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Lin S, Guo J, Nie P, Chen X, Guo J, Lin N, Liu F. Baduanjin for executive function in patients with mild cognitive impairment: A systematic review and meta-analysis. Complement Ther Clin Pract 2022; 49:101626. [PMID: 35785625 DOI: 10.1016/j.ctcp.2022.101626] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/26/2022] [Accepted: 06/26/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND AND PURPOSE Mild cognitive impairment (MCI) represents age-related cognitive decline and affects various aspects of cognitive function, including memory, attention, executive function (EF), mental processing speed, speech-language skills, and visual-spatial skills. Among these, the EF is the most likely to decline with increasing age. Existing RCTs have shown that Baduanjin can improve the EF in MCI patients. In this study, we aimed to perform a systematic review to assess the efficacy of Baduanjin in improving the EF of patients with MCI. METHODS Ten databases [English: Cochrane Library, PubMed, Web of Science, Embase, OVID, and EBSCOhost; Chinese: Wanfang Data, China National Knowledge Infrastructure Database (CNKI), China Science and Technology Journal Database (VIP), and SinoMed] were systematically searched in April 2021. We herein included randomized controlled trials (RCTs) written in Chinese or English that assessed the effect of Baduanjin on the EF of patients with MCI. Two researchers used the Cochrane Collaboration's tool and assessed the risks of bias and performed a meta-analysis through the RevMan 5.4 software. We used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) to evaluate the quality of the body of evidence. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines were followed. RESULTS Sixteen RCTs involving 934 patients with MCI were included. The duration of Baduanjin was 16-24 weeks. The study showed that Baduanjin could significantly improve the EF (P < 0.05) based on the evaluation of the EF of patients with MCI using Montreal Cognitive Assessment, the Clock Drawing Test, the Digit Symbol Coding test, and the Trail Making Test. CONCLUSION Baduanjin significantly improved the EF of patients with MCI.
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Affiliation(s)
- Shaohong Lin
- College of Nursing, Fujian University of Traditional Chinese Medicine, Fuzhou, PR China.
| | - Jiaying Guo
- College of Nursing, Fujian University of Traditional Chinese Medicine, Fuzhou, PR China.
| | - Pingying Nie
- College of Nursing, Fujian University of Traditional Chinese Medicine, Fuzhou, PR China.
| | - Xinming Chen
- College of Nursing, Fujian University of Traditional Chinese Medicine, Fuzhou, PR China.
| | - Jiayao Guo
- College of Pharmacy, Fujian University of Traditional Chinese Medicine, Fuzhou, PR China.
| | - Nan Lin
- College of Acupuncture and Massage, Fujian University of Traditional Chinese Medicine, Fuzhou, PR China.
| | - Fang Liu
- College of Nursing, Fujian University of Traditional Chinese Medicine, Fuzhou, PR China.
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Effect of Executive Dysfunction on Posture Control and Gait after Stroke. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:3051750. [PMID: 34675982 PMCID: PMC8526208 DOI: 10.1155/2021/3051750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 09/20/2021] [Indexed: 12/01/2022]
Abstract
Objective The purpose of the study was to observe the effects of executive dysfunction (ED) on gait and postural control during walking after stroke. Methods In this study, 34 subjects with stroke and ED (8 women and 26 men; age, 55.41 ± 7.89 years; time since stroke onset, 1.3 ± 0.12 months) were recruited. Stroop color-word test (SCWT), 10-meter walk test (10MWT), timed-up-and-go test (TUGT), and gait analysis were evaluated. The correlation among the correct number of Stroop tasks (SCWT-C), the number of time-consuming tasks (SCWT-T), the amount of interference (SIE-M and SIE-T) and posture control, and gait-related parameters was analyzed. Results The results indicated that SCWT-C was negatively correlated with 10MWT, TUGT, and bilateral symmetry (P < 0.05). However, there was no significant correlation between SCWT-C and stride (P > 0.05). A significant negative correlation was seen between SCWT-C and bilateral symmetry (P < 0.05). There was no significant correlation between SCWT-T and stride (P > 0.05). SCWT-T was positively correlated with TUGT, 10MWT, and bilateral symmetry (P < 0.05). SIE-T was positively correlated with TUGT and bilateral symmetry (P < 0.05). There was no significant correlation between SIE-T and 10MWT or stride (P > 0.05). SIE-M was positively correlated with TUGT and bilateral symmetry (P < 0.05). There was no significant correlation between SIE-T and 10MWT or stride (P > 0.05). Conclusions ED is closely related to the decline in postural control and the occurrence of falls. In the early phases of stroke rehabilitation, physiotherapists should focus on the patients' executive function to accelerate the recovery of postural control.
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Oveisgharan S, Yu L, Capuano A, Arvanitakis Z, Barnes LL, Schneider JA, Bennett DA, Buchman AS. Late-Life Vascular Risk Score in Association With Postmortem Cerebrovascular Disease Brain Pathologies. Stroke 2021; 52:2060-2067. [PMID: 33840227 DOI: 10.1161/strokeaha.120.030226] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND AND PURPOSE The general cardiovascular Framingham risk score (FRS) identifies adults at increased risk for stroke. We tested the hypothesis that baseline FRS is associated with the presence of postmortem cerebrovascular disease (CVD) pathologies. METHODS We studied the brains of 1672 older decedents with baseline FRS and measured CVD pathologies including macroinfarcts, microinfarcts, atherosclerosis, arteriolosclerosis, and cerebral amyloid angiopathy. We employed a series of logistic regressions to examine the association of baseline FRS with each of the 5 CVD pathologies. RESULTS Average age at baseline was 80.5±7.0 years and average age at death was 89.2±6.7 years. A higher baseline FRS was associated with higher odds of macroinfarcts (odds ratio, 1.10 [95% CI, 1.07-1.13], P<0.001), microinfarcts (odds ratio, 1.04 [95% CI, 1.01-1.07], P=0.009), atherosclerosis (odds ratio, 1.07 [95% CI, 1.04-1.11], P<0.001), and arteriolosclerosis (odds ratio, 1.04 [95% CI, 1.01-1.07], P=0.005). C statistics for these models ranged from 0.537 to 0.595 indicating low accuracy for predicting CVD pathologies. FRS was not associated with the presence of cerebral amyloid angiopathy. CONCLUSIONS A higher FRS score in older adults is associated with higher odds of some, but not all, CVD pathologies, with low discrimination at the individual level. Further work is needed to develop a more robust risk score to identify adults at risk for accumulating CVD pathologies.
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Affiliation(s)
- Shahram Oveisgharan
- Rush Alzheimer's Disease Center (S.O., L.Y., A.C., Z.A., L.L.B., J.A.S., D.A.B., A.S.B.), Rush University Medical Center, Chicago, IL.,Department of Neurological Sciences (S.O., L.Y., A.C., Z.A., L.L.B., J.A.S., D.A.B., A.S.B.), Rush University Medical Center, Chicago, IL
| | - Lei Yu
- Rush Alzheimer's Disease Center (S.O., L.Y., A.C., Z.A., L.L.B., J.A.S., D.A.B., A.S.B.), Rush University Medical Center, Chicago, IL.,Department of Neurological Sciences (S.O., L.Y., A.C., Z.A., L.L.B., J.A.S., D.A.B., A.S.B.), Rush University Medical Center, Chicago, IL
| | - Ana Capuano
- Rush Alzheimer's Disease Center (S.O., L.Y., A.C., Z.A., L.L.B., J.A.S., D.A.B., A.S.B.), Rush University Medical Center, Chicago, IL.,Department of Neurological Sciences (S.O., L.Y., A.C., Z.A., L.L.B., J.A.S., D.A.B., A.S.B.), Rush University Medical Center, Chicago, IL
| | - Zoe Arvanitakis
- Rush Alzheimer's Disease Center (S.O., L.Y., A.C., Z.A., L.L.B., J.A.S., D.A.B., A.S.B.), Rush University Medical Center, Chicago, IL.,Department of Neurological Sciences (S.O., L.Y., A.C., Z.A., L.L.B., J.A.S., D.A.B., A.S.B.), Rush University Medical Center, Chicago, IL
| | - Lisa L Barnes
- Rush Alzheimer's Disease Center (S.O., L.Y., A.C., Z.A., L.L.B., J.A.S., D.A.B., A.S.B.), Rush University Medical Center, Chicago, IL.,Department of Neurological Sciences (S.O., L.Y., A.C., Z.A., L.L.B., J.A.S., D.A.B., A.S.B.), Rush University Medical Center, Chicago, IL.,Department of Behavioral Sciences (L.L.B.), Rush University Medical Center, Chicago, IL
| | - Julie A Schneider
- Rush Alzheimer's Disease Center (S.O., L.Y., A.C., Z.A., L.L.B., J.A.S., D.A.B., A.S.B.), Rush University Medical Center, Chicago, IL.,Department of Neurological Sciences (S.O., L.Y., A.C., Z.A., L.L.B., J.A.S., D.A.B., A.S.B.), Rush University Medical Center, Chicago, IL.,Department of Pathology (J.A.S.), Rush University Medical Center, Chicago, IL
| | - David A Bennett
- Rush Alzheimer's Disease Center (S.O., L.Y., A.C., Z.A., L.L.B., J.A.S., D.A.B., A.S.B.), Rush University Medical Center, Chicago, IL.,Department of Neurological Sciences (S.O., L.Y., A.C., Z.A., L.L.B., J.A.S., D.A.B., A.S.B.), Rush University Medical Center, Chicago, IL
| | - Aron S Buchman
- Rush Alzheimer's Disease Center (S.O., L.Y., A.C., Z.A., L.L.B., J.A.S., D.A.B., A.S.B.), Rush University Medical Center, Chicago, IL.,Department of Neurological Sciences (S.O., L.Y., A.C., Z.A., L.L.B., J.A.S., D.A.B., A.S.B.), Rush University Medical Center, Chicago, IL
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Wei J, Jin X, Chen B, Liu X, Zheng H, Guo R, Liang X, Fu C, Zhang Y. Comparative Study of Two Short-Form Versions of the Montreal Cognitive Assessment for Screening of Post-Stroke Cognitive Impairment in a Chinese Population. Clin Interv Aging 2020; 15:907-914. [PMID: 32606632 PMCID: PMC7308117 DOI: 10.2147/cia.s248856] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 03/27/2020] [Indexed: 12/12/2022] Open
Abstract
Purpose Cognitive impairment (CI) is one of the most significant post-stroke complications. The Montreal Cognitive Assessment (MoCA) is widely applied to the early screening of post-stroke CI (PSCI), and has good sensitivity and specificity, but needs a long time to administer. Clinicians and researchers need shorter, more effective cognitive testing tools. The purpose of this study was to detect the sensitivity and specificity of two different short-form versions of the MoCA (SF-MoCA) for screening of PSCI in a Chinese population. Methods A total of 2,989 stroke participants were included from 14 hospitals in northern and southern China between June 2011 and September 2013. The sensitivity and specificity of the two SF-MoCA versions were compared. Results Using an MoCA score <26 as the critical value, the National Institute of Neurological Disease and Stroke–Canadian Stroke Network SF-MoCA showed sensitivity of 91% and specificity of 63% (PPV 71%, BPV 87%) with scores ≤10 points. The sensitivity and specificity of the Bocti SF-MoCA were 92% and 69% (PPV 75%, BPV 89%) with scores ≤7, respectively. The area under the curve was 0.885 (95% CI 0.873–0.897) and 0.912 (95% CI 0.902–0.922), respectively. Conclusion The Bocti SF-MoCA can be used as a briefer and more effective screening tool for PSCI in Chinese.
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Affiliation(s)
- Jingjing Wei
- Beijing University of Chinese Medicine, Beijing, People's Republic of China.,Department of Neurology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, People's Republic of China.,Department of Neurology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, People's Republic of China
| | - Xianglan Jin
- Department of Neurology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, People's Republic of China
| | - Baoxin Chen
- Department of Neurology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, People's Republic of China
| | - Xuemei Liu
- Central Laboratory, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, People's Republic of China
| | - Hong Zheng
- Central Laboratory, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, People's Republic of China
| | - Rongjuan Guo
- Department of Neurology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, People's Republic of China
| | - Xiao Liang
- Department of Neurology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, People's Republic of China
| | - Chen Fu
- Department of Neurology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, People's Republic of China.,Central Laboratory, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, People's Republic of China
| | - Yunling Zhang
- Department of Neurology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, People's Republic of China.,Department of Neurology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, People's Republic of China
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Sun MK. Executive functioning: perspectives on neurotrophic activity and pharmacology. Behav Pharmacol 2018; 29:592-604. [PMID: 30179884 DOI: 10.1097/fbp.0000000000000427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Executive functioning is a high-level cognitive ability, regulating other abilities and behaviors to achieve desired goals. A typical executive task can be defined as the capacity to maintain one's attention on the current task, that is, responding only to the correct but not to distractive stimuli. Impairments of executive functions, or executive dysfunctions, have a growing impact on everyday life and academic achievement and are usually an early feature, and one of the core features, in brain injury and memory and behavioral disorders. Furthermore, emerging evidence indicates that memory therapeutics cannot achieve their clinical benefits in cognition if executive dysfunction is not effectively and simultaneously treated. Improvement of executive functions might be achieved through targeting some signaling pathways in the brain, including the brain-derived neurotrophic factor signaling pathways. These agents may be useful either as stand-alone interventions for patients with executive dysfunction and/or psychiatric and memory disorders or as essential adjuncts to drugs that target the underlying pathology in various brain injury and memory and behavioral disorders.
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Affiliation(s)
- Miao-Kun Sun
- Blanchette Rockefeller Neurosciences Institute, Morgantown, West Virginia, USA
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Madsen TE, Howard VJ, Jiménez M, Rexrode KM, Acelajado MC, Kleindorfer D, Chaturvedi S. Impact of Conventional Stroke Risk Factors on Stroke in Women: An Update. Stroke 2018; 49:536-542. [PMID: 29438086 PMCID: PMC5828997 DOI: 10.1161/strokeaha.117.018418] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 11/09/2017] [Accepted: 11/10/2017] [Indexed: 12/12/2022]
Affiliation(s)
- Tracy E Madsen
- From the Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI (T.E.M.); Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (V.J.H.); Division of Women's Health, Department of Medicine, Brigham and Women's Hospital, Boston, MA (M.J., K.M.R.); Department of Medicine, Athens-Limestone Hospital, AL (M.C.); Department of Neurology, University of Cincinnati School of Medicine, OH (D.K.); and Department of Neurology, University of Miami Miller School of Medicine, FL (S.C.).
| | - Virginia J Howard
- From the Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI (T.E.M.); Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (V.J.H.); Division of Women's Health, Department of Medicine, Brigham and Women's Hospital, Boston, MA (M.J., K.M.R.); Department of Medicine, Athens-Limestone Hospital, AL (M.C.); Department of Neurology, University of Cincinnati School of Medicine, OH (D.K.); and Department of Neurology, University of Miami Miller School of Medicine, FL (S.C.)
| | - Monik Jiménez
- From the Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI (T.E.M.); Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (V.J.H.); Division of Women's Health, Department of Medicine, Brigham and Women's Hospital, Boston, MA (M.J., K.M.R.); Department of Medicine, Athens-Limestone Hospital, AL (M.C.); Department of Neurology, University of Cincinnati School of Medicine, OH (D.K.); and Department of Neurology, University of Miami Miller School of Medicine, FL (S.C.)
| | - Kathryn M Rexrode
- From the Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI (T.E.M.); Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (V.J.H.); Division of Women's Health, Department of Medicine, Brigham and Women's Hospital, Boston, MA (M.J., K.M.R.); Department of Medicine, Athens-Limestone Hospital, AL (M.C.); Department of Neurology, University of Cincinnati School of Medicine, OH (D.K.); and Department of Neurology, University of Miami Miller School of Medicine, FL (S.C.)
| | - Maria Czarina Acelajado
- From the Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI (T.E.M.); Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (V.J.H.); Division of Women's Health, Department of Medicine, Brigham and Women's Hospital, Boston, MA (M.J., K.M.R.); Department of Medicine, Athens-Limestone Hospital, AL (M.C.); Department of Neurology, University of Cincinnati School of Medicine, OH (D.K.); and Department of Neurology, University of Miami Miller School of Medicine, FL (S.C.)
| | - Dawn Kleindorfer
- From the Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI (T.E.M.); Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (V.J.H.); Division of Women's Health, Department of Medicine, Brigham and Women's Hospital, Boston, MA (M.J., K.M.R.); Department of Medicine, Athens-Limestone Hospital, AL (M.C.); Department of Neurology, University of Cincinnati School of Medicine, OH (D.K.); and Department of Neurology, University of Miami Miller School of Medicine, FL (S.C.)
| | - Seemant Chaturvedi
- From the Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI (T.E.M.); Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (V.J.H.); Division of Women's Health, Department of Medicine, Brigham and Women's Hospital, Boston, MA (M.J., K.M.R.); Department of Medicine, Athens-Limestone Hospital, AL (M.C.); Department of Neurology, University of Cincinnati School of Medicine, OH (D.K.); and Department of Neurology, University of Miami Miller School of Medicine, FL (S.C.)
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Fu C, Jin X, Chen B, Xue F, Niu H, Guo R, Chen Z, Zheng H, Wang L, Zhang Y. Comparison of the Mini-Mental State Examination and Montreal Cognitive Assessment executive subtests in detecting post-stroke cognitive impairment. Geriatr Gerontol Int 2017; 17:2329-2335. [PMID: 28675607 DOI: 10.1111/ggi.13069] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 02/21/2017] [Accepted: 03/07/2017] [Indexed: 01/12/2023]
Abstract
AIM The Montreal Cognitive Assessment (MoCA) has been shown to be more sensitive in detecting executive dysfunction than the Mini-Mental State Examination (MMSE). However, it is still not known whether all the MoCA executive subtests contribute to the superior sensitivity. Thus, the present study aimed to determine how much executive abnormality was detected by the MMSE and MoCA executive subtests in a population-based cohort of Chinese post-stroke patients. METHODS The MMSE and MoCA were collected from post-stroke patients (within 15 days to 1 month after stroke, including ischemic stroke and hemorrhagic stroke) in 14 hospitals of northern and southern China (including 10 top-graded hospitals and 4 community hospitals) between June 2011 and September 2013. The proportions of patients with incorrect MoCA executive subtests and the proportions of patients with incorrect MMSE executive subtests were compared. RESULTS A total of 1222 patients (703 men and 519 women, aged 62.06 ± 10.68 and 62.76 ± 9.86 years, respectively) were recruited. The MoCA detected more patients with executive dysfunction than the MMSE (OR 15.399, 95% CI 12.631-18.773; P < 0.001). The likelihood of incorrect MMSE executive tasks increased across decreasing scores of MoCA executive tasks (P < 0.001 for trend). Compared with the MMSE three-step command test (15.5%), the MoCA trail-making (57.8%), abstraction (48.0%) and abstraction (measurement tool; 45.7%) detected more patients with executive dysfunction (P < 0.001), whereas the MoCA digit span forwards (4.3%) and backwards (11.6%) detected fewer patients (P < 0.001 and P = 0.005, respectively). CONCLUSIONS The MoCA executive tasks are more sensitive in detecting executive dysfunction compared with the MMSE executive tasks. Geriatr Gerontol Int 2017; 17: 2329-2335.
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Affiliation(s)
- Chen Fu
- Department of Neurology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Xianglan Jin
- Department of Neurology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Baoxin Chen
- Department of Neurology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Feiran Xue
- Department of Neurology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Huanmin Niu
- Department of Neurology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Rongjuan Guo
- Department of Neurology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Zhigang Chen
- Department of Neurology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Hong Zheng
- Department of Neurology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Le Wang
- Department of Neurology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Yunling Zhang
- Department of Neurology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
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The Behavioral and Cognitive Executive Disorders of Stroke: The GREFEX Study. PLoS One 2016; 11:e0147602. [PMID: 26824746 PMCID: PMC4732595 DOI: 10.1371/journal.pone.0147602] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 01/06/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Many studies have highlighted the high prevalence of executive disorders in stroke. However, major uncertainties remain due to use of variable and non-validated methods. The objectives of this study were: 1) to characterize the executive disorder profile in stroke using a standardized battery, validated diagnosis criteria of executive disorders and validated framework for the interpretation of neuropsychological data and 2) examine the sensitivity of the harmonization standards protocol proposed by the National Institute of Neurological Disorders and Stroke and Canadian Stroke Network (NINDS-CSN) for the diagnosis of Vascular Cognitive Impairment. METHODS 237 patients (infarct: 57; cerebral hemorrhage: 54; ruptured aneurysm of the anterior communicating artery (ACoA): 80; cerebral venous thrombosis (CVT): 46) were examined by using the GREFEX battery. The patients' test results were interpreted with a validated framework derived from normative data from 780 controls. RESULTS Dysexecutive syndrome was observed in 88 (55.7%; 95%CI: 48-63.4) out of the 156 patients with full cognitive and behavioral data: 40 (45.5%) had combined behavioral and cognitive syndromes, 29 (33%) had a behavioral disorder alone and 19 (21.6%) had a cognitive syndrome alone. The dysexecutive profile was characterized by prominent impairments of initiation and generation in the cognitive domain and by hypoactivity with disinterest and anticipation loss in the behavioral domain. Cognitive impairment was more frequent (p = 0.014) in hemorrhage and behavioral disorders were more frequent (p = 0.004) in infarct and hemorrhage. The harmonization standards protocol underestimated (p = 0.007) executive disorders in CVT or ACoA. CONCLUSIONS This profile of executive disorders implies that the assessment should include both cognitive tests and a validated inventory for behavioral dysexecutive syndrome. Initial assessment may be performed with a short cognitive battery, such as the harmonization standards protocol. However, administration of a full cognitive battery is required in selected patients.
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