الفهرس 
Introduction
Aim of the studyOnly 14 pages are availabe for public view
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Abstract
Cognitive impairment is a frequent consequence of stroke, with estimates of 50% of patients presenting cognitive impairment in the early phase after stroke Laver, et al, (2011). Cognitive impairment following stroke can reduce a person’s independence in performing basic activities of daily living (ADL) such as eating, dressing, and toileting as well as instrumental ADL such as housework and social interactions (Nys, , et al, (2007). So improvement of the cognitive impairment will improve the daily living activity and quality of life of those patients.
The aim of the present study was to improve cognitive function of elderly patients with stroke.
The study was carried out at three setting; neuropsychiatric department, physical medicine and rehabilitation department and outpatient neurology clinics at Assiut University hospital. Convenient sample of elderly people attending to the previous setting were included in this study, their number were 70 elderly stroke patients aged 60years and above. They randomly selected assigned into one of two group, study group (35elderly patient with stroke )and other control group(35 elderly patient) using closed envelop.
Data collection was during the period from September 2011 to September 2012, three days weekly, the average number which interviewed was 1-2 elderly per day. The approximate time spent during the filling of sheet was around 30-45 minutes according to respond of patient.
The following tools were utilized for data collection; 1) The study tools include six tools; first tool Interview sheet for the elderly include socio-demographic data and questions related to elderly knowledge about stroke as signs and symptoms of stroke, risk factor for stroke and possible ways for prevention of recurrent stroke. 2) The following neuropsychological tests to characterize various aspects of cognitive function (baseline testing) and provide a screen for cognitive impairment and general psychological status include Second tool: Mini-Mental State Examination ( Folstein et al., 1975):, include This scale include five items( orientation, registration, Attention &calculation, recall and language.
Third tool: Digit Span (forward and backward ;Wechsler, 1987), forward span measures simple attention, with backward span providing a general index of working memory. Fourth tool; logical Memory (Wechsler, 1987). Fifth tool; Geriatric Depression Scale (GDS; Brink , 1982, Yesavage ., 1983 - & Sheik ., 1986,), and six tool; Barthel Index scale (Shah,et al, 1989) . This scale include items related to activities of daily living (ADL).
These scales were assessed pre rehabilitation intervention program (at base Line), two weeks and one months after rehabilitation program.
An official approval letters was obtained from local ethical committee. oral consent was obtained from each patient or his or her giver after demonstration of the program. A pilot study carried out on 5 elderly persons to evaluate the clarity and applicability of the questionnaire and to do the necessary modification.
The rehabilitation program included:
Pictures to improve memory, this pictures repeat for two weeks . (three times per week (see appendix 7). Also the researcher training the group 1 on computerized program(fish face task and N400 task) in this task the researcher show on computer screen the pictures of two persons and pictures of two fish and give every person color of fish and after that change position of fish and persons and at the end of training ask the elderly if he know the correct color of person with the correct answer of fish. As regard (N400task the elderly hear the name of two things as sea and fish , boy and dog and ask if two things similar or different. ).
After that give patients health education about prevention of diabetes, hypertension and recurrent stroke and also teach patients exercise to improve activities of daily living and tips for memory improvement (see appendix 9,10,11).
Main findings of the present study were the following:
The mean age of studied sample ranged from 60 to 84 years . The majority of them (85.7%) were married. (34.3%) of the studied sample had education less than 6 years and (51.4,71.4%) of them were illiterate.
The majority of the studied sample (82.9, 91.4% respectively) were have hypertension as a common risk factor for stroke followed by diabetes mellitus in the second (57.1%, 48.6% respectively).
Nearly half of both studied group (48.6%) had mild depression before starting the program, and there was statistical significant difference between two group in pre, post and follow up test (P-value = 0.0001).
More than one third (34.3%) of studied groups before starting the program was totally dependent in barthel scale item and more than half of both group I and group II (51.4%, 68.6% respectively) were severe dependent before starting the program.
More than two third of group I (68.6%) , had mild cognitive impairment and (25.7%) of them had sever cognitive impairment before starting the program compare to 62.9% of group II had mild cognitive impairment and 37.1% of them had sever cognitive impairment.
After application of the training program there was statistical significant difference in pre, post, and follow up test for group I compared with group II in MMSE, ADL, and in other psychometric tests (P-value = 0.000*).
from these result, It could be concluded that elderly Patients with stroke are at high risk for cognitive impairment, cognitive impairment have a significant impact on physical and psychological status of stroke patient so the following recommendations are suggested:
1. Screening assessment of cognitive impairment in every stroke patient for early detection .
2. The nature of the impairment should be determined, and its impact on activity and participation should be explained to patients, and care givers.
3. Replication of the study on a larger probability sample acquired from different geographical areas in Egypt to figure out the main aspects of this problems. And generalize the result.