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Phillips MR, Byrne J, Gibson EC, Gilbert C, Ford L, Marsh G, Chow J, Robinson GA. The brief executive language screen: sensitivity and specificity in acute to early sub-acute stroke. Top Stroke Rehabil 2024:1-13. [PMID: 38833512 DOI: 10.1080/10749357.2024.2356412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 04/23/2024] [Indexed: 06/06/2024]
Abstract
INTRODUCTION Propositional language and underlying executive functions can be impaired post-stroke and affect communication and quality of life. Current stroke screening tools are largely tailored to patients with aphasia, being either non-verbal or focussed on core language skills such as naming and repetition. The Brief Executive Language Screening Test (BELS) is a newly developed cognitive screening tool that assesses memory, oral apraxia, core language, as well as propositional language and associated executive functions that can be impacted and overlooked in stroke patients without aphasia. This study examines BELS sensitivity and specificity, and performance in acute to early sub-acute stroke relative to controls. METHOD Cross-sectional BELS data from 88 acute left and right hemisphere stroke patients (within 7 weeks of stroke) and 116 age-matched healthy controls were compared using independent samples t-tests. ROC Curve Analysis was performed to determine a cutoff score for the BELS. RESULTS Left and right stroke patients were reduced on all propositional language subtests, and executive function subtests of inhibition, strategy, and selection. Differences were also observed for Oral Apraxia, Naming, and Memory. By contrast, Word Comprehension and Repetition, and Sentence Completion Initiation (after corrections applied) did not differ between groups. A total BELS score of 79.25/100 was highly sensitive (.89) and specific (.89) when classifying stroke patients and healthy controls. CONCLUSION The BELS is brief, sensitive, suitable for bedside administration, and can aid in detection and rehabilitation of subtle executive language impairments. This in turn will help improve relationships and quality of life post-stroke.
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Affiliation(s)
- Mia R Phillips
- Queensland Brain Institute, the University of Queensland, St Lucia, QLD, Australia
| | - Jessica Byrne
- Neuropsychology Research Unit, School of Psychology, the University of Queensland, St Lucia, QLD, Australia
| | - Emily C Gibson
- Neuropsychology Research Unit, School of Psychology, the University of Queensland, St Lucia, QLD, Australia
| | - Casey Gilbert
- Neuropsychology Research Unit, School of Psychology, the University of Queensland, St Lucia, QLD, Australia
| | - Lucy Ford
- Queensland Brain Institute, the University of Queensland, St Lucia, QLD, Australia
- Neuropsychology Research Unit, School of Psychology, the University of Queensland, St Lucia, QLD, Australia
| | - Georgia Marsh
- Neuropsychology Research Unit, School of Psychology, the University of Queensland, St Lucia, QLD, Australia
| | - Jessica Chow
- Neuropsychology Research Unit, School of Psychology, the University of Queensland, St Lucia, QLD, Australia
| | - Gail A Robinson
- Queensland Brain Institute, the University of Queensland, St Lucia, QLD, Australia
- Neuropsychology Research Unit, School of Psychology, the University of Queensland, St Lucia, QLD, Australia
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Webb SS, Demeyere N. Comparing the Oxford Digital Multiple Errands Test (OxMET) to a real-life version: Convergence, feasibility, and acceptability. Neuropsychol Rehabil 2024:1-26. [PMID: 38733612 DOI: 10.1080/09602011.2024.2344326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 12/23/2023] [Indexed: 05/13/2024]
Abstract
We aimed to assess the convergence, feasibility, and acceptability of the Oxford Digital Multiple Errands Test (OxMET) and the in-person Multiple Errands Test-Home version (MET-Home). Participants completed OxMET, MET-Home, Montreal Cognitive Assessment (MoCA), and questionnaires on activities of daily living, depression, technology usage, mobility, and disability. Forty-eight stroke survivors (mean age 69.61, 41.67% female, and average 16.5 months post-stroke) and 50 controls (mean age 71.46, 56.00% female) took part. No performance differences were found for healthy and stroke participants for MET-Home, and only found below p = .05 for OxMET but not below the corrected p = .006. Convergent validity was found between MET-Home and OxMET metrics (most r ≥ .30, p < .006). MET-Home accuracy was related to age (B = -.04, p = .03), sex (B = -.98, p = .03), disability (B = -0.63, p = .04), and MoCA (B = .26, p < .001), whereas OxMET accuracy was predicted by MoCA score (B = .40, p < .001). Feedback indicated that the OxMET was easy and fun and more acceptable than the MET-Home. The MET-Home was more stressful and interesting. The MET tasks demonstrated good convergent validity, with the OxMET digital administration providing a more feasible, inclusive, and acceptable assessment, especially to people with mobility restrictions and more severe stroke.
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Affiliation(s)
- Sam S Webb
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom
| | - Nele Demeyere
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
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Moore MJ, Byrne J, Gibson EC, Ford L, Robinson GA. Hayling and stroop tests tap dissociable deficits and network-level neural correlates. Brain Struct Funct 2024; 229:879-896. [PMID: 38478051 PMCID: PMC11004053 DOI: 10.1007/s00429-024-02767-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 01/24/2024] [Indexed: 04/10/2024]
Abstract
Although many executive function screens have been developed, it is not yet clear whether these assessments are equally effective in detecting post-stroke deficits of initiation and inhibition. This study presents a comparative analysis of the Stroop and Hayling tests aiming to evaluate whether these tests measure the same underlying cognitive functions and to identify the neural correlates of the deficits detected by both tasks. Sixty six stroke survivors and 70 healthy ageing controls completed the Hayling and Stroop tests. Stroke patients were found to exhibit qualitative performance differences across analogous Stroop and Hayling Test metrics intended to tap initiation and inhibition. The Stroop test was found to have high specificity to abnormal performance, but low sensitivity relative to the Hayling Test. Minimal overlap was present between the network-level correlates of analogous Stroop and Hayling Test metrics. Hayling Task strategy use metrics were significantly associated with distinct patterns of disconnection in stroke survivors, providing novel insight into the neural correlates of fine-grained behavioural patterns. Overall, these findings strongly suggest that the functions tapped by the Stroop and Hayling Test are both behaviourally and anatomically dissociable. The Hayling Test was found to offer improved sensitivity and detail relative to the Stroop test. This novel demonstration of the Hayling Test within the stroke population suggests that this task represents an effective measure for quantifying post-stroke initiation and inhibition deficits.
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Affiliation(s)
- Margaret Jane Moore
- Queensland Brain Institute, The University of Queensland, St Lucia, Brisbane, Australia
| | - Jessica Byrne
- Neuropsychology Research Unit, School of Psychology, The University of Queensland, St Lucia, Brisbane, QLD, 4072, Australia
| | - Emily C Gibson
- Neuropsychology Research Unit, School of Psychology, The University of Queensland, St Lucia, Brisbane, QLD, 4072, Australia
| | - Lucy Ford
- Queensland Brain Institute, The University of Queensland, St Lucia, Brisbane, Australia
- Neuropsychology Research Unit, School of Psychology, The University of Queensland, St Lucia, Brisbane, QLD, 4072, Australia
| | - Gail A Robinson
- Queensland Brain Institute, The University of Queensland, St Lucia, Brisbane, Australia.
- Neuropsychology Research Unit, School of Psychology, The University of Queensland, St Lucia, Brisbane, QLD, 4072, Australia.
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Grieb EJ, Schmid AA, Riggs NR, Stephens JA. Executive Function After Yoga: Adults With Acquired Brain Injury-A Pilot Study. Am J Occup Ther 2024; 78:7802180130. [PMID: 38407977 DOI: 10.5014/ajot.2024.050403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024] Open
Abstract
IMPORTANCE Acquired brain injury (ABI) may result in deficits in executive function (EF), which affects engagement in occupations. OBJECTIVE To explore the impact of group yoga on EF in people with ABI. DESIGN Single-arm pilot study with preyoga assessments and postyoga assessments (after 8 wk of yoga). SETTING Yoga classes and assessments were completed within university buildings on a college campus. PARTICIPANTS Twelve participants with chronic ABI (>6 mo post-ABI) were recruited through convenience and purposive strategies from the local community. INTERVENTION An 8-wk adaptive group yoga intervention was provided by an adaptive yoga specialist. Yoga classes were 60 min and occurred once per week. OUTCOMES AND MEASURES EF was assessed before and after the yoga intervention using the Behavior Rating Inventory of Executive Function-Adult Version (BRIEF-A) self-report form. Normative data were analyzed with paired sample t tests. RESULTS Nine participants completed all study procedures. Results from paired sample t tests showed significant improvements on the Behavioral Regulation Index of the BRIEF-A (p = .046). No significant improvements were found on individual EF scales, the Metacognition Index, or the Global Executive Composite (ps > .05). CONCLUSIONS AND RELEVANCE Group-based yoga may improve some aspects of EF for adults with chronic ABI; however, further research with larger sample sizes is needed. Plain-Language Summary: Yoga, an intervention increasingly used in occupational therapy practice, may be beneficial in improving behavioral regulation (an executive function) for adults with acquired brain injury.
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Affiliation(s)
- Emily J Grieb
- Emily J. Grieb, MS, OTR, is Occupational Therapist, Peaks & Bounds, Inc., Fort Collins, CO. At the time this research was completed, Grieb was Occupational Therapy Student, Department of Occupational Therapy, Colorado State University, Fort Collins;
| | - Arlene A Schmid
- Arlene A. Schmid, PhD, OTR, FAOTA, is Professor, Department of Occupational Therapy, Colorado State University, Fort Collins
| | - Nathaniel R Riggs
- Nathaniel R. Riggs, PhD, is Professor, Department of Human Development and Family Studies, Colorado State University, Fort Collins
| | - Jaclyn A Stephens
- Jaclyn A. Stephens, PhD, OTR, is Associate Professor, Department of Health and Exercise Science, Colorado State University, Fort Collins
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Hobden G, Moore MJ, Mair G, Pendlebury ST, Demeyere N. Poststroke Executive Function in Relation to White Matter Damage on Clinically Acquired CT Brain Imaging. Cogn Behav Neurol 2024; 37:23-31. [PMID: 37724754 DOI: 10.1097/wnn.0000000000000355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 04/21/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Executive function (EF) impairments are prevalent post stroke and are associated with white matter (WM) damage on MRI. However, less is known about the relationship between poststroke EF and WM damage on CT imaging. OBJECTIVE To investigate the relationship between poststroke EF and WM damage associated with stroke lesions and WM hypointensities (WMHs) on clinically acquired CT imaging. METHOD This study analyzed data from the Oxford Cognitive Screening Program, which recruited individuals aged ≥18 years with a confirmed stroke from an acute stroke unit. The individuals completed a follow-up assessment 6 months post stroke. We included individuals with a CT scan showing a visible stroke who completed follow-up EF assessment using the Oxford Cognitive Screen-Plus rule-finding task. We manually delineated stroke lesions and quantified then dichotomized WM damage caused by the stroke using the HCP-842 atlas. We visually rated then dichotomized WMHs using the Age-Related White Matter Changes Scale. RESULTS Among 87 stroke survivors (M age = 73.60 ± 11.75; 41 female; 61 ischemic stroke), multivariable linear regression showed that stroke damage to the medial lemniscus ( B = -8.86, P < 0.001) and the presence of WMHs ( B = -5.42, P = 0.005) were associated with poorer EF 6 months post stroke after adjusting for covariates including age and education. CONCLUSION Poorer EF was associated with WM damage caused by stroke lesions and WMHs on CT. These results confirm the importance of WM integrity for EF post stroke and demonstrate the prognostic utility of CT-derived imaging markers for poststroke cognitive outcomes.
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Affiliation(s)
- Georgina Hobden
- Department of Experimental Psychology, University of Oxford, Oxford, England
| | - Margaret Jane Moore
- Department of Experimental Psychology, University of Oxford, Oxford, England
- Queensland Brain Institute, University of Queensland, Queensland, Australia
| | - Grant Mair
- Centre for Clinical Brain Sciences, University of Edinburgh, and Neuroradiology, Department of Clinical Neurosciences, National Health Service Lothian, Edinburgh, Scotland
| | - Sarah T Pendlebury
- Wolfson Centre for Prevention of Stroke and Dementia, Wolfson Building, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, England
- National Institute for Health Research Oxford Biomedical Research Centre and Departments of General (Internal) Medicine and Geratology, John Radcliffe Hospital, Oxford, England
| | - Nele Demeyere
- Department of Experimental Psychology, University of Oxford, Oxford, England
- Wolfson Centre for Prevention of Stroke and Dementia, Wolfson Building, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, England
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6
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Sen A, Tai XY. Sleep Duration and Executive Function in Adults. Curr Neurol Neurosci Rep 2023; 23:801-813. [PMID: 37957525 PMCID: PMC10673787 DOI: 10.1007/s11910-023-01309-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2023] [Indexed: 11/15/2023]
Abstract
PURPOSE OF REVIEW To review the literature examining the relationship between sleep and cognition, specifically examining the sub-domain of executive function. We explore the impact of sleep deprivation and the important question of how much sleep is required for optimal cognitive performance. We consider how other sleep metrics, such as sleep quality, may be a more meaningful measure of sleep. We then discuss the putative mechanisms between sleep and cognition followed by their contribution to developing dementia. RECENT FINDINGS Sleep duration and executive function display a quadratic relationship. This suggests an optimal amount of sleep is required for daily cognitive processes. Poor sleep efficiency and sleep fragmentation are linked with poorer executive function and increased risk of dementia during follow-up. Sleep quality may therefore be more important than absolute duration. Biological mechanisms which may underpin the relationship between sleep and cognition include brain structural and functional changes as well as disruption of the glymphatic system. Sleep is an important modifiable lifestyle factor to improve daily cognition and, possibly, reduce the risk of developing dementia. The impact of optimal sleep duration and sleep quality may have important implications for every ageing individual.
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Affiliation(s)
- Aayushi Sen
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
- Division of Clinical Neurology, John Radcliffe Hospital, Oxford University Hospitals Trust, Level 6 West Wing, Oxford, UK.
| | - Xin You Tai
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Division of Clinical Neurology, John Radcliffe Hospital, Oxford University Hospitals Trust, Level 6 West Wing, Oxford, UK
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Webb SS, Demeyere N. Predictive validity of the Oxford digital multiple errands test (OxMET) for functional outcomes after stroke. Neuropsychol Rehabil 2023:1-17. [PMID: 37590556 DOI: 10.1080/09602011.2023.2247152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 08/02/2023] [Indexed: 08/19/2023]
Abstract
The Oxford Digital Multiple Errands Test (OxMET) is a brief computer-tablet based cognitive screen, intended as an ecologically valid assessment of executive dysfunction. We examined aspects of predictive validity in relation to functional outcomes. Participants (≤ 2 months post-stroke) were recruited from an English-speaking stroke rehabilitation in-patient setting. Participants completed OxMET. The Barthel Index, Therapy Outcome Measure (TOMS), and modified Rankin Scale (mRS) were collected from medical notes. Participants were followed up after 6-months and completed the Nottingham Extended Activities of Daily Living (NEADL) scale. 117 participants were recruited (M = 26.18 days post-stroke (SD = 25.16), mean 74.44yrs (SD = 12.88), median NIHSS 8.32 (IQR = 5-11)). Sixty-six completed a follow-up (M = 73.94yrs (SD = 12.68), median NIHSS 8 (IQR = 4-11)). Significant associations were found between TOMS and mRS. At 6-month follow up, we found a moderate predictive relationship between the OxMET accuracy and NEADL (R2 = .29, p < .001), and we did not find this prediction with MoCA taken at 6-months. The subacute OxMET associated with measures of functionality and disability in a rehabilitation context, and in activities of daily living. The OxMET is an assessment of executive function with good predictive validity on clinically relevant functional outcome measures that may be more predictive than other cognitive tests.
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Affiliation(s)
- Sam S Webb
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Nele Demeyere
- Experimental Psychology, University of Oxford, Oxford, UK
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Waller R, Hase Y, Simpson JE, Heath PR, Wyles M, Kalaria RN, Wharton SB. Transcriptomic Profiling Reveals Discrete Poststroke Dementia Neuronal and Gliovascular Signatures. Transl Stroke Res 2023; 14:383-396. [PMID: 35639336 PMCID: PMC10160172 DOI: 10.1007/s12975-022-01038-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 05/13/2022] [Accepted: 05/14/2022] [Indexed: 11/24/2022]
Abstract
Poststroke dementia (PSD) is associated with pathology in frontal brain regions, in particular dorsolateral prefrontal cortex (DLPFC) neurons and white matter, remote from the infarct. We hypothesised that PSD results from progressive DLPFC neuronal damage, associated with frontal white matter gliovascular unit (GVU) alterations. We investigated the transcriptomic profile of the neurons and white matter GVU cells previously implicated in pathology. Laser-capture microdissected neurons, astrocytes and endothelial cells were obtained from the Cognitive Function After Stroke cohort of control, PSD and poststroke non-dementia (PSND) human subjects. Gene expression was assessed using microarrays and pathway analysis to compare changes in PSD with controls and PSND. Neuronal findings were validated using NanoString technology and compared with those in the bilateral common carotid artery stenosis (BCAS) mouse model. Comparing changes in PSD compared to controls with changes in PSND compared to controls identified transcriptomic changes associated specifically with dementia. DLPFC neurons showed defects in energy production (tricarboxylic acid (TCA) cycle, adenosine triphosphate (ATP) binding and mitochondria), signalling and communication (MAPK signalling, Toll-like receptor signalling, endocytosis). Similar changes were identified in neurons isolated from BCAS mice. Neuronal findings accompanied by altered astrocyte communication and endothelium immune changes in the frontal white matter, suggesting GVU dysfunction. We propose a pathogenic model in PSD whereby neuronal changes are associated with frontal white matter GVU dysfunction leading to astrocyte failure in supporting neuronal circuits resulting in delayed cognitive decline associated with PSD. Therefore, targeting these processes could potentially ameliorate the dementia seen in PSD.
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Affiliation(s)
- Rachel Waller
- Sheffield Institute for Translational Neuroscience, University of Sheffield, 385A Glossop Road, Sheffield, S10 2HQ, UK.
| | - Yoshiki Hase
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - Julie E Simpson
- Sheffield Institute for Translational Neuroscience, University of Sheffield, 385A Glossop Road, Sheffield, S10 2HQ, UK
| | - Paul R Heath
- Sheffield Institute for Translational Neuroscience, University of Sheffield, 385A Glossop Road, Sheffield, S10 2HQ, UK
| | - Matthew Wyles
- Sheffield Institute for Translational Neuroscience, University of Sheffield, 385A Glossop Road, Sheffield, S10 2HQ, UK
| | - Rajesh N Kalaria
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - Stephen B Wharton
- Sheffield Institute for Translational Neuroscience, University of Sheffield, 385A Glossop Road, Sheffield, S10 2HQ, UK
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Sakai K, Hosoi Y, Harada Y. Walking Ability Associated with Executive Dysfunction in Patients with Stroke: A Cross-Sectional Study. Brain Sci 2023; 13:brainsci13040627. [PMID: 37190592 DOI: 10.3390/brainsci13040627] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 03/30/2023] [Accepted: 04/05/2023] [Indexed: 04/08/2023] Open
Abstract
Previous studies have shown an association between executive dysfunction and walking ability. However, it remains unclear whether the degree of executive dysfunction is associated with differences in walking ability in patients with stroke. The aim of this study was to investigate whether there are differences in walking ability according to executive dysfunction in patients with stroke. A total of 51 patients with stroke were enrolled in this study. Executive function was measured using the Trail Making Test (TMT) Part B, and walking ability was assessed using the 10 m walk test and the Timed Up and Go Test (TUGT). Cluster analysis was performed using the TMT Part B and compared within each cluster. TMT Part B was categorized into three groups (cluster 1: n = 20, cluster 2: n = 24, and cluster 3: n = 7). Cluster 1 was significantly better than clusters 2 and 3, and cluster 2 was significantly better than cluster 3. The 10 m walk time and TUGT of cluster 1 were significantly better than those of cluster 3. However, the 10 m walk time and TUGT of clusters 1 and 2 did not differ significantly. In conclusion, these findings may indicate differences in walking ability according to executive dysfunction.
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Affiliation(s)
- Katsuya Sakai
- Department of Physical Therapy, Faculty of Health Sciences, Tokyo Metropolitan University, Tokyo 116-8551, Japan
| | - Yuichiro Hosoi
- Department of Rehabilitation of Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan
- Department of Sports Health Sciences, Ritsumeikan University, Kusatsu 525-3760, Japan
| | - Yusuke Harada
- Department of Rehabilitation, Reiwa Rehabilitation Hospital, Chiba 260-0026, Japan
- Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo 116-8551, Japan
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Bergqvist M, Möller MC, Björklund M, Borg J, Palmcrantz S. The impact of visuospatial and executive function on activity performance and outcome after robotic or conventional gait training, long-term after stroke-as part of a randomized controlled trial. PLoS One 2023; 18:e0281212. [PMID: 36893079 PMCID: PMC9997896 DOI: 10.1371/journal.pone.0281212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 12/22/2022] [Indexed: 03/10/2023] Open
Abstract
INTRODUCTION Visuospatial and executive impairments have been associated with poor activity performance sub-acute after stroke. Potential associations long-term and in relation to outcome of rehabilitation interventions need further exploration. AIMS To explore associations between visuospatial and executive function and 1) activity performance (mobility, self-care and domestic life) and 2) outcome after 6 weeks of conventional gait training and/or robotic gait training, long term (1-10 years) after stroke. METHODS Participants (n = 45), living with stroke affecting walking ability and who could perform the items assessing visuospatial/executive function included in the Montreal Cognitive Assessment (MoCA Vis/Ex) were included as part of a randomized controlled trial. Executive function was evaluated using ratings by significant others according to the Dysexecutive Questionnaire (DEX); activity performance using 6-minute walk test (6MWT), 10-meter walk test (10MWT), Berg balance scale, Functional Ambulation Categories, Barthel Index and Stroke Impact Scale. RESULTS MoCA Vis/Ex was significantly associated with baseline activity performance, long-term after stroke (r = .34-.69, p < .05). In the conventional gait training group, MoCA Vis/Ex explained 34% of the variance in 6MWT after the six-week intervention (p = 0.017) and 31% (p = 0.032) at the 6 month follow up, which indicate that a higher MoCA Vis/Ex score enhanced the improvement. The robotic gait training group presented no significant associations between MoCA Vis/Ex and 6MWT indicating that visuospatial/executive function did not affect outcome. Rated executive function (DEX) presented no significant associations to activity performance or outcome after gait training. CONCLUSION Visuospatial/executive function may significantly affect activity performance and the outcome of rehabilitation interventions for impaired mobility long-term after stroke and should be considered in the planning of such interventions. Patients with severely impaired visuospatial/executive function may benefit from robotic gait training since improvement was seen irrespective of visuospatial/executive function. These results may guide future larger studies on interventions targeting long-term walking ability and activity performance. TRIAL REGISTRATION clinicaltrials.gov (NCT02545088) August 24, 2015.
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Affiliation(s)
- Maria Bergqvist
- Department of Rehabilitation Medicine, Danderyd University Hospital, Stockholm, Sweden
| | - Marika C Möller
- Department of Rehabilitation Medicine, Danderyd University Hospital, Stockholm, Sweden
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Martin Björklund
- Department of Community Medicine and Rehabilitation Physiotherapy, Umeå University, Umeå, Sweden
| | - Jörgen Borg
- Department of Rehabilitation Medicine, Danderyd University Hospital, Stockholm, Sweden
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Susanne Palmcrantz
- Department of Rehabilitation Medicine, Danderyd University Hospital, Stockholm, Sweden
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
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11
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Ferris J, Greeley B, Yeganeh NM, Rinat S, Ramirez J, Black S, Boyd L. Exploring biomarkers of processing speed and executive function: The role of the anterior thalamic radiations. Neuroimage Clin 2022; 36:103174. [PMID: 36067614 PMCID: PMC9460835 DOI: 10.1016/j.nicl.2022.103174] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 08/08/2022] [Accepted: 08/27/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Processing speed and executive function are often impaired after stroke and in typical aging. However, there are no reliable neurological markers of these cognitive impairments. The trail making test (TMT) is a common index of processing speed and executive function. Here, we tested candidate MRI markers of TMT performance in a cohort of older adults and individuals with chronic stroke. METHODS In 61 older adults and 32 individuals with chronic stroke, we indexed white matter structure with region-specific lesion load (of white matter hyperintensities (WMHs) and stroke lesions) and diffusion tensor imaging (DTI) from four regions related to TMT performance: the anterior thalamic radiations (ATR), superior longitudinal fasciculus (SLF), forceps minor, and cholinergic pathways. Regression modelling was used to identify the marker(s) that explained the most variance in TMT performance. RESULTS DTI metrics of the ATR related to processing speed in both the older adult (TMT A: β = -3.431, p < 0.001) and chronic stroke (TMT A: β = 11.282, p < 0.001) groups. In the chronic stroke group executive function was best predicted by a combination of ATR and forceps minor DTI metrics (TMT B: adjustedR2 = 0.438, p < 0.001); no significant predictors of executive function (TMT B) emerged in the older adult group. No imaging metrics related to set shifting (TMT B-A). Regional DTI metrics predicted TMT performance above and beyond whole-brain stroke and WMH volumes and removing whole-brain lesion volumes improved model fits. CONCLUSIONS In this comprehensive assessment of candidate imaging markers, we demonstrate an association between ATR microstructure and processing speed and executive function performance. Regional DTI metrics provided better predictors of cognitive performance than whole-brain lesion volumes or regional lesion load, emphasizing the importance of lesion location in understanding cognition. We propose ATR DTI metrics as novel candidate imaging biomarker of post-stroke cognitive impairment.
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Affiliation(s)
- Jennifer Ferris
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada,Graduate Programs in Rehabilitation Sciences, University of British Columbia, Vancouver, Canada
| | - Brian Greeley
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
| | - Negin Motamed Yeganeh
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada
| | - Shie Rinat
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada,Graduate Programs in Rehabilitation Sciences, University of British Columbia, Vancouver, Canada
| | - Joel Ramirez
- LC Campbell Cognitive Neurology Research Unit, Dr Sandra Black Centre for Brain Resilience and Recovery, Toronto, Canada,Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto, Toronto, Canada
| | - Sandra Black
- LC Campbell Cognitive Neurology Research Unit, Dr Sandra Black Centre for Brain Resilience and Recovery, Toronto, Canada,Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto, Toronto, Canada
| | - Lara Boyd
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada,Graduate Programs in Rehabilitation Sciences, University of British Columbia, Vancouver, Canada,Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada,Corresponding author at: University of British Columbia, 212-2177 Wesbrook Mall, Vancouver, British Columbia V6T 2B5, Canada.
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12
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Nerdal V, Gjestad E, Saltvedt I, Munthe-Kaas R, Ihle-Hansen H, Ryum T, Lydersen S, Grambaite R. The relationship of acute delirium with cognitive and psychiatric symptoms after stroke: a longitudinal study. BMC Neurol 2022; 22:234. [PMID: 35761180 PMCID: PMC9235162 DOI: 10.1186/s12883-022-02756-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 06/14/2022] [Indexed: 12/03/2022] Open
Abstract
Objective Delirium, a common complication after stroke, is often overlooked, and long-term consequences are poorly understood. This study aims to explore whether delirium in the acute phase of stroke predicts cognitive and psychiatric symptoms three, 18 and 36 months later. Method As part of the Norwegian Cognitive Impairment After Stroke Study (Nor-COAST), 139 hospitalized stroke patients (49% women, mean (SD) age: 71.4 (13.4) years; mean (SD) National Institutes of Health Stroke Scale (NIHSS) 3.0 (4.0)) were screened for delirium with the Confusion Assessment Method (CAM). Global cognition was measured with the Montreal Cognitive Assessment (MoCA), while psychiatric symptoms were measured using the Hospital Anxiety and Depression Scale (HADS) and the Neuropsychiatric Inventory-Questionnaire (NPI-Q). Data was analyzed using mixed-model linear regression, adjusting for age, gender, education, NIHSS score at baseline and premorbid dementia. Results Thirteen patients met the criteria for delirium. Patients with delirium had lower MoCA scores compared to non-delirious patients, with the largest between-group difference found at 18 months (Mean (SE): 20.8 (1.4) versus (25.1 (0.4)). Delirium was associated with higher NPI-Q scores at 3 months (Mean (SE): 2.4 (0.6) versus 0.8 (0.1)), and higher HADS anxiety scores at 18 and 36 months, with the largest difference found at 36 months (Mean (SE): 6.2 (1.3) versus 2.2 (0.3)). Conclusions Suffering a delirium in the acute phase of stroke predicted more cognitive and psychiatric symptoms at follow-up, compared to non-delirious patients. Preventing and treating delirium may be important for decreasing the burden of post-stroke disability. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-022-02756-5.
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13
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Mood and Cognitive Trajectories Over the First Year after Mild Ischemic Stroke. J Stroke Cerebrovasc Dis 2022; 31:106323. [DOI: 10.1016/j.jstrokecerebrovasdis.2022.106323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 01/08/2022] [Accepted: 01/11/2022] [Indexed: 11/17/2022] Open
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14
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Luo M, Duan Z, Song X, Liu C, Li R, Su K, Bai Y, Wang X, Fu W, Gao J, Feng X. Effects of Optimized Acupuncture and Moxibustion Treatment on Depressive Symptoms and Executive Functions in Patients With Post-Stroke Depression: Study Protocol for a Randomized Controlled Trial. Front Neurol 2022; 13:833696. [PMID: 35370914 PMCID: PMC8975266 DOI: 10.3389/fneur.2022.833696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 02/14/2022] [Indexed: 12/11/2022] Open
Abstract
Background Post-stroke depression (PSD), a common neuropsychiatric comorbidity after stroke, has a negative impact on the functional recovery and quality of life of survivors. It lacks effective therapeutic drugs with good curative effects and few adverse reactions. Preliminary experiments have shown that the optimized acupuncture and moxibustion treatment (OAMT), including acupuncture, moxibustion, and auricular intradermal acupuncture, improved depressive symptoms and neurological deficits in patients with PSD. However, the evidence for its effectiveness is still insufficient. Hence, we designed this study to evaluate the efficacy and safety of the OAMT in the treatment of PSD and to explore its possible mechanism from the perspective of executive functions. Methods/Design This is a randomized controlled trial, which comprises a total of 134 patients with PSD. Participants are randomized into intervention group and control group at a 1:1 ratio. All treatments are given five times per week for 4 weeks. The primary outcome is the severity of depression, which is evaluated by the Hamilton Depression Scale-17 (HAMD-17) and the Beck Depression Rating Scale (BDI). Secondary outcomes are executive abilities, which are measured by several neuropsychological tests, including the Stroop Color and Word Test (SCWT), the Trial Making Test (TMT), the Digit Symbol Substitution Test (DSST), and the Matrix Reasoning Test (MRT). All outcomes have been evaluated at baseline and weeks 4, 8, 12, and 20. At the same time, functional MRI (fMRI) is used to measure the functional connectivity in the cognitive control network (CCN) at baseline and 4 weeks after intervention. Discussion This study aims to provide high-quality evidence for the efficacy and safety of the OAMT for treating PSD. In addition, this trial is the first trial to explore if the improvement condition of depression in the OAMT group is related to the improvement of executive functions and the favorable changes in the structure. Clinical Trial Registration Chinese Clinical Trial Registry, identifier: ChiCTR2100048431.
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Affiliation(s)
- Meng Luo
- Department of Rehabilitation Medicine, Henan University of Chinese Medicine, Zhengzhou, China
| | - Zhaoyuan Duan
- Department of Rehabilitation Medicine, Henan University of Chinese Medicine, Zhengzhou, China
| | - Xiaolei Song
- Rehabilitation Center, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
- The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Chengmei Liu
- Department of Rehabilitation Medicine, Henan University of Chinese Medicine, Zhengzhou, China
- Rehabilitation Center, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Ruiqing Li
- Department of Rehabilitation Medicine, Henan University of Chinese Medicine, Zhengzhou, China
- Rehabilitation Center, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Kaiqi Su
- Department of Rehabilitation Medicine, Henan University of Chinese Medicine, Zhengzhou, China
| | - Yanjie Bai
- Department of Rehabilitation Medicine, Henan University of Chinese Medicine, Zhengzhou, China
- Rehabilitation Center, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Xiaodan Wang
- Rehabilitation Center, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Wenbin Fu
- Department of Acupuncture and Moxibustion, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China
| | - Jing Gao
- Rehabilitation Center, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
- *Correspondence: Jing Gao
| | - Xiaodong Feng
- Department of Rehabilitation Medicine, Henan University of Chinese Medicine, Zhengzhou, China
- Rehabilitation Center, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
- Xiaodong Feng
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15
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Jaywant A, DelPonte L, Kanellopoulos D, O'Dell MW, Gunning FM. The Structural and Functional Neuroanatomy of Post-Stroke Depression and Executive Dysfunction: A Review of Neuroimaging Findings and Implications for Treatment. J Geriatr Psychiatry Neurol 2022; 35:3-11. [PMID: 33073704 DOI: 10.1177/0891988720968270] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Post-stroke depression and executive dysfunction co-occur and are highly debilitating. Few treatments alleviate both depression and executive dysfunction after stroke. Understanding the brain network changes underlying post-stroke depression with executive dysfunction can inform the development of targeted and efficacious treatment. In this review, we synthesize neuroimaging findings in post-stroke depression and post-stroke executive dysfunction and highlight the network commonalities that may underlie this comorbidity. Structural and functional alterations in the cognitive control network, salience network, and default mode network are associated with depression and executive dysfunction after stroke. Specifically, post-stroke depression and executive dysfunction are both linked to changes in intrinsic functional connectivity within resting state networks, functional over-connectivity between the default mode and salience/cognitive control networks, and reduced cross-hemispheric frontoparietal functional connectivity. Cognitive training and noninvasive brain stimulation targeted at these brain network abnormalities and specific clinical phenotypes may help advance treatment for post-stroke depression with executive dysfunction.
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Affiliation(s)
- Abhishek Jaywant
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA.,Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, NY, USA.,NewYork-Presbyterian Hospital, New York, NY, USA
| | - Larissa DelPonte
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA
| | - Dora Kanellopoulos
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA.,NewYork-Presbyterian Hospital, New York, NY, USA.,Weill Cornell Institute of Geriatric Psychiatry, White Plains, NY, USA
| | - Michael W O'Dell
- Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, NY, USA.,NewYork-Presbyterian Hospital, New York, NY, USA
| | - Faith M Gunning
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA.,NewYork-Presbyterian Hospital, New York, NY, USA.,Weill Cornell Institute of Geriatric Psychiatry, White Plains, NY, USA
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16
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Jobson DD, Hase Y, Clarkson AN, Kalaria RN. The role of the medial prefrontal cortex in cognition, ageing and dementia. Brain Commun 2021; 3:fcab125. [PMID: 34222873 PMCID: PMC8249104 DOI: 10.1093/braincomms/fcab125] [Citation(s) in RCA: 86] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 04/08/2021] [Accepted: 04/14/2021] [Indexed: 01/18/2023] Open
Abstract
Humans require a plethora of higher cognitive skills to perform executive functions, such as reasoning, planning, language and social interactions, which are regulated predominantly by the prefrontal cortex. The prefrontal cortex comprises the lateral, medial and orbitofrontal regions. In higher primates, the lateral prefrontal cortex is further separated into the respective dorsal and ventral subregions. However, all these regions have variably been implicated in several fronto-subcortical circuits. Dysfunction of these circuits has been highlighted in vascular and other neurocognitive disorders. Recent advances suggest the medial prefrontal cortex plays an important regulatory role in numerous cognitive functions, including attention, inhibitory control, habit formation and working, spatial or long-term memory. The medial prefrontal cortex appears highly interconnected with subcortical regions (thalamus, amygdala and hippocampus) and exerts top-down executive control over various cognitive domains and stimuli. Much of our knowledge comes from rodent models using precise lesions and electrophysiology readouts from specific medial prefrontal cortex locations. Although, anatomical disparities of the rodent medial prefrontal cortex compared to the primate homologue are apparent, current rodent models have effectively implicated the medial prefrontal cortex as a neural substrate of cognitive decline within ageing and dementia. Human brain connectivity-based neuroimaging has demonstrated that large-scale medial prefrontal cortex networks, such as the default mode network, are equally important for cognition. However, there is little consensus on how medial prefrontal cortex functional connectivity specifically changes during brain pathological states. In context with previous work in rodents and non-human primates, we attempt to convey a consensus on the current understanding of the role of predominantly the medial prefrontal cortex and its functional connectivity measured by resting-state functional MRI in ageing associated disorders, including prodromal dementia states, Alzheimer's disease, post-ischaemic stroke, Parkinsonism and frontotemporal dementia. Previous cross-sectional studies suggest that medial prefrontal cortex functional connectivity abnormalities are consistently found in the default mode network across both ageing and neurocognitive disorders such as Alzheimer's disease and vascular cognitive impairment. Distinct disease-specific patterns of medial prefrontal cortex functional connectivity alterations within specific large-scale networks appear to consistently feature in the default mode network, whilst detrimental connectivity alterations are associated with cognitive impairments independently from structural pathological aberrations, such as grey matter atrophy. These disease-specific patterns of medial prefrontal cortex functional connectivity also precede structural pathological changes and may be driven by ageing-related vascular mechanisms. The default mode network supports utility as a potential biomarker and therapeutic target for dementia-associated conditions. Yet, these associations still require validation in longitudinal studies using larger sample sizes.
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Affiliation(s)
- Dan D Jobson
- Translational and Clinical Research Institute,
Newcastle University, Campus for Ageing & Vitality,
Newcastle upon Tyne NE4 5PL, UK
| | - Yoshiki Hase
- Translational and Clinical Research Institute,
Newcastle University, Campus for Ageing & Vitality,
Newcastle upon Tyne NE4 5PL, UK
| | - Andrew N Clarkson
- Department of Anatomy, Brain Health Research Centre
and Brain Research New Zealand, University of Otago, Dunedin 9054,
New Zealand
| | - Rajesh N Kalaria
- Translational and Clinical Research Institute,
Newcastle University, Campus for Ageing & Vitality,
Newcastle upon Tyne NE4 5PL, UK
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17
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Villain M, Sibon I, Renou P, Poli M, Swendsen J. Depression and routinization following stroke. Rev Neurol (Paris) 2021; 177:964-968. [PMID: 34215428 DOI: 10.1016/j.neurol.2020.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 08/19/2020] [Accepted: 08/28/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Post-stroke depression is a frequent complication of stroke that has detrimental consequences for quality of life and functional outcomes. Daily life routines may increase feelings of security for some individuals confronted with age-related health concerns, but little information is available concerning their role following stroke. The aim of this investigation was to examine the association of depression and other psychological variables at hospitalization for stroke and behavioral routines and mood symptoms three months later using Ecological Momentary Assessment (EMA). METHODS Forty-four patients with minor ischemic stroke were consecutively enrolled in the study. Stroke severity, handicap, depression and anxiety symptoms were assessed at baseline. EMA data acquired three months later were coded for the repetition of specific activities or behaviors occurring within the same time period across days. RESULTS Higher baseline depression and anxiety symptom severity were significantly associated with increased behavioral routines three months after stroke. The occurrence of routines was associated with a higher level of depressive symptomatology over subsequent hours of the day. CONCLUSION The findings demonstrate a general correlation between baseline psychological vulnerability and routines three months later, but within-day analyses suggest that routines may increase the risk of negative affect in this vulnerable population.
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Affiliation(s)
- M Villain
- Service de médecine physique et réadaptation, Pitié-Salpêtrière, AP-HP, Paris, France; GRC n(o) 24, handicap moteur et cognitif & réadaptation (HaMCRe), Sorbonne université, Paris, France
| | - I Sibon
- Université de Bordeaux, INCIA, CNRS UMR5287, 33400 Talence, France; CHU de Bordeaux, pôle de neurosciences cliniques, hôpital Pellegrin, 33076 Bordeaux, France
| | - P Renou
- Université de Bordeaux, INCIA, CNRS UMR5287, 33400 Talence, France
| | - M Poli
- Université de Bordeaux, INCIA, CNRS UMR5287, 33400 Talence, France
| | - J Swendsen
- Université de Bordeaux, INCIA, CNRS UMR5287, 33400 Talence, France; École pratique des Hautes Études, Paris, France.
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18
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Tajuddin K, Justine M, Mohd Mustafah N, Latif L, Manaf H. Dual-Tasking Effects on Gait and Turning Performance of Stroke Survivors with Diabetic Peripheral Neuropathy. Malays J Med Sci 2021; 28:63-71. [PMID: 33958961 PMCID: PMC8075590 DOI: 10.21315/mjms2021.28.2.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 12/12/2020] [Indexed: 11/23/2022] Open
Abstract
Background Stroke survivors depend on the unaffected leg during walking and standing. The presence of diabetic peripheral neuropathy (DPN) affecting both legs may further affect the postural balance and gait instability and increase the risk for falls in such patients. Thus, this study was conducted to investigate the effect of dual taskings on the gait and turning performance of stroke survivors with DPN. Methods Forty stroke survivors were recruited (20 with DPN and 20 without DPN) in this cross-sectional study design. Instrumented timed up and go (iTUG) tests were conducted in three different tasking conditions (single task, dual motor and dual cognitive). APDM® Mobility Lab system was used to capture the gait parameters during the iTUG tests. A two-way mixed analysis of variance was used to determine the main effects of gait performance on three taskings during the iTUG test. Results Spatiotemporal gait parameters and turning performance (turning time and turning step times) were more affected by the tasking conditions in stroke survivors with DPN compared to those without DPN (P < 0.05). Conclusion Stroke survivors with DPN had difficulty walking while turning and performing a secondary task simultaneously.
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Affiliation(s)
- Kamaruzaman Tajuddin
- Centre for Physiotherapy Studies, Faculty of Health Sciences, Universiti Teknologi MARA, Puncak Alam, Selangor, Malaysia
| | - Maria Justine
- Centre for Physiotherapy Studies, Faculty of Health Sciences, Universiti Teknologi MARA, Puncak Alam, Selangor, Malaysia
| | - Nadia Mohd Mustafah
- Department of Rehabilitation Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | - Lydia Latif
- Discipline of Rehabilitation Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Haidzir Manaf
- Centre for Physiotherapy Studies, Faculty of Health Sciences, Universiti Teknologi MARA, Puncak Alam, Selangor, Malaysia
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19
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Yao XW, Li YL, Yu ZJ, Mo CY, Pan HS, Li CY. The efficacy and safety of agomelatine, sertraline, and escitalopram for senile post-stroke depression: A randomized double-blind placebo-controlled trial. Clin Neurol Neurosurg 2021; 205:106651. [PMID: 33940563 DOI: 10.1016/j.clineuro.2021.106651] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 04/01/2021] [Accepted: 04/10/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVES This study aims to investigate the efficacy and safety of agomelatine, sertraline, and escitalopram for patients with senile post-stroke depression (SPSD, aged over 65 years). PATIENTS AND METHODS A total of 165 patients (aged over 65 years) with post-stroke depression (PSD) were recruited. These patients were randomly assigned to one of four groups and given an anti-depressant or a placebo as follows: group A (agomelatine in combination with conventional cerebrovascular disease medication) 48 patients; group B (sertraline in combination with conventional cerebrovascular disease medication) 47 patients; group C (escitalopram in combination with conventional cerebrovascular disease medication) 50 patients; and, a control group (conventional treatment alone) 20 patients. The efficacy of the different treatments was evaluated using the Hamilton Depression Scale (HAMD), the National Institute of Health Stroke Scale (NIHSS), and the Activities of Daily Living (ADL) Barthel index (BI) at one, two, four, and six weeks after treatment began. RESULTS According to the HAMD, NIHSS score, and BI index, the patients who received one of the three antidepressant treatments showed significant improvement compared with the control group (p < 0.05), but there was no significant difference between the three groups receiving anti-depressant medication (p > 0.05). Laboratory tests showed that the general adverse effects of the treatments were mild in all three groups, and patients generally tolerated the treatments. CONCLUSION A decrease of HAMD and NIHSS scores and an increase in the BI index could be observed in the patients receiving agomelatine, sertraline, or escitalopram treatment. Thus, it would appear that the condition of SPSD in older patients can be improved with the use of either agomelatine, sertraline, or escitalopram.
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Affiliation(s)
- Xian-Wei Yao
- Department of General Medicine, Wu Zhongpei Memorial Hospital, Foshan 528300, China.
| | - Yan-Lan Li
- Department of Outpatient, Guangdong Tongjiang Hospital, Foshan 528300, China
| | - Zhi-Jun Yu
- Department of General Medicine, Wu Zhongpei Memorial Hospital, Foshan 528300, China
| | - Cui-Ying Mo
- Department of General Medicine, Wu Zhongpei Memorial Hospital, Foshan 528300, China
| | - Hong-Shan Pan
- Department of General Medicine, Wu Zhongpei Memorial Hospital, Foshan 528300, China
| | - Chun-Yang Li
- Department of General Medicine, Wu Zhongpei Memorial Hospital, Foshan 528300, China
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20
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Stolwyk RJ, Mihaljcic T, Wong DK, Chapman JE, Rogers JM. Poststroke Cognitive Impairment Negatively Impacts Activity and Participation Outcomes: A Systematic Review and Meta-Analysis. Stroke 2021; 52:748-760. [PMID: 33493048 DOI: 10.1161/strokeaha.120.032215] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This systematic review and meta-analysis aimed to investigate whether cognition is associated with activity and participation outcomes in adult stroke survivors. Five databases were systematically searched for studies investigating the relationship between general- and domain-specific cognition and longer-term (>3 months) basic activities of daily living (ADL), instrumental ADLs, and participation outcomes. Eligibility for inclusion, data extraction, and study quality was evaluated by 2 reviewers using a standardized protocol. Effect sizes (r) were estimated using a random-effects model. Sixty-two publications were retained for review, comprising 7817 stroke survivors (median age 63.57 years, range:18-96 years). Median length of follow-up was 12 months (range: 3 months-11 years). Cognition (all domains combined) demonstrated a significant medium association with all 3 functional outcomes combined, r=0.37 (95% CI, 0.33-0.41), P<0.001. Moderator analyses revealed these effects persisted regardless of study quality, order in which outcomes were collected (sequential versus concurrent), age, sample size, or follow-up period. Small to medium associations were also identified between each individual cognitive domain and the separate ADL, instrumental ADL, and participation outcomes. In conclusion, poststroke cognitive impairment is associated with early and enduring activity limitations and participation restrictions, and the association is robust to study design factors, such as sample size, participant age, follow-up period, or study quality. Cognitive assessment early poststroke is recommended to facilitate early detection of disability, prediction of functional outcomes, and to inform tailored rehabilitation therapies.
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Affiliation(s)
- Renerus J Stolwyk
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia (R.J.S., T.M., J.E.C.)
| | - Tijana Mihaljcic
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia (R.J.S., T.M., J.E.C.)
| | - Dana K Wong
- School of Psychology and Public Health, La Trobe University, Bundoora, Australia (D.K.W.)
| | - Jodie E Chapman
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia (R.J.S., T.M., J.E.C.)
| | - Jeffrey M Rogers
- Faculty of Medicine and Health, The University of Sydney, Australia (J.M.R.)
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21
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Webb SS, Jespersen A, Chiu EG, Payne F, Basting R, Duta MD, Demeyere N. The Oxford digital multiple errands test (OxMET): Validation of a simplified computer tablet based multiple errands test. Neuropsychol Rehabil 2021; 32:1007-1032. [PMID: 33406992 DOI: 10.1080/09602011.2020.1862679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Impairments in executive functioning are common following Acquired Brain Injury, though there are few screening tools which present a time efficient and ecologically valid approach to assessing the consequences of executive impairments. We present the Oxford Digital Multiple Errands Test (OxMET), a novel and simplified computer-tablet version of a Multiple Errands Test. We recruited 124 neurologically healthy controls and 105 stroke survivors to complete the OxMET task. Normative data and internal consistency were established from the healthy control data. Convergent and divergent validation was assessed in a mixed subset of 158 participants who completed the OxMET and OCS-Plus. Test-retest reliability was examined across a mixed subset of 39 participants. Finally, we investigated the known-group discriminability of the OxMET. The OxMET demonstrated very high internal consistency, and stable group level test-retest performance as well as good convergent and divergent validity. The OxMET demonstrated high sensitivity and good specificity in overall differentiation of stroke survivors from controls. The Oxford Digital Multiple Errands Test is a brief, easy to administer tool, designed to quickly screen for potential consequences of executive impairments in a virtual environment shopping task on a computer tablet. Initial normative data and validation within a chronic stroke cohort is presented.
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Affiliation(s)
- Sam S Webb
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Anders Jespersen
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Evangeline G Chiu
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Francesca Payne
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Romina Basting
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Mihaela D Duta
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Nele Demeyere
- Department of Experimental Psychology, University of Oxford, Oxford, UK
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22
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Xu JJ, Ren M, Zhao JJ, Wu JJ, Zhang SC, Zhong YB, Xu ST, Cao ZY, Zhou ZQ, Li YL, Shan CL. Effectiveness of theta and gamma electroacupuncture for post-stroke patients on working memory and electrophysiology: study protocol for a double-center, randomized, patient- and assessor-blinded, sham-controlled, parallel, clinical trial. Trials 2020; 21:910. [PMID: 33148333 PMCID: PMC7641837 DOI: 10.1186/s13063-020-04807-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 10/16/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Practitioners of complementary and alternative medicine have suggested that electroacupuncture (EA) could improve post-stroke cognitive impairment, based on the clinical evidence. This study protocol is aimed at showing the effectiveness of theta and gamma EA for post-stroke patients on working memory (WM) and electrophysiology. METHODS After assessing their eligibility, 66 patients with stroke will be enrolled from two Chinese medicine hospitals and randomly divided into theta frequency EA group, gamma frequency EA group, and sham-EA group according to the ratio of 1:1:1. All patients will receive 20 sessions of EA procedures for 4 weeks. Patients in three groups will receive EA at two same acupoints in the head: Baihui (GV20) and Shenting (GV24). The frequency of the three groups of EA is set as follows: 6 Hz (theta-EA group), 40 Hz (gamma-EA group), and no current through the electrodes (sham EA). Patients and assessors will be blinded throughout the entire study. The primary outcome is the performance accuracy of 1-back task which is a frequently used measure of WM in cognitive neuroscience research contexts. Secondary outcome measures will include the response time of 1-back task, the Rivermead Behavioral Memory Test, Trail Making Test, Loewenstein Occupational Therapy Cognitive Assessment Scale, modified Barthel Index, and electroencephalogram (EEG) signals during 1-back tasks. A blinding index will be assessed. Data will be statistically analyzed by one-way ANOVA, at 5% of significance level. DISCUSSION We expect this double-center, randomized, patient- and assessor-blinded, sham-controlled, parallel, clinical trial to explore the effectiveness of theta and gamma EA therapy, compared with sham EA, for post-stroke WM. TRIAL REGISTRATION Chinese Clinical Trial Registry, ChiCTR2000031995 . Registered on 17 April 2020.
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Affiliation(s)
- Jing-Jing Xu
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, 110 Ganhe Road, Hongkou District, Shanghai, 200000, China.,Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Pudong New District, Shanghai, 200000, China
| | - Meng Ren
- Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Pudong New District, Shanghai, 200000, China
| | - Jing-Jun Zhao
- Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Pudong New District, Shanghai, 200000, China
| | - Jia-Jia Wu
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, 110 Ganhe Road, Hongkou District, Shanghai, 200000, China
| | - Si-Cong Zhang
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, 110 Ganhe Road, Hongkou District, Shanghai, 200000, China
| | - Yan-Biao Zhong
- Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Pudong New District, Shanghai, 200000, China
| | - Shu-Tian Xu
- Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Pudong New District, Shanghai, 200000, China
| | - Zhong-Yao Cao
- Anhui Wannan Rehabilitation Hospital, 3 Zheshang road, Jinghu District, Wuhu City, 241000, Anhui Province, China
| | - Zhi-Qing Zhou
- Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Pudong New District, Shanghai, 200000, China
| | - Yuan-Li Li
- Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Pudong New District, Shanghai, 200000, China.
| | - Chun-Lei Shan
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, 110 Ganhe Road, Hongkou District, Shanghai, 200000, China. .,Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Pudong New District, Shanghai, 200000, China.
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23
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Mohapatra B. The contribution of cognition to the rehabilitation of language and communication deficits. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2020. [DOI: 10.12968/ijtr.2019.0098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/Aims There is growing evidence to suggest that cognitive processes, in particular working memory and executive functions, are related to language functions such as syntactic processing, reading comprehension, narration and conversational discourse. This article offers rehabilitation considerations for speech-language pathologists to include cognitive assessment and treatment in their clinical practice. The information presented will also be useful in promoting multidisciplinary rehabilitation. Methods A critical review of the literature on the interaction between cognitive processes and linguistic functions in communication disorders was undertaken. Specific key terms including but not limited to executive functioning, working memory, language, assessment, intervention and communication disorders were searched on the Google Scholar database. Relevant literature from the last three decades pertaining to cognitive behavior, assessment and intervention in communication disorders of all age groups and severities is included in the review. Results The review presents analyses of the multidimensional and dynamic interaction of language and cognition in children (specific language impairment, attention deficit hyperactivity disorder, stuttering) and adults (traumatic brain injury, stroke, dementia) with communication disorders. The article elaborates on the speech-language pathologist's scope of practice in cognitive assessment and intervention that are consistent with the World Health Organization's International Classification of Functioning, Disability and Health framework. Conclusions By documenting cognitive-communication behaviour, speech-language pathologists are able to effectively contribute to the clinical assessment and management of cognitive deficits. However, future research efforts are required to develop clinically reliable tests of cognitive functioning in communication disorders and promote evidence-based cognitive treatment practices.
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Affiliation(s)
- Bijoyaa Mohapatra
- Department of Communication Disorders, New Mexico State University, Las Cruces, New Mexico, USA
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24
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Veldsman M, Werden E, Egorova N, Khlif MS, Brodtmann A. Microstructural degeneration and cerebrovascular risk burden underlying executive dysfunction after stroke. Sci Rep 2020; 10:17911. [PMID: 33087782 PMCID: PMC7578057 DOI: 10.1038/s41598-020-75074-w] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 10/07/2020] [Indexed: 01/12/2023] Open
Abstract
Executive dysfunction affects 40% of stroke patients, but is poorly predicted by characteristics of the stroke itself. Stroke typically occurs on a background of cerebrovascular burden, which impacts cognition and brain network structural integrity. We used structural equation modelling to investigate whether measures of white matter microstructural integrity (fractional anisotropy and mean diffusivity) and cerebrovascular risk factors better explain executive dysfunction than markers of stroke severity. 126 stroke patients (mean age 68.4 years) were scanned three months post-stroke and compared to 40 age- and sex-matched control participants on neuropsychological measures of executive function. Executive function was below what would be expected for age and education level in stroke patients as measured by the organizational components of the Rey Complex Figure Test, F(3,155) = 17, R2 = 0.25, p < 0.001 (group significant predictor at p < 0.001) and the Trail-Making Test (B), F(3,157) = 3.70, R2 = 0.07, p < 0.01 (group significant predictor at p < 0.001). A multivariate structural equation model illustrated the complex relationship between executive function, white matter integrity, stroke characteristics and cerebrovascular risk (root mean square error of approximation = 0.02). Pearson's correlations confirmed a stronger relationship between executive dysfunction and white matter integrity (r = - 0.74, p < 0.001), than executive dysfunction and stroke severity (r = 0.22, p < 0.01). The relationship between executive function and white matter integrity is mediated by cerebrovascular burden. White matter microstructural degeneration of the superior longitudinal fasciculus in the executive control network better explains executive dysfunction than markers of stroke severity. Executive dysfunction and incident stroke can be both considered manifestations of cerebrovascular risk factors.
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Affiliation(s)
- Michele Veldsman
- Department of Experimental Psychology, University of Oxford, New Radcliffe House, Radcliffe Observatory Quarter, Oxford, OX2 6GG, UK.
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia.
| | - Emilio Werden
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
| | - Natalia Egorova
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Mohamed Salah Khlif
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
| | - Amy Brodtmann
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
- Austin Health, Heidelberg, Melbourne, VIC, Australia
- Eastern Clinical Research Unit, Box Hill Hospital, Melbourne, VIC, Australia
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25
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Tiznado D, Clark JMR, McDowd J. Cognitive predictors of a performance-based measure of instrumental activities of daily living following stroke. Top Stroke Rehabil 2020; 28:401-409. [PMID: 33073728 DOI: 10.1080/10749357.2020.1834269] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND To inform cognitive interventions that target functional capacity for individuals who have survived stroke, an evaluation of predictors of daily functioning is necessary. The current literature is limited regarding identifying the associations between objective cognitive functioning and objective performance of Instrumental Activities of Daily Living (IADLs). OBJECTIVES To investigate the relationship between objectively measured cognitive domains/executive functions and performance on an objective measure of IADLs following a stroke. METHODS Cross-sectional examination of 52 participants who have survived strokes and completed assessments of immediate memory, visuospatial/constructional skills, language, attention, delayed memory, executive functions (i.e., inhibition and flexibility, concept-formation and problem-solving, abstract thinking, deductive thinking, and verbal abstraction), and a performance-based measure of IADLs (UCSD Performance-based Skills Assessment; UPSA). RESULTS Results indicated significant correlations between the UPSA and immediate memory, visuospatial/constructional skills, language, delayed memory, and executive functions (i.e., concept formation and problem-solving, flexibility of thinking, and verbal abstraction). A hierarchical multiple regression, controlling for age, severity of stroke, side of stroke, and depressive symptoms and including the cognitive measures individually significantly associated with the UPSA, explained approximately 62% of the variance in overall UPSA performance. This regression demonstrated that only language significantly predicted UPSA total score, in the context of multiple variables. CONCLUSIONS Cognitive functioning is significantly associated with IADL functioning post-stroke, and considering multiple domains of cognitive functioning together largely explains the performance of IADLs.
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Affiliation(s)
- Denisse Tiznado
- Department of Psychology, University of Missouri-Kansas City, Kansas City, MO, USA.,Mental Health Service, VA San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California, San Diego, CA, USA
| | - Jillian M R Clark
- Department of Psychiatry, University of California, San Diego, CA, USA.,Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA, USA
| | - Joan McDowd
- Department of Psychology, University of Missouri-Kansas City, Kansas City, MO, USA
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26
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Pugh M, Olabarrieta‐Landa L, Chagualá AC, Perrin PB, Arango‐Lasprilla JC. Spontaneous Recovery of Executive Function, Attention, and Processing Speed in Stroke Patients in Colombia. PM R 2020; 13:674-682. [DOI: 10.1002/pmrj.12467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 07/29/2020] [Accepted: 08/04/2020] [Indexed: 11/08/2022]
Affiliation(s)
| | | | | | | | - Juan Carlos Arango‐Lasprilla
- BioCruces Bizkaia Health Research Institute Cruces University Hospital Barakaldo, Barakaldo Spain
- IKERBASQUE, Basque Foundation for Science Plaza de Cruces s/n. 48903 Barakaldo, Bizkaia, Spain; and Department of Cell Biology and Histology, University of the Basque Country UPV/EHU Leioa Spain
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27
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Rodríguez-Lorenzana A, Ramos-Usuga D, Díaz LA, Mascialino G, Yacelga Ponce T, Rivera D, Arango-Lasprilla JC. Normative data of neuropsychological tests of attention and executive functions in Ecuadorian adult population. AGING NEUROPSYCHOLOGY AND COGNITION 2020; 28:508-527. [PMID: 32666879 DOI: 10.1080/13825585.2020.1790493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The purpose of this study was to generate normative data for five tests of attention and executive functions (M-WCST, Stroop test, TMT, BTA, and SDMT), in a group of 322 Ecuadorian adults from Quito between the ages of 18 and 85. METHOD Multiple regression analyzes taking into account age, education, and gender were used to generate the normative data. RESULTS Age and education were significantly related to test performance such that scores decreased with age and improved as a function of education. An online calculator is provided to generate normative test scores. CONCLUSIONS This is the first study that presents normative data for tests of executive functions and attention in an Ecuadorian adult population. This data will improve the clinical practice of neuropsychology and help to develop the field in the country.
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Affiliation(s)
| | - Daniela Ramos-Usuga
- Biocruces Bizkaia Health Research Institute , Barakaldo, Spain.,Biomedical Research Doctorate Program, University of the Basque Country (UPV/EHU) , Leioa, Spain
| | - Lila Adana Díaz
- Escuela De Psicología, Universidad De Las Américas , Quito, Ecuador
| | - Guido Mascialino
- Escuela De Psicología, Universidad De Las Américas , Quito, Ecuador
| | | | - Diego Rivera
- Departamento De Ciencias De La Salud, Universidad Pública De Navarra , Navarra, España
| | - Juan Carlos Arango-Lasprilla
- Biocruces Bizkaia Health Research Institute , Barakaldo, Spain.,IKERBASQUE. Basque Foundation for Science , Bilbao, Spain.,Department of Cell Biology and Histology, University of the Basque Country (UPV/EHU) , Leioa, Spain
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28
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Vicente SG, Rivera D, Barbosa F, Gaspar N, Dores AR, Mascialino G, Arango-Lasprilla JC. Normative data for tests of attention and executive functions in a sample of European Portuguese adult population. AGING NEUROPSYCHOLOGY AND COGNITION 2020; 28:418-437. [PMID: 32654600 DOI: 10.1080/13825585.2020.1781768] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The main goal of this study was to produce normative data for the Portuguese population on five neuropsychological tests frequently used to assess executive functions and attention: the Modified Wisconsin Card Sorting Test (M-WCST), the Stroop Color and Word Test, the Trail Making Test (TMT), the Brief Test of Attention (BTA), and the Symbol Digit Modalities Test (SDMT). METHOD The study included 300 individuals aged between 18 and 93 years, who had educational backgrounds ranging from 3 to 25 years. RESULTS The influence of age, education, and sex was explored for each measure, as well as their contribution to explain the performance variance. CONCLUSIONS The normative data are presented as regression-based algorithms to adjust direct and derived test scores for sex, age, and education. This study provides a calculator of normative data, derived from the results of the regression models.
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Affiliation(s)
- Selene G Vicente
- Centre for Psychology, Faculty of Psychology and Education Sciences, University of Porto , Porto, Portugal
| | - Diego Rivera
- Departamento De Ciencias De La Salud, Universidad Pública De Navarra , Navarra, España
| | - Fernando Barbosa
- Laboratory of Neuropsychophysiology, Faculty of Psychology and Education Sciences, University of Porto , Porto Portugal
| | - Nuno Gaspar
- Centre for Psychology, Faculty of Psychology and Education Sciences, University of Porto , Porto, Portugal
| | - Artemisa R Dores
- Laboratory of Neuropsychophysiology, Faculty of Psychology and Education Sciences, University of Porto , Porto Portugal.,School of Health, Polytechnic of Porto , Porto, Portugal
| | - Guido Mascialino
- School of Psychology, Universidad De Las Américas , Quito, Ecuador
| | - Juan Carlos Arango-Lasprilla
- IKERBASQUE. Basque Foundation for Science , Bilbao, Spain.,Biocruces Bizkaia Health Research Institute , Barakaldo, Spain.,Department of Cell Biology and Histology, University of the Basque Country (UPV/EHU) , Leioa, Spain
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29
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Merriman NA, Sexton E, McCabe G, Walsh ME, Rohde D, Gorman A, Jeffares I, Donnelly NA, Pender N, Williams DJ, Horgan F, Doyle F, Wren MA, Bennett KE, Hickey A. Addressing cognitive impairment following stroke: systematic review and meta-analysis of non-randomised controlled studies of psychological interventions. BMJ Open 2019; 9:e024429. [PMID: 30819706 PMCID: PMC6398645 DOI: 10.1136/bmjopen-2018-024429] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Cognitive impairment is a pervasive outcome of stroke, reported in over half of patients 6 months post-stroke and is associated with increased disability and a poorer quality of life. Despite the prevalence of post-stroke cognitive impairment, the efficacy of existing psychological interventions for the rehabilitation of cognitive impairment following stroke has yet to be established. The aim of this study is to identify psychological interventions from non-randomised studies that intended to improve post-stroke cognitive function and establish their efficacy. DESIGN Systematic review and meta-analysis of non-randomised studies of psychological interventions addressing post-stroke cognitive impairment. DATA SOURCES Electronic searches were performed in the Pubmed, EMBASE and PsycINFO databases, the search dating from inception to February 2017. ELIGIBILITY CRITERIA All non-randomised controlled studies and quasi-randomised controlled trials examining psychological interventions to improve cognitive function following stroke were included, such as feasibility studies, pilot studies, experimental studies, and quasi-experimental studies. The primary outcome was cognitive function. The prespecified secondary outcomes were functional abilities in daily life and quality of life. METHODS The current meta-analyses combined the findings of seven controlled studies, examining the efficacy of psychological interventions compared with treatment-as-usual controls or active controls, and 13 one-group pre-post studies. RESULTS Results indicated an overall small effect on cognition across the controlled studies (Hedges' g=0.38, 95% CI=0.06 to 0.7) and a moderate effect on cognition across the one-group pre-post studies (Hedges' g=0.51, 95% CI=0.3 to 0.73). Specific cognitive domains, such as memory and attention also demonstrated a benefit of psychological interventions. CONCLUSIONS This review provides support for the potential of psychological interventions to improve overall cognitive function post-stroke. Limitations of the study, in terms of risk of bias and quality of included studies, and future research directions are explored. PROSPERO REGISTRATION NUMBER CRD42017069714.
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Affiliation(s)
- Niamh A Merriman
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Eithne Sexton
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Grainne McCabe
- Library, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Mary E Walsh
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Daniela Rohde
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Ashleigh Gorman
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Isabelle Jeffares
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Nora-Ann Donnelly
- Social Research Division, Economic and Social Research Institute, Dublin, Ireland
| | - Niall Pender
- Department of Psychology, Beaumont Hospital, Dublin, Ireland
| | - David J Williams
- Department of Geriatric and Stroke Medicine, Beaumont Hospital, Dublin, Ireland
- Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Frances Horgan
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Frank Doyle
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Maev-Ann Wren
- Social Research Division, Economic and Social Research Institute, Dublin, Ireland
| | - Kathleen E Bennett
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Anne Hickey
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
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30
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Abstract
Objective: To review the research literature pertaining to post-stroke language recovery, and to discuss neurocognitive assessment in patients in the context of aphasia, time course of language recovery, factors associated with language recovery, and therapeutic techniques designed to facilitate language recovery. Method: Articles were identified through PubMed, MEDLINE, PsychINFO, and Google Scholar searches. Examples of utilized keywords include "post-stroke aphasia," "post-stroke language recovery," "post-stroke neurocognitive assessment," and "neuropsychology and aphasia." Results: Most language recovery occurs in the first few weeks following stroke, but residual recovery may occur for many years. Although initial aphasia severity is the single largest determinant of post-stroke language recovery, a number of other variables also contribute. Several techniques have been developed to aid in the recovery process including speech-language therapy and noninvasive brain stimulation, although the effectiveness of acute and subacute treatment remains unclear. Some degree of valid neurocognitive assessment is possible in patients with aphasia, and the information gained from such an evaluation can aid the rehabilitative process Conclusions: Significant recovery of language function is possible following a stroke, but prediction of level of recovery in an individual patient is difficult. Information about initial aphasia severity and the integrity of cognitive domains other than language can help guide the rehabilitation team, as well as manage expectations for recovery.
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Affiliation(s)
- Adam Gerstenecker
- a Department of Neurology , University of Alabama at Birmingham , Birmingham , AL, USA.,b Alzheimer's Disease Center , University of Alabama at Birmingham , Birmingham , AL, USA.,c Evelyn F. McKnight Brain Institute , University of Alabama at Birmingham , Birmingham , AL, USA
| | - Ronald M Lazar
- a Department of Neurology , University of Alabama at Birmingham , Birmingham , AL, USA.,c Evelyn F. McKnight Brain Institute , University of Alabama at Birmingham , Birmingham , AL, USA
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31
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Pinter D, Enzinger C, Gattringer T, Eppinger S, Niederkorn K, Horner S, Fandler S, Kneihsl M, Krenn K, Bachmaier G, Fazekas F. Prevalence and short-term changes of cognitive dysfunction in young ischaemic stroke patients. Eur J Neurol 2019; 26:727-732. [PMID: 30489673 PMCID: PMC6491967 DOI: 10.1111/ene.13879] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 11/26/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND PURPOSE Information on the prevalence and course of post-stroke cognitive impairment in young stroke patients is limited. The aim was to assess a consecutive sample of acute young ischaemic stroke patients (18-55 years) for the presence and development of neuropsychological deficits. METHODS Patients prospectively underwent a comprehensive clinical and cognitive assessment, examining general cognitive function, processing speed, attention, flexibility/executive function and word fluency within the first 3 weeks after hospital admission (median assessment at day 6) and at a 3 months' follow-up (FU). Cognitive dysfunction was defined in comparison to age-standardized published norms. RESULTS At baseline (N = 114), deficits were highly prevalent in processing speed (56.0%), flexibility/executive function (49.5%), attention (46.4%) and general cognitive function (42.1%). These frequencies were comparable for those with FU assessment (N = 87). In most domains, cognitive performance improved within 3 months, except for word fluency. However, in about one-third of patients, cognitive deficits (as defined by 1.5 standard deviations below the standardized mean) were still present 3 months after stroke. At FU, 44.0% were impaired in the domain flexibility/executive function, 35.0% in processing speed and 30.0% in attention. CONCLUSIONS The high prevalence of cognitive deficits in acute young patients with ischaemic stroke highlights the importance of early post-stroke cognitive assessment to capture a patient's dysfunction in a comprehensive manner and to offer adequate rehabilitation. The role of factors which promote neuropsychological deficits needs further exploration.
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Affiliation(s)
- D Pinter
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - C Enzinger
- Department of Neurology, Medical University of Graz, Graz, Austria.,Division of Neuroradiology, Vascular and Interventional Neuroradiology, Medical University of Graz, Graz, Austria
| | - T Gattringer
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - S Eppinger
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - K Niederkorn
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - S Horner
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - S Fandler
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - M Kneihsl
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - K Krenn
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - G Bachmaier
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - F Fazekas
- Department of Neurology, Medical University of Graz, Graz, Austria
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32
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The Association of Judgement Ability and Functional Status in Older Adult Rehabilitation Inpatients. BRAIN IMPAIR 2018. [DOI: 10.1017/brimp.2018.8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Purpose: Older adults have an increased likelihood of requiring rehabilitative care due to cognitive and physical risk factors. Research has found a link between executive functioning performance and functional outcomes; however, there is a dearth of research on the assessment of judgement ability. In the current pilot study, we investigated the clinical utility of the Test of Practical Judgment (TOP-J) in an older adult rehabilitation sample.Methods: Inpatients of mixed diagnoses (n= 25, mean age = 72.60) completed the TOP-J and Functional Independence Measure (FIM). We assessed TOP-J performance in the entire sample and in those with intact vs. impaired global cognition (on the Mini-Mental State Examination; MMSE). Correlational analyses were conducted between the TOP-J, MMSE and relevant FIM items.Results: TOP-J performance fell between the means typically observed in individuals with mild cognitive impairment and mild Alzheimer's disease. Participants with intact global cognition obtained significantly higher TOP-J scores than those with impaired global cognition. Moderate to strong positive correlations emerged between TOP-J, MMSE and FIM items of problem solving, comprehension and memory.Conclusions: Results provide support for the clinical utility and validity of the TOP-J among older adults in the rehabilitation setting. Administering the TOP-J may help identify patients at risk for future injury and facilitate role transitions.
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Laakso HM, Hietanen M, Melkas S, Sibolt G, Curtze S, Virta M, Ylikoski R, Pohjasvaara T, Kaste M, Erkinjuntti T, Jokinen H. Executive function subdomains are associated with post‐stroke functional outcome and permanent institutionalization. Eur J Neurol 2018; 26:546-552. [DOI: 10.1111/ene.13854] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 11/05/2018] [Indexed: 11/30/2022]
Affiliation(s)
- H. M. Laakso
- Neurology and Neuropsychology University of Helsinki and Helsinki University Hospital HelsinkiFinland
- Department of Psychology and Logopedics Faculty of Medicine University of Helsinki HelsinkiFinland Finland
| | - M. Hietanen
- Neurology and Neuropsychology University of Helsinki and Helsinki University Hospital HelsinkiFinland
| | - S. Melkas
- Neurology and Neuropsychology University of Helsinki and Helsinki University Hospital HelsinkiFinland
| | - G. Sibolt
- Neurology and Neuropsychology University of Helsinki and Helsinki University Hospital HelsinkiFinland
| | - S. Curtze
- Neurology and Neuropsychology University of Helsinki and Helsinki University Hospital HelsinkiFinland
| | - M. Virta
- Department of Psychology and Logopedics Faculty of Medicine University of Helsinki HelsinkiFinland Finland
| | - R. Ylikoski
- Neurology and Neuropsychology University of Helsinki and Helsinki University Hospital HelsinkiFinland
| | - T. Pohjasvaara
- Neurology and Neuropsychology University of Helsinki and Helsinki University Hospital HelsinkiFinland
| | - M. Kaste
- Neurology and Neuropsychology University of Helsinki and Helsinki University Hospital HelsinkiFinland
| | - T. Erkinjuntti
- Neurology and Neuropsychology University of Helsinki and Helsinki University Hospital HelsinkiFinland
| | - H. Jokinen
- Neurology and Neuropsychology University of Helsinki and Helsinki University Hospital HelsinkiFinland
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Povroznik JM, Ozga JE, Haar CV, Engler-Chiurazzi EB. Executive (dys)function after stroke: special considerations for behavioral pharmacology. Behav Pharmacol 2018; 29:638-653. [PMID: 30215622 PMCID: PMC6152929 DOI: 10.1097/fbp.0000000000000432] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Stroke is a worldwide leading cause of death and long-term disability with concurrent secondary consequences that are largely comprised of mood dysfunction, as well as sensory, motor, and cognitive deficits. This review focuses on the cognitive deficits associated with stroke specific to executive dysfunction (including decision making, working memory, and cognitive flexibility) in humans, nonhuman primates, and additional animal models. Further, we review some of the cellular and molecular underpinnings of the individual components of executive dysfunction and their neuroanatomical substrates after stroke, with an emphasis on the changes that occur during biogenic monoamine neurotransmission. We concentrate primarily on changes in the catecholaminergic (dopaminergic and noradrenergic) and serotonergic systems at the levels of neurotransmitter synthesis, distribution, reuptake, and degradation. We also discuss potential secondary stroke-related behavioral deficits (specifically, poststroke depression as well as drug-abuse potential and addiction) and their relationship with stroke-induced deficits in executive function, an especially important consideration given that the average age of the human stroke population is decreasing. In the final sections, we address pharmacological considerations for the treatment of ischemia and the subsequent functional impairment, as well as current limitations in the field of stroke and executive function research.
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Affiliation(s)
- Jessica M. Povroznik
- Center for Basic and Translational Stroke Research, West Virginia University, Morgantown, WV, USA
- Department of Physiology, Pharmacology, and Neuroscience, West Virginia University, Morgantown, WV, USA
- Rodent Behavior Core, Health Sciences Center, West Virginia University, Morgantown, WV, USA
| | - Jenny E. Ozga
- Injury and Recovery Laboratory, Department of Psychology, West Virginia University, Morgantown, WV, USA
| | - Cole Vonder Haar
- Injury and Recovery Laboratory, Department of Psychology, West Virginia University, Morgantown, WV, USA
| | - Elizabeth B. Engler-Chiurazzi
- Center for Basic and Translational Stroke Research, West Virginia University, Morgantown, WV, USA
- Department of Physiology, Pharmacology, and Neuroscience, West Virginia University, Morgantown, WV, USA
- Rodent Behavior Core, Health Sciences Center, West Virginia University, Morgantown, WV, USA
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35
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Nusrat L, Livingston-Thomas JM, Raguthevan V, Adams K, Vonderwalde I, Corbett D, Morshead CM. Cyclosporin A-Mediated Activation of Endogenous Neural Precursor Cells Promotes Cognitive Recovery in a Mouse Model of Stroke. Front Aging Neurosci 2018; 10:93. [PMID: 29740308 PMCID: PMC5928138 DOI: 10.3389/fnagi.2018.00093] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 03/19/2018] [Indexed: 11/17/2022] Open
Abstract
Cognitive dysfunction following stroke significantly impacts quality of life and functional independance; yet, despite the prevalence and negative impact of cognitive deficits, post-stroke interventions almost exclusively target motor impairments. As a result, current treatment options are limited in their ability to promote post-stroke cognitive recovery. Cyclosporin A (CsA) has been previously shown to improve post-stroke functional recovery of sensorimotor deficits. Interestingly, CsA is a commonly used immunosuppressant and also acts directly on endogenous neural precursor cells (NPCs) in the neurogenic regions of the brain (the periventricular region and the dentate gyrus). The immunosuppressive and NPC activation effects are mediated by calcineurin-dependent and calcineurin-independent pathways, respectively. To develop a cognitive stroke model, focal bilateral lesions were induced in the medial prefrontal cortex (mPFC) of adult mice using endothelin-1. First, we characterized this stroke model in the acute and chronic phase, using problem-solving and memory-based cognitive tests. mPFC stroke resulted in early and persistent deficits in short-term memory, problem-solving and behavioral flexibility, without affecting anxiety. Second, we investigated the effects of acute and chronic CsA treatment on NPC activation, neuroprotection, and tissue damage. Acute CsA administration post-stroke increased the size of the NPC pool. There was no effect on neurodegeneration or lesion volume. Lastly, we looked at the effects of chronic CsA treatment on cognitive recovery. Long-term CsA administration promoted NPC migration toward the lesion site and rescued cognitive deficits to control levels. This study demonstrates that CsA treatment activates the NPC population, promotes migration of NPCs to the site of injury, and leads to improved cognitive recovery following long-term treatment.
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Affiliation(s)
- Labeeba Nusrat
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | | | | | - Kelsey Adams
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
| | - Ilan Vonderwalde
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Dale Corbett
- Department of Cellular & Molecular Medicine, University of Ottawa, Ottawa, ON, Canada.,Canadian Partnership for Stroke Recovery, Ottawa, ON, Canada
| | - Cindi M Morshead
- Department of Surgery, University of Toronto, Toronto, ON, Canada.,Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada.,Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada
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Baseline Vascular Cognitive Impairment Predicts the Course of Apathetic Symptoms After Stroke: The CASPER Study. Am J Geriatr Psychiatry 2018; 26:291-300. [PMID: 29079017 DOI: 10.1016/j.jagp.2017.09.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 09/01/2017] [Accepted: 09/05/2017] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To examine the influence of vascular cognitive impairment (VCI) on the course of poststroke depression (PSD) and poststroke apathy (PSA). METHODS Included were 250 stroke patients who underwent neuropsychological and neuropsychiatric assessment 3 months after stroke (baseline) and at a 6- and 12-month follow-up after baseline. Linear mixed models tested the influence of VCI in at least one cognitive domain (any VCI) or multidomain VCI (VCI in multiple cognitive domains) at baseline and domain-specific VCI at baseline on levels of depression and apathy over time, with random effects for intercept and slope. RESULTS Almost half of the patients showed any VCI at baseline, and any VCI was associated with increasing apathy levels from baseline to the 12-month follow-up. Patients with multidomain VCI had higher apathy scores at the 6- and 12-month follow-up compared with patients with VCI in a single cognitive domain. Domain-specific analyses showed that impaired executive function and slowed information processing speed went together with increasing apathy levels from baseline to 6- and 12-month follow-up. None of the cognitive variables predicted the course of depressive symptoms. CONCLUSION Baseline VCI is associated with increasing apathy levels from baseline to the chronic stroke phase, whereas no association was found between baseline VCI and the course of depressive symptoms. Health professionals should be aware that apathy might be absent early after stroke but may evolve over time in patients with VCI.
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Nakling AE, Aarsland D, Næss H, Wollschlaeger D, Fladby T, Hofstad H, Wehling E. Cognitive Deficits in Chronic Stroke Patients: Neuropsychological Assessment, Depression, and Self-Reports. Dement Geriatr Cogn Dis Extra 2017; 7:283-296. [PMID: 29033974 PMCID: PMC5624240 DOI: 10.1159/000478851] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 06/16/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Following stroke, clinicians are challenged to detect and untangle symptoms of cognitive dysfunction and mood disorders. Additionally, they need to evaluate the informative value of self-reports to identify patients in need of further attendance. AIMS To examine the association between neuropsychological measures, symptoms of depression, and self-reported cognitive function. METHODS One-hundred and five chronic stroke patients underwent assessment covering 6 cognitive domains and answered the Hospital Anxiety and Depression Scale and the Memory and Thinking Scale from the Stroke Impact Scale 1 year after stroke. Age and gender difference in cognitive impairment were examined; linear regression was used to predict depression scores. Sensitivity and specificity analyses were used to validate self-reported functioning against performance on cognitive tests. RESULTS Cognitive impairment was observed in 60% of the patients in at least 1 cognitive domain. Cognitive performance was associated with symptoms of depression as well as with self-reported cognitive function. The final analyses revealed low sensitivity and specificity for the Memory and Thinking subscale from the Stroke Impact Scale. CONCLUSION Cognitive impairment occurs frequently even in patients in a chronic phase after stroke and predicts symptoms of depression. Using the Stroke Impact Scale, clinicians should be aware of low sensitivity of self-reported cognitive function.
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Affiliation(s)
- Arne E Nakling
- Institute of Clinical Medicine, University of Bergen, Bergen, Norway.,Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Dag Aarsland
- Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway.,Institute of Psychiatry, Psychology, and Neuroscience, King's College, London, United Kingdom
| | - Halvor Næss
- Institute of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Neurology, Haukeland University Hospital, Bergen, Norway.,Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Daniel Wollschlaeger
- Department of Medical Statistics, Epidemiology, and Informatics, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Tormod Fladby
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway.,Department of Neurology, Faculty Division, Akershus University Hospital, University of Oslo, Lørenskog, Norway
| | - Håkon Hofstad
- Department of Physical Medicine and Rehabilitation, Haukeland University Hospital, Bergen, Norway
| | - Eike Wehling
- Department of Physical Medicine and Rehabilitation, Haukeland University Hospital, Bergen, Norway
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Allanson F, Pestell C, Gignac GE, Yeo YX, Weinborn M. Neuropsychological Predictors of Outcome Following Traumatic Brain Injury in Adults: a Meta-Analysis. Neuropsychol Rev 2017; 27:187-201. [DOI: 10.1007/s11065-017-9353-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 06/06/2017] [Indexed: 11/29/2022]
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Executive Function Is Associated With Off-Line Motor Learning in People With Chronic Stroke. J Neurol Phys Ther 2017; 41:101-106. [DOI: 10.1097/npt.0000000000000170] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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40
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Villain M, Sibon I, Renou P, Poli M, Swendsen J. Very early social support following mild stroke is associated with emotional and behavioral outcomes three months later. Clin Rehabil 2016; 31:135-141. [PMID: 26851250 DOI: 10.1177/0269215515623600] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To investigate whether social contact and support received during hospitalization for acute ischemic stroke predict depression and daily life functioning three months later. DESIGN Prospective observational study using Ecological Momentary Assessments to evaluate the number of social contacts as well as social support received from family, friends and medical staff within 24 hours following admission for stroke. Patients also monitored depression symptoms and behavior in real-time and in daily life contexts three months later. SETTING A university hospital acute stroke unit. SUBJECTS Thirty-four mild ischemic stroke patients. INTERVENTIONS None. MAIN MEASURES One-day Ecological Momentary Assessments immediately following stroke collected information concerning perceived social support, number of social contacts and depression symptoms. Ecological Momentary Assessments was repeated three months later and addressed depression levels as well as activities of daily living, such as working, cooking, shopping and housework. RESULTS The number of social interactions received at hospitalization did not predict three-month outcomes. However, a better quality of moral support from friends and family immediately after stroke was associated with decreases in later depression levels ( p = 0.041) and increases in activities of daily living ( p = 0.011). Material support from friends and family was associated with increases in activities of daily living ( p = 0.012). No effect was observed for support received from medical staff. CONCLUSIONS Patient perceptions of better support quality, and not quantity, immediately following mild stroke, are associated with better behavioral and emotional outcomes three months later.
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Affiliation(s)
- Marie Villain
- 1 Université de Bordeaux, INCIA, Talence, France.,2 Ecole Pratique des Hautes Etudes, Paris, France
| | - Igor Sibon
- 1 Université de Bordeaux, INCIA, Talence, France.,3 CHU Bordeaux, Hôpital Pellegrin, Bordeaux, France
| | | | | | - Joel Swendsen
- 1 Université de Bordeaux, INCIA, Talence, France.,2 Ecole Pratique des Hautes Etudes, Paris, France
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Donnellan C, Al Banna M, Redha N, Al Sharoqi I, Al-Jishi A, Bakhiet M, Taha S, Abdulla F. Association Between Metacognition and Mood Symptoms Poststroke. J Geriatr Psychiatry Neurol 2016; 29:212-20. [PMID: 27056067 DOI: 10.1177/0891988716640374] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 02/10/2016] [Indexed: 12/20/2022]
Abstract
INTRODUCTION The link between metacognition and mood has been well established, particularly in other conditions with psychological comorbidity, however, there is no evidence regarding this association in the area of stroke. AIM The aim of this study was to examine the association between metacognition, based on the Self-Regulatory Executive Function model, and mood symptoms in the acute phase after stroke. METHODS One hundred thirty patients were recruited to a prospective stroke study in Bahrain, and n = 64 were assessed for mood and cognition. A neuropsychological battery of cognitive assessments included the following measures: the Mini-Mental State Examination, the Trail Making Test (A+B), and the Metacognition Questionnaire 30 (MCQ-30) for metacognition. The Hospital Anxiety and Depression Scale assessed mood symptoms, and stroke severity was measured using the National Institute of Health Stroke Severity Scale. RESULTS Total MCQ-30 scores were significantly associated with both anxiety (r = .47, P = .001) and depression (r = .54, P <. 0001). The MCQ-30 subscales' cognitive confidence, cognitive self-consciousness, and uncontrollability/danger were the specific factors to be associated with mood symptoms (P < .01). Global cognition (r =.32, P < .01), but not executive function, was significantly associated with depression only. Metacognition remained a statistically significant correlate with depression (β = .42, P < .0001) and anxiety (β = .51, P < .0001) after adjusting for education and global cognition. DISCUSSION Metacognition is a better determinant of mood symptoms after stroke, especially in regions where illiteracy levels are high in older populations, in comparison to executive function and global cognition.
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Affiliation(s)
- Claire Donnellan
- School of Medicine, Royal College of Surgeons in Ireland-Medical University of Bahrain, Busaiteen, Kingdom of Bahrain School of Postgraduate Studies, Royal College of Surgeons in Ireland-Medical University of Bahrain, Busaiteen, Kingdom of Bahrain School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - M Al Banna
- School of Postgraduate Studies, Royal College of Surgeons in Ireland-Medical University of Bahrain, Busaiteen, Kingdom of Bahrain
| | - N Redha
- School of Postgraduate Studies, Royal College of Surgeons in Ireland-Medical University of Bahrain, Busaiteen, Kingdom of Bahrain
| | - I Al Sharoqi
- Department of Clinical Neurosciences, Salmaniya Medical Complex, Salmaniya, Kingdom of Bahrain
| | - A Al-Jishi
- Department of Clinical Neurosciences, Salmaniya Medical Complex, Salmaniya, Kingdom of Bahrain
| | - M Bakhiet
- Department of Molecular Medicine, Princess Al-Jawhara Center for Genetics and Inherited Diseases, Salmaniya Kingdom of Bahrain
| | - S Taha
- Department of Molecular Medicine, Princess Al-Jawhara Center for Genetics and Inherited Diseases, Salmaniya Kingdom of Bahrain
| | - F Abdulla
- Department of Clinical Neurosciences, Salmaniya Medical Complex, Salmaniya, Kingdom of Bahrain
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Katz N, Tadmor I, Felzen B, Hartman-Maeir A. Validity of the Executive Function Performance Test in Individuals with Schizophrenia. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2016. [DOI: 10.1177/153944920702700202] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purpose of this study was to examine the reliability and validity of the Executive Function Performance Test (EFPT) in a schizophrenic population. Participants were 30 individuals with the acute phase of schizophrenia and 31 with the chronic stage. Internal consistency using Cronbach's alpha was high (α = .88). Two-way multiple analysis of covariance revealed that the acute group scored significantly higher than the chronic group on almost all tasks and components of the EFPT ( p = .045 to .000), supporting construct validity. Moderate to high Spearman correlation coefficients were found between the total EFPT score and the total Behavioral Assessment of the Dysexecutive Syndrome profile and standardized scores within each of the groups ( r =.433 to .764; p < .017 to .000), supporting criterion validity. The findings support the use of the EFPT for identifying executive functions in the context of everyday life and instrumental activities of daily living tasks. However, further studies are needed in different populations and cultures.
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A Review of Risk Factors for Cognitive Impairment in Stroke Survivors. ScientificWorldJournal 2016; 2016:3456943. [PMID: 27340686 PMCID: PMC4906214 DOI: 10.1155/2016/3456943] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Accepted: 05/04/2016] [Indexed: 02/02/2023] Open
Abstract
In this review, we aimed to identify the risk factors that may influence cognitive impairment among stroke survivors, namely, demographic, clinical, psychological, and physical determinants. A search from Medline, Scopus, and ISI Web of Science databases was conducted for papers published from year 2004 to 2015 related to risk factors of cognitive impairment among adult stroke survivors. A total of 1931 articles were retrieved, but only 27 articles met the criteria and were reviewed. In more than half of the articles it was found that demographical variables that include age, education level, and history of stroke were significant risk factors of cognitive impairment among stroke survivors. The review also indicated that diabetes mellitus, hypertension, types of stroke and affected region of brain, and stroke characteristics (e.g., size and location of infarctions) were clinical determinants that affected cognitive status. In addition, the presence of emotional disturbances mainly depressive symptoms showed significant effects on cognition. Independent relationships between cognition and functional impairment were also identified as determinants in a few studies. This review provided information on the possible risk factors of cognitive impairment in stroke survivors. This information may be beneficial in the prevention and management strategy of cognitive impairments among stroke survivors.
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Livingston-Thomas J, Nelson P, Karthikeyan S, Antonescu S, Jeffers MS, Marzolini S, Corbett D. Exercise and Environmental Enrichment as Enablers of Task-Specific Neuroplasticity and Stroke Recovery. Neurotherapeutics 2016; 13:395-402. [PMID: 26868018 PMCID: PMC4824016 DOI: 10.1007/s13311-016-0423-9] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Improved stroke care has resulted in greater survival, but >50% of patients have chronic disabilities and 33% are institutionalized. While stroke rehabilitation is helpful, recovery is limited and the most significant gains occur in the first 2-3 months. Stroke triggers an early wave of gene and protein changes, many of which are potentially beneficial for recovery. It is likely that these molecular changes are what subserve spontaneous recovery. Two interventions, aerobic exercise and environmental enrichment, have pleiotropic actions that influence many of the same molecular changes associated with stroke injury and subsequent spontaneous recovery. Enrichment paradigms have been used for decades in adult and neonatal animal models of brain injury and are now being adapted for use in the clinic. Aerobic exercise enhances motor recovery and helps reduce depression after stroke. While exercise attenuates many of the signs associated with normal aging (e.g., hippocampal atrophy), its ability to reverse cognitive impairments subsequent to stroke is less evident. It may be that stroke, like other diseases such as cancer, needs to use multimodal treatments that augment complimentary neurorestorative processes.
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Affiliation(s)
- Jessica Livingston-Thomas
- Canadian Partnership for Stroke Recovery, University of Ottawa, Ottawa, ON, Canada
- Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Paul Nelson
- Canadian Partnership for Stroke Recovery, University of Ottawa, Ottawa, ON, Canada
- Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Sudhir Karthikeyan
- Canadian Partnership for Stroke Recovery, University of Ottawa, Ottawa, ON, Canada
- Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Sabina Antonescu
- Canadian Partnership for Stroke Recovery, University of Ottawa, Ottawa, ON, Canada
- Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Matthew Strider Jeffers
- Canadian Partnership for Stroke Recovery, University of Ottawa, Ottawa, ON, Canada
- Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Susan Marzolini
- Canadian Partnership for Stroke Recovery, University of Ottawa, Ottawa, ON, Canada
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Dale Corbett
- Canadian Partnership for Stroke Recovery, University of Ottawa, Ottawa, ON, Canada.
- Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada.
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
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Mohd Zulkifly MF, Ghazali SE, Che Din N, Subramaniam P. The Influence of Demographic, Clinical, Psychological and Functional Determinants on Post-stroke Cognitive Impairment at Day Care Stroke Center, Malaysia. Malays J Med Sci 2016; 23:53-64. [PMID: 27547115 PMCID: PMC4976714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 01/30/2016] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND This study aims to estimate the prevalence and explore the predictors for post-stroke cognitive impairment at the community level in Malaysia. METHODS A total of 50 stroke patients aged 29 to 81-year-old were included in this study. A face to face interview was conducted to gather the demographic and clinical data. Subsequently, assessments including Barthel ADL Index (BI), Addenbrooke's Cognitive Examination-Revised (ACE-R) and Hospital Anxiety and Depression Scale (HADS) were administered to the subjects. RESULTS The results showed that the prevalence of cognitive impairment was 76% among the studied populations. The subjects' race (Fisher's value= 9.56, P < 0.05) and education level (Fisher's value = 7.29, P < 0.05) were significantly associated with the cognitive status. The depression score was significantly higher in cognitively impaired group [t (48) = -4.42, P < 0.001] while the Barthel Index score was significantly lower in cognitively impaired group (median = 18.00, P < 0.05). The univariate logistic analysis demonstrated that Chinese (OR 7.33, 95% CI = 1.61-33.51), lower education level (OR 9.33, 95% CI = 0.89-97.62), right sided lesion (OR 0.29, 95% CI = 0.06-1.54), left face weaknesses (OR 0.40, 95% CI 0.09-1.83), high cholesterol (OR 0.45, 95% CI = 0.12-1.75), depression (OR 2.16, 95% CI = 0.85-1.35), and Barthel Index (OR 0.79, 95% CI = 0.57-1.10) were significant predictors. Finally, multivariate logistic regression verified that depression was the only significant predictor of post-stroke cognitive impairment (OR 2.03, 95% CI = 1.20-3.45). CONCLUSION In conclusion, the prevalence of cognitive impairment in this study was higher than other community based studies and depression was a risk factor for cognitive impairment.
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Affiliation(s)
- Mohd Faizal Mohd Zulkifly
- Health Psychology Program, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia
- Center for Neuroscience Services and Research (P3Neuro), Health Campus, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Shazli Ezzat Ghazali
- Health Psychology Program, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia
| | - Normah Che Din
- Health Psychology Program, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia
| | - Ponnusamy Subramaniam
- Health Psychology Program, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia
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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: 30] [Impact Index Per Article: 3.8] [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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Simblett SK, Ring H, Bateman A. The Dysexecutive Questionnaire Revised (DEX-R): An extended measure of everyday dysexecutive problems after acquired brain injury. Neuropsychol Rehabil 2016; 27:1124-1141. [DOI: 10.1080/09602011.2015.1121880] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Sara Katherine Simblett
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- National Institute for Health Research (NIHR) Collaborations for Leadership in Applied Health Research and Care (CLAHRC) East at Cambridgeshire and Peterborough NHS Trust, Cambridge, UK
- Department of Psychology, Institute of Psychiatry, King's College London, London, UK
| | - Howard Ring
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- National Institute for Health Research (NIHR) Collaborations for Leadership in Applied Health Research and Care (CLAHRC) East at Cambridgeshire and Peterborough NHS Trust, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Andrew Bateman
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- National Institute for Health Research (NIHR) Collaborations for Leadership in Applied Health Research and Care (CLAHRC) East at Cambridgeshire and Peterborough NHS Trust, Cambridge, UK
- Oliver Zangwill Centre for Neuropsychological Rehabilitation, Ely, UK
- Cambridgeshire Community Services NHS Trust, St Ives, UK
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Paiva S, Magalhães R, Alves J, Sampaio A. Efficacy of cognitive intervention in stroke: A long road ahead. Restor Neurol Neurosci 2015; 34:139-52. [PMID: 26684266 DOI: 10.3233/rnn-150590] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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50
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Assessing cognitive function following medial prefrontal stroke in the rat. Behav Brain Res 2015; 294:102-10. [DOI: 10.1016/j.bbr.2015.07.053] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 07/22/2015] [Accepted: 07/27/2015] [Indexed: 01/01/2023]
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