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Egorova-Brumley N, Dhollander T, Khan W, Khlif MS, Ebaid D, Brodtmann A. Changes in White Matter Microstructure Over 3 Years in People With and Without Stroke. Neurology 2023; 100:e1664-e1672. [PMID: 36792378 PMCID: PMC10115498 DOI: 10.1212/wnl.0000000000207065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 01/03/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Cerebral white matter health can be estimated by MRI-derived indices of microstructure. White matter dysfunction is increasingly recognized as a contributor to neurodegenerative disorders affecting cognition and to functional outcomes after stroke. Reduced indices of white matter microstructure have been demonstrated cross-sectionally in stroke survivors compared with stroke-free participants, but longitudinal changes in the structure of white matter after stroke remain largely unexplored. We aimed to characterize white matter micro- and macrostructure over 3 years after stroke and study associations with white matter metrics and cognitive functions. METHODS Patients with first-ever or recurrent ischemic stroke of any etiology in any vascular territory were compared with stroke-free age- and sex-matched controls. Those diagnosed with hemorrhagic stroke, TIA, venous infarction, or significant medical comorbidities, psychiatric and neurodegenerative disorders, substance abuse, or history of dementia were excluded. Diffusion-weighted MRI data at 3, 12, and 36 months were analyzed using a longitudinal fixel-based analysis, sensitive to fiber tract-specific differences within a voxel. It was used to examine whole-brain white matter degeneration in stroke compared with control participants. We studied microstructural differences in fiber density and macrostructural changes in fiber-bundle cross-section, in relation to cognitive performance. Analyses were performed controlling for age, intracranial volume, and education (family-wise error-corrected p < 0.05, nonparametric testing over 5,000 permutations). RESULTS We included 71 participants with stroke (age 66 ± 12 years, 22 women) and 36 controls (age 69 ± 5 years, 13 women). We observed extensive white matter structural degeneration across the whole brain, particularly affecting the thalamic, cerebellar, striatal, and superior longitudinal tracts and corpus callosum. Importantly, follow-up regression analyses in 72 predefined tracts showed that the decline in fiber density and cross-section from 3 months to 3 years was associated with worse cognitive performance at 3 years after stroke, especially affecting visuospatial processing, processing speed, language, and recognition memory. DISCUSSION We conclude that white matter neurodegeneration in ipsi- and contralesional thalamic, striatal, and cerebellar tracts continues to be greater in stroke survivors compared with stroke-free controls. White matter degeneration persists even years after stroke and is associated with poststroke cognitive impairment. TRIAL REGISTRATION INFORMATION ClinicalTrails.gov NCT02205424.
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Affiliation(s)
- Natalia Egorova-Brumley
- From the Melbourne School of Psychological Sciences (N.E.-B.), University of Melbourne; Dementia Theme (N.E.-B., W.K., M.S.K., D.E., A.B.), The Florey Institute of Neuroscience and Mental Health; Developmental Imaging (T.D.), Murdoch Children's Research Institute; and Cognitive Health Initiative (M.S.K., A.B.), Central Clinical School (CCS), Monash University, Melbourne, Australia.
| | - Thijs Dhollander
- From the Melbourne School of Psychological Sciences (N.E.-B.), University of Melbourne; Dementia Theme (N.E.-B., W.K., M.S.K., D.E., A.B.), The Florey Institute of Neuroscience and Mental Health; Developmental Imaging (T.D.), Murdoch Children's Research Institute; and Cognitive Health Initiative (M.S.K., A.B.), Central Clinical School (CCS), Monash University, Melbourne, Australia
| | - Wasim Khan
- From the Melbourne School of Psychological Sciences (N.E.-B.), University of Melbourne; Dementia Theme (N.E.-B., W.K., M.S.K., D.E., A.B.), The Florey Institute of Neuroscience and Mental Health; Developmental Imaging (T.D.), Murdoch Children's Research Institute; and Cognitive Health Initiative (M.S.K., A.B.), Central Clinical School (CCS), Monash University, Melbourne, Australia
| | - Mohamed Salah Khlif
- From the Melbourne School of Psychological Sciences (N.E.-B.), University of Melbourne; Dementia Theme (N.E.-B., W.K., M.S.K., D.E., A.B.), The Florey Institute of Neuroscience and Mental Health; Developmental Imaging (T.D.), Murdoch Children's Research Institute; and Cognitive Health Initiative (M.S.K., A.B.), Central Clinical School (CCS), Monash University, Melbourne, Australia
| | - Deena Ebaid
- From the Melbourne School of Psychological Sciences (N.E.-B.), University of Melbourne; Dementia Theme (N.E.-B., W.K., M.S.K., D.E., A.B.), The Florey Institute of Neuroscience and Mental Health; Developmental Imaging (T.D.), Murdoch Children's Research Institute; and Cognitive Health Initiative (M.S.K., A.B.), Central Clinical School (CCS), Monash University, Melbourne, Australia
| | - Amy Brodtmann
- From the Melbourne School of Psychological Sciences (N.E.-B.), University of Melbourne; Dementia Theme (N.E.-B., W.K., M.S.K., D.E., A.B.), The Florey Institute of Neuroscience and Mental Health; Developmental Imaging (T.D.), Murdoch Children's Research Institute; and Cognitive Health Initiative (M.S.K., A.B.), Central Clinical School (CCS), Monash University, Melbourne, Australia
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Zhang Y, Xing Y, Li C, Hua Y, Hu J, Wang Y, Ya R, Meng Q, Bai Y. Mirror therapy for unilateral neglect after stroke: A systematic review. Eur J Neurol 2021; 29:358-371. [PMID: 34558762 DOI: 10.1111/ene.15122] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 09/10/2021] [Accepted: 09/11/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND PURPOSE The effect of mirror therapy for unilateral neglect after stroke currently remains uncertain. METHODS This systematic review investigated the effect of mirror therapy on neglect and daily living activities in patients with unilateral neglect after stroke when compared with no treatment, sham mirror therapy, or routinely applied therapies only. We performed a systematic electronic search of PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, and Wanfang Data to identify relevant randomized control trials (RCTs). RESULTS We included five RCTs in the data synthesis. Mirror therapy (combined or not with other treatments) was more effective in improving neglect as compared with sham mirror therapy or no treatment (combined or not with the other therapies; standard mean difference [SMD] = 1.62, 95% confidence interval [CI] = 1.03-2.21, p < 0.00001). Mirror therapy (combined or not with other therapies) was effective in improving daily living activities as compared with sham mirror therapy or no treatment (combined or not with the other therapies; SMD = 2.09, 95% CI = 0.63-3.56, p = 0.005). CONCLUSIONS Our results show that mirror therapy effectively improves neglect and daily living activities in patients with unilateral neglect after stroke. Future trials with high methodological quality and larger sample sizes are needed to determine the immediate and long-term effect of appropriate mirror therapy protocol for unilateral neglect.
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Affiliation(s)
- Yuqian Zhang
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Ying Xing
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Congqin Li
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yan Hua
- Department of Rehabilitation Medicine, Huashan Hospital North, Fudan University, Shanghai, China
| | - Jian Hu
- Department of Rehabilitation Medicine, Huashan Hospital North, Fudan University, Shanghai, China
| | - Yuyuan Wang
- Department of Rehabilitation Medicine, Huashan Hospital North, Fudan University, Shanghai, China
| | - Ru Ya
- Department of Rehabilitation Medicine, Shanghai No. 3 Rehabilitation Hospital, Shanghai, China
| | - Qiong Meng
- Department of Internal Medicine, Shanghai No. 3 Rehabilitation Hospital, Shanghai, China
| | - Yulong Bai
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
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Bedside video-oculographic evaluation of eye movements in acute supratentorial stroke patients: A potential biomarker for hemispatial neglect. J Neurol Sci 2021; 425:117442. [PMID: 33857735 DOI: 10.1016/j.jns.2021.117442] [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: 01/27/2021] [Revised: 03/25/2021] [Accepted: 04/05/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND PURPOSE The presence of hemispatial neglect adversely affects functional outcomes in stroke patients; consequently, it warrants early targeted rehabilitative intervention. Nevertheless, hemispatial neglect in the acute phase of stroke has often been underdiagnosed. In this study, we aimed to detect hemispatial neglect at the bedside in acute stroke patients by measuring eye movements using video-oculography (VOG). METHODS Forty-seven patients with acute unilateral supratentorial stroke were enrolled. We quantitatively measured horizontal saccade (latency, velocity, and amplitude) and smooth pursuit (gain) at the bedside using VOG and compared these variables with scores on the Behavioral Inattention Test (BIT), a screening battery to assess hemispatial neglect. RESULTS Contralesional saccade latency, velocity, and amplitude, and ipsilesional smooth pursuit gain were suppressed compared with those in the opposite directions (p = 0.08, 0.02, 0.04, and 0.02, respectively). These directional ocular hypokinesia values correlated with the total BIT score (correlation coefficients -0.53, 0.48, 0.51, and 0.39, respectively). The association was significant even after adjusting for age and stroke severity. CONCLUSIONS Eye movement measurements performed using VOG significantly correlated with the tendency for hemispatial neglect in acute supratentorial stroke patients. Bedside VOG measurement may be a simple biomarker for detecting hemispatial neglect even in patients in the supine position during the acute phase of stroke.
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Stolwyk RJ, Mihaljcic T, Wong DK, Chapman JE, Rogers JM. Poststroke Cognitive Impairment Negatively Impacts Activity and Participation Outcomes: A Systematic Review and Meta-Analysis. Stroke 2021; 52:748-760. [PMID: 33493048 DOI: 10.1161/strokeaha.120.032215] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This systematic review and meta-analysis aimed to investigate whether cognition is associated with activity and participation outcomes in adult stroke survivors. Five databases were systematically searched for studies investigating the relationship between general- and domain-specific cognition and longer-term (>3 months) basic activities of daily living (ADL), instrumental ADLs, and participation outcomes. Eligibility for inclusion, data extraction, and study quality was evaluated by 2 reviewers using a standardized protocol. Effect sizes (r) were estimated using a random-effects model. Sixty-two publications were retained for review, comprising 7817 stroke survivors (median age 63.57 years, range:18-96 years). Median length of follow-up was 12 months (range: 3 months-11 years). Cognition (all domains combined) demonstrated a significant medium association with all 3 functional outcomes combined, r=0.37 (95% CI, 0.33-0.41), P<0.001. Moderator analyses revealed these effects persisted regardless of study quality, order in which outcomes were collected (sequential versus concurrent), age, sample size, or follow-up period. Small to medium associations were also identified between each individual cognitive domain and the separate ADL, instrumental ADL, and participation outcomes. In conclusion, poststroke cognitive impairment is associated with early and enduring activity limitations and participation restrictions, and the association is robust to study design factors, such as sample size, participant age, follow-up period, or study quality. Cognitive assessment early poststroke is recommended to facilitate early detection of disability, prediction of functional outcomes, and to inform tailored rehabilitation therapies.
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Affiliation(s)
- Renerus J Stolwyk
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia (R.J.S., T.M., J.E.C.)
| | - Tijana Mihaljcic
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia (R.J.S., T.M., J.E.C.)
| | - Dana K Wong
- School of Psychology and Public Health, La Trobe University, Bundoora, Australia (D.K.W.)
| | - Jodie E Chapman
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia (R.J.S., T.M., J.E.C.)
| | - Jeffrey M Rogers
- Faculty of Medicine and Health, The University of Sydney, Australia (J.M.R.)
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Domensino AF, van Haastregt JCM, Winkens I, van Bennekom CAM, van Heugten CM. Feasibility of a minimal dataset for adults with acquired brain injury in Dutch healthcare practice. PLoS One 2020; 15:e0235085. [PMID: 32569269 PMCID: PMC7307757 DOI: 10.1371/journal.pone.0235085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 06/08/2020] [Indexed: 11/18/2022] Open
Abstract
Objective Data collection in the field of acquired brain injury (ABI) lacks uniformity due to the broad spectrum of available measurement instruments, leading to incomparability of data and the need for patients to ‘repeat their story’. To pursue uniform data collection, an ABI-specific minimal dataset (MDS-ABI) is currently under development. The current study aimed to assess the feasibility (performance according to protocol, user opinion, potential implementation barriers, and suggested improvements) of the MDS-ABI in clinical settings. Methods A mixed-methods approach was used in a range of healthcare sectors for persons with ABI. Clinicians of several relevant disciplines within these sectors were asked to administer the MDS-ABI to five patients. Subsequently, feasibility according to clinicians was assessed by means of a paper questionnaire about every administration and an online questionnaire about the feasibility in general. Feasibility according to patients was assessed with a paper questionnaire and think aloud interviews. Results Thirteen clinicians and 50 patients were included. In general, the MDS-ABI performed according to protocol. Both clinicians and patients were overall satisfied with the content of the MDS-ABI. The Cumulative Illness Rating Scale was regarded incomprehensible, leading to missing data. Further, clinicians indicated that the MDS-ABI would not be suitable for all ABI-patients, as some are incapable of self-report due to potential cognitive problems, communicative problems, fatigue, perceptual problems, or impaired awareness of deficits. Conclusion The MDS-ABI is a promising tool for obtaining core information on ABI-patients. The MDS-ABI will be adjusted according to the suggestions. For patients who are incapable of self-report, a proxy-reported version of the self-reported part was developed.
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Affiliation(s)
- Anne-Fleur Domensino
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Center, Maastricht, The Netherlands
- Limburg Brain Injury Center, Maastricht, The Netherlands
- * E-mail: ,
| | - Jolanda C. M. van Haastregt
- Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Ieke Winkens
- Limburg Brain Injury Center, Maastricht, The Netherlands
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Coen A. M. van Bennekom
- Department of Research and Development, Heliomare Rehabilitation Center, Wijk aan Zee, The Netherlands
- Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, location AMC, The Netherlands
| | - Caroline M. van Heugten
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Center, Maastricht, The Netherlands
- Limburg Brain Injury Center, Maastricht, The Netherlands
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
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Affiliation(s)
- Cathy M Stinear
- From the Department of Medicine (C.M.S., M.-C.S.), University of Auckland, New Zealand.,Centre for Brain Research (C.M.S., M.-C.S., W.D.B.), University of Auckland, New Zealand
| | - Marie-Claire Smith
- From the Department of Medicine (C.M.S., M.-C.S.), University of Auckland, New Zealand.,Centre for Brain Research (C.M.S., M.-C.S., W.D.B.), University of Auckland, New Zealand
| | - Winston D Byblow
- Centre for Brain Research (C.M.S., M.-C.S., W.D.B.), University of Auckland, New Zealand.,Department of Exercise Sciences (W.D.B.), University of Auckland, New Zealand
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Schapira AHV. Progress in neurology 2017-2018. Eur J Neurol 2018; 25:1389-1397. [DOI: 10.1111/ene.13846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- A. H. V. Schapira
- Department of Clinical and Movement Neurosciences; UCL Queen Square Institute of Neurology; London UK
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Mottaz A, Corbet T, Doganci N, Magnin C, Nicolo P, Schnider A, Guggisberg AG. Modulating functional connectivity after stroke with neurofeedback: Effect on motor deficits in a controlled cross-over study. NEUROIMAGE-CLINICAL 2018; 20:336-346. [PMID: 30112275 PMCID: PMC6091229 DOI: 10.1016/j.nicl.2018.07.029] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 07/13/2018] [Accepted: 07/27/2018] [Indexed: 01/03/2023]
Abstract
Synchronization of neural activity as measured with functional connectivity (FC) is increasingly used to study the neural basis of brain disease and to develop new treatment targets. However, solid evidence for a causal role of FC in disease and therapy is lacking. Here, we manipulated FC of the ipsilesional primary motor cortex in ten chronic human stroke patients through brain-computer interface technology with visual neurofeedback. We conducted a double-blind controlled crossover study to test whether manipulation of FC through neurofeedback had a behavioral effect on motor performance. Patients succeeded in increasing FC in the motor cortex. This led to improvement in motor function that was significantly greater than during neurofeedback training of a control brain area and proportional to the degree of FC enhancement. This result provides evidence that FC has a causal role in neurological function and that it can be effectively targeted with therapy. Stroke patients participated in clinical trial on neurofeedback of functional connectivity. Patients learned to enhance synchrony of neural activity in their motor cortex. This led to reduced motor impairment. Evidence for a causal role of neural synchrony in neurological deficits and recovery.
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Affiliation(s)
- Anaïs Mottaz
- Division of Neurorehabilitation, Department of Clinical Neurosciences, University Hospitals Geneva, Avenue de Beau-Séjour 26, 1211 Geneva, Switzerland
| | - Tiffany Corbet
- Division of Neurorehabilitation, Department of Clinical Neurosciences, University Hospitals Geneva, Avenue de Beau-Séjour 26, 1211 Geneva, Switzerland
| | - Naz Doganci
- Division of Neurorehabilitation, Department of Clinical Neurosciences, University Hospitals Geneva, Avenue de Beau-Séjour 26, 1211 Geneva, Switzerland
| | - Cécile Magnin
- Division of Neurorehabilitation, Department of Clinical Neurosciences, University Hospitals Geneva, Avenue de Beau-Séjour 26, 1211 Geneva, Switzerland
| | - Pierre Nicolo
- Division of Neurorehabilitation, Department of Clinical Neurosciences, University Hospitals Geneva, Avenue de Beau-Séjour 26, 1211 Geneva, Switzerland
| | - Armin Schnider
- Division of Neurorehabilitation, Department of Clinical Neurosciences, University Hospitals Geneva, Avenue de Beau-Séjour 26, 1211 Geneva, Switzerland
| | - Adrian G Guggisberg
- Division of Neurorehabilitation, Department of Clinical Neurosciences, University Hospitals Geneva, Avenue de Beau-Séjour 26, 1211 Geneva, Switzerland.
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