Rationale for the study of the relationship between post-stroke cognitive

The rationale for the current study was the lack of research on the association between cognitive dysfunction and mood disorders in the KSA. The purpose of the study was to fill the gaps identified above in the previous research literature.

The examination of the literature about stroke in the KSA shows that past researchers have focused only superficially on the neuropsychological aspects, despite the fact that a large portion of the stroke population in the country suffers from different types of cognitive dysfunctions. To our knowledge, only two published studies aimed to explore the prevalence of psychological disorders in the KSA. One investigation by Hamad, Siddiqui, and AI-Mansoor (2011) investigated the distribution of depression in 60 stroke patients in Saudi Arabia. Ten patients had depression, 7 patients had mild depression, 2 had moderate depression and 1 patient had severe depression. In conclusion, the team of researchers noted that the rates of depression were infrequent in the patients with stroke; however, depression was significantly linked to the individual‟s severity of disability rather than to the type of stroke. In the second investigation by Abdul-Sattar and Godab

62 (2013), the authors attempted to identify the possible factors influencing the functional outcomes of stroke patients after inpatient rehabilitation. They reported that the key neuropsychiatric conditions after stroke are: cognitive condition, depression, and stroke severity. Additionally, the findings found that the functional dependency of the Saudi population of post-stroke patients was highly correlated with their cognitive or neuropsychiatric conditions (Abdul-Sattar & Godab, 2013).

Among the available studies in KSA, stroke is becoming a growing problem for individuals in Saudi Arabia due to rapid changes in the health-related quality of life of the region. Individuals of all ages can suffer from stroke at any stage of life. To minimise this risk, timely diagnosis and outcomes are needed. An overview of the Saudi Arabian population was provided above, showing that the number of medical centres and research facilities available for treating stroke – only four – is too few for the country‟s population. The provision of treatment for blood clots is also lacking. Relatedly, Khathaami et al. (2011) have indicated a low level of awareness and poor practices in treating stroke, and accordingly poor outcomes and consequences from suffering a stroke in Saudi Arabia. The findings of the current doctoral research are expected to increase awareness of and knowledge about stroke outcomes, including cognitive and mood outcomes, and the indirect associations between the two.

A very limited number of past neuropsychological studies can be found which concentrate on the Saudi context. It is recommend that future research should focus on the impact of stroke on cognitive processes, which are directly associated

63 with the brain. Future research should also investigate the potential aspects associated with cognitive dysfunctions. Specifically, future studies should be directed towards demographic factors to identify their relation to cognitive dysfunction and mood disorders after stroke. These include: age, gender, and literacy, as well as „side of weakness‟, settings, and time since stroke. Of these factors, literacy is of particular importance because, according to the Ministry of Education in Saudi Arabia, around 19% of people over 60 years of age are illiterate. The high level of illiteracy compared to Western countries, makes this neuropsychological study an urgent social and economic medical issue in the KSA. Similarly, the influence of old age on increasing stroke patterns, mainly in the seventh decade of a person‟s life needs further study to highlight the changes occurring in the cognitive functioning of the old-aged person in the post-stroke period. Exactly how the impairments suffered by such patients impact upon living their routine lives must also be more thoroughly studied. Moreover, past studies confirm that the prevalence of stroke in men is higher than that in women. This underscores the need to investigate cognitive functions in men, which will help in identifying differences in the relationship between the cognitive dysfunctions found among males as well as among females.

In addition, changes in patients‟ cognitive abilities, especially neuropsychological disorders, after stroke, have rarely been examined in Saudi Arabia. Loss of attention, memory and language may result in long-term dependence of the stroke patient on others and may contribute to feelings of frustration and fear due to being unable to communicate with others or carry out tasks for themselves. Due to the

64 cognitive dysfunctions that can occur after a stroke, some survivors may lose their jobs, and have less social contact and activity, thereby contributing to the development of depression and anxiety related to their disabilities. It follows that there may be potential interactions between neuropsychological dysfunctions (e.g., attention deficit, memory disorder, visual neglect and executive dysfunction) and mood disorders (depression and anxiety) after stroke. Thus, expanding the focus of neuropsychological studies in Saudi Arabia is critical for inferring patterns and differences between the cognitions of one stroke patient and another, which can help in offering effective interventions in the post-stroke period too.

In sum, the current research extends into multiple dimensions, including substantiating the general findings extracted from the literature review with the primary findings gathered from KSA medical centres. Another rationale for the present study is the lack of knowledge and awareness among KSA medical professionals as well as in the Saudi population about the relationship between cognitive dysfunctions and mood disorders.