also assessed as part of the neuropsychological assessment.
For the full Scottish Stroke AHP Forum driving assessment references see the Additional Information box below.
When working with individuals, such as Ray, who demonstrate a lack of insight into their function and safety, it is important to address the issues with sensitivity and care.
The following strategies can be used to help the individual, their family and the MDT. Select the crosses for more details.
As the charge nurse suspected Eddie had a UTI. Once this was treated his confusion quickly improved and his ‘memory problems’ resolved. A number of other conditions or cognitive issues can present as or ‘mimic’ memory problems, these include:
- Attentional Problems- People with attentional difficulties will often look like they have poor memories. If we are not attending well then the chances of getting information into short term and then long term storage is slim. However, for such individuals the focus in rehab should be working on their poor attention rather than strategies to assist with memory difficulties.
- Executive Problems- In certain situations we know there might be something we want to/ is important to remember. As a result we plan and organise ; we might take notes or photographs and/or rehearse the information afterwards to aid recall. Sometimes we call this ‘remembering to remember’. Individuals with executive difficulties may struggle with this and it can look like their memory is poor. In these circumstances it’s important that our rehab focuses on these executive issues and not just memory alone.
- Depression- Individual who are depressed often report memory difficulties (and remember, unfortunately mood disorders are relatively common post stroke. Prevalence and Course of Depression During the First Year After Mild to Moderate Stroke Liming Dong, Linda S. Williams, Devin L. Brown, Erin Case, Lewis B. Morgenstern and Lynda D. Lisabeth Originally published29 Jun 2021 https://doi.org/10.1161/JAHA.120.02049Journal of the American Heart Association. 2021;10:e020494) and perform less well on memory assessments. However, it wouldn’t make sense to provide strategies to help their memory while ignoring the underlying mood disorder- this needs to be the focus.
- Word finding difficulties (WFD)– Individuals with expressive language difficulties especially WFD’s often describe this as a sort of memory problem e.g. ‘I know what it is but I forget what it’s called’, ‘It’s so annoying I know the word I want to use but I just can’t remember it’. These are generally language difficulties rather than memory problems and the rehab needs to concentrate on language.
We met Ana in the Thinking Processes and Behaviour Core competency. She had a left PACS age 75 and after getting home noticed she was struggling with family gatherings and was forgetting things. This in turn led to her losing confidence and socially withdrawing. Contact with the neuropsychologist helped clarify these issues and together they arrived at strategies to assist with her memory and help her deal with the emotional consequences of her stroke.
It is now almost two years since her stroke and Ana has continued to move forward. She sees her children and grandchildren regularly, volunteers at her local mandir (temple) and has become a leading member of her local stroke club. Next week she is giving a talk on her experience of having a stroke and what has helped her memory. On the next page Ana thinks about some of the memory strategies she has used.
The cognitive screen suggests that Dorothy has a potential memory impairment. The Occupational Therapist therefore decided to carry out a standardised memory assessment along with functional tasks.
For more information on the difference between cognitive screening, neuropsychological and perceptual assessments see ‘Additional Information’ below.
It seems that Dorothy is struggling to remember some things. From what you have seen what do you think are Dorothy’s memory difficulties.
