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Jiang T, Wang M, Hao X, Xu J, Zhang Q, Wei X, Lu M. Intermittent theta burst stimulation for poststroke non-spatial attention deficit: a protocol of prospective, double-blinded, single-centre, randomised controlled trial in China. BMJ Open 2023; 13:e075131. [PMID: 37816555 PMCID: PMC10565327 DOI: 10.1136/bmjopen-2023-075131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 09/19/2023] [Indexed: 10/12/2023] Open
Abstract
INTRODUCTION Attention deficit is the most common cognitive impairment after stroke, which can significantly hinder the recovery of both other cognitive domains and motor functions. Increasing evidence suggests that the left dorsolateral prefrontal cortex (DLPFC) is related to non-spatial attention functions, which indicates that it may be a promising target of repetitive transcranial magnetic stimulation (rTMS) for treating poststroke non-spatial attention deficit. Theta burst stimulation (TBS) is a modified pattern of rTMS that delivers shorter stimulation times and exhibits superior therapeutic efficacy. This study aims to provide evidence regarding the efficacy of intermittent TBS (iTBS) over the left DLPFC to improve poststroke non-spatial attention deficits and elucidate the potential neurophysiological mechanisms. METHODS AND ANALYSIS In this single-centre, prospective, randomised, sham-controlled clinical trial, patients with non-spatial attention deficits (n=38) received 10 sessions of real iTBS (n=19) or sham iTBS (n=19) over the left DLPFC and a 30-min conventional attention training. Neuropsychological evaluations, electrophysiological examination and neuroimaging scan will be conducted at baseline, postintervention (second week) and 2-week follow-up (fourth week). The primary outcomes are the change in the Montreal Cognitive Assessment scores and the Digital Span Test scores from baseline to the end of the intervention (second week). The secondary outcomes comprise changes in magnetic resonance spectroscopy neuroimaging from baseline to the end of the intervention (second week) as well as attention test batteries (including tests of selective attention, sustained attention, divided attention and shifting attention) and ERP P300 from baseline to endpoint (fourth week). ETHICS AND DISSEMINATION This study has been approved by the Institutional Ethical Committee of Tongji Hospital (ID: TJ-IRB20230879). All participants will sign the informed consent. Findings will be published in peer-reviewed journals and conference presentations. TRIAL REGISTRATION NUMBER ChiCTR2300068669.
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Affiliation(s)
- Tingting Jiang
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Mingzhu Wang
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiaoxia Hao
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jiang Xu
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Qiya Zhang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiupan Wei
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Min Lu
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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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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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.
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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
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Deng Y, Wang L, Sun X, Liu L, Zhu M, Wang C, Sui B, Shen M, Gu W, Mo D, Ma N, Song L, Li X, Huo X, Miao Z, Chen D, Gao F. Association Between Cerebral Hypoperfusion and Cognitive Impairment in Patients With Chronic Vertebra-Basilar Stenosis. Front Psychiatry 2018; 9:455. [PMID: 30319462 PMCID: PMC6168951 DOI: 10.3389/fpsyt.2018.00455] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 08/31/2018] [Indexed: 12/02/2022] Open
Abstract
Objective: This study aimed to investigate the association between cognitive impairment and cerebral haemodynamic changes in patients with chronic vertebra-basilar (VB) stenosis. Methods: Patients with severe posterior circulation VB stenosis and infarction or a history of infarction for more than 2 weeks from January 2014 to January 2015 were enrolled (n = 96). They were divided into three groups, namely, the computed tomography perfusion (CTP) normal group, the CTP compensated group, and the CTP decompensated group. Cognitive function was assessed using a validated Chinese version of the Mini-Mental State Examination (MMSE), the Frontal Assessment Battery (FAB), and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Regression models were used to identify independent risk factors for cognitive impairment. Results: The MMSE and FAB scores of patients in the CTP decompensated group were significantly lower than those of patients in the CTP normal and CTP compensated groups (all p < 0.05). The RBANS total and its domain scores, including immediate memory, visual acuity, and delayed memory, in the CTP compensated and CTP decompensated groups were significantly lower than those in the CTP normal group (all p < 0.05). Multiple regression analyses showed that CTP compensation, CTP decompensation, severe VB tandem stenosis, and multiple infarctions were independent risk factors for cognitive impairment. Conclusions: Low perfusion caused by severe VB stenosis can lead to extensive cognitive impairments in areas such as immediate memory, visual span, and delayed memory.
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Affiliation(s)
- Yiming Deng
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Luyao Wang
- Intelligent Robotics Institute, School of Mechatronical Engineering, Beijing Institute of Technology, Beijing, China
| | - Xuan Sun
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Lian Liu
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Meifang Zhu
- China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Departments of Neuropsychiatry and Clinical Psychology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chunxue Wang
- China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Departments of Neuropsychiatry and Clinical Psychology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Binbin Sui
- China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Mi Shen
- China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Weibin Gu
- China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Dapeng Mo
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Ning Ma
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Ligang Song
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Xiaoqing Li
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Xiaochuan Huo
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Zhongrong Miao
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Duanduan Chen
- School of Life Science, Beijing Institute of Technology, Beijing, China.,Key Laboratory of Convergence Medical Engineering System and Healthcare Technology, The Ministry of Industry and Information Technology, Beijing Institute of Technology, Beijing, China
| | - Feng Gao
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
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