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Tang WK, Hui E, Leung TWH. Behavioral disinhibition in stroke. Front Neurol 2024; 15:1345756. [PMID: 38500811 PMCID: PMC10944941 DOI: 10.3389/fneur.2024.1345756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 02/21/2024] [Indexed: 03/20/2024] Open
Abstract
Background Post-stroke behavioral disinhibition (PSBD) is common in stroke survivors and often presents as impulsive, tactless or vulgar behavior. However, it often remains undiagnosed and thus untreated, even though it can lead to a longer length of stay in a rehabilitation facility. The proposed study will aim to evaluate the clinical, neuropsychological and magnetic resonance imaging (MRI) correlates of PSBD in a cohort of stroke survivors and describe its 12-month course. Methods This prospective cohort study will recruit 237 patients and will be conducted at the Neurology Unit of the Prince of Wales Hospital. The project duration will be 24 months. The patients will be examined by multiple MRI methods, including diffusion-weighted imaging, within 1 week after stroke onset. The patients and their caregivers will receive a detailed assessment at a research clinic at 3, 9 and 15 months after stroke onset (T1, T2 and T3, respectively). The disinhibition subscale of the Frontal Systems Behavior Scale (FrSBe) will be completed by each subject and caregiver, and scores ≥65 will be considered to indicate PSBD.A stepwise logistic regression will be performed to assess the importance of lesions in the regions of interest (ROIs), together with other significant variables identified in the univariate analyses. For patients with PSBD at T1, the FrSBe disinhibition scores will be compared between the groups of patients with and without ROI infarcts, using covariance analysis. The demographic, clinical and MRI variables of remitters and non-remitters will be examined again at T2 and T3 by logistic regression. Discussion This project will be the first MRI study on PSBD in stroke survivors. The results will shed light on the associations of lesions in the orbitofrontal cortex, anterior temporal lobe and subcortical brain structures with the risk of PSBD. The obtained data will advance our understanding of the pathogenesis and clinical course of PSBD in stroke, as well as other neurological conditions. The findings are thus likely to be applicable to the large population of patients with neurological disorders at risk of PSBD and are expected to stimulate further research in this field.
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Affiliation(s)
- Wai Kwong Tang
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Edward Hui
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Department of Imaging and Interventional Radiology, Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Thomas Wai Hong Leung
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
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Kumral E, Çetin FE, Özdemir HN, Çelikay H, Özkan S. Post-stroke aggressive behavior in patients wıth first-ever ischemic stroke: underlying clinical and imaging factors. Acta Neurol Belg 2024; 124:55-63. [PMID: 37442871 DOI: 10.1007/s13760-023-02319-6] [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: 02/19/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND Aggression is defined as a complex behavior consisting of a combination of sensory, emotional, cognitive and motor elements. We aimed to examine the relationships between post-stroke aggressive behavior (PSAB) and neuropsychological and neuroimaging findings. METHODS 380 patients in the stroke unit were classified as aggressive or non-aggressive based on symptoms elicited by the Neuropsychiatric Inventory (NPI) and aggression screening questionnaire. RESULTS Aggressive behavior was detected in 42 (11.1%) of 380 patients who had a first ischemic stroke. Patients with PSAB were older than those without (338 patients) (66.98 + 13.68 vs. 62.61 + 13.06, P = 0.043). Hamilton depression and anxiety scales showed significantly higher rates of depression and anxiety in the PSAB group compared to the non-PSAB group (47.6% vs. 16.3% and 57.1% vs. 15.4%, respectively; P = 0.001). Lesion mapping analysis showed that lesions in patients with PSAB mostly included the lower parietal lobe and lateral frontal gyrus. Multiple regression analysis showed that gender (OR, 2.81; CI%, 1.24-6.39), lateral prefrontal infarction (OR, 6.43; CI%, 1.51-27.44), parietal infarction (OR, 2.98; CI%, 1.15-7.76), occipital infarction (OR, 2.84; CI%, 1.00-8.06), multiple infarcts (OR, 5.62; CI%, 2.27-13.93), anxiety (OR, 2.06; CI%, 0.89-4.81) and verbal memory deficit (OR, 4.21; CI%, 1.37-12.93) were significant independent predictors of PSAB. CONCLUSION The presence of PSAB may be related to neuropsychiatric symptoms such as high anxiety and verbal memory impairment, and neuroanatomical location of the lesions.
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Affiliation(s)
- Emre Kumral
- Neurology Department, Ege University Medical School Hospital, İzmir, Turkey.
- Medical School, Department of Neurology, Stroke Unit, Ege University, Bornova, 35100, Izmir, Turkey.
| | | | | | - Hande Çelikay
- Neurology Department, Ege University Medical School Hospital, Neuropsychology Unit, İzmir, Turkey
| | - Sevinç Özkan
- Neurology Department, Ege University Medical School Hospital, Neuropsychology Unit, İzmir, Turkey
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Barclay KM, Kilkenny MF, Breen SJ, Ryan OF, Bagot KL, Lannin NA, Thijs V, Cadilhac DA. Denial of Cerebrovascular Events in a National Clinical Quality Registry for Stroke: A Retrospective Cohort Study. J Stroke Cerebrovasc Dis 2021; 31:106210. [PMID: 34864608 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 10/19/2021] [Accepted: 10/28/2021] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVES To investigate cerebrovascular event (CVE) denials reported by registered patients to the Australian Stroke Clinical Registry, and to examine the factors associated with CVE denial. MATERIAL AND METHODS CVE denials reported from January 1, 2017 to June 30, 2018 were followed up with hospitals to verify their discharge diagnosis. CVE denials were compared with all non-CVE denial registrants and a 5% random sub-sample of non-CVE deniers according to patient and clinical characteristics, quality of care indicators and health outcomes. Multilevel, multivariable logistic regression models were used. Factors explored were age, sex, stroke severity, type of stroke, treatment in a stroke unit, length of stay and discharge destination. Level was defined as hospital. RESULTS Overall, 339/23,830 (<2%) CVE denials were reported during the 18-month period. Hospitals confirmed 117 (61%) of CVE denials as a verified diagnosis of stroke or transient ischaemic attack (TIA). Compared to non-CVE deniers, CVE deniers were younger, had a shorter median length of stay (four days versus one day) and were more likely to be diagnosed with a TIA (64%) compared to the other types of stroke (11% intracerebral haemorrhage; 20% ischaemic; 5% undetermined). CONCLUSION Very few patients denied their CVE, with the majority of denials subsequently confirmed as eligible for registry inclusion. Diagnosis of a TIA and shorter length of stay were associated with CVE denial. These findings provide evidence that very few cases are incorrectly entered into a national registry, and highlight the characteristics of those unlikely to accept their clinical diagnosis where further education of diagnosis may be needed.
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Affiliation(s)
- Karen M Barclay
- Stroke Theme, The Florey Institute of Neuroscience and Mental Health, Heidelberg, University of Melbourne, Heidelberg, VIC, Australia
| | - Monique F Kilkenny
- Stroke Theme, The Florey Institute of Neuroscience and Mental Health, Heidelberg, University of Melbourne, Heidelberg, VIC, Australia; Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Sibilah J Breen
- Stroke Theme, The Florey Institute of Neuroscience and Mental Health, Heidelberg, University of Melbourne, Heidelberg, VIC, Australia
| | - Olivia F Ryan
- Stroke Theme, The Florey Institute of Neuroscience and Mental Health, Heidelberg, University of Melbourne, Heidelberg, VIC, Australia
| | - Kathleen L Bagot
- Stroke Theme, The Florey Institute of Neuroscience and Mental Health, Heidelberg, University of Melbourne, Heidelberg, VIC, Australia; Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Natasha A Lannin
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia; Alfred Health, Melbourne, VIC, Australia
| | - Vincent Thijs
- Stroke Theme, The Florey Institute of Neuroscience and Mental Health, Heidelberg, University of Melbourne, Heidelberg, VIC, Australia; Department of Neurology, Austin Health, Heidelberg, VIC, Australia
| | - Dominique A Cadilhac
- Stroke Theme, The Florey Institute of Neuroscience and Mental Health, Heidelberg, University of Melbourne, Heidelberg, VIC, Australia; Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia.
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Wijeratne T, Sales C, Wijeratne C, Jakovljevic M. Happiness: A Novel Outcome Measure in Stroke? Ther Clin Risk Manag 2021; 17:747-754. [PMID: 34349515 PMCID: PMC8327473 DOI: 10.2147/tcrm.s307587] [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: 02/20/2021] [Accepted: 07/06/2021] [Indexed: 12/02/2022] Open
Abstract
In this narrated review, we draw attention to the use of happiness as a novel outcome measure in clinical research studies regarding patients with stroke. Commonly used outcome measures in clinical trials in stroke rehabilitation include the modified Rankin Score (mRS), Functional Impairment Measures (FIM), Barthel Index and quality of life (QoL). Despite being a part of QoL, happiness is arguably a significant construct on its own. While QoL assesses perceptions of various extrinsic aspects of life, happiness may be used as a measure of subjective enjoyment of life after an illness. We review the literature discussing the use of happiness as a formal outcome measure in stroke care and subacute and long-term stroke rehabilitation. Ultimately we recommend the wider use of happiness as an outcome measure where appropriate in these settings. ![]()
Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/iJY-DFLp2WU
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Affiliation(s)
- Tissa Wijeratne
- Department of Neurology, Sunshine Hospital, Western Health, St. Albans, VIC, Australia.,Department of Psychology & Counselling, School of Psychology & Public Health, La Trobe University, Bundoora, VIC, Australia.,Department of Medicine, AIMSS, Melbourne Medical School, University of Melbourne, Sunshine Hospital, St Albans, VIC, Australia.,Department of Medicine, University of Rajarata, Salypura, Anuradhapuraya, Sri Lanka
| | - Carmela Sales
- Department of Neurology, Sunshine Hospital, Western Health, St. Albans, VIC, Australia.,Department of Psychology & Counselling, School of Psychology & Public Health, La Trobe University, Bundoora, VIC, Australia
| | | | - Mihajlo Jakovljevic
- Department Global Health Economics & Policy, University of Kragujevac Faculty of Medical Sciences, Kragujevac, Serbia.,Institute of Comparative Economic Studies, Hosei University Faculty of Economics, Tokyo, Japan
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Stolwyk RJ, Low T, Gooden JR, Lawson DW, O’Connell EL, Thrift AG, New PW. A longitudinal examination of the frequency and correlates of self-reported neurobehavioural disability following stroke. Disabil Rehabil 2020; 44:2823-2831. [DOI: 10.1080/09638288.2020.1840637] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Renerus J. Stolwyk
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Clayton, Australia
- Monash-Epworth Rehabilitation Research Centre, Richmond, Australia
| | - Tiffany Low
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Clayton, Australia
| | - James R. Gooden
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Clayton, Australia
- Monash-Epworth Rehabilitation Research Centre, Richmond, Australia
| | - David W. Lawson
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Clayton, Australia
- Monash-Epworth Rehabilitation Research Centre, Richmond, Australia
| | - Elissa L. O’Connell
- Rehabilitation and Aged Care Services, Medicine Program, Monash Health, Cheltenham, Australia
| | - Amanda G. Thrift
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
| | - Peter W. New
- Rehabilitation and Aged Care Services, Medicine Program, Monash Health, Cheltenham, Australia
- Epworth-Monash Rehabilitation Medicine Unit, Monash University, Clayton, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Australia
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Abstract
AIM In this narrative review we aimed to describe how stroke affects emotions and update the readers on the emotional disturbances that occur after stroke. METHODS We searched Medline from 1.1.2013 to 1.7.2019, personal files and references of selected publications. All retrieved systematic reviews and randomized controlled trials were included. Other references were selected by relevance. SUMMARY OF REVIEW The emotional response includes a reactive behavior with arousal, somatic, motivational and motor components, and a distinctive cognitive and subjective affective experience. Emotional category responses and experiences after stroke can show dissociations between the behavioral response and the cognitive and affective experiences. Emotional disturbances that often occur after stroke include fear, anger, emotional indifference, lack of understanding of other emotions, and lack of control of emotional expression. Emotional disturbances limit social reintegration of the persons with stroke and are a source of caregiver burnout. The evidence to support the management of the majority of emotional disorders in stroke survivors is currently weak and of low or very low methodologic quality. An exception are the disorders of emotional expression control where antidepressants can have a strong beneficial effect, by reducing the number and duration of the uncontrollable episodes of crying or laughing. CONCLUSION Our current knowledge of the emotional disorders that occurs in acute stroke patients and in stroke survivors is heterogeneous and limited. Joint efforts of different research approaches, methodologies and disciplines will improve our current understanding on emotional disorder after stroke and indicate rational pathways to manage them.
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Affiliation(s)
- José M Ferro
- Serviço de Neurologia, Departamento de Neurociências e Saúde Mental, Hospital Santa Maria-,Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal.,Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Ana C Santos
- Hospital do Mar - Cuidados Especializados Lisboa, Bobadela, Portugal
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Stolwyk RJ, O'Connell E, Lawson DW, Thrift AG, New PW. Neurobehavioral disability in stroke patients during subacute inpatient rehabilitation: prevalence and biopsychosocial associations. Top Stroke Rehabil 2018; 25:1-8. [PMID: 30213238 DOI: 10.1080/10749357.2018.1499301] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 07/07/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND AND OBJECTIVES There are scarce data on post-stroke neurobehavioral disability (NBD). The aim of this study was to identify the prevalence of NBD in a subacute inpatient stroke population and examine potential associations with demographic, stroke-related, functional and psychosocial variables. METHODS 82 survivors of stroke were consecutively recruited during their inpatient rehabilitation admission. Nursing staff rated NBD in patients using the St Andrews -Swansea Neurobehavioral Outcome Scale (SASNOS). Measures of patient functional independence (FIM), cognition (MoCA), and mood symptoms (HADS) were collected in addition to nursing reports of whether observed NBD negatively impacted on the patient or those around them. RESULTS NBD relating to interpersonal relationships (44.4% of participants) and cognition (52.4%) were highly prevalent within the sample while NBD relating to inhibition (1.2%), aggression (3.6%), and communication (2.5%) were relatively rare. Presence of NBD was significantly associated with reduced functional independence (rs=0.39, p < 0.01) and associated with trends in cognitive impairment (rs=0.29, p = 0.03), increased anxiety (rs=-0.43, p = 0.02) and depressive symptoms (rs=-0.43, p = 0.02). Presence of NBD was significantly correlated with negative impact to the patient and those around them across all SASNOS domains (rs range 0.42 - 0.45, all p ≤ 0.01). CONCLUSIONS NBD is common within a subacute stroke inpatient population, particularly interpersonal and cognitive difficulties and preliminary analyses indicate associations with reduced functional ability, cognition and mood. There is a need to provide education and support to clinicians to facilitate routine assessment and management of NBD following stroke.
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Affiliation(s)
- Renerus J Stolwyk
- a Monash Institute of Cognitive and Clinical Neurosciences , School of Psychological Sciences, Monash University , Melbourne , Victoria , Australia
- b Monash-Epworth Rehabilitation Research Centre , Melbourne , Victoria , Australia
| | - Elissa O'Connell
- c Rehabilitation and Aged Care Services , Medicine Program, Monash Health , Melbourne , Australia
| | - David W Lawson
- a Monash Institute of Cognitive and Clinical Neurosciences , School of Psychological Sciences, Monash University , Melbourne , Victoria , Australia
- b Monash-Epworth Rehabilitation Research Centre , Melbourne , Victoria , Australia
| | - Amanda G Thrift
- d Department of Medicine, School of Clinical Sciences at Monash Health , Monash University , Melbourne , Victoria , Australia
| | - Peter W New
- e Epworth-Monash Rehabilitation Medicine Unit , Monash University , Melbourne , Victoria , Australia
- f Department of Epidemiology and Preventive Medicine , Monash University , Melbourne , Victoria , Australia
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Abzhandadze T, Rafsten L, Lundgren-Nilsson Å, Sunnerhagen KS. Feasibility of Cognitive Functions Screened With the Montreal Cognitive Assessment in Determining ADL Dependence Early After Stroke. Front Neurol 2018; 9:705. [PMID: 30210432 PMCID: PMC6119694 DOI: 10.3389/fneur.2018.00705] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 08/03/2018] [Indexed: 11/13/2022] Open
Abstract
Objective: To investigate the feasibility of assessing cognitive function using the Montreal Cognitive Assessment (MoCA) given 36-48 h post stroke to explain dependence in activities of daily living (ADL). Methods: This is a cross-sectional, exploratory study. Cognitive function and basic ADL were assessed with the MoCA and the Barthel Index (BI), respectively, within 36-48 h of admission. Neurological functions were assessed with the National Institute of Health Stroke Scale (NIHSS) upon admittance to the hospital. Binary logistic regression analyses were performed to assess the feasibility of the MoCA in explaining ADL dependence. Results: Data were available for 550 patients (42% females, mean age 69 years). Moderate correlations (rs > +0.30, p < 0.001) were found between the total score on the BI, MoCA, and visuospatial/executive functions. The regression analysis model including only MoCA as an independent variable had a high sensitivity for explaining ADL dependence. However, the model with independent variables of MoCA, NIHSS, and age had the best area under the curve value (0.74). Conclusions: Cognitive functions assessed with the MoCA partly explain ADL dependence 36-48 h post stroke. Stroke-related neurological deficits and age should be additional considerations.
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Affiliation(s)
- Tamar Abzhandadze
- Institute of Neuroscience and Physiology, Rehabilitation medicine, University of Gothenburg, Gothenburg, Sweden.,Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lena Rafsten
- Institute of Neuroscience and Physiology, Rehabilitation medicine, University of Gothenburg, Gothenburg, Sweden.,Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Åsa Lundgren-Nilsson
- Institute of Neuroscience and Physiology, Rehabilitation medicine, University of Gothenburg, Gothenburg, Sweden.,Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
| | - Katharina S Sunnerhagen
- Institute of Neuroscience and Physiology, Rehabilitation medicine, University of Gothenburg, Gothenburg, Sweden.,Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
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Abstract
INTRODUCTION Mood and emotional disturbances are common in stroke patients. Out of diverse post-stroke emotional disturbances, depression, anxiety, emotional incontinence, anger proneness, and fatigue are frequent and important symptoms. These symptoms are distressing for both the patients and their caregivers, and negatively influence the patient's quality of life. The emotional symptoms are not apparent and are therefore often neglected by neurologists. Their phenomenology, predicting factors, and pathophysiology have been under-studied, and are under-recognized. In addition, well-designed clinical trials targeting on these symptoms are rare. Areas covered: This review will describe some of the most common or relevant post-stroke mood and emotional disturbances. The phenomenology, factors or predictors, and presumed etio-pathogenesis will be described. Current pharmacological and non-pharmacological management strategies of these diverse emotional disturbances will be discussed based on different pathophysiological mechanisms. Expert commentary: It is fortunate that these mood and emotional disturbances can be treated by various methods, including pharmacological and non-pharmacological therapy. To administer the appropriate therapy, we must understand the similarities and differences in the pathophysiological mechanisms associated with these emotional symptoms.
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Affiliation(s)
- Jong S Kim
- a Department of Neurology , University of Ulsan, Asan Medical Center , Seoul , Republic of Korea
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Flowers HL, Skoretz SA, Silver FL, Rochon E, Fang J, Flamand-Roze C, Martino R. Poststroke Aphasia Frequency, Recovery, and Outcomes: A Systematic Review and Meta-Analysis. Arch Phys Med Rehabil 2016; 97:2188-2201.e8. [DOI: 10.1016/j.apmr.2016.03.006] [Citation(s) in RCA: 161] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 03/10/2016] [Accepted: 03/11/2016] [Indexed: 11/28/2022]
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Abstract
OBJECTIVE To assess the relationship between states of anger and stroke. METHODS Systematic review of the literature. RESULTS In total, 21 papers were selected for the systematic review of data published on the subject of anger and stroke. A state of anger may be a risk factor for stroke, as well as a consequence of brain lesions affecting specific areas that are caused by a stroke. Scales to assess anger varied among authors. There was no consensus regarding the area of brain lesions that might lead to a state of anger. Although some authors agreed that lesions on the right side led to angrier behaviour, others found that lesions on the left side were more relevant to anger. Likewise, there was no consensus regarding the prevalence of anger pre or post-stroke. Some authors did not even find that these two conditions were related. CONCLUSION Although most authors have accepted that there is a relationship between anger and stroke, studies with uniform methodology need to be conducted if this association is to be properly evaluated and understood.
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Lau CG, Tang WK, Liu XX, Liang HJ, Liang Y, Wong A, Mok V, Ungvari GS, Wong KS, Kim JS, Paradiso S. Poststroke agitation and aggression and social quality of life: a case control study. Top Stroke Rehabil 2016; 24:126-133. [PMID: 27603431 DOI: 10.1080/10749357.2016.1212564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND OBJECTIVE Aggression and agitation are common after a stroke. The association between agitation/aggression following stroke and Health-Related Quality of Life (HRQoL) in stroke survivors is unknown. This study aimed to examine the association between agitation/aggression and HRQoL in Chinese stroke survivors. METHODS Three hundred and twenty-four stroke patients entered this cross-sectional study. Agitation/aggression was assessed using the Chinese version of Neuropsychiatric Inventory (CNPI). HRQoL was measured with the Stroke Specific Quality of Life (SSQoL). RESULTS Three months after the index stroke, agitation/aggression was found in 60 (18.5%) patients. In the agitation/aggression group, 44 patients (73.3%) showed passive agitation/aggression, whereas 16 (26.7%) displayed passive and active agitation/aggression. No patients showed only active agitation/aggression. Patients with agitation/aggression were more likely to have history of diabetes and greater severity of depression, as well as lower SSQoL total score and Personality Changes and Social Role scores. Controlling for diabetes and depression severity did not alter the above results. The Energy and Thinking scores of the SSQoL were significantly lower in the passive/active agitation/aggression group relative to the passive agitation/aggression group (adjusted for CNPI aggression/agitation score). CONCLUSION In this study sample, agitation/aggression was preponderantly of the passive type and was associated with poorer HRQoL independently from depression or medical conditions. Patients with both passive and active agitation/aggression had lower Quality of Life (QoL) than patients with only passive agitation/aggression. The causality of the association between low QoL and agitation/aggression needs to be explored in future studies.
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Affiliation(s)
- Chieh Grace Lau
- a Department of Psychiatry , Chinese University of Hong Kong , Hong Kong SAR , China
| | - Wai Kwong Tang
- a Department of Psychiatry , Chinese University of Hong Kong , Hong Kong SAR , China
| | - Xiang Xin Liu
- a Department of Psychiatry , Chinese University of Hong Kong , Hong Kong SAR , China
| | - Hua Jun Liang
- a Department of Psychiatry , Chinese University of Hong Kong , Hong Kong SAR , China
| | - Yan Liang
- a Department of Psychiatry , Chinese University of Hong Kong , Hong Kong SAR , China
| | - Adrian Wong
- b Department of Medicine and Therapeutics , Chinese University of Hong Kong , Hong Kong SAR , China
| | - Vincent Mok
- b Department of Medicine and Therapeutics , Chinese University of Hong Kong , Hong Kong SAR , China
| | - Gabor S Ungvari
- c School of Psychiatry & Clinical Neurosciences , University of Western Australia , Perth , Australia.,d Department of Psychiatry , University of Notre Dame Australia/Marian Centre , Perth , Australia
| | - Ka Sing Wong
- b Department of Medicine and Therapeutics , Chinese University of Hong Kong , Hong Kong SAR , China
| | - Jong S Kim
- e Department of Neurology , Asan Medical Center, University of Ulsan , Seoul , Korea
| | - Sergio Paradiso
- f Una Mano per la Vita - Association of Families and their Doctors , Catania , Italy.,g Facultad de Psicología , Universidad Diego Portales , Santiago , Chile
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Kim JS. Post-stroke Mood and Emotional Disturbances: Pharmacological Therapy Based on Mechanisms. J Stroke 2016; 18:244-255. [PMID: 27733031 PMCID: PMC5066431 DOI: 10.5853/jos.2016.01144] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 09/07/2016] [Accepted: 09/08/2016] [Indexed: 11/11/2022] Open
Abstract
Post-stroke mood and emotional disturbances are frequent and diverse in their manifestations. Out of the many post-stroke disturbances, post-stroke depression, post-stroke anxiety, post-stroke emotional incontinence, post-stroke anger proneness, and post-stroke fatigue are frequent and important symptoms. These symptoms are distressing for both the patients and their caregivers, and negatively influence the patient's quality of life. Unfortunately, these emotional disturbances are not apparent and are therefore often unnoticed by busy clinicians. Their phenomenology, predicting factors, and pathophysiology have been under-studied, and are under-recognized. In addition, well-designed clinical trials regarding these symptoms are rare. Fortunately, these mood and emotional disturbances may be treated or prevented by various methods, including pharmacological therapy. To administer the appropriate therapy, we have to understand the phenomenology and the similarities and differences in the pathophysiological mechanisms associated with these emotional symptoms. This narrative review will describe some of the most common or relevant post-stroke mood and emotional disturbances. The phenomenology, factors or predictors, and relevant lesion locations will be described, and pharmacological treatment of these emotional disturbances will be discussed based on presumable pathophysiological mechanisms.
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Affiliation(s)
- Jong S. Kim
- Department of Neurology, University of Ulsan, Asan Medical Center, Seoul, Korea
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A Framework to Support Cognitive Behavior Therapy for Emotional Disorder After Stroke. COGNITIVE AND BEHAVIORAL PRACTICE 2016. [DOI: 10.1016/j.cbpra.2015.02.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Toscano M, Viganò A, Puledda F, Verzina A, Rocco A, Lenzi GL, Di Piero V. Serotonergic Correlation with Anger and Aggressive Behavior in Acute Stroke Patients: An Intensity Dependence of Auditory Evoked Potentials (IDAP) Study. Eur Neurol 2014; 72:186-92. [DOI: 10.1159/000362268] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Accepted: 03/16/2014] [Indexed: 11/19/2022]
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Abstract
The most common neuropsychiatric outcomes of stroke are depression, anxiety, fatigue, and apathy, which each occur in at least 30% of patients and have substantial overlap of prevalence and symptoms. Emotional lability, personality changes, psychosis, and mania are less common but equally distressing symptoms that are also challenging to manage. The cause of these syndromes is not known, and there is no clear relation to location of brain lesion. There are important gaps in knowledge about how to manage these disorders, even for depression, which is the most studied syndrome. Further research is needed to identify causes and interventions to prevent and treat these disorders.
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Affiliation(s)
- Maree L Hackett
- The George Institute for Global Health, The University of Sydney, Sydney, NSW, Australia; University of Central Lancashire, Preston, UK
| | - Sebastian Köhler
- Alzheimer Centre Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - John T O'Brien
- Department of Psychiatry, University of Cambridge, Cambridge, UK; Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
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Abstract
PRIMARY OBJECTIVES This study examined the role of expressed emotion (EE) in post-stroke depression (PSD) and the extent to which partner/spouse EE interacted with lesion laterality in PSD. The relationship between (i) lesion location and levels of PSD and (ii) levels of EE and levels of PSD were investigated. The role of perceived EE in PSD was also explored. DESIGN Cross-sectional, between-subjects design. METHODS Measures applied to stroke survivors included Extended Activities of Daily Living Scale (EADL), Post-Stroke Depression Rating Scale (PSDRS) and Level of Expressed Emotion Scale (LEE); spouses/partners completed the LEE. RESULTS The interaction between lesion laterality and levels of partner/spouse EE on PSD was not statistically significant (p = 0.63, F = 0.24, df = 1,56). However, a clear relationship was found between lesion laterality and PSD (p = 0.028). As levels of spouse/partner LEE scores increased, levels of PSD also increased (p = 0.039). Perceived EE scores illustrated a significant interaction between lesion laterality and levels of EE on PSD (p = 0.005, F = 8.591, df = 1,56). CONCLUSION Whilst spouse/partner EE scores showed no interaction with lesion laterality to determine levels of PSD, a significant interaction was found when compared with stroke survivor perceived EE scores. Furthermore, left hemisphere (LHS) stroke survivors reported higher levels of depression than right hemisphere (RHS) stroke survivors. As levels of EE increased, PSD also increased, with LHS being greater than RHS.
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Affiliation(s)
- Naheed Rashid
- Department of Clinical Psychology and Psychological Therapies, The University of Hull, Hull, UK.
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Caeiro L, Ferro JM, Pinho e Melo T, Canhão P, Figueira ML. Post-Stroke Apathy: An Exploratory Longitudinal Study. Cerebrovasc Dis 2013; 35:507-13. [DOI: 10.1159/000350202] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Accepted: 02/20/2013] [Indexed: 11/19/2022] Open
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Psychometric properties and feasibility of instruments used to assess awareness of deficits after acquired brain injury: a systematic review. J Head Trauma Rehabil 2013; 27:433-42. [PMID: 21897287 DOI: 10.1097/htr.0b013e3182242f98] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Unawareness of deficits after acquired brain injury (ABI) is often reported in the clinic. Several methods have been developed to measure a patient's awareness of deficits after ABI; however, no criterion standard currently exists to measure this phenomenon. OBJECTIVE To review all instruments for measuring awareness of deficits and evaluate their psychometric and conceptual properties as well as their feasibility. METHODS Systematic literature search for available awareness measurement instruments used in experimental ABI studies. Instruments were divided into the following 4 assessment methods: clinician ratings, structured interviews, performance-based discrepancy, and self-other rating discrepancy methods. The quality of the instruments was evaluated. RESULTS The literature search identified 39 instruments and 8 of these were selected. The following 3 instruments stood out in terms of quality: Self-Awareness of Deficits Interview, Patient Competency Rating Scale, and Awareness Questionnaire. CONCLUSION Although these quantitative instruments are useful tools in research, they have limited utility in the clinic because they only measure intellectual awareness. Therefore, in addition to these instruments, qualitative tools should also be used to gain a complete view of a patient's awareness problem.
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Caeiro L, Ferro JM, Costa J. Apathy Secondary to Stroke: A Systematic Review and Meta-Analysis. Cerebrovasc Dis 2013; 35:23-39. [DOI: 10.1159/000346076] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Accepted: 11/22/2012] [Indexed: 11/19/2022] Open
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Spurgeon L, Humphreys G, James G, Sackley C. A Q-Methodology Study of Patients' Subjective Experiences of TIA. Stroke Res Treat 2012; 2012:486261. [PMID: 22848864 PMCID: PMC3398653 DOI: 10.1155/2012/486261] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Revised: 04/17/2012] [Accepted: 04/19/2012] [Indexed: 11/17/2022] Open
Abstract
Background. An expanding body of research has focused on a range of consequences of TIA. However, no work has been conducted on the patient's subjective experience of TIA. Aim. To capture patients' first-hand experiences of TIA. Method. Using Q-methodology which employs both qualitative and quantitative approaches, 39 statements relating to the clinical, physical, affective, and psychological impact of TIA were distilled from the literature and from patient narratives. Consistent with conventional Q-methodology, a purposive sample of twentythree post-TIA patients sorted these statements into a normally-distributed 39-cell grid, according to the extent to which each represented their experience of TIA. Results. Casewise factoranalysis was conducted on the sorted statements. Eight factors emerged which were labelled: lack of knowledge/awareness of TIA; life impact; anxiety; interpersonal impact; depression; physical consequences; cognitive avoidance/denial; constructive optimism. Conclusions. Five of the eight factors confirmed existing research on the impact of TIA, but three new issues emerged: deep-seated anxiety, denial and constructive optimism. The emerging perspectives highlight areas to target in the management of TIA and could inform health education messages, patient information, individualised caremanagement, and enhancement of coping strategies. With development, the findings could be used as a basis for psychometric risk assessment of TIA patients.
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Affiliation(s)
- Laura Spurgeon
- Department of Primary Care, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Glyn Humphreys
- Department of Experimental Psychology, University of Oxford, OX1 3UD, UK
| | - Gill James
- Department of Nursing and Physiotherapy, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Cath Sackley
- Department of Primary Care, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
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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]
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Gillespie DC, Joice S, Lawrence M, Whittick J. Interventions for post-stroke disturbances of mood and emotional behaviour: recommendations from SIGN 118. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2011. [DOI: 10.12968/ijtr.2011.18.3.166] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- David C Gillespie
- Department of Clinical Psychology, Astley Ainslie Hospital, Edinburgh
| | - Sara Joice
- Social Dimensions of Health Institute/School of Nursing and Midwifery, University of Dundee, Dundee
| | - Maggie Lawrence
- Centre for Evidence Based Care of Older People, Glasgow Caledonian University, Glasgow
| | - Janice Whittick
- Department of Clinical Psychology, Stratheden Hospital, Cupar, Scotland
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Vocat R, Staub F, Stroppini T, Vuilleumier P. Anosognosia for hemiplegia: a clinical-anatomical prospective study. Brain 2010; 133:3578-97. [PMID: 21126995 DOI: 10.1093/brain/awq297] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Roland Vocat
- Laboratory for Behavioural Neurology and Imaging of Cognition, Department of Neuroscience and Clinic of Neurology, University of Geneva School of Medicine, 1211 Geneva, Switzerland.
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Carota A, Bogousslavsky J. Stroke-related psychiatric disorders. HANDBOOK OF CLINICAL NEUROLOGY 2009; 93:623-651. [PMID: 18804672 DOI: 10.1016/s0072-9752(08)93031-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Antonio Carota
- Centre Hospitalier Universitaire Vaudois-CHUV, Lausanne, Switzerland.
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Lee ACK, Tang SW, Yu GKK, Cheung RTF. The smiley as a simple screening tool for depression after stroke: A preliminary study. Int J Nurs Stud 2008; 45:1081-9. [PMID: 17707824 DOI: 10.1016/j.ijnurstu.2007.05.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2006] [Revised: 03/13/2007] [Accepted: 05/14/2007] [Indexed: 10/22/2022]
Abstract
UNLABELLED In Hong Kong, there is a paucity of evidence to support which tool is superior in measuring depression after stroke (DAS). A simple, non-language-based, culturally neutral, non-verbal and easy to apply tool that is not highly dependent on training will be desirable. OBJECTIVES The present study aimed to examine the clinical utility of three smiley pictures in detecting DAS for older Chinese patients at 1 month after first-ever ischemic stroke. METHODS This was a cross-sectional study. A total of 253 stroke patients were interviewed by a research nurse at 1-month follow-up. RESULTS Taking Diagnostic and Statistic Manual (DSM IV) as the gold standard, the measurement properties of emoticon (sad) in terms of sensitivity, specificity, positive and negative predictive values, as well as Kappa's value were found comparable to Geriatric Depression Scale (GDS). The emoticon (happy) demonstrated a highly significant inverse relationship with all depression assessment tools (p<0.001). It was also found that the emoticon (flat) could capture 98% of all depressed subjects identified by DSM IV, although its predictive values were less satisfactory. CONCLUSIONS The smiley pictures seemed to fulfil the requirements for early and prompt screening among older patients. Cultural implication regarding emotions dissipation among Chinese patients should be further studied.
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Affiliation(s)
- A C K Lee
- Department of Nursing Studies, 4/F, William MW Mong Bldg., Academic and Administration Block, Faculty of Medicine, The University of Hong Kong, 21, Sassoon Road, Pokfulam, Hong Kong.
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Townend E, Brady M, McLaughlan K. A Systematic Evaluation of the Adaptation of Depression Diagnostic Methods for Stroke Survivors Who Have Aphasia. Stroke 2007; 38:3076-83. [DOI: 10.1161/strokeaha.107.484238] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Ellen Townend
- From the NMAHP Research Unit (E.T., M.B.), Buchannan House, Glasgow Caledonian University, UK; and the NHS Grampian (K.N.), Department of Speech and Language Therapy, Spynie Hospital, Morayshire, UK
| | - Marian Brady
- From the NMAHP Research Unit (E.T., M.B.), Buchannan House, Glasgow Caledonian University, UK; and the NHS Grampian (K.N.), Department of Speech and Language Therapy, Spynie Hospital, Morayshire, UK
| | - Kirsty McLaughlan
- From the NMAHP Research Unit (E.T., M.B.), Buchannan House, Glasgow Caledonian University, UK; and the NHS Grampian (K.N.), Department of Speech and Language Therapy, Spynie Hospital, Morayshire, UK
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Townend E, Brady M, McLaughlan K. Exclusion and inclusion criteria for people with aphasia in studies of depression after stroke: a systematic review and future recommendations. Neuroepidemiology 2007; 29:1-17. [PMID: 17898519 DOI: 10.1159/000108913] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND/AIMS A third of individuals are depressed following stroke. A similar proportion have aphasia. The extent of their inclusion in depression following stroke studies affects the generalizability of findings. METHODS We systematically reviewed published studies (to December 2005) that diagnosed depression following stroke. We identified aphasia screening methods, aphasia exclusion and inclusion criteria and respective numbers of individuals with aphasia. RESULTS Of 129 studies (n = 19,183), aphasia screening methods were only reported by 57 (31 described a published aphasia-specific tool). No mention of aphasia was made in 13 studies. Most studies (92, 71%) reported some exclusion of people with aphasia (49 reported how many: n = 3,082, range = 2-554). Almost half of the studies (60, 47%) actually reported participants with aphasia (37 specified numbers: n = 829, range = 5-60). Aphasia exclusion or inclusion was not associated with sample source (community, acute hospital, other) or study purpose (observation, intervention, screening). Studies that reported screening for aphasia were more likely to describe aphasia exclusion and inclusion criteria and include participants with aphasia. CONCLUSION Aphasia screening, exclusion and inclusion criteria reporting across studies of depression following stroke has been highly inconsistent. This impairs the interpretation of generalizability. Improved aphasia screening and reporting of exclusion and inclusion criteria are urgently recommended.
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Affiliation(s)
- Ellen Townend
- NMAHP Research Unit, Glasgow Caledonian University, Glasgow, UK.
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Eslinger PJ, Tranel D. Integrative study of cognitive, social, and emotional processes in clinical neuroscience. Cogn Behav Neurol 2005; 18:1-4. [PMID: 15761271 DOI: 10.1097/01.wnn.0000152206.73195.1e] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Paul J Eslinger
- Department of Neurology, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania 17033-0850, USA.
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