1
|
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.
Collapse
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
| |
Collapse
|
2
|
Stolwyk RJ, Mihaljcic T, Wong DK, Hernandez DR, Wolff B, Rogers JM. Post-stroke Cognition is Associated with Stroke Survivor Quality of Life and Caregiver Outcomes: A Systematic Review and Meta-analysis. Neuropsychol Rev 2024:10.1007/s11065-024-09635-5. [PMID: 38466357 DOI: 10.1007/s11065-024-09635-5] [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: 01/18/2022] [Accepted: 02/05/2024] [Indexed: 03/13/2024]
Abstract
Disability arising from post-stroke cognitive impairment is a likely contributor to the poor quality of life (QoL) stroke survivors and their carers frequently experience, but this has not been summarily quantified. A systematic literature review and meta-analysis was completed examining the association between general and domain-specific post-stroke cognitive functioning and adult stroke survivor QoL, caregiver QoL, and caregiver burden. Five databases were systematically searched, and eligibility for inclusion, data extraction, and study quality were evaluated by two reviewers using a standardised protocol. Effects sizes (r) were estimated using a random effects model. Thirty-eight studies were identified, generating a sample of 7365 stroke survivors (median age 63.02 years, range 25-93) followed for 3 to 132 months post-stroke. Overall cognition (all domains combined) demonstrated a significant small to medium association with QoL, r = 0.23 (95% CI 0.18-0.28), p < 0.001. The cognitive domains of speed, attention, visuospatial, memory, and executive skills, but not language, also demonstrated a significant relationship with QoL. Regarding caregiver outcomes, 15 studies were identified resulting in a sample of 2421 caregivers (median age 58.12 years, range 18-82) followed for 3 to 84 months post-stroke. Stroke survivor overall cognitive ability again demonstrated a significant small to medium association with caregiver outcomes (QoL and burden combined), r = 0.17 (95% CI 0.10-0.24), p < 0.001. In conclusion, lower post-stroke cognitive performance is associated with significant reductions in stroke survivor QoL and poorer caregiver outcomes. Cognitive assessment is recommended early to identify those at risk and implement timely interventions to support both stroke survivors and their caregivers.
Collapse
Affiliation(s)
- Renerus J Stolwyk
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, 18 Innovation Walk, Monash Clayton Campus, Melbourne, VIC, 3800, Australia.
| | - Tijana Mihaljcic
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, 18 Innovation Walk, Monash Clayton Campus, Melbourne, VIC, 3800, Australia
| | - Dana K Wong
- School of Psychology & Public Health, La Trobe University, Bundoora, Australia
| | - Diana Ramirez Hernandez
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, 18 Innovation Walk, Monash Clayton Campus, Melbourne, VIC, 3800, Australia
| | - Brittany Wolff
- School of Psychological Science, The University of Western Australia, Perth, Australia
| | | |
Collapse
|
3
|
Li T, Hu W, Han Q, Wang Y, Ma Z, Chu J, He Q, Feng Z, Sun N, Shen Y. Trajectories of quality of life and cognition in different multimorbidity patterns: Evidence from SHARE. Arch Gerontol Geriatr 2024; 117:105219. [PMID: 37812973 DOI: 10.1016/j.archger.2023.105219] [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: 07/23/2023] [Revised: 10/01/2023] [Accepted: 10/03/2023] [Indexed: 10/11/2023]
Abstract
OBJECTIVES The study aimed to observe the trajectory of quality of life (QoL) and cognition, and to a analyze the bidirectional association between cognition and QoL for diverse multimorbidity patterns. METHODS In total, 16,153 older participants age ≥50 years were included from the Survey of Health, Ageing and Retirement in Europe (SHARE). We used latent class analysis (LCA) to identify multimorbidity patterns in the baseline population. We used linear mixed models (LMM) to examine the trajectory of cognition and QoL in different multimorbidity patterns. A cross-lagged model was employed to analyze the bidirectional association between cognition and QoL in diverse multimorbidity patterns. RESULTS Latent class analysis identified four multimorbidity patterns: high and low comorbidity burden (HC and LC), cardiometabolic (CA), and osteoarthrosis (OS). The HC group had the poorest cognitive function and QoL (p for trend < 0.001). Delayed and immediate episodic memory in the OS group declined at a highest rate (p for trend < 0.001). Additionally, a bidirectional association between cognition and QoL was observed. The effect of cognitive function on QoL was relatively stronger than the reverse in the CA and LC groups. CONCLUSIONS The rate of decline in cognition and QoL over the time differs in diverse multimorbidity patterns, and patients with four or more chronic diseases should be specially considered. Notably, early monitoring of cognitive function and can help break the vicious cycle between cognitive deterioration and poor QoL in patients with OS or CA diseases.
Collapse
Affiliation(s)
- Tongxing Li
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou 215123, China
| | - Wei Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou 215123, China
| | - Qiang Han
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou 215123, China
| | - Yu Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou 215123, China
| | - Ze Ma
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou 215123, China
| | - Jiadong Chu
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou 215123, China
| | - Qida He
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou 215123, China
| | - Zhaolong Feng
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou 215123, China
| | - Na Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou 215123, China
| | - Yueping Shen
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou 215123, China.
| |
Collapse
|
4
|
Murphy D, Cornford E, Higginson A, Norman A, Long R, Noad R. Oxford cognitive screen: A critical review and independent psychometric evaluation. J Neuropsychol 2023; 17:491-504. [PMID: 37186035 DOI: 10.1111/jnp.12318] [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: 01/17/2023] [Accepted: 04/03/2023] [Indexed: 05/17/2023]
Abstract
The Oxford cognitive screen (OCS) is a stroke-specific cognitive screening assessment. Although the test developers have provided psychometric information for the assessment, the OCS has received minimal external scrutiny, with which to triangulate the underpinning psychometrics. The purpose of this study is to provide a critical review and independent validation of the OCS. This study analysed data from an anonymised clinical database, which consisted of 316 patients who were assessed using the OCS on an Acute Stroke Unit. The rates of impairment on tests of memory and receptive communication were lower than expectation, suggesting that these subtests may be relatively insensitive. Patients with aphasia were more likely to be unable to categorised as impaired on non-language tests, suggesting that they remain sensitive to language processing or non-dominant hand usage. Some of the subtests of the OCS achieve high retest reliability, which makes them good candidates for measuring cognitive change over time. Although the OCS has many advantages, it is also important to adequately consider its limitations, that is insensitivity to memory problems, the potential confounding impact of non-dominant hand usage, and the potential that some tests may sample overall cognitive ability instead of domain-specific functioning.
Collapse
Affiliation(s)
- Donnchadh Murphy
- University of Plymouth, Plymouth, UK
- Livewell Southwest, Plymouth, UK
| | | | | | | | - Rebecca Long
- University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Rupert Noad
- University of Plymouth, Plymouth, UK
- University Hospitals Plymouth NHS Trust, Plymouth, UK
| |
Collapse
|
5
|
Fleury L, Koch PJ, Wessel MJ, Bonvin C, San Millan D, Constantin C, Vuadens P, Adolphsen J, Cadic Melchior A, Brügger J, Beanato E, Ceroni M, Menoud P, De Leon Rodriguez D, Zufferey V, Meyer NH, Egger P, Harquel S, Popa T, Raffin E, Girard G, Thiran JP, Vaney C, Alvarez V, Turlan JL, Mühl A, Léger B, Morishita T, Micera S, Blanke O, Van De Ville D, Hummel FC. Toward individualized medicine in stroke—The TiMeS project: Protocol of longitudinal, multi-modal, multi-domain study in stroke. Front Neurol 2022; 13:939640. [PMID: 36226086 PMCID: PMC9549862 DOI: 10.3389/fneur.2022.939640] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 08/31/2022] [Indexed: 11/13/2022] Open
Abstract
Despite recent improvements, complete motor recovery occurs in <15% of stroke patients. To improve the therapeutic outcomes, there is a strong need to tailor treatments to each individual patient. However, there is a lack of knowledge concerning the precise neuronal mechanisms underlying the degree and course of motor recovery and its individual differences, especially in the view of brain network properties despite the fact that it became more and more clear that stroke is a network disorder. The TiMeS project is a longitudinal exploratory study aiming at characterizing stroke phenotypes of a large, representative stroke cohort through an extensive, multi-modal and multi-domain evaluation. The ultimate goal of the study is to identify prognostic biomarkers allowing to predict the individual degree and course of motor recovery and its underlying neuronal mechanisms paving the way for novel interventions and treatment stratification for the individual patients. A total of up to 100 patients will be assessed at 4 timepoints over the first year after the stroke: during the first (T1) and third (T2) week, then three (T3) and twelve (T4) months after stroke onset. To assess underlying mechanisms of recovery with a focus on network analyses and brain connectivity, we will apply synergistic state-of-the-art systems neuroscience methods including functional, diffusion, and structural magnetic resonance imaging (MRI), and electrophysiological evaluation based on transcranial magnetic stimulation (TMS) coupled with electroencephalography (EEG) and electromyography (EMG). In addition, an extensive, multi-domain neuropsychological evaluation will be performed at each timepoint, covering all sensorimotor and cognitive domains. This project will significantly add to the understanding of underlying mechanisms of motor recovery with a strong focus on the interactions between the motor and other cognitive domains and multimodal network analyses. The population-based, multi-dimensional dataset will serve as a basis to develop biomarkers to predict outcome and promote personalized stratification toward individually tailored treatment concepts using neuro-technologies, thus paving the way toward personalized precision medicine approaches in stroke rehabilitation.
Collapse
Affiliation(s)
- Lisa Fleury
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), EPFL, Campus Biotech, Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, INX and BMI, EPFL Valais, Clinique Romande de Réadaptation, Sion, Switzerland
| | - Philipp J. Koch
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), EPFL, Campus Biotech, Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, INX and BMI, EPFL Valais, Clinique Romande de Réadaptation, Sion, Switzerland
- Department of Neurology, University of Lübeck, Lübeck, Germany
| | - Maximilian J. Wessel
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), EPFL, Campus Biotech, Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, INX and BMI, EPFL Valais, Clinique Romande de Réadaptation, Sion, Switzerland
- Department of Neurology, University Hospital and Julius-Maximilians-University, Wuerzburg, Germany
| | | | | | | | | | | | - Andéol Cadic Melchior
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), EPFL, Campus Biotech, Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, INX and BMI, EPFL Valais, Clinique Romande de Réadaptation, Sion, Switzerland
| | - Julia Brügger
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), EPFL, Campus Biotech, Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, INX and BMI, EPFL Valais, Clinique Romande de Réadaptation, Sion, Switzerland
| | - Elena Beanato
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), EPFL, Campus Biotech, Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, INX and BMI, EPFL Valais, Clinique Romande de Réadaptation, Sion, Switzerland
| | - Martino Ceroni
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), EPFL, Campus Biotech, Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, INX and BMI, EPFL Valais, Clinique Romande de Réadaptation, Sion, Switzerland
| | - Pauline Menoud
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), EPFL, Campus Biotech, Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, INX and BMI, EPFL Valais, Clinique Romande de Réadaptation, Sion, Switzerland
| | - Diego De Leon Rodriguez
- Defitech Chair of Clinical Neuroengineering, INX and BMI, EPFL Valais, Clinique Romande de Réadaptation, Sion, Switzerland
| | - Valérie Zufferey
- Defitech Chair of Clinical Neuroengineering, INX and BMI, EPFL Valais, Clinique Romande de Réadaptation, Sion, Switzerland
| | - Nathalie H. Meyer
- Laboratory of Cognitive Neuroscience, INX and BMI, EPFL, Campus Biotech, Geneva, Switzerland
| | - Philip Egger
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), EPFL, Campus Biotech, Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, INX and BMI, EPFL Valais, Clinique Romande de Réadaptation, Sion, Switzerland
| | - Sylvain Harquel
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), EPFL, Campus Biotech, Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, INX and BMI, EPFL Valais, Clinique Romande de Réadaptation, Sion, Switzerland
| | - Traian Popa
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), EPFL, Campus Biotech, Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, INX and BMI, EPFL Valais, Clinique Romande de Réadaptation, Sion, Switzerland
| | - Estelle Raffin
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), EPFL, Campus Biotech, Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, INX and BMI, EPFL Valais, Clinique Romande de Réadaptation, Sion, Switzerland
| | - Gabriel Girard
- CIBM Center for Biomedical Imaging, Lausanne, Switzerland
- Department of Radiology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
- Signal Processing Laboratory (LTS5), EPFL, Lausanne, Switzerland
| | - Jean-Philippe Thiran
- CIBM Center for Biomedical Imaging, Lausanne, Switzerland
- Department of Radiology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
- Signal Processing Laboratory (LTS5), EPFL, Lausanne, Switzerland
| | | | | | | | - Andreas Mühl
- Clinique Romande de Réadaptation, Sion, Switzerland
| | | | - Takuya Morishita
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), EPFL, Campus Biotech, Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, INX and BMI, EPFL Valais, Clinique Romande de Réadaptation, Sion, Switzerland
| | - Silvestro Micera
- The Biorobotics Institute and Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, Pisa, Italy
- Bertarelli Foundation Chair in Translational Neuroengineering, Centre for Neuroprosthetics and Institute of Bioengineering, School of Engineering, EPFL, Lausanne, Switzerland
| | - Olaf Blanke
- Laboratory of Cognitive Neuroscience, INX and BMI, EPFL, Campus Biotech, Geneva, Switzerland
- Department of Clinical Neurosciences, University of Geneva (UNIGE), Geneva, Switzerland
| | - Dimitri Van De Ville
- CIBM Center for Biomedical Imaging, Lausanne, Switzerland
- Medical Image Processing Lab, Center for Neuroprosthetics, Institute of Bioengineering, EPFL, Lausanne, Switzerland
- Department of Radiology and Medical Informatics, University of Geneva (UNIGE), Geneva, Switzerland
| | - Friedhelm C. Hummel
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), EPFL, Campus Biotech, Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, INX and BMI, EPFL Valais, Clinique Romande de Réadaptation, Sion, Switzerland
- Clinical Neuroscience, Geneva University Hospital, Geneva, Switzerland
- *Correspondence: Friedhelm C. Hummel
| |
Collapse
|
6
|
Wang Y, Ye M, Tong Y, Xiong L, Wu X, Geng C, Zhang W, Dai Z, Tian W, Rong J. Effects of robot-assisted therapy on upper limb and cognitive function in patients with stroke: study protocol of a randomized controlled study. Trials 2022; 23:538. [PMID: 35765084 PMCID: PMC9238006 DOI: 10.1186/s13063-022-06361-2] [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: 09/24/2021] [Accepted: 04/26/2022] [Indexed: 12/01/2022] Open
Abstract
Background Impairments in upper limb motor function and cognitive ability are major health problems experienced by stroke patients, necessitating the development of novel and effective treatment options in stroke care. The aim of this study is to examine the effects of robot-assisted therapy on improving upper limb and cognitive functions in stroke patients. Methods This will be a single-blinded, 2-arm, parallel design, randomized controlled trial which will include a sample size of 86 acute and subacute stroke patients to be recruited from a single clinical hospital in Shanghai, China. Upon qualifying the study eligibility, participants will be randomly assigned to receive either robot-assisted therapy or conventional therapy with both interventions being conducted over a 6-week period in a clinical rehabilitation setting. In addition to comprehensive rehabilitation, the robot-assisted therapy group will receive a 30-min Armguider robot-assisted therapy intervention 5 days a week. Primary efficacy outcomes will include Fugl-Meyer Assessment for Upper Extremity (FMA-UE) and Mini-Mental Status Examination (MMSE). Other secondary outcomes will include Trail Making Test (TMT), Auditory Verbal Learning Test (AVLT), Digit Symbol Substitution Test (DSST), and Rey–Osterrieth Complex Figure Test (ROCFT). All trial outcomes will be assessed at baseline and at 6-week follow-up. Intention-to-treat analyses will be performed to examine changes from baseline in the outcomes. Adverse events will be monitored throughout the trial period. Discussion This will be the first randomized controlled trial aimed at examining the effects of robot-assisted therapy on upper limb and cognitive functions in acute and subacute stroke patients. Findings from the study will contribute to our understanding of using a novel robotic rehabilitation approach to stroke care and rehabilitation. Trial registration Chinese Clinical Trial Registry ChiCTR2100050856. Registered on 5 September 2021.
Collapse
Affiliation(s)
- Yana Wang
- The Center of Rehabilitation Therapy, the First Rehabilitation Hospital of Shanghai, No.349 Hangzhou Rd., Yangpu District, Shanghai, 200090, China.,Key Laboratory of Exercise and Health Science of Ministry of Education, Shanghai University of Sport, Shanghai, China
| | - Mingzhu Ye
- The Center of Rehabilitation Therapy, the First Rehabilitation Hospital of Shanghai, No.349 Hangzhou Rd., Yangpu District, Shanghai, 200090, China
| | - Yujie Tong
- The Center of Rehabilitation Therapy, the First Rehabilitation Hospital of Shanghai, No.349 Hangzhou Rd., Yangpu District, Shanghai, 200090, China
| | - Li Xiong
- The Center of Rehabilitation Therapy, the First Rehabilitation Hospital of Shanghai, No.349 Hangzhou Rd., Yangpu District, Shanghai, 200090, China
| | - Xuejiao Wu
- The Center of Rehabilitation Therapy, the First Rehabilitation Hospital of Shanghai, No.349 Hangzhou Rd., Yangpu District, Shanghai, 200090, China
| | - Chao Geng
- The Center of Rehabilitation Therapy, the First Rehabilitation Hospital of Shanghai, No.349 Hangzhou Rd., Yangpu District, Shanghai, 200090, China
| | - Wen Zhang
- The Center of Rehabilitation Therapy, the First Rehabilitation Hospital of Shanghai, No.349 Hangzhou Rd., Yangpu District, Shanghai, 200090, China
| | - Ziqi Dai
- The Center of Rehabilitation Therapy, the First Rehabilitation Hospital of Shanghai, No.349 Hangzhou Rd., Yangpu District, Shanghai, 200090, China
| | - Wei Tian
- The Neurorehabilitation Center, the First Rehabilitation Hospital of Shanghai, Shanghai, China
| | - Jifeng Rong
- The Center of Rehabilitation Therapy, the First Rehabilitation Hospital of Shanghai, No.349 Hangzhou Rd., Yangpu District, Shanghai, 200090, China.
| |
Collapse
|
7
|
Kotlęga D, Peda B, Drozd A, Zembroń-Łacny A, Stachowska E, Gramacki J, Szczuko M. Prostaglandin E2, 9S-, 13S-HODE and resolvin D1 are strongly associated with the post-stroke cognitive impairment. Prostaglandins Other Lipid Mediat 2021; 156:106576. [PMID: 34119645 DOI: 10.1016/j.prostaglandins.2021.106576] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 05/18/2021] [Accepted: 06/07/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND Inflammatory derivatives of free fatty acids are involved in the development of neuroinflammation and cognitive dysfunctions. The study aim was to establish the influence of eicosanoids on the cognitive status of stroke patients. METHODS 73 stroke patients were prospectively evaluated towards the neuropsychological cognitive functions on the 7th day after stroke and after follow-up of 6 months. Eicosanoids levels were measured in all patients and compared to stroke-free controls (n = 30). RESULTS Prostaglandin E2 was negatively correlated with Montreal Cognitive Assessment (MOCA) test on the 7th day after stroke. The level of 9-hydroxyoctadecadienoic acid (9S-HODE) was significantly higher in patients with cognitive dysfunctions in MOCA test compared to the others (group I mean ± SD: 0.040 ± 0.035 vs. group II: 0.0271 ± 0.016). In the initial neuropsychological assessment maresin 1-, 5-hydroxyeicosatetraenoic acid (HETE), 12S-HETE and 15S-HETE were negatively correlated with California Verbal Learning Test (CVLT) and thus with cognitive functions, while in the follow-up examination negative correlations were identified for prostaglandin E2, meresin 1, leukotriene B4, 13S HODE, 9S-HODE; the only positive correlation was observed in 15S-HETE. Other neuropsychological tests showed a beneficial impact of resolvin D1 and a negative role of prostaglandin E2 was observed in the first examination and in the follow-up. Resolvin D1 and the group of all analyzed eicosanoids predict changes in cognitive functions. CONCLUSIONS Eicosanoids can play a role in the neuroinflammation. They can affect the cognitive status at the stroke onset and have a predictive value for post-stroke cognitive decline. Prostaglandin E2, 9S-, 13S-HODE and resolvin D1 are the most important inflammatory free fatty acid derivatives in the cognitive functions in stroke. Eicosanoids predict post-stroke cognitive functions.
Collapse
Affiliation(s)
| | - Barbara Peda
- Department of Neurology, District Hospital, Glogow, Poland.
| | - Arleta Drozd
- Department of Human Nutrition and Metabolomics, Pomeranian Medical University in Szczecin, Poland.
| | - Agnieszka Zembroń-Łacny
- Department of Applied and Clinical Physiology, Collegium Medicum, University of Zielona Gora, Poland.
| | - Ewa Stachowska
- Department of Human Nutrition and Metabolomics, Pomeranian Medical University in Szczecin, Poland.
| | - Jarosław Gramacki
- Centre of Information Technologies, University of Zielona Gora, 65-417 Zielona Gora, Poland.
| | - Małgorzata Szczuko
- Department of Human Nutrition and Metabolomics, Pomeranian Medical University in Szczecin, Poland.
| |
Collapse
|
8
|
Wiklund L, Sharma A, Patnaik R, Muresanu DF, Sahib S, Tian ZR, Castellani RJ, Nozari A, Lafuente JV, Sharma HS. Upregulation of hemeoxygenase enzymes HO-1 and HO-2 following ischemia-reperfusion injury in connection with experimental cardiac arrest and cardiopulmonary resuscitation: Neuroprotective effects of methylene blue. PROGRESS IN BRAIN RESEARCH 2021; 265:317-375. [PMID: 34560924 DOI: 10.1016/bs.pbr.2021.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Oxidative stress plays an important role in neuronal injuries after cardiac arrest. Increased production of carbon monoxide (CO) by the enzyme hemeoxygenase (HO) in the brain is induced by the oxidative stress. HO is present in the CNS in two isoforms, namely the inducible HO-1 and the constitutive HO-2. Elevated levels of serum HO-1 occurs in cardiac arrest patients and upregulation of HO-1 in cardiac arrest is seen in the neurons. However, the role of HO-2 in cardiac arrest is not well known. In this review involvement of HO-1 and HO-2 enzymes in the porcine brain following cardiac arrest and resuscitation is discussed based on our own observations. In addition, neuroprotective role of methylene blue- an antioxidant dye on alterations in HO under in cardiac arrest is also presented. The biochemical findings of HO-1 and HO-2 enzymes using ELISA were further confirmed by immunocytochemical approach to localize selective regional alterations in cardiac arrest. Our observations are the first to show that cardiac arrest followed by successful cardiopulmonary resuscitation results in significant alteration in cerebral concentrations of HO-1 and HO-2 levels indicating a prominent role of CO in brain pathology and methylene blue during CPR followed by induced hypothermia leading to superior neuroprotection after return of spontaneous circulation (ROSC), not reported earlier.
Collapse
Affiliation(s)
- Lars Wiklund
- International Experimental Central Nervous System Injury & Repair (IECNSIR), Department of Surgical Sciences, Anesthesiology & Intensive Care Medicine, Uppsala University Hospital, Uppsala University, Uppsala, Sweden
| | - Aruna Sharma
- International Experimental Central Nervous System Injury & Repair (IECNSIR), Department of Surgical Sciences, Anesthesiology & Intensive Care Medicine, Uppsala University Hospital, Uppsala University, Uppsala, Sweden.
| | - Ranjana Patnaik
- Department of Biomaterials, School of Biomedical Engineering, Indian Institute of Technology, Banaras Hindu University, Varanasi, India
| | - Dafin F Muresanu
- Department of Clinical Neurosciences, University of Medicine & Pharmacy, Cluj-Napoca, Romania; "RoNeuro" Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania
| | - Seaab Sahib
- Department of Chemistry & Biochemistry, University of Arkansas, Fayetteville, AR, United States
| | - Z Ryan Tian
- Department of Chemistry & Biochemistry, University of Arkansas, Fayetteville, AR, United States
| | - Rudy J Castellani
- Department of Pathology, University of Maryland, Baltimore, MD, United States
| | - Ala Nozari
- Anesthesiology & Intensive Care, Massachusetts General Hospital, Boston, MA, United States
| | - José Vicente Lafuente
- LaNCE, Department of Neuroscience, University of the Basque Country (UPV/EHU), Leioa, Bizkaia, Spain
| | - Hari Shanker Sharma
- International Experimental Central Nervous System Injury & Repair (IECNSIR), Department of Surgical Sciences, Anesthesiology & Intensive Care Medicine, Uppsala University Hospital, Uppsala University, Uppsala, Sweden.
| |
Collapse
|
9
|
Kotlęga D, Peda B, Palma J, Zembroń-Łacny A, Gołąb-Janowska M, Masztalewicz M, Nowacki P, Szczuko M. Free Fatty Acids Are Associated with the Cognitive Functions in Stroke Survivors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126500. [PMID: 34208689 PMCID: PMC8296333 DOI: 10.3390/ijerph18126500] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/06/2021] [Accepted: 06/13/2021] [Indexed: 11/16/2022]
Abstract
Ischemic stroke is a leading cause of motor impairment and psychosocial disability. Although free fatty acids (FFA) have been proven to affect the risk of stroke and potentially dementia, the evidence of their impact on cognitive functions in stroke patients is lacking. We aimed to establish such potential relationships. Seventy-two ischemic stroke patients were prospectively analysed. Their cognitive functions were assessed seven days post-stroke and six months later as follow-up (n = 41). Seven days post-stroke analysis of serum FFAs levels showed direct correlations between Cognitive Verbal Learning Test (CVLT) and the following FFAs: C20:4n6 arachidonic acid and C20:5n3 eicosapentaenoic acid, while negative correlations were observed for C18:3n3 linolenic acid (ALA), C18:4 n3 stearidonic acid and C23:0 tricosanoic acid. Follow-up examination with CVLT revealed positive correlations with C15:0 pentadecanoid acid, C18:3n6 gamma linoleic acid, SDA, C23:0 tricosanoic acid and negative correlations with C14:0 myristic acid and C14:1 myristolenic acids. Several tests (Trail Making Test, Stroop Dots Trail, Digit Span Test and Verbal Fluency Test) were directly correlated mainly with C14:0 myristic acid and C14:1 myristolenic acid, while corresponding negatively with C18:1 vaccinic acid, C20:3n3 cis-11-eicosatrienoic acid, C22:1/C20:1 cis11- eicosanic acid and C20:2 cis-11-eicodienoic acid. No correlations between Montreal Cognitive Assessment (MOCA) test performed on seventh day, and FFAs levels were found. Saturated fatty acids play a negative role in long-term cognitive outcomes in stroke patients. The metabolic cascade of polyunsaturated fatty acids (n3 PUFA) and the synthesis of (AA) can be involved in pathogenesis of stroke-related cognitive impairment.
Collapse
Affiliation(s)
- Dariusz Kotlęga
- Department of Neurology, District Hospital, 67-200 Glogow, Poland;
- Correspondence:
| | - Barbara Peda
- Department of Neurology, District Hospital, 67-200 Glogow, Poland;
| | - Joanna Palma
- Department of Human Nutrition and Metabolomics, Pomeranian Medical University, 71-460 Szczecin, Poland; (J.P.); (M.S.)
| | - Agnieszka Zembroń-Łacny
- Department of Applied and Clinical Physiology, Collegium Medicum, University of Zielona Gora, 65-001 Zielona Góra, Poland;
| | - Monika Gołąb-Janowska
- Department of Neurology, Pomeranian Medical University, 71-252 Szczecin, Poland; (M.G.-J.); (M.M.); (P.N.)
| | - Marta Masztalewicz
- Department of Neurology, Pomeranian Medical University, 71-252 Szczecin, Poland; (M.G.-J.); (M.M.); (P.N.)
| | - Przemysław Nowacki
- Department of Neurology, Pomeranian Medical University, 71-252 Szczecin, Poland; (M.G.-J.); (M.M.); (P.N.)
| | - Małgorzata Szczuko
- Department of Human Nutrition and Metabolomics, Pomeranian Medical University, 71-460 Szczecin, Poland; (J.P.); (M.S.)
| |
Collapse
|
10
|
Cognitive impairment after focal brain lesions is better predicted by damage to structural than functional network hubs. Proc Natl Acad Sci U S A 2021; 118:2018784118. [PMID: 33941692 DOI: 10.1073/pnas.2018784118] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Hubs are highly connected brain regions important for coordinating processing in brain networks. It is unclear, however, which measures of network "hubness" are most useful in identifying brain regions critical to human cognition. We tested how closely two measures of hubness-edge density and participation coefficient, derived from white and gray matter, respectively-were associated with general cognitive impairment after brain damage in two large cohorts of patients with focal brain lesions (N = 402 and 102, respectively) using cognitive tests spanning multiple cognitive domains. Lesions disrupting white matter regions with high edge density were associated with cognitive impairment, whereas lesions damaging gray matter regions with high participation coefficient had a weaker, less consistent association with cognitive outcomes. Similar results were observed with six other gray matter hubness measures. This suggests that damage to densely connected white matter regions is more cognitively impairing than similar damage to gray matter hubs, helping to explain interindividual differences in cognitive outcomes after brain damage.
Collapse
|
11
|
Aprile I, Guardati G, Cipollini V, Papadopoulou D, Mastrorosa A, Castelli L, Monteleone S, Redolfi A, Galeri S, Germanotta M. Robotic Rehabilitation: An Opportunity to Improve Cognitive Functions in Subjects With Stroke. An Explorative Study. Front Neurol 2020; 11:588285. [PMID: 33329334 PMCID: PMC7710798 DOI: 10.3389/fneur.2020.588285] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 10/21/2020] [Indexed: 12/18/2022] Open
Abstract
Background: After a stroke, up to three-quarters of acute and subacute stroke survivors exhibit cognitive impairment, with a significant impact on functional recovery, quality of life, and social engagement. Robotic therapy has shown its effectiveness on motor recovery, but its effectiveness on cognitive recovery has not fully investigated. Objective: This study aims to assess the impact of a technological rehabilitation intervention on cognitive functions in patients with stroke, using a set of three robots and one sensor-based device for upper limb rehabilitation. Methods: This is a pilot study in which 51 patients were enrolled. An upper limb rehabilitation program was performed using three robots and one sensor-based device. The intervention comprised motor/cognitive exercises, especially selected among the available ones to train also cognitive functions. Patients underwent 30 rehabilitation sessions, each session lasting 45 minutes, 5 days a week. Patients were assessed before and after the treatment with several cognitive tests (Oxford Cognitive Scale, Symbol Digit Modalities Test, Digit Span, Rey-Osterrieth Complex Figure, Tower of London, and Stroop test). In addition, motor (Fugl-Meyer Assessment and Motricity Index) and disability (modified Barthel Index) scales were used. Results: According to the Oxford Cognitive Scale domains, a significant percentage of patients exhibited cognitive deficits. Excluding perception (with only one patient impaired), the domain with the lowest percentage of patients showing a pathological score was praxis (about 25%), while the highest percentage of impaired patients was found in calculation (about 70%). After the treatment, patients improved in all the investigated cognitive domains, as measured by the selected cognitive assessment scales. Moreover, motor and disability scales confirmed the efficacy of robotics on upper limb rehabilitation in patients with stroke. Conclusions: This explorative study suggests that robotic technology can be used to combine motor and cognitive exercises in a unique treatment session. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT04164381.
Collapse
Affiliation(s)
- Irene Aprile
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Florence, Italy
| | | | | | | | | | - Letizia Castelli
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Neuroriabilitazione ad Alta Intensità, Rome, Italy
| | | | | | - Silvia Galeri
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | | |
Collapse
|
12
|
Stolwyk RJ. Cognitive Screening Following Stroke: Are We Following Best Evidence‐based Practice in Australian Clinical Settings? AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12191] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
13
|
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.
Collapse
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.
| |
Collapse
|
14
|
Watson PA, Gignac GE, Weinborn M, Green S, Pestell C. A Meta-Analysis of Neuropsychological Predictors of Outcome Following Stroke and Other Non-Traumatic Acquired Brain Injuries in Adults. Neuropsychol Rev 2020; 30:194-223. [PMID: 32198606 DOI: 10.1007/s11065-020-09433-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 02/23/2020] [Indexed: 11/25/2022]
Abstract
A number of cognitive abilities have been reported to predict outcome following a non-traumatic acquired brain injury (ABI) in adults. However, the results are inconsistent. Furthermore, the unique and combined capacity of these cognitive abilities to predict ABI outcome has not been evaluated. Consequently, we employed meta-analysis and multiple regression to evaluate the capacity of various neuropsychological domains to predict two separate outcome variables in adults: (1) activities of daily living; and (2) quality of life. Based on the activities of daily living meta-analysis (N = 2384), we estimated the following significant bivariate effects: memory (r = .31, 95% CI: .20/.41]), language (r = .33, 95% CI:.26/.40), attention (r = .38, 95% CI: .30/.46]), executive functions (r = .29, 95% CI: .19/.39]), and visuospatial abilities (r = .41, 95% CI: .34/ .48). Based on the quality of life meta-analysis (N = 1037), we estimated the following significant bivariate effects: memory (r = .12, 95% CI: .03/.20]), language (r = .19, 95% CI: .06/ .32), attention (r = .30, 95% CI: .16/.44]), executive functions (r = .24, 95% CI: .12/.37) and visuospatial/constructional abilities (r = .30, 95% CI: .14/.46). Meta-analytic structural equation modelling (metaSEM) identified two significant, unique predictors of activities of daily living, attention and visuospatial abilities, and the model accounted for 21% of the variance (multiple R2 = .21, 95%CI: .16/.26). For the corresponding quality of life metaSEM, no statistically significant unique predictors were identified, however, a significant multiple correlation was observed, multiple R2 = .11 (95%CI: 04/.18). We conclude that practitioners may be able to predict, with some degree of accuracy, functional outcome following a stroke and other non-traumatic ABI in adults. We also provide some critical commentary on the nature and quality of the measures used in this area of research to represent the cognitive dimensions of interest.
Collapse
Affiliation(s)
- Prue A Watson
- School of Psychological Science, University of Western Australia, 35 Stirling Highway, Crawley, Western Australia, 6009
| | - Gilles E Gignac
- School of Psychological Science, University of Western Australia, 35 Stirling Highway, Crawley, Western Australia, 6009.
| | - Michael Weinborn
- School of Psychological Science, University of Western Australia, 35 Stirling Highway, Crawley, Western Australia, 6009
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia
| | - Sarah Green
- School of Psychological Science, University of Western Australia, 35 Stirling Highway, Crawley, Western Australia, 6009
| | - Carmela Pestell
- School of Psychological Science, University of Western Australia, 35 Stirling Highway, Crawley, Western Australia, 6009
| |
Collapse
|
15
|
Gu S, Li X, Zhao L, Ren H, Pei C, Li W, Mu J, Song J, Zhang Z. Decreased Npas4 expression in patients with post-stroke depression. JOURNAL OF NEURORESTORATOLOGY 2019. [DOI: 10.26599/jnr.2019.9040012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Purpose: Post-stroke depression (PSD) is a frequent neuropsychiatric disorder following stroke which is associated with poor outcome. Neuronal Per-Arnt-Sim (PAS) domain protein 4 (Npas4) is associated with cognitive function. Npas4 expression in peripheral blood mononuclear cells (PBMCs) from patients with PSD was measured to find new therapeutic strategy. Patients and methods: Ischemic stroke patients (n = 152) within 1 week of stroke onset were recruited. At 3 months follow-up, the patients were divided into a PSD group (n = 77) and a stroke group (n = 75) using the Hamilton Rating Scale. Healthy subjects (n = 75) were also recruited in the study. The PSD group received 12 weeks of duloxetine treatment. Cognitive function was evaluated using the P300 test. Npas4 expression in PBMCs was measured by quantitative RT-PCR (qPCR). Results: Before treatment, P300 latencies in the PSD group were prolonged and the P300 amplitudes were lower than the control group (P < 0.01). Npas4 expression in the PSD group was also lower than the control group (P < 0.01). After treatment, the P300 latencies were reduced and the amplitudes were significantly elevated in the PSD group compared to that before treatment (P < 0.01). Meanwhile, Npas4 levels were significantly higher than that before treatment (P < 0.01). Npas4 expression was positively correlated to the P300 amplitudes (P < 0.05). Conclusion: Changes of Npas4 expression in PBMCs are associated with cognitive impairment in PSD patients and new therapeutic options applying Npas4-related transcript mechanism could be considered in the future.
Collapse
|
16
|
Abstract
Stroke remains the second leading cause of death in the world, and its prevalence is projected to rise in the United States and globally. The main driver for increased stroke prevalence is aging of the population; however, best evidenced-based strategies for stroke treatment and prevention are not always followed for older patients. Furthermore, considerable gaps in knowledge exist for stroke prevention and treatment in elderly and very elderly patients. In this chapter, we discuss various aspects of stroke care in the elderly, including the evidence that guides stroke prevention and treatment. We focus on the challenges in managing stroke in the very elderly including the paucity of data to guide management. The sections span the continuum of stroke care, from primary prevention to management of stroke complications. Finally, we highlight the most significant unanswered questions regarding stroke care in the elderly.
Collapse
Affiliation(s)
- Anjail Sharrief
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center, Houston, TX, United States
| | - James C Grotta
- Clinical Innovation and Research Institute, Memorial Hermann Hospital, Houston, TX, United States.
| |
Collapse
|
17
|
General and Domain-Specific Effectiveness of Cognitive Remediation after Stroke: Systematic Literature Review and Meta-Analysis. Neuropsychol Rev 2018; 28:285-309. [DOI: 10.1007/s11065-018-9378-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 06/21/2018] [Indexed: 12/26/2022]
|
18
|
Leitner D, Miller H, Libben M. Assessing the predictive value of a neuropsychological model on concurrent function in acute stroke recovery and rehabilitation. Clin Neuropsychol 2018; 33:831-853. [DOI: 10.1080/13854046.2018.1487586] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Damian Leitner
- Department of Psychology, University of British Columbia Okanagan, Kelowna, Canada
| | - Harry Miller
- Department of Psychology, Kelowna General Hospital, Kelowna, Canada
| | - Maya Libben
- Department of Psychology, University of British Columbia Okanagan, Kelowna, Canada
| |
Collapse
|
19
|
Mandić M, Arandjelović M, Nikolić M, Rančić N. ASSESSMENT OF HEALTH - RELATED QUALITY OF LIFE OF POST - STROKE SURVIVORS. ACTA MEDICA MEDIANAE 2018. [DOI: 10.5633/amm.2018.0112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
20
|
Mancuso M, Demeyere N, Abbruzzese L, Damora A, Varalta V, Pirrotta F, Antonucci G, Matano A, Caputo M, Caruso MG, Pontiggia GT, Coccia M, Ciancarelli I, Zoccolotti P. Using the Oxford Cognitive Screen to Detect Cognitive Impairment in Stroke Patients: A Comparison with the Mini-Mental State Examination. Front Neurol 2018. [PMID: 29541055 PMCID: PMC5836594 DOI: 10.3389/fneur.2018.00101] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background The Oxford Cognitive Screen (OCS) was recently developed with the aim of describing the cognitive deficits after stroke. The scale consists of 10 tasks encompassing five cognitive domains: attention and executive function, language, memory, number processing, and praxis. OCS was devised to be inclusive and un-confounded by aphasia and neglect. As such, it may have a greater potential to be informative on stroke cognitive deficits of widely used instruments, such as the Mini-Mental State Examination (MMSE) or the Montreal Cognitive Assessment, which were originally devised for demented patients. Objective The present study compared the OCS with the MMSE with regards to their ability to detect cognitive impairments post-stroke. We further aimed to examine performance on the OCS as a function of subtypes of cerebral infarction and clinical severity. Methods 325 first stroke patients were consecutively enrolled in the study over a 9-month period. The OCS and MMSE, as well as the Bamford classification and NIHSS, were given according to standard procedures. Results About a third of patients (35.3%) had a performance lower than the cutoff (<22) on the MMSE, whereas 91.6% were impaired in at least one OCS domain, indicating higher incidences of impairment for the OCS. More than 80% of patients showed an impairment in two or more cognitive domains of the OCS. Using the MMSE as a standard of clinical practice, the comparative sensitivity of OCS was 100%. Out of the 208 patients with normal MMSE performance 180 showed impaired performance in at least one domain of the OCS. The discrepancy between OCS and MMSE was particularly strong for patients with milder strokes. As for subtypes of cerebral infarction, fewer patients demonstrated widespread impairments in the OCS in the Posterior Circulation Infarcts category than in the other categories. Conclusion Overall, the results showed a much higher incidence of cognitive impairment with the OCS than with the MMSE and demonstrated no false negatives for OCS vs MMSE. It is concluded that OCS is a sensitive screen tool for cognitive deficits after stroke. In particular, the OCS detects high incidences of stroke-specific cognitive impairments, not detected by the MMSE, demonstrating the importance of cognitive profiling.
Collapse
Affiliation(s)
| | - Nele Demeyere
- Cognitive Neuropsychology Centre, Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom
| | | | | | - Valentina Varalta
- Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurological, Biomedical and Movement Sciences, University of Verona, Verona, Italy
| | | | - Gabriella Antonucci
- Department of Psychology, Sapienza University of Rome, Rome, Italy.,Neuropsychology Center, IRCCS Santa Lucia Foundation, Rome, Italy
| | | | - Marina Caputo
- Neurological Rehabilitation Unit, Auxilium Vitae Volterra, Volterra, Italy
| | - Maria Giovanna Caruso
- Physical and Rehabilitation Medicine, Department of Medical and Surgical Sciences "Magna Graecia" University, Catanzaro, Italy
| | | | - Michela Coccia
- Department of Neuroscience, Neurorehabilitation Clinic, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
| | - Irene Ciancarelli
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Nova Salus s.r.l., L'Aquila, Italy
| | - Pierluigi Zoccolotti
- Department of Psychology, Sapienza University of Rome, Rome, Italy.,Neuropsychology Center, IRCCS Santa Lucia Foundation, Rome, Italy
| | | |
Collapse
|
21
|
Verberne D, Moulaert V, Verbunt J, van Heugten C. Factors predicting quality of life and societal participation after survival of a cardiac arrest: A prognostic longitudinal cohort study. Resuscitation 2018; 123:51-57. [DOI: 10.1016/j.resuscitation.2017.11.069] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 11/09/2017] [Accepted: 11/30/2017] [Indexed: 11/28/2022]
|
22
|
Swatridge K, Regan K, Staines WR, Roy E, Middleton LE. The Acute Effects of Aerobic Exercise on Cognitive Control among People with Chronic Stroke. J Stroke Cerebrovasc Dis 2017; 26:2742-2748. [DOI: 10.1016/j.jstrokecerebrovasdis.2017.06.050] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 06/27/2017] [Accepted: 06/28/2017] [Indexed: 11/26/2022] Open
|
23
|
Veldsman M, Churilov L, Werden E, Li Q, Cumming T, Brodtmann A. Physical Activity After Stroke Is Associated With Increased Interhemispheric Connectivity of the Dorsal Attention Network. Neurorehabil Neural Repair 2016; 31:157-167. [PMID: 27605568 DOI: 10.1177/1545968316666958] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Attention is frequently impaired after stroke, and its impairment is associated with poor quality of life. Physical activity benefits attention in healthy populations and has also been associated with recovery after brain injury. OBJECTIVE We investigated the relationship between objectively measured daily physical activity, attention network connectivity, and attention task performance after stroke. We hypothesized that increased daily physical activity would be associated with improved attention network function. METHODS Stroke patients (n = 62; mean age = 67 years, SD = 12.6 years) and healthy controls (n = 27; mean age = 68 years, SD = 6 years) underwent cognitive testing and 7 minutes of functional magnetic resonance imaging in the resting-state. Patients were tested 3 months after ischemic stroke. Physical activity was monitored with an electronic armband worn for 7 days. Dorsal and ventral attention network function was examined using seed-based connectivity analyses. RESULTS Greater daily physical activity was associated with increased interhemispheric connectivity of the superior parietal lobule in the dorsal attention network (DAN; P < .05, false discovery rate corrected). This relationship was not explained by stroke lesion volume. Importantly, stronger connectivity in this region was related to faster reaction time in 3 attention tasks, as revealed by robust linear regression. The relationship remained after adjusting for age, gray matter volume, and white matter hyperintensity load. CONCLUSIONS Daily physical activity was associated with increased resting interhemispheric connectivity of the DAN. Increased connectivity was associated with faster attention performance, suggesting a cognitive correlate to increased network connectivity. Attentional modulation by physical activity represents a key focus for intervention studies.
Collapse
Affiliation(s)
- Michele Veldsman
- 1 Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK.,2 University of Melbourne, Melbourne, Victoria, Australia
| | | | - Emilio Werden
- 2 University of Melbourne, Melbourne, Victoria, Australia
| | - Qi Li
- 2 University of Melbourne, Melbourne, Victoria, Australia
| | - Toby Cumming
- 2 University of Melbourne, Melbourne, Victoria, Australia
| | - Amy Brodtmann
- 2 University of Melbourne, Melbourne, Victoria, Australia.,3 University of Melbourne, Heidelberg, Melbourne, Victoria, Australia.,4 Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
24
|
Abstract
Background: Neuropsychological deficits occur in over half of the stroke survivors and are associated with the reduced functioning and a decline in quality of life. However, the trajectory of recovery and predictors of neuropsychological outcomes over the first year post stroke are poorly understood.Method: Neuropsychological performance, assessed using the CNS-Vital signs, was examined at 1 month, 6 months and 12 months after ischaemic stroke (IS) in a sample drawn from a population-based study (N = 198).Results: While mean scores across neuropsychological domains at each time-point fell in the average range, one in five individuals produced very low-range scores for verbal memory, attention and psychomotor speed. Significant improvements were seen for executive functioning, psychomotor speed and cognitive flexibility within 6 months post stroke, but no gains were noted from 6 to 12 months. Stroke-related neurological deficits and depression at baseline significantly contributed to the prediction of neuropsychological function at 12 month follow-up.Conclusions: In a significant minority of IS survivors, focal deficits are evident in psychomotor speed, verbal memory, executive functions and attention. Significant improvements in these domains were only evident in the first 6 months post stroke. Initial stroke-related neurological deficits and concurrent depression may be the best predictors of later cognitive functioning.
Collapse
|
25
|
Mancuso M, Varalta V, Sardella L, Capitani D, Zoccolotti P, Antonucci G. Italian normative data for a stroke specific cognitive screening tool: the Oxford Cognitive Screen (OCS). Neurol Sci 2016; 37:1713-21. [PMID: 27395388 DOI: 10.1007/s10072-016-2650-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 06/27/2016] [Indexed: 12/18/2022]
Abstract
Cognitive deficits occur in most stroke patients and cognitive impairment is an important predictor of adverse long term outcome. However, current screening measures, such as the Mini Mental State Examination or the Montreal Cognitive Assessment, do not provide information tuned for evaluating the impact of cognitive impairment in the early phase after stroke. The Oxford Cognitive Screen (OCS) represents an important new development in this regard. The OCS is now available for assessment of Italian individuals and the aim of this study is to standardize the OCS on a large sample of healthy Italian participants stratified for age, gender and education level. Results confirmed the influence of these factors in several of the OCS tasks. Age-, education- and gender-adjusted norms are provided for the ten sub-tests of the test. The availability of normative data represents an important prerequite for the reliable use of OCS with stroke patients.
Collapse
Affiliation(s)
- M Mancuso
- Rehabilitation Center, Terranuova Bracciolini, Arezzo, Italy.
| | - V Varalta
- Department of Neuroscience Biomedicine and Movement, Neuromotor and Cognitive Rehabilitation Research Center, University of Verona, Verona, Italy
| | - L Sardella
- Rehabilitation Center, Terranuova Bracciolini, Arezzo, Italy
| | - D Capitani
- ESTAR Sud Est, ICT-Department, Grosseto, Italy
| | - P Zoccolotti
- Department of Psychology, Sapienza University of Rome, Rome, Italy.,Neuropsychology Centre, IRCCS Santa Lucia Foundation, Rome, Italy
| | - G Antonucci
- Department of Psychology, Sapienza University of Rome, Rome, Italy.,Neuropsychology Centre, IRCCS Santa Lucia Foundation, Rome, Italy
| | | |
Collapse
|
26
|
Hall MW, Hopkins RO, Long JW, Mohammad SF, Solen KA. Hypothermia-induced platelet aggregation and cognitive decline in coronary artery bypass surgery: a pilot study. Perfusion 2016; 20:157-67. [PMID: 16038388 DOI: 10.1191/0267659105pf814oa] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Hypothermia-induced platelet aggregation (HIPA) was previously reported in whole blood exposed to synthetic surfaces at 24°-32°C in one-third of normal subjects tested. Cardiopulmonary bypass, conducted with hypothermia, may lead to such aggregation, resulting in microvascular occlusion contributing to cognitive impairment. This pilot study was conducted to explore the relationship between HIPA and cognitive outcome at hospital discharge in patients undergoing coronary artery bypass graft (CABG) surgery as a first step toward a longer-term study. Patients (n=45) undergoing mild to moderate hypothermia (32°-28°8C) during CABG surgery underwent cognitive testing preoperatively and prior to hospital discharge. Tests included: visual and verbal memory, mental processing speed, executive function, language, and intellectual function. HIPA was identified using an in vitro assay in which blood flowing in polyvinychloride tubing was subjected to hypothermia, and platelet aggregates were detected using microscopy and passing the exiting blood through a 20-μm pore filter. Forty-four percent of patients exhibited HIPA. The entire cohort exhibited significant postoperative cognitive decline in verbal memory, mental processing speed and executive function. There was greater cognitive decline in the group with HIPA compared with the group not exhibiting this phenomenon. The patients with HIPA showed significant decline in four of five cognitive measures whereas patients not exhibiting this phenomenon declined in only two of five cognitive measures. HIPA appears to be associated with an added risk of cognitive decline immediately following CABG surgery employing mild to moderate hypothermia. The findings of our study suggest the long-term cognitive effects of hypothermia-induced platelet aggregation need to be explored.
Collapse
Affiliation(s)
- Matthew W Hall
- Department of Chemical Engineering, 350 CB, Brigham Young University, Provo, UT 84602, USA
| | | | | | | | | |
Collapse
|
27
|
Mitrovic A, Mathews M, Ohlsson S, Holland J, McKinlay A. Computer-Based Post-Stroke Rehabilitation of Prospective Memory. JOURNAL OF APPLIED RESEARCH IN MEMORY AND COGNITION 2016. [DOI: 10.1016/j.jarmac.2016.03.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
28
|
Abstract
We reviewed current knowledge about the interaction between stroke and vascular risk factors and the development of cognitive impairment and dementia. Stroke is increasingly recognized as an important cause of cognitive problems and has been implicated in the development of both Alzheimer’s disease and vascular dementia. The prevalence of cognitive impairment after stroke is high, and their combined effects significantly increase the cost of care and health resource utilization, with reflections on hospital readmissions and increased mortality rates. There is also substantial evidence that vascular risk factors (such as hypertension, diabetes, obesity, dyslipidemia, and tobacco smoking) are independently associated with an increased risk of cognitive decline and dementia. Thus, a successful management of these factors, as well as optimal acute stroke management, might have a great impact on the development of cognitive impairment. Notwithstanding, the pathological link between cognitive impairment, stroke, and vascular risk factors is complex and still partially unclear so that further studies are needed to better elucidate the boundaries of this relationship. Many specific pharmacological treatments, including anticholinergic drugs and antihypertensive medications, and nonpharmacological approaches, such as diet, cognitive rehabilitation, and physical activity, have been studied for patients with vascular cognitive impairment, but the optimal care is still far away. Meanwhile, according to the most recent knowledge, optimal stroke care should also include cognitive assessment in the short and long term, and great efforts should be oriented toward a multidisciplinary approach, including quality-of-life assessment and support of caregivers.
Collapse
Affiliation(s)
- Daniele Lo Coco
- Neurology and Stroke Unit, National Relevance and High Specialization Hospital Trust ARNAS Civico, Di Cristina, Benfratelli, Palermo, Italy
| | - Gianluca Lopez
- Neurology and Stroke Unit, National Relevance and High Specialization Hospital Trust ARNAS Civico, Di Cristina, Benfratelli, Palermo, Italy
| | - Salvatore Corrao
- Department of Internal Medicine, National Relevance and High Specialization Hospital Trust ARNAS Civico, Di Cristina, Benfratelli, Palermo, Italy; Centre of Research for Effectiveness and Appropriateness in Medicine (C.R.E.A.M.), Di.Bi.M.I.S., University of Palermo, Palermo, Italy
| |
Collapse
|
29
|
A Virtual Reality Environment for Rehabilitation of Prospective Memory in Stroke Patients. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.procs.2016.08.081] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
30
|
Huang J, McCaskey MA, Yang S, Ye H, Tao J, Jiang C, Schuster-Amft C, Balzer C, Ettlin T, Schupp W, Kulke H, Chen L. Effects of acupuncture and computer-assisted cognitive training for post-stroke attention deficits: study protocol for a randomized controlled trial. Trials 2015; 16:546. [PMID: 26631161 PMCID: PMC4667410 DOI: 10.1186/s13063-015-1054-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 11/12/2015] [Indexed: 11/20/2022] Open
Abstract
Background A majority of stroke survivors present with cognitive impairments. Attention disturbance, which leads to impaired concentration and overall reduced cognitive functions, is strongly associated with stroke. The clinical efficacy of acupuncture with Baihui (GV20) and Shenting (GV24) as well as computer-assisted cognitive training in stroke and post-stroke cognitive impairment have both been demonstrated in previous studies. To date, no systematic comparison of these exists and the potential beneficial effects of a combined application are yet to be examined. The main objective of this pilot study is to evaluate the effects of computer-assisted cognitive training compared to acupuncture on the outcomes of attention assessments. The second objective is to test the effects of a combined cognitive intervention that incorporates computer-assisted cognitive training and acupuncture (ACoTrain). Methods/Design An international multicentre, single-blinded, randomised controlled pilot trial will be conducted. In a 1:1:1 ratio, 60 inpatients with post-stroke cognitive dysfunction will be randomly allocated into either the acupuncture group, the computer-assisted cognitive training group, or the ACoTrain group in addition to their individual rehabilitation programme. The intervention period of this pilot trial will last 4 weeks (30 minutes per day, 5 days per week, Monday to Friday). The primary outcome is the test battery for attentional performance. The secondary outcomes include the Trail Making Test, Test des Deux Barrages, National Institute of Health Stroke Scale, and Modified Barthel Index for assessment of daily life competence, and the EuroQol Questionnaire for health-related quality of life. Discussion This trial mainly focuses on evaluating the effects of computer-assisted cognitive training compared to acupuncture on the outcomes of attention assessments. The results of this pilot trial are expected to provide new insights on how Eastern and Western medicine can complement one another and improve the treatment of cognitive impairments in early stroke rehabilitation. Including patients with different cultural backgrounds allows a more generalisable interpretation of the results but also poses risks of performance bias. Using standardised and well-described assessments, validated for each region, is pivotal to allow pooling of the data. Trial registration Clinical Trails.gov ID: NCT02324959 (8 December 2014)
Collapse
Affiliation(s)
- Jia Huang
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, No.1 Huatuo Road, Minhou District, Fuzhou, 350122, Fujian Province, China.
| | - Michael A McCaskey
- Research Department, Reha Rheinfelden, Salinenstrasse 98, 4310, Rheinfelden, Switzerland.
| | - Shanli Yang
- Fujian University of Traditional Chinese Medicine Affiliated Rehabilitation Hospital, No. 282 Wusi Road, Fuzhou, 350003, Fujian Province, China.
| | - Haicheng Ye
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, No.1 Huatuo Road, Minhou District, Fuzhou, 350122, Fujian Province, China.
| | - Jing Tao
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, No.1 Huatuo Road, Minhou District, Fuzhou, 350122, Fujian Province, China. .,Fujian University of Traditional Chinese Medicine Affiliated Rehabilitation Hospital, No. 282 Wusi Road, Fuzhou, 350003, Fujian Province, China.
| | - Cai Jiang
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, No.1 Huatuo Road, Minhou District, Fuzhou, 350122, Fujian Province, China.
| | - Corina Schuster-Amft
- Research Department, Reha Rheinfelden, Salinenstrasse 98, 4310, Rheinfelden, Switzerland.
| | - Christian Balzer
- Research Department, Reha Rheinfelden, Salinenstrasse 98, 4310, Rheinfelden, Switzerland.
| | - Thierry Ettlin
- Research Department, Reha Rheinfelden, Salinenstrasse 98, 4310, Rheinfelden, Switzerland.
| | - Wilfried Schupp
- m&i-Fachklinik Herzogenaurach, In der Reuth 1, 91074, Herzogenaurach, Germany.
| | - Hartwig Kulke
- m&i-Fachklinik Herzogenaurach, In der Reuth 1, 91074, Herzogenaurach, Germany.
| | - Lidian Chen
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, No.1 Huatuo Road, Minhou District, Fuzhou, 350122, Fujian Province, China.
| |
Collapse
|
31
|
Boosman H, Winkens I, van Heugten CM, Rasquin SMC, Heijnen VA, Visser-Meily JMA. Predictors of health-related quality of life and participation after brain injury rehabilitation: The role of neuropsychological factors. Neuropsychol Rehabil 2015; 27:581-598. [DOI: 10.1080/09602011.2015.1113996] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
32
|
Van Heugten CM, Walton L, Hentschel U. Can we forget the Mini-Mental State Examination? A systematic review of the validity of cognitive screening instruments within one month after stroke. Clin Rehabil 2014; 29:694-704. [PMID: 25381346 DOI: 10.1177/0269215514553012] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 09/04/2014] [Indexed: 11/15/2022]
Abstract
Objective: To review systematically studies investigating the convergent, criterion, and predictive validity of multi-domain cognitive screening instruments in the first four weeks after stroke. Data sources: Electronic databases (Pubmed, PsycINFO, CINAHL, Embase) were searched until June 2014. Review methods: Studies concerning screening for cognitive dysfunction in stroke patients using multi-domain instruments, within four weeks postinfarct or haemorrhagic stroke, using tests taking no longer than one hour. Convergent, criterion, and predictive validity were examined. Results: A total of 51 studies investigating 16 cognitive screening instruments were identified. None of the instruments covered all of the most affected cognitive domains. Only one study investigated the convergent validity of a multi-domain test during the (sub)acute phase after stroke. A total of 15 studies examined the criterion validity of cognitive measurements during the acute phase after stroke. The Montreal Cognitive Assessment and Higher Cortical Function Deficit Test had good criterion validity. A total of 24 studies examined the predictive ability of multi-domain cognitive instruments applied in the acute phase after stroke. The Cognistat, Montreal Cognitive Assessment, and Functional Independence Measure-cognitive showed good predictive validity. The Mini-Mental State Examination is the most widely used cognitive screening instrument, but shows insufficient criterion validity. Conclusion: None of the existing instruments fulfils all criteria. The Montreal Cognitive Assessment is the best candidate at present, provided items measuring speed of information processing are added, and further studies investigating the optimal cut-offs are conducted.
Collapse
Affiliation(s)
- Caroline M Van Heugten
- Department Neuropsychology and Psychopharmacology, Maastricht University, Maastricht, The Netherlands
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - L Walton
- Department Neuropsychology and Psychopharmacology, Maastricht University, Maastricht, The Netherlands
| | - U Hentschel
- Department Neuropsychology and Psychopharmacology, Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
33
|
The importance of cognition to quality of life after stroke. J Psychosom Res 2014; 77:374-9. [PMID: 25217449 DOI: 10.1016/j.jpsychores.2014.08.009] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 08/20/2014] [Accepted: 08/21/2014] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Suffering a stroke typically has a negative impact on a person's quality of life. There is some evidence that post-stroke cognitive impairment is associated with poor quality of life, but the relative importance of deficits in different cognitive domains has not been established. METHODS Patients with confirmed stroke were recruited in the acute hospital. A subgroup of patients completed 2 computerized cognitive tasks (simple and choice reaction time) within 2 weeks of stroke. The full cohort was followed up at 3 months with a comprehensive neuropsychological battery and then at 12 months with the Assessment of Quality of Life ('AQoL). RESULTS Sixty patients participated in the study (mean age 72.1 years, SD 13.9), with a subgroup of 33 patients tested acutely (mean age 75.5 years, SD 11.9). Presence of cognitive impairment at 3 months was independently associated with lower quality of life at 12 months (p=0.021). Attention and visuospatial ability were the cognitive domains most closely associated with quality of life. Faster choice reaction time in the acute stage (mean 5.4 days post-stroke) was significantly associated with better quality of life at 12 months (p=0.003). CONCLUSION Cognition, particularly attention and visuospatial ability, is strongly associated with quality of life after stroke. It is possible that straightforward reaction time tasks are sensitive to the extent of brain damage, and might therefore be surrogate markers for quality of life.
Collapse
|
34
|
Stolwyk RJ, O’Neill MH, McKay AJ, Wong DK. Are Cognitive Screening Tools Sensitive and Specific Enough for Use After Stroke? Stroke 2014; 45:3129-34. [DOI: 10.1161/strokeaha.114.004232] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Renerus J. Stolwyk
- From the School of Psychological Sciences, Monash University, Melbourne, Australia (R.J.S., M.H.O., A.J.D.M., D.K.W.); and Epworth Rehabilitation, Melbourne, Australia (A.J.D.M.)
| | - Megan H. O’Neill
- From the School of Psychological Sciences, Monash University, Melbourne, Australia (R.J.S., M.H.O., A.J.D.M., D.K.W.); and Epworth Rehabilitation, Melbourne, Australia (A.J.D.M.)
| | - Adam J.D. McKay
- From the School of Psychological Sciences, Monash University, Melbourne, Australia (R.J.S., M.H.O., A.J.D.M., D.K.W.); and Epworth Rehabilitation, Melbourne, Australia (A.J.D.M.)
| | - Dana K. Wong
- From the School of Psychological Sciences, Monash University, Melbourne, Australia (R.J.S., M.H.O., A.J.D.M., D.K.W.); and Epworth Rehabilitation, Melbourne, Australia (A.J.D.M.)
| |
Collapse
|
35
|
Xu XD, Ren HY, Prakash R, Vijayadas, Kumar R. Outcomes of neuropsychological interventions of stroke. Ann Indian Acad Neurol 2014; 16:319-28. [PMID: 24101809 PMCID: PMC3788273 DOI: 10.4103/0972-2327.116909] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 07/12/2013] [Accepted: 07/17/2013] [Indexed: 11/23/2022] Open
Abstract
The reported prevalence of cognitive deficits within the first month of stroke ranges widely from 10% to 82%, depending primarily on the criteria used to define cognitive impairment and on the selected patient population. These cognitive defects progress toward impairment over a course of time if left untreated. Among the most common cognitive deficits are the attentional, the visuoperceptual, the memory and executive function deficits. As these impairments are being increasingly recognized in the scientific communities, more and more studies are being devoted to the outcomes of various therapies for these disorders. In this review, we focus on the outcomes of various therapies for these cognitive disorders over time. We reviewed all the possible medical databases using key words for individual cognitive deficit treatment outcomes. All the possible studies including randomized controlled trials, pre-post design studies, case series and single case reports were included in this study. On the basis of present literature review, we conclude that the evidence is definitively positive only for outcomes of attentional and visuoperceptive skill deficits. On the other hand, there have been very few studies to conclude for effectiveness of various therapies for memory and executive function outcomes.
Collapse
Affiliation(s)
- Xiao-Di Xu
- Department of Neurology, Liaocheng People's Hospital, Shandong, China
| | | | | | | | | |
Collapse
|
36
|
Bushnell CD, Reeves MJ, Zhao X, Pan W, Prvu-Bettger J, Zimmer L, Olson D, Peterson E. Sex differences in quality of life after ischemic stroke. Neurology 2014; 82:922-31. [PMID: 24510493 DOI: 10.1212/wnl.0000000000000208] [Citation(s) in RCA: 125] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE We aimed to compare quality of life (QOL) in women and men after ischemic stroke or TIA, and to determine the incremental impact of demographic, socioeconomic, clinical, and stroke-specific effects on longitudinal QOL. METHODS We assessed QOL in patients with ischemic stroke or TIA at 3 and 12 months postdischarge in the Adherence eValuation After Ischemic stroke-Longitudinal Registry using the European Quality of Life-5 Dimensions (EQ-5D) instrument. We generated multivariable linear regression models to evaluate the association between sex and EQ-5D while sequentially adjusting for sociodemographic, clinical, and stroke-related variables. We also used a proportional odds model to assess sex differences in the change in EQ-5D scores from 3 to 12 months. RESULTS A total of 1,370 patients were included, 53.7% male, median age 65 years (interquartile range 56-77 years). Women had significantly lower QOL at 3 months (unadjusted EQ-5D 0.81 in women vs 0.84 in men; p < 0.001) and 12 months (0.83 vs men 0.84; p < 0.001) poststroke. After multivariable adjustment for sociodemographic, clinical, and stroke-related factors, women continued to have lower QOL at 3 months (mean difference -0.036; p = 0.003) and at 12 months (mean difference -0.022; p = 0.046). Women fared worse in the dimensions of mobility, pain/discomfort, and anxiety/depression at 3 and 12 months. There were no sex differences in change in EQ-5D score from 3 to 12 months. CONCLUSION Women have worse QOL than men up to 12 months after stroke, even after adjusting for important sociodemographic variables, stroke severity, and disability.
Collapse
Affiliation(s)
- Cheryl D Bushnell
- From Wake Forest School of Medicine (C.D.B.), Department of Neurology and Women's Health Center of Excellence for Leadership, Research, and Education, Winston-Salem, NC; Department of Epidemiology (M.J.R.), Michigan State University, East Lansing; Duke Clinical Research Institute (X.Z., W.P., J.P.-B., L.Z., E.P.), Durham; Duke University School of Nursing (J.P.-B.), Durham, NC; and University of Texas Southwestern (D.O.), Houston
| | | | | | | | | | | | | | | |
Collapse
|
37
|
Cumming TB, Churilov L, Linden T, Bernhardt J. Montreal Cognitive Assessment and Mini-Mental State Examination are both valid cognitive tools in stroke. Acta Neurol Scand 2013; 128:122-9. [PMID: 23425001 DOI: 10.1111/ane.12084] [Citation(s) in RCA: 125] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine the validity of the Montreal Cognitive Assessment (MoCA) and the Mini-Mental State Examination (MMSE) as screening tools for cognitive impairment after stroke. MATERIALS AND METHODS Cognitive assessments were administered over 2 sessions (1 week apart) at 3 months post-stroke. Scores on the MoCA and MMSE were evaluated against a diagnosis of cognitive impairment derived from a comprehensive neuropsychological battery (the criterion standard). RESULTS Sixty patients participated in the study [mean age 72.1 years (SD = 13.9), mean education 10.5 years (SD = 3.9), median acute NIHSS score 5 (IQR 3-7)]. The MoCA yielded lower scores (median = 21, IQR = 17-24; mean = 20.0, SD = 5.4) than the MMSE (median = 26, IQR = 22-27; mean = 24.2, SD = 4.5). MMSE data were more skewed towards ceiling than MoCA data (skewness = -1.09 vs -0.73). Area under the receiver operator curve was higher for MoCA than for MMSE (0.87 vs 0.84), although this difference was not significant (χ(2) = 0.48, P = 0.49). At their optimal cut-offs, the MoCA had better sensitivity than the MMSE (0.92 vs 0.82) but poorer specificity (0.67 vs 0.76). CONCLUSIONS The MoCA is a valid screening tool for post-stroke cognitive impairment; it is more sensitive but less specific than the MMSE. Contrary to the prevailing view, the MMSE also exhibited acceptable validity in this setting.
Collapse
Affiliation(s)
- T. B. Cumming
- Stroke Division; Florey Institute of Neuroscience and Mental Health; Melbourne; Australia
| | - L. Churilov
- Stroke Division; Florey Institute of Neuroscience and Mental Health; Melbourne; Australia
| | | | - J. Bernhardt
- Stroke Division; Florey Institute of Neuroscience and Mental Health; Melbourne; Australia
| |
Collapse
|
38
|
Lamy A, Devereaux PJ, Prabhakaran D, Taggart DP, Hu S, Paolasso E, Straka Z, Piegas LS, Akar AR, Jain AR, Noiseux N, Padmanabhan C, Bahamondes JC, Novick RJ, Vaijyanath P, Reddy SK, Tao L, Olavegogeascoechea PA, Airan B, Sulling TA, Whitlock RP, Ou Y, Pogue J, Chrolavicius S, Yusuf S. Effects of off-pump and on-pump coronary-artery bypass grafting at 1 year. N Engl J Med 2013; 368:1179-88. [PMID: 23477676 DOI: 10.1056/nejmoa1301228] [Citation(s) in RCA: 310] [Impact Index Per Article: 28.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Previously, we reported that there was no significant difference at 30 days in the rate of a primary composite outcome of death, myocardial infarction, stroke, or new renal failure requiring dialysis between patients who underwent coronary-artery bypass grafting (CABG) performed with a beating-heart technique (off-pump) and those who underwent CABG performed with cardiopulmonary bypass (on-pump). We now report results on quality of life and cognitive function and on clinical outcomes at 1 year. METHODS We enrolled 4752 patients with coronary artery disease who were scheduled to undergo CABG and randomly assigned them to undergo the procedure off-pump or on-pump. Patients were enrolled at 79 centers in 19 countries. We assessed quality of life and cognitive function at discharge, at 30 days, and at 1 year and clinical outcomes at 1 year. RESULTS At 1 year, there was no significant difference in the rate of the primary composite outcome between off-pump and on-pump CABG (12.1% and 13.3%, respectively; hazard ratio with off-pump CABG, 0.91; 95% confidence interval [CI], 0.77 to 1.07; P=0.24). The rate of the primary outcome was also similar in the two groups in the period between 31 days and 1 year (hazard ratio, 0.79; 95% CI, 0.55 to 1.13; P=0.19). The rate of repeat coronary revascularization at 1 year was 1.4% in the off-pump group and 0.8% in the on-pump group (hazard ratio, 1.66; 95% CI, 0.95 to 2.89; P=0.07). There were no significant differences between the two groups at 1 year in measures of quality of life or neurocognitive function. CONCLUSIONS At 1 year after CABG, there was no significant difference between off-pump and on-pump CABG with respect to the primary composite outcome, the rate of repeat coronary revascularization, quality of life, or neurocognitive function. (Funded by the Canadian Institutes of Health Research; CORONARY ClinicalTrials.gov number, NCT00463294.).
Collapse
Affiliation(s)
- André Lamy
- The Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Park JH, Kim BJ, Bae HJ, Lee J, Lee J, Han MK, O KY, Park SH, Kang Y, Yu KH, Lee BC. Impact of post-stroke cognitive impairment with no dementia on health-related quality of life. J Stroke 2013; 15:49-56. [PMID: 24324939 PMCID: PMC3779672 DOI: 10.5853/jos.2013.15.1.49] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Revised: 12/28/2012] [Accepted: 12/28/2012] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND AND PURPOSE Health-related quality of life (HRQoL) is a multidimensional concept that signifies a subjective evaluation of perceived health; hence, it has gained wide acceptance in geriatrics. However, its application has not been tested in patients with post-stroke cognitive impairment with no dementia (PSCIND). We investigated whether PSCIND interferes with HRQoL measured by EQ-5D, compared the findings to those of healthy people with normal cognition, and evaluated the influence of each cognitive domain on this score. METHODS In total, 1,528 subjects were identified who had undergone neuropsychological assessment using the 60-min protocol of the Korean version of Vascular Cognitive Impairment Harmonization Standards, EQ-5D, and magnetic resonance imaging at the stroke prevention clinic. Fifty PSCIND patients were matched to 50 post-stroke dementia (PSD) patients and 50 normal age- (±3 years) and sex-matched controls. The effects of PSCIND, PSD, and control groups upon the EQ-5Dindex score were tested by generalized estimating equation modeling. RESULTS Estimated means±standard errors of EQ-5Dindex scores were as follows: 0.94±0.06 (control group), 0.86±0.08 (PSCIND group), and 0.61±0.32 (PSD group); and the difference among the three groups was statistically significant (P<0.0001). Pairwise comparisons showed that EQ-5Dindex scores in the PSCIND group differed from those in the PSD and control groups (both P<0.01). No cognitive domain was specifically associated with EQ-5Dindex scores after adjusting for functional status. CONCLUSIONS This study shows that PSCIND may interfere with the quality of life in stroke victims.
Collapse
Affiliation(s)
- Jung Hyun Park
- Department of Neurology, Dongguk University Gyeongju Hospital, Gyeongju, Korea
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Abstract
BACKGROUND Research in both humans and animals indicates that physical activity can enhance cognitive activity, but whether this is true in patients with stroke is largely unknown.We aimed to evaluate the relationship between increased physical activity after stroke and cognitive performance. METHODS A systematic review was conducted of MEDLINE, EMBASE, PsycINFO and other electronic databases. All randomized controlled trials and controlled clinical studies that evaluated the effect of physical activity or exercise on cognitive function in stroke were included. Study quality was assessed using four criteria concerning sources of bias (use of randomization, allocation concealment, blinding of outcome assessment, whether all patients were accounted for in outcome data). RESULTS The literature search (first run in 2008, updated in 2011) yielded 12 studies that satisfied inclusion criteria. Exercise interventions were heterogeneous; some studies compared different intensities of movement rehabilitation, others included a specific exercise program. Cognitive function was rarely the primary outcome measure, and cognitive assessment tools used were generally suboptimal. Nine studies had sufficient data to be included in a meta-analysis, which indicated a significant benefit of intervention over control (SMD = 0.20, 95% CI: 0.04–0.36; z = 2.43, p = 0.015). Studies that met all four quality criteria reported smaller treatment benefit than studies that did not. CONCLUSIONS There is some evidence that increased physical activity after stroke enhances cognitive performance. The pool of studies identified, however, was small and methodological shortcomings were widespread.
Collapse
|
41
|
I. Kneebone I, B. Lincoln N. Psychological Problems after Stroke and Their Management: State of Knowledge. ACTA ACUST UNITED AC 2012. [DOI: 10.4236/nm.2012.31013] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
42
|
Barker-Collo S, Starkey N, Lawes CM, Feigin V, Senior H, Parag V. Neuropsychological Profiles of 5-Year Ischemic Stroke Survivors by Oxfordshire Stroke Classification and Hemisphere of Lesion. Stroke 2012; 43:50-5. [DOI: 10.1161/strokeaha.111.627182] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Although the neuropsychological literature typically examines stroke outcomes by hemisphere of lesion, the medical literature provides classifications more closely linked to circulatory distribution impacted by stroke. This article examined profiles of cognitive function by hemisphere and by Oxfordshire Community Stroke Project stroke classification.
Methods—
This study included a sample of 315 5-year ischemic stroke survivors. Assessment included tests of verbal memory, visual memory, word finding/verbal fluency, abstract visual reasoning, executive functioning, and speed of processing.
Results—
The sample produced scores within 1 standard deviation of the normative mean on tests of abstract visual reasoning, verbal memory, and visual recall. Impaired performances were observed for executive function and processing speed. Profile analysis revealed no significant differences in overall cognitive performance or in the profile of performance across measures by hemisphere of lesion. However, groups defined by Oxfordshire Community Stroke Project categories produced significantly different cognitive profiles. Post hoc analyses indicate those with posterior stroke performed best overall on all tests except the Stroop Dots trial, whereas those with total anterior stroke produced significantly worse scores on tasks requiring visual abstract reasoning (Block Design, Rey Figure Copy), word finding (Boston Naming Test), and processing speed (Stroop Dots, Trails A).
Conclusions—
Oxfordshire Community Stroke Project stroke subtypes identified significant differences between groups, suggesting this classification system is of greater use than hemisphere of lesion in predicting poststroke cognitive outcomes.
Collapse
Affiliation(s)
- Suzanne Barker-Collo
- From the Department of Psychology (S.B.C.), Faculty of Sciences, University of Auckland, Auckland, New Zealand; School of Psychology (N.S.), Faculty of Arts and Social Sciences, University of Waikato, Hamilton, New Zealand; Clinical Trials Research Unit (C.M.M.L.), Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand; National Institute for Stroke and Applied Neurosciences (V.F.), School of Rehabilitation and Occupation Studies, AUT University, Auckland, New
| | - Nicola Starkey
- From the Department of Psychology (S.B.C.), Faculty of Sciences, University of Auckland, Auckland, New Zealand; School of Psychology (N.S.), Faculty of Arts and Social Sciences, University of Waikato, Hamilton, New Zealand; Clinical Trials Research Unit (C.M.M.L.), Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand; National Institute for Stroke and Applied Neurosciences (V.F.), School of Rehabilitation and Occupation Studies, AUT University, Auckland, New
| | - Carlene M.M. Lawes
- From the Department of Psychology (S.B.C.), Faculty of Sciences, University of Auckland, Auckland, New Zealand; School of Psychology (N.S.), Faculty of Arts and Social Sciences, University of Waikato, Hamilton, New Zealand; Clinical Trials Research Unit (C.M.M.L.), Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand; National Institute for Stroke and Applied Neurosciences (V.F.), School of Rehabilitation and Occupation Studies, AUT University, Auckland, New
| | - Valery Feigin
- From the Department of Psychology (S.B.C.), Faculty of Sciences, University of Auckland, Auckland, New Zealand; School of Psychology (N.S.), Faculty of Arts and Social Sciences, University of Waikato, Hamilton, New Zealand; Clinical Trials Research Unit (C.M.M.L.), Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand; National Institute for Stroke and Applied Neurosciences (V.F.), School of Rehabilitation and Occupation Studies, AUT University, Auckland, New
| | - Hugh Senior
- From the Department of Psychology (S.B.C.), Faculty of Sciences, University of Auckland, Auckland, New Zealand; School of Psychology (N.S.), Faculty of Arts and Social Sciences, University of Waikato, Hamilton, New Zealand; Clinical Trials Research Unit (C.M.M.L.), Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand; National Institute for Stroke and Applied Neurosciences (V.F.), School of Rehabilitation and Occupation Studies, AUT University, Auckland, New
| | - Varsha Parag
- From the Department of Psychology (S.B.C.), Faculty of Sciences, University of Auckland, Auckland, New Zealand; School of Psychology (N.S.), Faculty of Arts and Social Sciences, University of Waikato, Hamilton, New Zealand; Clinical Trials Research Unit (C.M.M.L.), Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand; National Institute for Stroke and Applied Neurosciences (V.F.), School of Rehabilitation and Occupation Studies, AUT University, Auckland, New
| |
Collapse
|
43
|
Is Cognitive Functioning 1 Year Poststroke Related to Quality of Life Domain? J Stroke Cerebrovasc Dis 2011; 20:450-8. [DOI: 10.1016/j.jstrokecerebrovasdis.2010.02.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2009] [Revised: 12/23/2009] [Accepted: 02/05/2010] [Indexed: 11/23/2022] Open
|
44
|
Franzén-Dahlin A, Karlsson MR, Mejhert M, Laska AC. Quality of life in chronic disease: a comparison between patients with heart failure and patients with aphasia after stroke. J Clin Nurs 2011; 19:1855-60. [PMID: 20920012 DOI: 10.1111/j.1365-2702.2010.03219.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES This study aimed to describe the impact of heart failure and of stroke with aphasia on quality of life (QoL) and to compare the different domains of QoL in these groups. BACKGROUND The prevalence of chronic conditions has increased during the last decades, and chronic diseases such as stroke and heart failure may have a great impact on QoL. DESIGN Comparative study of patients from two randomised controlled studies. METHOD Seventy-nine patients with heart failure and 70 patients with aphasia after stroke were evaluated concerning the severity of their disease and by QoL, as measured with the Nottingham Health Profile, in the acute phase and after six months. RESULTS The severity of the disease improved between baseline and six month for both groups. Correlations between New York Heart Association (NYHA) class and all QoL domains were seen in patients with heart failure after six months. The degree of aphasia correlated to mobility, social, emotional and total score after six month. QoL in patients with heart failure was more affected in the domains of sleep and energy in the acute phase and in the energy domain at six months. CONCLUSION Although low energy is more frequent among patients with heart failure, both groups report poor QoL. Improvement in severity of the disease is not necessarily accompanied by improvement in QoL. RELEVANCE TO CLINICAL PRACTICE Nottingham Health Profile can easily be used as a screening instrument, aiming to identify patients at risk for adverse effects on QoL. A better understanding of the subjective QoL of patients with chronic disease is fundamental for health care professionals to be able to identify and support vulnerable patients.
Collapse
Affiliation(s)
- Asa Franzén-Dahlin
- Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden.
| | | | | | | |
Collapse
|
45
|
Cardiac arrest-induced regional blood-brain barrier breakdown, edema formation and brain pathology: a light and electron microscopic study on a new model for neurodegeneration and neuroprotection in porcine brain. J Neural Transm (Vienna) 2010; 118:87-114. [PMID: 20963453 DOI: 10.1007/s00702-010-0486-4] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2010] [Accepted: 08/30/2010] [Indexed: 12/23/2022]
Abstract
Brief cardiac arrest and survival is often associated with marked neurological alterations related to cognitive and sensory motor functions. However, detail studies using selective vulnerability of brain after cardiac arrest in animal models are still lacking. We examined selective vulnerability of five brain regions in our well-established cardiac arrest model in pigs. Using light and electron microscopic techniques in combinations with immunohistochemistry, we observed that 5, 30, 60 and 180 min after cardiac arrest results in progressive neuronal damage that was most marked in the thalamus followed by cortex, hippocampus, hypothalamus and the brain stem. The neuronal damages are largely evident in the areas showing leakage of serum albumin in the neuropil. Furthermore, a tight correlation was seen between neuronal damage and increase in brain water content and Na(+) indicating vasogenic edema formation after cardiac arrest. Damage to myelinated fibers and loss of myelin as seen using Luxol fast blue and myelin basic protein (MBP) immunoreactivity is clearly evident in the brain areas exhibiting neuronal damage. Upregulation of GFAP positive astrocytes closely corresponds with neuronal damages in different brain areas after cardiac arrest. At the ultrastructural level, perivascular edema together with neuronal, glial and endothelia cell damages is frequent in the brain areas showing albumin leakage. Damage to both pre- and post-synaptic membrane is also common. Treatment with methylene blue, an antioxidant markedly reduced neuronal damage, leakage of albumin, overexpression of GFAP and damage to myelin following cardiac arrest. Taken together, these observations suggest that (a) cardiac arrest is capable to induce selective neuronal, glial and myelin damage in different parts of the pig brain, and (b) antioxidant methylene blue is capable to induce neuroprotection by reducing BBB disruption. These observations strongly suggest that the model could be used to explore new therapeutic agents to enhance neurorepair following cardiac arrest-induced brain damage for therapeutic purposes.
Collapse
|
46
|
Aben L, Kessel MAV, Duivenvoorden HJ, Busschbach JJV, Eling PATM, Bogert MA, Ribbers GM. Metamemory and memory test performance in stroke patients. Neuropsychol Rehabil 2009; 19:742-53. [DOI: 10.1080/09602010902754185] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
47
|
Barker-Collo SL, Feigin VL, Lawes CM, Parag V, Senior H, Rodgers A. Reducing Attention Deficits After Stroke Using Attention Process Training. Stroke 2009; 40:3293-8. [DOI: 10.1161/strokeaha.109.558239] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Impaired attention contributes to poor stroke outcomes. Attention process training (APT) reduces attention deficits after traumatic brain injury. There was no evidence for effectiveness of APT in stroke patients. This trial evaluated effectiveness of APT in improving attention and broader outcomes in stroke survivors 6 months after stroke.
Methods—
Participants in this prospective, single-blinded, randomized, clinical trial were 78 incident stroke survivors admitted over 18 months and identified via neuropsychological assessment as having attention deficit. Participants were randomly allocated to standard care plus up to 30 hours of APT or standard care alone. Both groups were impaired (z≤−2.0) across measures of attention at baseline, with the exception of Paced Auditory Serial Addition Test, which was below average (z≤−1.0). Outcome assessment occurred at 5 weeks and 6 months after randomization. The primary outcome was Integrated Visual Auditory Continuous Performance Test Full-Scale Attention Quotient.
Results—
APT resulted in a significantly greater (
P
<0.01) improvement on the primary outcome than standard care. Difference in change on the Cognitive Failures Questionnaire approached significance (
P
=0.07). Differences on other measures of attention and broader outcomes were not significant.
Conclusion—
APT is a viable and effective means of improving attention deficits after incident stroke.
Collapse
Affiliation(s)
- Suzanne L. Barker-Collo
- From the Clinical Training Programme (S.L.B.-C.), Department of Psychology, Faculty of Science, University of Auckland, Auckland, New Zealand; National Research Centre for Stroke (V.L.F.), Applied Neurosciences and Neurorehabilitation, Faculty of Health and Environmental Studies, AUT University, Auckland, New Zealand; Clinical Trials Research Unit (C.M.M.L., V.P.), School of Population Health, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand; The George
| | - Valery L. Feigin
- From the Clinical Training Programme (S.L.B.-C.), Department of Psychology, Faculty of Science, University of Auckland, Auckland, New Zealand; National Research Centre for Stroke (V.L.F.), Applied Neurosciences and Neurorehabilitation, Faculty of Health and Environmental Studies, AUT University, Auckland, New Zealand; Clinical Trials Research Unit (C.M.M.L., V.P.), School of Population Health, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand; The George
| | - Carlene M.M. Lawes
- From the Clinical Training Programme (S.L.B.-C.), Department of Psychology, Faculty of Science, University of Auckland, Auckland, New Zealand; National Research Centre for Stroke (V.L.F.), Applied Neurosciences and Neurorehabilitation, Faculty of Health and Environmental Studies, AUT University, Auckland, New Zealand; Clinical Trials Research Unit (C.M.M.L., V.P.), School of Population Health, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand; The George
| | - Varsha Parag
- From the Clinical Training Programme (S.L.B.-C.), Department of Psychology, Faculty of Science, University of Auckland, Auckland, New Zealand; National Research Centre for Stroke (V.L.F.), Applied Neurosciences and Neurorehabilitation, Faculty of Health and Environmental Studies, AUT University, Auckland, New Zealand; Clinical Trials Research Unit (C.M.M.L., V.P.), School of Population Health, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand; The George
| | - Hugh Senior
- From the Clinical Training Programme (S.L.B.-C.), Department of Psychology, Faculty of Science, University of Auckland, Auckland, New Zealand; National Research Centre for Stroke (V.L.F.), Applied Neurosciences and Neurorehabilitation, Faculty of Health and Environmental Studies, AUT University, Auckland, New Zealand; Clinical Trials Research Unit (C.M.M.L., V.P.), School of Population Health, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand; The George
| | - Anthony Rodgers
- From the Clinical Training Programme (S.L.B.-C.), Department of Psychology, Faculty of Science, University of Auckland, Auckland, New Zealand; National Research Centre for Stroke (V.L.F.), Applied Neurosciences and Neurorehabilitation, Faculty of Health and Environmental Studies, AUT University, Auckland, New Zealand; Clinical Trials Research Unit (C.M.M.L., V.P.), School of Population Health, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand; The George
| |
Collapse
|
48
|
Adams RA, Sherer M, Struchen MA, Nick TG. Post-acute brain injury rehabilitation for patients with stroke. Brain Inj 2009; 18:811-23. [PMID: 15204321 DOI: 10.1080/02699050410001671810] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PRIMARY OBJECTIVE Conduct an investigation of post-acute brain injury rehabilitation (PABIR) for persons with stroke. RESEARCH DESIGN Pre-post-treatment observation study. METHODS AND PROCEDURES Demographic and medical data for 127 persons with stroke admitted for PABIR at a median interval of 87 days post-stroke were abstracted from medical records. Participants' levels of independence and productivity were assessed at admission and discharge. Follow-up data were available for 90 participants at a median interval of 346 days post-discharge. EXPERIMENTAL INTERVENTIONS Not applicable. MAIN OUTCOMES AND RESULTS Participants showed improvements in productivity and independence level from admission to discharge and these gains were maintained at follow-up. Predictors of productivity at discharge were gender and level of independence at admission (Model R(2) = 0.28). Predictors of independence at discharge were similar (Model R(2) = 0.37). CONCLUSION While this investigation has limitations, findings suggest that PABIR is beneficial for some persons with strokes.
Collapse
|
49
|
Feigin VL, Barker-Collo S, McNaughton H, Brown P, Kerse N. Long-term neuropsychological and functional outcomes in stroke survivors: current evidence and perspectives for new research. Int J Stroke 2008; 3:33-40. [PMID: 18705913 DOI: 10.1111/j.1747-4949.2008.00177.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS To appraise the literature on long-term neuropsychological and functional outcomes in stroke survivors and identify the gaps, challenges and future research in this area. BACKGROUND Stroke care resources are scarce, and the number of stroke survivors is likely to increase with the ageing of the population. Thus, evaluating the cost, frequency and prognostic factors of long-terms stroke functional and neuropsychological outcomes is of paramount importance for evidence-based clinical decision making, including the rationale, planning, provision and allocation of health services, and the development of effective interventions. Summary of review Stroke has an enormous physical, emotional and economic impact on the patients, families and society. However, accurate data on frequency, relationship and predictors of various long-term functional (body functioning, activity and participation) outcomes and costs of stroke are scarce, and no accurate and comprehensive data exist on long-term neuropsychological outcomes and their relationships with other functional outcomes poststroke. CONCLUSIONS There is a lack of accurate data on the frequency, relationship and predictors of various long-term functional outcomes and costs of stroke. There is a pressing need for good-quality population-based studies for evaluating the frequency and prognostic factors of long-term functional and neuropsychological outcomes of stroke in various populations.
Collapse
Affiliation(s)
- Valery L Feigin
- Clinical Trials Research Unit, School of Population Health and Department of Medicine, Faculty of Health & Medical Sciences, University of Auckland, Auckland, New Zealand
| | | | | | | | | |
Collapse
|
50
|
Mota JF, Nicolato R. Qualidade de vida em sobreviventes de acidente vascular cerebral: instrumentos de avaliação e seus resultados. JORNAL BRASILEIRO DE PSIQUIATRIA 2008. [DOI: 10.1590/s0047-20852008000200013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJETIVOS: Os objetivos deste estudo foram identificar os instrumentos genéricos e específicos utilizados na avaliação da qualidade de vida (QV) e os seus resultados em sobreviventes de acidente vascular cerebral (AVC). MÉTODOS: Realizou-se revisão da literatura dos últimos dez anos, com população acima de 18 anos, nos bancos de dados MedLine e Lilacs, cujas publicações utilizassem instrumentos padronizados e validados no país de origem. Combinaram-se os descritores quality of life, cerebrovascular accident, stroke, QV e acidente cerebrovascular. RESULTADOS: Consideraram-se relevantes 96 estudos e 31 entram neste trabalho, de acordo com os critérios de inclusão. Foram encontrados cinco tipos diferentes de instrumentos genéricos/perfil, nove genérico/utility e dois específicos. O mais freqüente foi o SF-36, em 45,2% dos estudos. Observou-se que a baixa QV relacionou-se, principalmente, ao déficit da função física, à presença de depressão ou de seus sintomas, ser do sexo feminino e ser mais idoso. De modo geral, os sujeitos no pós-AVC possuíam pior QV do que aqueles que não sofreram o evento. CONCLUSÃO: Foram encontrados 16 instrumentos para avaliação da QV. A baixa QV foi prevalente nos sobreviventes pós-AVC e se correlacionou com a função física, a depressão, o sexo e a idade.
Collapse
Affiliation(s)
| | - Rodrigo Nicolato
- Instituto de Previdência dos Servidores do Estado de Minas Gerais
| |
Collapse
|