Life after stroke: long term psychological consequences

The project is a Stroke Association Priority Programme Award, following on from our early post-stroke screening programme, where patients are screened for cognitive problems in the acute stroke unit, and subsequently followed up 6 months later at home.

The aim of this project is to determine the prevalence, nature, trajectories and wider impact of cognitive impairment in long term stroke survivors, in relation with mood and fatigue.

A 3 year longitudinal observational study with yearly detailed neuropsychological profiling will be conducted in a well-defined cohort (N=200) of long term (> 2 year) stroke survivors. Importantly, detailed baseline and 6month stroke and cognitive information is available on this cohort. These repeated in depth neuropsychological profiles allow us to distinguish between domain-general (e.g. sustaining attention) and domain-specific cognitive problems (e.g. aphasia), which contribute differentially to recovery and decline. In addition, we will examine the cognitive underpinnings of post stroke fatigue, and map long term changes in mood and behaviour. We will investigate the impact of these complex psychological consequences on survivors’ and their carers, in terms of symptoms, quality of life and achievement of personal goals. This research will significantly enhance our understanding of post-stroke cognition and its inter-relations with mood and fatigue in long term stroke survivors, impacting the policies on planning of services for longer term follow up after stroke. Additionally, specific cognitive intervention developments (e.g. neglect, apraxia) can build on this increased understanding of trajectories.


Oxford COMPASS (COMPetency ASSessment) is a new planned project to provide cognitive screening specifically aligned to Mental Capacity Assessments.

Assessment of mental capacity is a critical aspect of clinical practice, particularly for neurological patients. It provides the crucial judgement on patients’ ability to make informed decisions on a wide range of situations, from choosing treatment and discharge destination, to making financial decisions (e.g. selling a house), creating a power of attorney or making a will. Careful, well-informed capacity assessments are vital for ensuring the protection of peoples’ rights. In order to establish that a person lacks capacity, the law states that the person concerned must be unable to (i) understand information relevant to the decision, (ii) retain that information, (iii) use or weigh that information as part of the process of making the decision, or (iv) communicate the decision made.

In spite of clear legal guidance, mental capacity assessments are typically conducted in a short non-standardized interview and are highly variable in practice.  They often fail to align with legal standards of the MCA, are solely based on a subjective, qualitative interview and are poorly documented. 

We are therefore developing a standardised mental capacity assessment app, in line with legal standards, to improve the approach and documenting of this decision-making process, which has long-lasting and highly impactful consequences to patients’ rights to self-determination. This project brings together expertise in neuropsychological cognitive screening and in depth knowledge of mental capacity law with high level statistical methods and software engineering. 

The end goal is for this application (COMPASS, short for COMPetency ASSessment) to be brief (using adaptive testing methods), easy to use by health professionals and to provide them with a standardised and quantified graded mental capacity profile that will inform and guide situation specific capacity judgements.


As an elaboration of the domain specific OCS, the OCS-Plus was developed by the late Prof Humphreys, with Dr Demeyere and Dr Duta. The OCS-Plus was conceived as a set of tablet based, finer grained tests to include measures of domain general cognitive functions, such as executive attention, working memory, constructional planning, and selective and sustained attention. 

The aim of OCS-Plus was to sensitively pick up on domain general impairments in healthy ageing, mild cognitive impairment and vascular dementia, without undue loading of language requirements. The OCS-Plus, is currently only available as a research tool, and has been validated, and normed with 200 participants.

The OCS-Plus has been translated and is currently used in a low-education, rural community in the HAALSI cohort,  under the lead of Prof Lisa Berkman (Epidemiology, University of Harvard)

A collaboration at LMU, Munich, is validating a German translation of OCS-Plus in a cohort of MCI patients (Ms Marleen Haupt and Dr Kathrin Finke).