Beyond Neglect: Preliminary Evidence of Retrospective Time Estimation Abnormalities in Non-Neglect Stroke and Transient Ischemic Attack Patients

Stroke damages attentional maintenance in working memory

Stroke is the main cause of acquired disability in adults, and specific deficits in working memory (WM) are among the most common cognitive consequences. In neuropsychological routine, WM is most of the time investigated in the framework of the multicomponent model (Baddeley & Hitch, 1974, The psychology of learning and motivation, 47). Using a more recent theoretical WM model, the time-based resource-sharing (TBRS) model (Barrouillet et al., 2011, Psychol. Rev., 118, 175), the aim of the present study was to investigate in young post-stroke patients to which extent attentional maintenance is impaired in WM. To address this question, we discarded other factors known to directly influence WM performance, that is processing speed and short-term memory span. We proposed to 53 post-stroke patients and to 63 healthy controls a complex span paradigm in which participants were asked to alternate between the memorization of a series of images and a concurrent parity judgement task of a series of digits. To investigate the attentional maintenance processes, we manipulated the cognitive load (CL) of the concurrent task. CL effect is typically interpreted as the involvement of attentional maintenance processes. The task was adapted to each participant according to their processing speed and memory span. As expected, the results showed higher recall performance in healthy controls compared with post-stroke patients. Consistent with the literature, we also observed higher performance when the CL was low compared with high. However, the improvement in recall at low CL was smaller for post-stroke patients compared with controls, suggesting that post-stroke WM deficit could be in part due to a deficit of the attentional maintenance processes.

Temporal judgments of actions following unilateral brain damage

Sense of time is a complex construct, and its neural correlates remain to date in most part unknown. To complicate the frame, physical attributes of the stimulus, such as its intensity or movement, influence temporal perception. Although previous studies have shown that time perception can be compromised after a brain lesion, the evidence on the role of the left and right hemispheres are meager. In two experiments, the study explores the ability of temporal estimation of multi-second actions and non-biological movements in 33 patients suffering from unilateral brain lesion. Furthermore, the modulatory role of induced embodiment processes is investigated. The results reveal a joint contribution of the two hemispheres depending not only on different durations but also on the presence of actions. Indeed, the left hemisphere damaged patients find it difficult to estimate 4500 ms or longer durations, while the right hemisphere damaged patients fail in 3000 ms durations. Furthermore, the former fail when a biological action is shown, while the latter fail in non-biological movement. Embodiment processes have a modulatory effect only after right hemisphere lesions. Among neuropsychological variables, only spatial neglect influences estimation of non-biological movement.

Time perception changes in stroke patients: A systematic literature review

Introduction

Time perception comprises the subjective experience of passing of time and of the duration of an event. Although already described in some neurological and psychiatric conditions, there is a paucity of details regarding this neurocognitive change in stroke patients. We aimed to describe time perception dysfunction in stroke patient.

Methods

We performed a systematic review of the literature in Pubmed, PsycInfo and EMBASE including manuscripts from their inception until December 2020. We collected data regarding the type of time perception that was detected, type of stroke, most common location of lesions, evaluation tests that were used and time of evaluation after stroke onset.

Results

A total of 27 manuscripts were selected, concerning a total of 418 patients (n = 253 male; 60.5%). Most manuscripts (n = 21) evaluated patients with ischaemic lesions (n = 407; 97.4%). The majority referred to evaluations between 2 months and seven years after stroke. Underestimation in temporal evaluation in sub- and supra-second was the most common dysfunction (n = 165; 41.7%). Overestimation of time (n = 116; 27.8%) and impaired time interval comparison (n = 88; 22.2%) were also found. Most patients had right hemisphere lesions (n = 219 patients; 52.4%). Common reported lesion locations included the thalamus, insula, basal ganglia, dorsolateral prefrontal cortex, parietal cortex including supramarginal, angular gyrus and right inferior parietal cortex and cerebellum.

Conclusion

There are multiple stroke locations associated with time perception dysfunction, which highlights the complex system involved in time perception. There is still scarce knowledge about specific time perception deficits after stroke. Most studies rely in psychometric analysis without clear clinical and functional translation, namely regarding impact on daily activities.

Post-Stroke Working Memory Dysfunction: A Meta-Analysis and Systematic Review

This review investigates the severity and nature of post-stroke working memory deficits with reference to the multi-component model of working memory. We conducted a systematic search in PubMed up to March 2019 with search terms for stroke and memory. Studies on adult stroke patients, that included a control group, and assessed working memory function, were selected. Effect sizes (Hedges' g) were extracted from 50 studies (in total 3,084 stroke patients) based on the sample size, mean and standard deviation of patients and controls. Performance of stroke patients was compared to healthy controls on low-load (i.e. capacity) and high-load (executively demanding) working memory tasks, grouped by modality (verbal, non-verbal). A separate analysis compared patients in the sub-acute and the chronic stage. Longitudinal studies and effects of lesion location were systematically reviewed. Stroke patients demonstrated significant deficits in working memory with a moderate effect size for both low-load (Hedges' g = -.58 [-.82 to -.43]) and high-load (Hedges' g = -.59 [-.73 to -.45]) tasks. The effect sizes were comparable for verbal and non-verbal material. Systematically reviewing the literature showed that working memory deficits remain prominent in the chronic stage of stroke. Lesions in a widespread fronto-parietal network are associated with working memory deficits. Stroke patients show decrements of moderate magnitude in all subsystems of working memory. This review clearly demonstrates the global nature of the impairment in working memory post-stroke.

Impaired decision-making and time perception in individuals with stroke: Behavioral and neural correlates

Several studies have demonstrated that stroke subjects present impairment of functions related to decision-making and timing, involving the information processing in the neural circuits of the cerebellum in association with the prefrontal cortex. This review is aimed to identify the gaps, and demonstrate a better understanding of decision-making and timing functions in the patients with stroke. Electronic literature database was searched and the findings of relevant studies were used to explore the mechanisms of decision-making and timing in patients with stroke, as well as the circuit connections in timing mediated by prefrontal cortex and cerebellum. A literature review was conducted with 65 studies that synthesized findings on decision-making and time perception in individuals with stroke. Types of neurobiological modalities in this study included: Relationships among decision-making, time perception, related cognitive aspects (such as discrimination tasks, verbal estimation, bisection tasks, time production and motor reproduction), and motor control. We demonstrate that the timing processes are important for the performance in cognitive tasks and that the cerebellum and prefrontal cortex are involved in decision-making and time perception. In the context, the decision-making is impaired in stroke patients has a great impact on executive functions, and this seems to be important in determining neurobiological aspects relevant to the time interval interpretation.

Temporal Aspects of Memory: A Comparison of Memory Performance, Processing Speed and Time Estimation Between Young and Older Adults

Cognitive abilities are often reported to decline across the lifespan, particularly when assessed with working memory (WM) measures such as the auditory backward digit span and complex N-back tasks. However, some debate still exists regarding which aspects of cognition are most susceptible to the aging process and which may remain intact. Additionally, time estimation, though a complex psychological dimension, is often studied in relative isolation and is particularly neglected in traditional studies of WM, with little research from the viewpoint of retrospective temporal estimation. In particular, research seldom considers whether the ability to accurately estimate time retrospectively, is correlated with performance on traditional memory and processing speed measures in healthy populations. Thus, we chose to investigate performance of comparably educated young and older adult groups on both classical memory tasks including auditory and visual digit spans, N-back, Wechsler Adult Intelligence Scale (WAIS)-based measures of processing speed (i.e., Symbol Search [SS] and Coding [Cod]) and a temporal measure of WM with a focus on retrospective time estimation. Our sample included 66 university students (58 F, 8 M) between the ages of 18-29, and 33 university-educated healthy older adults (25 F, 8 M) between the ages of 60-81. Results indicated that older adults performed significantly worse on auditory but not the visual digit span tasks, as well as on both the SS and Cod, though performed equally well on the N = 1 back task. Results also showed that retrospective time estimation was not significantly different between young and older adults, with both groups substantially underestimating duration of a simple task. Retrospective time estimation was not significantly correlated to any memory or processing speed measure, emphasizing the need for future research into the specific cognitive domains underlying the subjective estimation of a temporal interval.

Compromised Motor Dexterity Confounds Processing Speed Task Outcomes in Stroke Patients

Most conventional measures of information processing speed require motor responses to facilitate performance. However, although not often addressed clinically, motor impairment, whether due to age or acquired brain injury, would be expected to confound the outcome measure of such tasks. The current study recruited 29 patients (20 stroke and 9 transient ischemic attack) with documented reduction in dexterity of the dominant hand, and 29 controls, to investigate the extent to which 3 commonly used processing speed measures with varying motor demands (a Visuo-Motor Reaction Time task, and the Wechsler Adult Intelligence Scale-IV Symbol Search and Coding subtests) may be measuring motor-related speed more so than cognitive speed. Analyses include correlations between indices of cognitive and motor speed obtained from two other tasks (Inspection Time and Pegboard task, respectively) with the three speed measures, followed by hierarchical regressions to determine the relative contribution of cognitive and motor speed indices toward task performance. Results revealed that speed outcomes on tasks with relatively high motor demands, such as Coding, were largely reflecting motor speed in individuals with reduced dominant hand dexterity. Thus, findings indicate the importance of employing measures with minimal motor requirements, especially when the assessment of speed is aimed at understanding cognitive rather than physical function.