1
|
Valenzuela-López L, Moreno-Verdú M, Cuenca-Zaldívar JN, Romero JP. Effects of Hand Motor Interventions on Cognitive Outcomes Post-stroke: A Systematic Review and Bayesian Network Meta-analysis. Arch Phys Med Rehabil 2024; 105:1770-1783. [PMID: 38211761 DOI: 10.1016/j.apmr.2023.12.013] [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: 05/30/2023] [Revised: 11/29/2023] [Accepted: 12/14/2023] [Indexed: 01/13/2024]
Abstract
OBJECTIVE To synthetize the evidence on the effects of hand rehabilitation (RHB) interventions on cognition post-stroke and compare their efficacy. DATA SOURCES PubMed, Embase, Cochrane, Scopus, Web of Science, and CINAHL were searched from inception to November 2022. DATA SELECTION Randomized controlled trials conducted in adults with stroke where the effects of hand motor interventions on any cognitive domains were assessed. DATA EXTRACTION Data were extracted by 2 independent reviewers. A Bayesian Network Meta-analysis (NMA) was applied for measures with enough studies and comparisons. Risk of bias was assessed with the Cochrane Risk of Bias tool. DATA SYNTHESIS Fifteen studies were included in qualitative synthesis, and 11 in NMA. Virtual reality (VR) (n=7), robot-assisted (n=5), or handgrip strength (n=3) training were the experimental interventions and conventional RHB (n=14) control intervention. Two separate NMA were performed with MoCA (n=480 participants) and MMSE (n=350 participants) as outcome measures. Both coincided that the most probable best interventions were robot-assisted and strength training, according to SUCRA and rankogram, followed by conventional RHB and VR training. No significant differences between any of the treatments were found in the MoCA network, but in the MMSE, robot-assisted and strength training were significantly better than conventional RHB and VR. No significant differences between robot-assisted and strength training were found nor between conventional RHB and VR. CONCLUSIONS Motor interventions can improve MoCA/MMSE scores post-stroke. Most probable best interventions were robot-assisted and strength training. Limited literature assessing domain-specific cognitive effects was found.
Collapse
Affiliation(s)
- Laura Valenzuela-López
- Faculty of Experimental Sciences, Francisco de Vitoria University, Pozuelo de Alarcón, Spain; Brain Injury and Movement Disorders Neurorehabilitation Group (GINDAT), Institute of Life Sciences, Francisco de Vitoria University, Pozuelo de Alarcón, Spain
| | - Marcos Moreno-Verdú
- Faculty of Experimental Sciences, Francisco de Vitoria University, Pozuelo de Alarcón, Spain; Brain Injury and Movement Disorders Neurorehabilitation Group (GINDAT), Institute of Life Sciences, Francisco de Vitoria University, Pozuelo de Alarcón, Spain.
| | - Juan Nicolás Cuenca-Zaldívar
- Research Group in Physiotherapy and Pain, Department of Nursing and Physiotherapy, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Spain; Research Group in Nursing and Health Care, Puerta de Hierro Health Research Institute - Segovia de Arana (IDIPHISA), Madrid, Spain; Physical Therapy Unit. Primary Health Care Center "El Abajón", Madrid, Spain; Interdisciplinary Group on Musculoskeletal Disorders, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Spain
| | - Juan Pablo Romero
- Faculty of Experimental Sciences, Francisco de Vitoria University, Pozuelo de Alarcón, Spain; Brain Injury and Movement Disorders Neurorehabilitation Group (GINDAT), Institute of Life Sciences, Francisco de Vitoria University, Pozuelo de Alarcón, Spain; Brain Damage Unit, Beata María Ana Hospital, Madrid, Spain
| |
Collapse
|
2
|
Aytenew TM, Kefale D, Birhane BM, Kebede SD, Asferie WN, Kassaw A, Tiruneh YM, Legas G, Getie A, Bantie B, Asnakew S. Poststroke cognitive impairment among stroke survivors in Sub-Saharan Africa: a systematic review and meta-analysis. BMC Public Health 2024; 24:2143. [PMID: 39112982 PMCID: PMC11308218 DOI: 10.1186/s12889-024-19684-3] [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: 02/15/2024] [Accepted: 08/02/2024] [Indexed: 08/10/2024] Open
Abstract
INTRODUCTION Stroke is the leading cause of death and disability among adults and elderly individuals worldwide. Although several primary studies have been conducted to determine the prevalence of poststroke cognitive impairment among stroke survivors in sub-Saharan Africa, these studies have presented inconsistent findings. Therefore, this study aimed to determine the pooled prevalence of poststroke cognitive impairment and identify its associated factors among stroke survivors in sub-Saharan Africa. METHODS The studies were retrieved from the Google Scholar, Scopus, PubMed, and Web of Science databases. A manual search of the reference lists of the included studies was performed. A random-effects DerSimonian-Laird model was used to compute the pooled prevalence of poststroke cognitive impairment among stroke survivors in sub-Saharan Africa. RESULTS A total of 10 primary studies with a sample size of 1,709 stroke survivors were included in the final meta-analysis. The pooled prevalence of PSCI was obtained from the 9 included studies with a sample size of 1,566. In contrast, the data regarding the associated factors were obtained from all the 10 included studies with a sample size of 1,709. The pooled prevalence of poststroke cognitive impairment among stroke survivors was 59.61% (95% CI: 46.87, 72.35); I2 = 96.47%; P < 0.001). Increased age (≥ 45 years) [AOR = 1.23, 95% CI: 1.09, 1.40], lower educational level [AOR = 4.35, 95% CI: 2.87, 6.61], poor functional recovery [AOR = 1.75, 95% CI: 1.42, 2.15], and left hemisphere stroke [AOR = 4.88, 95% CI: 2.98, 7.99] were significantly associated with poststroke cognitive impairment. CONCLUSIONS The pooled prevalence of poststroke cognitive impairment was considerably high among stroke survivors in sub-Saharan Africa. Increased age, lower educational level, poor functional recovery, and left hemisphere stroke were the pooled independent predictors of poststroke cognitive impairment in sub-Saharan Africa. Stakeholders should focus on empowering education and lifestyle modifications, keeping their minds engaged, staying connected with social activities and introducing rehabilitative services for stroke survivors with these identified factors to reduce the risk of developing poststroke cognitive impairment.
Collapse
Affiliation(s)
- Tigabu Munye Aytenew
- Department of Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia.
| | - Demewoz Kefale
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Binyam Minuye Birhane
- School of Public Health, University of Technology Sydney, Sydney, NSW, Australia
- Department of Maternity and Neonatal Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Solomon Demis Kebede
- Department of Maternity and Neonatal Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Worku Necho Asferie
- Department of Maternity and Neonatal Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Amare Kassaw
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | | | - Getasew Legas
- Department of Psychiatry, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Addisu Getie
- Department of Nursing, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Berihun Bantie
- Department of Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Sintayehu Asnakew
- Department of Psychiatry, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| |
Collapse
|
3
|
Fahmi A, Garon M, Ribon-Demars A, Dubois L, Caouette M, Lamontagne MÈ, Beaulieu-Bonneau S. Learning to drive with neurological conditions: profile of users of an adapted driver training program and cognitive factors associated with success. Disabil Rehabil 2024; 46:3869-3877. [PMID: 37728095 DOI: 10.1080/09638288.2023.2258332] [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: 05/25/2022] [Revised: 08/31/2023] [Accepted: 09/07/2023] [Indexed: 09/21/2023]
Abstract
PURPOSE To describe the sociodemographic and cognitive profile of participants enrolled in an adapted driving program for individuals with neurological conditions, to explore the association between cognitive functioning and driving program outcome, and to describe driving habits after program completion. METHODS This study combined retrospective chart review and cross-sectional data collection. RESULTS The sample included 71 participants with neurological disorders (aged 15-56 years, M = 22.2 ± 8.6; 39% women). Driving program was either successful (47%), failed (7%), discontinued (34%), or ongoing (13%). Among 35 participants with complete neuropsychological and driving program outcome data, those who successfully completed the program showed better attention functioning, and better performance relative to global functioning for attention, executive functions, and working memory, compared to those who discontinued/failed the program. Among 21 participants who completed a telephone questionnaire on average 3.7 years after program enrollment, 67% obtained their driver's license and drove regularly. Participants reported high levels of satisfaction with the program. CONCLUSION These results suggest that approximately half of the persons enrolled in a driver training program designed for learners with neurological conditions, obtain a driver's license; and that attention, and to a lesser extent executive functioning and working memory, are related to driving program success.IMPLICATIONS FOR REHABILITATIONIn individual with neurological conditions, learning how to drive can be challenging.An adapted driver training program, involving collaboration between driving instructors and healthcare professionals, simplification of theoretical learning, and increasing driving practice opportunities, can be effective, both in terms of licensing success and client satisfaction.Conducting a pre-driving program neuropsychological assessment, with identification of cognitive strengths and weaknesses, can provide valuable information for clinicians and driving instructors for optimizing training and predicting outcome.Better performance in attention, and better relative to global cognitive functioning in attention, executive functions, and working memory, are related to higher success rate of an adapted driving program.
Collapse
Affiliation(s)
- Adam Fahmi
- École de psychologie, Faculté des sciences sociales, Université Laval, Québec, QC, Canada
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (Cirris), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSS-CN), Québec, QC, Canada
| | - Mathieu Garon
- Centre intégré universitaire de santé et de services sociaux de l'Estrie, Centre hospitalier universitaire de Sherbrooke; Sherbrooke, QC, Canada
| | - Alexandra Ribon-Demars
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (Cirris), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSS-CN), Québec, QC, Canada
| | - Laurie Dubois
- École de psychologie, Faculté des sciences sociales, Université Laval, Québec, QC, Canada
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (Cirris), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSS-CN), Québec, QC, Canada
| | - Martin Caouette
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (Cirris), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSS-CN), Québec, QC, Canada
- Département de psychoéducation, Université du Québec à Trois-Rivières; Trois-Rivières, QC, Canada
| | - Marie-Ève Lamontagne
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (Cirris), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSS-CN), Québec, QC, Canada
- École des sciences de la réadaptation, Faculté de médecine, Université Laval, Québec, QC, Canada
| | - Simon Beaulieu-Bonneau
- École de psychologie, Faculté des sciences sociales, Université Laval, Québec, QC, Canada
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (Cirris), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSS-CN), Québec, QC, Canada
| |
Collapse
|
4
|
Valenzuela-Lopez L, Moreno-Verdu M, Alvarez R, Delgado-Oleas G, Soliverdi Mesa L, Arroyo-Ferrer A, Jose Sanchez-Cuesta F, Gonzalez-Zamorano Y, Barrachina Fernandez M, Sanchez Avila C, Romero JP. AMBER: A Device for Hand Motor and Cognitive Rehabilitation-Development and Proof of Concept. IEEE Trans Neural Syst Rehabil Eng 2024; 32:2654-2664. [PMID: 39028607 DOI: 10.1109/tnsre.2024.3429155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2024]
Abstract
Stroke survivors usually exhibit concurrent motor and cognitive impairment. Historically, rehabilitation strategies post-stroke occur separately in terms of motor and cognitive functions. However, recent studies show that hand motor interventions can have a positive impact on cognitive recovery. In this work, we introduce AMBER (portAble and Modular device for comprehensive Brain Evaluation and Rehabilitation), a new device developed for the evaluation and rehabilitation of both hand motor function and cognition simultaneously. AMBER is a simple, portable, ergonomic and cheap device based on Force Sensitive Resistors, in which every finger interaction is recorded to provide information about finger strength, processing speed, and memory status. This paper presents the requirements of the device and the design of the system. In addition, a pilot study was conducted with 36 healthy individuals using the evaluation module of the device to assess its psychometric properties, as test-retest reliability and measurement error. Its validity was also evaluated comparing its measurements with three different gold standards for strength, processing speed and memory. The device showed good test-retest reliability for strength (ICC =0.741-0.852), reaction time (ICC =0.715 - 0.900) and memory (ICC =0.556-0.885). These measures were correlated with their corresponding gold standards (r =0.780-890). AMBER shows great potential to impact hand rehabilitation, offering therapists a valid, reliable and versatile tool to comprehensively assess patients. With ongoing advancements and refinements, it has the opportunity to significantly impact rehabilitation practices and improve patient outcomes.
Collapse
|
5
|
Fruhwirth V, Berger L, Gattringer T, Fandler-Höfler S, Kneihsl M, Eppinger S, Ropele S, Fink A, Deutschmann H, Reishofer G, Enzinger C, Pinter D. White matter integrity and functional connectivity of the default mode network in acute stroke are associated with cognitive outcome three months post-stroke. J Neurol Sci 2024; 462:123071. [PMID: 38850772 DOI: 10.1016/j.jns.2024.123071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 05/27/2024] [Accepted: 05/29/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND Knowledge about factors that are associated with post-stroke cognitive outcome is important to identify patients with high risk for impairment. We therefore investigated the associations of white matter integrity and functional connectivity (FC) within the brain's default-mode network (DMN) in acute stroke patients with cognitive outcome three months post-stroke. METHODS Patients aged between 18 and 85 years with an acute symptomatic MRI-proven unilateral ischemic middle cerebral artery infarction, who had received reperfusion therapy, were invited to participate in this longitudinal study. All patients underwent brain MRI within 24-72 h after symptom onset, and participated in a neuropsychological assessment three months post-stroke. We performed hierarchical regression analyses to explore the incremental value of baseline white matter integrity and FC beyond demographic, clinical, and macrostructural information for cognitive outcome. RESULTS The study cohort comprised 34 patients (mean age: 64 ± 12 years, 35% female). The initial median National Institutes of Health Stroke Scale (NIHSS) score was 10, and significantly improved three months post-stroke to a median NIHSS = 1 (p < .001). Nonetheless, 50% of patients showed cognitive impairment three months post-stroke. FC of the non-lesioned anterior cingulate cortex of the affected hemisphere explained 15% of incremental variance for processing speed (p = .007), and fractional anisotropy of the non-lesioned cingulum of the affected hemisphere explained 13% of incremental variance for cognitive flexibility (p = .033). CONCLUSIONS White matter integrity and functional MRI markers of the DMN in acute stroke explain incremental variance for post-stroke cognitive outcome beyond demographic, clinical, and macrostructural information.
Collapse
Affiliation(s)
- Viktoria Fruhwirth
- Department of Neurology, Medical University of Graz, Graz, Austria; Department of Neurology, Research Unit for Neuronal Plasticity and Repair, Medical University of Graz, Graz, Austria; Institute of Psychology, Department of Biological Psychology, University of Graz, Graz, Austria
| | - Lisa Berger
- Institute of Psychology, Department of Neuropsychology - Neuroimaging, University of Graz, Graz, Austria
| | - Thomas Gattringer
- Department of Neurology, Medical University of Graz, Graz, Austria; Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | | | - Markus Kneihsl
- Department of Neurology, Medical University of Graz, Graz, Austria
| | | | - Stefan Ropele
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Andreas Fink
- Institute of Psychology, Department of Biological Psychology, University of Graz, Graz, Austria
| | - Hannes Deutschmann
- Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Gernot Reishofer
- Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Christian Enzinger
- Department of Neurology, Medical University of Graz, Graz, Austria; Department of Neurology, Research Unit for Neuronal Plasticity and Repair, Medical University of Graz, Graz, Austria; Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Daniela Pinter
- Department of Neurology, Medical University of Graz, Graz, Austria; Department of Neurology, Research Unit for Neuronal Plasticity and Repair, Medical University of Graz, Graz, Austria.
| |
Collapse
|
6
|
Kettlety SA, Finley JM, Leech KA. Visuospatial Skills Explain Differences in the Ability to Use Propulsion Biofeedback Post-stroke. J Neurol Phys Ther 2024:01253086-990000000-00070. [PMID: 38912856 DOI: 10.1097/npt.0000000000000487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2024]
Abstract
BACKGROUND AND PURPOSE Visual biofeedback can be used to help people post-stroke reduce biomechanical gait impairments. Using visual biofeedback engages an explicit, cognitively demanding motor learning process. Participants with better overall cognitive function are better able to use visual biofeedback to promote locomotor learning; however, which specific cognitive domains are responsible for this effect are unknown. We aimed to understand which cognitive domains were associated with performance during acquisition and immediate retention when using visual biofeedback to increase paretic propulsion in individuals post-stroke. METHODS Participants post-stroke completed cognitive testing, which provided scores for different cognitive domains, including executive function, immediate memory, visuospatial/constructional skills, language, attention, and delayed memory. Next, participants completed a single session of paretic propulsion biofeedback training, where we collected treadmill-walking data for 20 min with biofeedback and 2 min without biofeedback. We fit separate regression models to determine if cognitive domain scores, motor impairment (measured with the lower-extremity Fugl-Meyer), and gait speed could explain propulsion error and variability during biofeedback use and recall error during immediate retention. RESULTS Visuospatial/constructional skills and motor impairment best-explained propulsion error during biofeedback use (adjusted R 2 = 0.56, P = 0.0008), and attention best-explained performance variability (adjusted R 2 = 0.17, P = 0.048). Language skills best-explained recall error during immediate retention (adjusted R 2 = 0.37, P = 0.02). DISCUSSION AND CONCLUSIONS These results demonstrate that specific cognitive domain impairments explain variability in locomotor learning outcomes in individuals with chronic stroke. This suggests that with further investigation, specific cognitive impairment information may be useful to predict responsiveness to interventions and personalize training parameters to facilitate locomotor learning.
Collapse
Affiliation(s)
- Sarah A Kettlety
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California (S.A.K., J.M.F., K.A.L.); Neuroscience Graduate Program, University of Southern California, Los Angeles, California (J.M.F., K.A.L.); and Department of Biomedical Engineering, University of Southern California, Los Angeles, California (J.M.F.)
| | | | | |
Collapse
|
7
|
Sloane KL, Hamilton RH. Transcranial Direct Current Stimulation to Ameliorate Post-Stroke Cognitive Impairment. Brain Sci 2024; 14:614. [PMID: 38928614 PMCID: PMC11202055 DOI: 10.3390/brainsci14060614] [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: 04/22/2024] [Revised: 06/04/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024] Open
Abstract
Post-stroke cognitive impairment is a common and disabling condition with few effective therapeutic options. After stroke, neural reorganization and other neuroplastic processes occur in response to ischemic injury, which can result in clinical improvement through spontaneous recovery. Neuromodulation through transcranial direct current stimulation (tDCS) is a promising intervention to augment underlying neuroplasticity in order to improve cognitive function. This form of neuromodulation leverages mechanisms of neuroplasticity post-stroke to optimize neural reorganization and improve function. In this review, we summarize the current state of cognitive neurorehabilitation post-stroke, the practical features of tDCS, its uses in stroke-related cognitive impairment across cognitive domains, and special considerations for the use of tDCS in the post-stroke patient population.
Collapse
Affiliation(s)
- Kelly L. Sloane
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Physical Medicine and Rehabilitation, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Roy H. Hamilton
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Physical Medicine and Rehabilitation, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| |
Collapse
|
8
|
Oestreich LKL, Wright P, O'Sullivan MJ. Cardiovascular risk factors are associated with cognitive trajectory in the first year after stroke. CEREBRAL CIRCULATION - COGNITION AND BEHAVIOR 2024; 7:100230. [PMID: 38988670 PMCID: PMC11231527 DOI: 10.1016/j.cccb.2024.100230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 05/05/2024] [Accepted: 06/07/2024] [Indexed: 07/12/2024]
Abstract
Introduction Stroke often leads to cognitive impairment, but its progression and influencing factors over time remain poorly understood. This study evaluates immediate post-stroke cognitive impacts and investigates the influence of concurrent factors on cognitive evolution over the first year. Patients and methods In the STRATEGIC study, 179 patients with first symptomatic ischemic stroke underwent neuropsychological assessments within three months post-stroke, and 141 were re-evaluated at 12 months. Risk factors tested for associations with cognitive outcome included demographic variables, cardiovascular and other medical factors, and lesion characteristics. Cognitive performance was primarily measured via the Montreal Cognitive Assessment (MoCA), with domain-specific assessments for episodic memory (Free and Cued Selective Reminding Task), short-term memory (Digit Span forward), and working memory (Digit Span backward). Results At the time of stroke, participants ranged in age from 46 to 89 years (M = 70, SD = 9.5) and 36.9% were female. Ischemic heart disease predicted cognitive non-improvement between 3 and 12 months. Atrial fibrillation and carotid stenosis were linked to changes in episodic and working memory, respectively. Moreover, female sex and lower education correlated with stagnant global cognition and episodic memory. Discussion and conclusion Our findings underscore the important influence of cardiovascular risk factors on cognitive functional recovery after stroke. Interventions targeting these risk factors may improve cognitive prognosis and affect traditional outcome measures such as recurrent vascular events. Future trials should include cognitive measures to fully capture the potential benefits of intensive risk factor intervention.
Collapse
Affiliation(s)
- Lena KL Oestreich
- School of Psychology, The University of Queensland, Brisbane, Australia
- Australian Institute for Bioengineering and Nanotechnology, The University of Queensland, Brisbane, Australia
- Centre for Advanced Imaging, The University of Queensland, Brisbane, Australia
- National Imaging Facility, University of Queensland, Brisbane, Australia
| | - Paul Wright
- Department of Biomedical Engineering and Imaging Sciences, King's College London, United Kingdom
| | - Michael J O'Sullivan
- Department of Neurology, Royal Brisbane and Women's Hospital, Herston, Australia
- Institute for Molecular Bioscience, University of Queensland, Brisbane, Australia
| |
Collapse
|
9
|
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
|
10
|
Alphonce B, Meda J, Nyundo A. Incidence and predictors of post-stroke cognitive impairment among patients admitted with first stroke at tertiary hospitals in Dodoma, Tanzania: A prospective cohort study. PLoS One 2024; 19:e0287952. [PMID: 38598466 PMCID: PMC11006170 DOI: 10.1371/journal.pone.0287952] [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: 06/18/2023] [Accepted: 02/01/2024] [Indexed: 04/12/2024] Open
Abstract
INTRODUCTION Stroke survivors develop cognitive impairment, which significantly impacts their quality of life, their families, and the community as a whole but not given attention. This study aims to determine the incidence and predictors of post-stroke cognitive impairment (PSCI) among adult stroke patients admitted to a tertiary hospital in Dodoma, Tanzania. METHODOLOGY A prospective cohort study was conducted at tertiary hospitals in the Dodoma region, central Tanzania. A sample size of 158 participants with the first stroke confirmed by CT/MRI brain aged ≥ 18 years met the criteria. At baseline, social-demographic, cardiovascular risks and stroke characteristics were acquired, and then at 30 days, participants were evaluated for cognitive functioning using Montreal Cognitive Assessment (MoCA). Key confounders for cognitive impairment, such as depression and apathy, were evaluated using the Personal Health Questionnaire (PHQ-9) and Apathy Evaluation Scale (AES), respectively. Descriptive statistics were used to summarise data; continuous data were reported as Mean (SD) or Median (IQR), and categorical data were summarised using proportions and frequencies. Univariate and multivariable logistic regression analysis was used to determine predictors of PSCI. RESULTS The median age of the 158 participants was 58.7 years; 57.6% of them were female, and 80.4% of them met the required criteria for post-stroke cognitive impairment. After multivariable logistic regression, left hemisphere stroke (AOR: 5.798, CI: 1.030-32.623, p = 0.046), a unit cm3 increase in infarct volume (AOR: 1.064, 95% CI: 1.018-1.113, p = 0.007), and apathy symptoms (AOR: 12.259, CI: 1.112-89.173, p = 0.041) had a significant association with PSCI. CONCLUSION The study revealed a significant prevalence of PSCI; early intervention targeting stroke survivors at risk may improve their outcomes. Future research in the field will serve to dictate policies and initiatives.
Collapse
Affiliation(s)
- Baraka Alphonce
- Department of Internal Medicine, School of Medicine & Dentistry, The University Dodoma, Dodoma, Tanzania
- Department of Internal Medicine, The Benjamin Mkapa Hospital, Dodoma, Tanzania
| | - John Meda
- Department of Internal Medicine, School of Medicine & Dentistry, The University Dodoma, Dodoma, Tanzania
- Department of Cardiology, The Benjamin Mkapa Hospital, Dodoma, Tanzania
| | - Azan Nyundo
- Department of Internal Medicine, The Benjamin Mkapa Hospital, Dodoma, Tanzania
- Department of Psychiatry and Mental Health, School of Medicine, The University Dodoma, Dodoma, Tanzania
| |
Collapse
|
11
|
Gangaram-Panday SG, Zhou Y, Gillebert CR. Screening for post-stroke neurocognitive disorders in diverse populations: A systematic review. Clin Neuropsychol 2024; 38:588-611. [PMID: 37480233 DOI: 10.1080/13854046.2023.2237676] [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: 11/28/2022] [Accepted: 07/12/2023] [Indexed: 07/23/2023]
Abstract
Objective: Although neurocognitive disorders (NCD) are common post-stroke, many populations do not have adapted cognitive screens and cut-offs. We therefore reviewed the appropriateness of the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA) and Oxford Cognitive Screen (OCS) for diagnosing NCD in culturally diverse stroke populations. Method: Using an extensive search string, diagnostic accuracy studies for MMSE, MoCA and OCS in the stroke population were retrieved from four databases. We compared translations and adaptations, adjustments in scores and cut-offs, and their diagnostic accuracy. Results: The search resulted in 28 MMSE, 39 MoCA and 5 OCS-studies in 13 western, educated, industrialized, rich and democratic (WEIRD) and 4 other countries. There was a lack of studies on South-American, African, and non-Chinese-Asian populations. All three tests needed adaptation for less WEIRD populations and populations with languages with non-Latin features. Optimal MMSE and OCS subtest cut-offs were similar across WEIRD and less WEIRD populations, whereas optimal MoCA cut-offs appeared lower for less WEIRD populations. The use of adjusted scores resulted in different optimal cut-offs or similar cut-offs with better accuracy. Conclusions: MoCA, MMSE and OCS are promising tools for diagnosing post-stroke-NCD. For culturally diverse populations, translation, adaptation and adjusted scores or cut-offs are necessary for diagnostic accuracy. Available studies report scarcely about their sample's cultural background and there is a lack of diagnostic accuracy studies in less WEIRD or culturally diverse populations. Future studies should report more cultural characteristics of their sample to provide better insight into the tests' accuracy in culturally diverse populations.
Collapse
Affiliation(s)
- Shonimá G Gangaram-Panday
- Brain and Cognition, Leuven Brain Institute, KU Leuven, Leuven, Belgium
- Psychology, Anton de Kom University of Suriname, Paramaribo, Suriname
| | - Yanyao Zhou
- Psychology, University of Hong Kong, Hong Kong
| | - Céline R Gillebert
- Brain and Cognition, Leuven Brain Institute, KU Leuven, Leuven, Belgium
- TRACE Center for Translational Health Research, KU Leuven, Leuven, Belgium
| |
Collapse
|
12
|
Gallucci L, Sperber C, Guggisberg AG, Kaller CP, Heldner MR, Monsch AU, Hakim A, Silimon N, Fischer U, Arnold M, Umarova RM. Post-stroke cognitive impairment remains highly prevalent and disabling despite state-of-the-art stroke treatment. Int J Stroke 2024:17474930241238637. [PMID: 38425239 DOI: 10.1177/17474930241238637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
BACKGROUND State-of-the-art stroke treatment significantly reduces lesion size and stroke severity, but it remains unclear whether these therapeutic advances have diminished the burden of post-stroke cognitive impairment (PSCI). AIMS In a cohort of patients receiving modern state-of-the-art stroke care including endovascular therapy, we assessed the frequency of PSCI and the pattern of domain-specific cognitive deficits, identified risk factors for PSCI, and determined the impact of acute PSCI on stroke outcome. METHODS In this prospective monocentric cohort study, we examined patients with first-ever anterior circulation ischemic stroke without pre-stroke cognitive decline, using a comprehensive neuropsychological assessment ⩽10 days after symptom onset. Normative data were stratified by demographic variables. We defined PSCI as at least moderate (<1.5 standard deviation) deficits in ⩾2 cognitive domains. Multivariable regression analysis was applied to define risk factors for PSCI. RESULTS We analyzed 329 non-aphasic patients admitted from December 2020 to July 2023 (67.2 ± 14.4 years old, 41.3% female, 13.1 ± 2.7 years of education). Although most patients had mild stroke (median National Institutes of Health Stroke Scale (NIHSS) 24 h = 1.00 (0.00; 3.00); 87.5% with NIHSS ⩽ 5), 69.3% of them presented with PSCI 2.7 ± 2.0 days post-stroke. The most severely and often affected cognitive domains were verbal learning, episodic memory, executive functions, selective attention, and constructive abilities (39.1%-51.2% of patients), whereas spatial neglect was less frequent (18.5%). The risk of PSCI was reduced with more years of education (odds ratio (OR) = 0.47, 95% confidence interval (CI) = 0.23-0.99) and right hemisphere lesions (OR = 0.47, 95% CI = 0.26-0.84), and increased with stroke severity (NIHSS 24 h, OR = 4.19, 95% CI = 2.72-6.45), presence of hyperlipidemia (OR = 1.93, 95% CI = 1.01-3.68), but was not influenced by age. After adjusting for stroke severity and depressive symptoms, acute PSCI was associated with poor functional outcome (modified Rankin Scale > 2, F = 13.695, p < 0.001) and worse global cognition (Montreal Cognitive Assessment (MoCA) score, F = 20.069, p < 0.001) at 3 months post-stroke. CONCLUSION Despite modern stroke therapy and many strokes having mild severity, PSCI in the acute stroke phase remains frequent and associated with worse outcome. The most prevalent were learning and memory deficits. Cognitive reserve operationalized as years of education independently protects post-stroke cognition.
Collapse
Affiliation(s)
- Laura Gallucci
- Department of Neurology, University Hospital, Inselspital, University of Bern, Bern, Switzerland
- Graduate School of Health Sciences, University of Bern, Bern, Switzerland
| | - Christoph Sperber
- Department of Neurology, University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Adrian G Guggisberg
- Department of Neurology, University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Christoph P Kaller
- Department of Neuroradiology, University Medical Center Freiburg, Freiburg, Germany
| | - Mirjam R Heldner
- Department of Neurology, University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | | | - Arsany Hakim
- University Institute of Diagnostic and Interventional Neuroradiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Norbert Silimon
- Department of Neurology, University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Urs Fischer
- Department of Neurology, University Hospital, Inselspital, University of Bern, Bern, Switzerland
- Department of Neurology, University Hospital and University of Basel, Basel, Switzerland
| | - Marcel Arnold
- Department of Neurology, University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Roza M Umarova
- Department of Neurology, University Hospital, Inselspital, University of Bern, Bern, Switzerland
| |
Collapse
|
13
|
Milosevich ET, Moore MJ, Pendlebury ST, Demeyere N. Domain-specific cognitive impairment 6 months after stroke: The value of early cognitive screening. Int J Stroke 2024; 19:331-341. [PMID: 37749759 PMCID: PMC10903146 DOI: 10.1177/17474930231205787] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 09/12/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND Cognitive screening following stroke is widely recommended, yet few studies have considered the prognostic value of acute domain-specific function for longer-term cognitive outcome. Identifying which post-stroke cognitive impairments more commonly occur, recover, and persist, and which impairments hold prognostic value, could inform care planning, and resource allocation. AIMS This study aimed to determine the prevalence of domain-specific impairment acutely and at 6 months, assess the proportion of change in cognitive performance, and examine the prognostic value of acute domain-specific cognitive screening. METHODS A prospective stroke cohort completed the Oxford Cognitive Screen acutely (⩽2 weeks) and 6 months post-stroke. We determined the prevalence of acute and 6-month domain-specific impairment and proportion of change in performance from acute to 6 months. Hierarchical multivariable regression was used to predict global and domain-specific cognitive impairment at 6 months adjusted for demographic/vascular factors, stroke severity, and lesion volume. RESULTS A total of 430 stroke survivors (mean/SD age 73.9/12.5 years, 46.5% female, median/interquartile range (IQR) National Institute of Health Stroke Scale (NIHSS) 5/2-10) completed 6-month follow-up. Acutely, domain-specific impairments were highly prevalent ranging from 26.7% (n = 112) in praxis to 46.8% (n = 183) in attention. At 6 months, the proportion of domain-specific recovery was highest in praxis (n = 73, 71%) and lowest in language (n = 89, 46%) and memory (n = 82, 48%). Severity of 6-month cognitive impairment was best predicted by the addition of acute cognitive impairment (adj R2 = 0.298, p < 0.0001) over demographic and clinical factors alone (adj R2 = 0.105, p < 0.0001). Acute cognitive function was the strongest predictor of 6-month cognitive performance (p < 0.0001). Acute domain-specific impairments in memory (p < 0.0001), language (p < 0.0001), and praxis (p < 0.0001) significantly predicted overall severity of cognitive impairment at 6 months. CONCLUSION Post-stroke cognitive impairment is highly prevalent across all domains acutely, while impairments in language, memory, and attention predominate at 6 months. Early domain-specific screening can provide valuable prognostic information for longer-term cognitive outcomes.
Collapse
Affiliation(s)
- Elise T Milosevich
- Department of Experimental Psychology, Radcliffe Observatory Quarter, University of Oxford, Oxford, UK
| | - Margaret J Moore
- Department of Experimental Psychology, Radcliffe Observatory Quarter, University of Oxford, Oxford, UK
- Queensland Brain Institute, University of Queensland, St Lucia, QLD, Australia
| | - Sarah T Pendlebury
- Wolfson Centre for Prevention of Stroke and Dementia, Wolfson Building, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre and Departments of General Medicine and Geratology, John Radcliffe Hospital, Oxford, UK
| | - Nele Demeyere
- Department of Experimental Psychology, Radcliffe Observatory Quarter, University of Oxford, Oxford, UK
- Wolfson Centre for Prevention of Stroke and Dementia, Wolfson Building, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| |
Collapse
|
14
|
Koob JL, Gorski M, Krick S, Mustin M, Fink GR, Grefkes C, Rehme AK. Behavioral and neuroanatomical correlates of facial emotion processing in post-stroke depression. Neuroimage Clin 2024; 41:103586. [PMID: 38428325 PMCID: PMC10944179 DOI: 10.1016/j.nicl.2024.103586] [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: 10/27/2023] [Revised: 02/24/2024] [Accepted: 02/25/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND Emotion processing deficits are known to accompany depressive symptoms and are often seen in stroke patients. Little is known about the influence of post-stroke depressive (PSD) symptoms and specific brain lesions on altered emotion processing abilities and how these phenomena develop over time. This potential relationship may impact post-stroke rehabilitation of neurological and psychosocial function. To address this scientific gap, we investigated the relationship between PSD symptoms and emotion processing abilities in a longitudinal study design from the first days post-stroke into the early chronic phase. METHODS Twenty-six ischemic stroke patients performed an emotion processing task on videos with emotional faces ('happy,' 'sad,' 'anger,' 'fear,' and 'neutral') at different intensity levels (20%, 40%, 60%, 80%, 100%). Recognition accuracies and response times were measured, as well as scores of depressive symptoms (Montgomery-Åsberg Depression Rating Scale). Twenty-eight healthy participants matched in age and sex were included as a control group. Whole-brain support-vector regression lesion-symptom mapping (SVR-LSM) analyses were performed to investigate whether specific lesion locations were associated with the recognition accuracy of specific emotion categories. RESULTS Stroke patients performed worse in overall recognition accuracy compared to controls, specifically in the recognition of happy, sad, and fearful faces. Notably, more depressed stroke patients showed an increased processing towards specific negative emotions, as they responded significantly faster to angry faces and recognized sad faces of low intensities significantly more accurately. These effects obtained for the first days after stroke partly persisted to follow-up assessment several months later. SVR-LSM analyses revealed that inferior and middle frontal regions (IFG/MFG) and insula and putamen were associated with emotion-recognition deficits in stroke. Specifically, recognizing happy facial expressions was influenced by lesions affecting the anterior insula, putamen, IFG, MFG, orbitofrontal cortex, and rolandic operculum. Lesions in the posterior insula, rolandic operculum, and MFG were also related to reduced recognition accuracy of fearful facial expressions, whereas recognition deficits of sad faces were associated with frontal pole, IFG, and MFG damage. CONCLUSION PSD symptoms facilitate processing negative emotional stimuli, specifically angry and sad facial expressions. The recognition accuracy of different emotional categories was linked to brain lesions in emotion-related processing circuits, including insula, basal ganglia, IFG, and MFG. In summary, our study provides support for psychosocial and neural factors underlying emotional processing after stroke, contributing to the pathophysiology of PSD.
Collapse
Affiliation(s)
- Janusz L Koob
- University Hospital Cologne, Department of Neurology, Cologne 50937, Germany
| | - Maximilian Gorski
- University Hospital Cologne, Department of Neurology, Cologne 50937, Germany
| | - Sebastian Krick
- University Hospital Cologne, Department of Neurology, Cologne 50937, Germany
| | - Maike Mustin
- University Hospital Cologne, Department of Neurology, Cologne 50937, Germany
| | - Gereon R Fink
- University Hospital Cologne, Department of Neurology, Cologne 50937, Germany; Institute of Neuroscience and Medicine, Cognitive Neuroscience (INM-3), Forschungszentrum Jülich, Jülich 52428, Germany
| | - Christian Grefkes
- University Hospital Cologne, Department of Neurology, Cologne 50937, Germany; Institute of Neuroscience and Medicine, Cognitive Neuroscience (INM-3), Forschungszentrum Jülich, Jülich 52428, Germany; Goethe University Frankfurt and University Hospital Frankfurt, Department of Neurology, Frankfurt am Main 60596, Germany.
| | - Anne K Rehme
- University Hospital Cologne, Department of Neurology, Cologne 50937, Germany
| |
Collapse
|
15
|
Minga J, Rich T, Boukrina O, Chen P, Hreha K. Identifying Spatial Neglect in Chronic Right Hemisphere Stroke Survivors Using the RHDBank Outcomes. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2024; 67:511-523. [PMID: 38181442 PMCID: PMC11000791 DOI: 10.1044/2023_jslhr-23-00285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 08/23/2023] [Accepted: 10/19/2023] [Indexed: 01/07/2024]
Abstract
PURPOSE The chronicity of spatial neglect (SN) and the utility of existing diagnostic measures used by speech-language pathologists remain poorly understood. In this retrospective study, we examined how the RHDBank test battery informs the identification of SN after right hemisphere brain damage (RHD) during the chronic phase of recovery. METHOD Data from 29 right hemisphere stroke survivors were extracted from the RHDBank, including SN tests, for which we performed laterality index scoring: a 51-item demographic survey, the Apples Test, the Indented Paragraph Test, and the clock drawing task from the Cognitive Linguistic Quick Test (CLQT). Two groups (SN+ and SN-) were identified using the Apples Test. A hierarchical cluster analysis explored CLQT performance clusters in association with SN, and group comparisons of demographic variables and test scores were conducted. RESULTS Ten patients were identified as having SN+ (34%) using the Apples Test. The Indented Paragraph Test and the CLQT's clock drawing test identified only two of the 20 stroke survivors with SN+. Cluster analyses showed that domain and task scores on the CLQT carried information to classify participants into SN+ and SN- in concordance with performance on the Apples Test. Participants in the SN+ cluster had moderately impaired attention and executive function skills and mildly impaired visuospatial skills. CONCLUSIONS The Apples Test differentiated SN in a group of chronic right hemisphere stroke survivors. Using multiple measures from the CLQT seemed to capture a greater range of problems than clock drawing and paragraph reading tests alone. Therefore, the RHDBank test battery as a whole-and in part the CLQT, Apples Test, and Indented Paragraph Test-can detect certain subtypes of SN in the chronic deficit profile after RHD and is a starting point for diagnostic integration by speech-language pathologists.
Collapse
Affiliation(s)
- Jamila Minga
- Department of Head and Neck Surgery & Communication Sciences and Department of Neurology, Duke University, Durham, NC
| | - Timothy Rich
- Center for Stroke Rehabilitation Research, Kessler Foundation, West Orange, NJ
| | - Olga Boukrina
- Center for Stroke Rehabilitation Research, Kessler Foundation, West Orange, NJ
| | - Peii Chen
- Center for Stroke Rehabilitation Research, Kessler Foundation, West Orange, NJ
| | - Kimberly Hreha
- Occupational Therapy Doctorate Division, Department of Orthopaedic Surgery, Duke University, Durham, NC
| |
Collapse
|
16
|
Lu H, Wang Y, Shen D, Ruan J, Lu J, Wang L, Song Y, Fan J, Li D, Shi L, Xia M, Xu T. Effects and central mechanism of electroacupuncture and MRI-navigated rTMS for PSD: study protocol for an fMRI-based single-center, randomized, controlled, open-label trial. Front Psychiatry 2024; 14:1226777. [PMID: 38250275 PMCID: PMC10799680 DOI: 10.3389/fpsyt.2023.1226777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 11/27/2023] [Indexed: 01/23/2024] Open
Abstract
Background Post-stroke depression (PSD) is the most common mental complication after stroke and has a serious impact on functional outcomes and quality of life for stroke patients. Antidepressants are the first-line treatment for PSD; however, many reported side effects remain. Clinical research and practice guidelines have shown that electro-acupuncture (EA) or rTMS have a positive effect on PSD. However, there are few clinical studies on EA and MRI-navigated rTMS for PSD that explore the fMRI-based central mechanism in depression. Methods In this randomized, controlled, open-label trial, 64 patients with PSD will be randomly allocated into the experiment group (n = 32) or control group (n = 32). The experiment group will receive EA and MRI-navigated rTMS and the control group will receive MRI-navigated rTMS treatment, in 12-20 sessions over 4 weeks. In addition, 10 healthy people for fMRI scanning will be recruited as a healthy control group without any intervention. The primary outcome will be the change from baseline in the Hamilton Depression Scale-24 item (HAMD-24) scores at week 4. The primary analysis of the central mechanism will mainly involve cortical morphology, local spontaneous brain activity, and the default mode network (DMN) functional connectivity based on fMRI at 0 and 4 weeks. Secondary outcomes will include the neuro-patho-physiological and quality of life changes in cortical excitability, determined using the motor evoked potential test (MEP), National Institutes of Health Stroke Scale (NIHSS), EuroQol Five Dimensions Questionnaire (EQ-5D) Scale, Modified Barthel Index (MBI) Scale, and Health Scale of Traditional Chinese Medicine (HSTCM). Additional indicators will include the Acceptability Questionnaire and Health Economics Evaluation (cost-effectiveness analysis) to assess the acceptability and economic practicality of the treatment under study. Outcomes will be assessed at baseline and post intervention. Discussion EA and MRI-navigated rTMS therapy could become an alternative treatment for PSD, and it is expected that this trial will provide reliable clinical evidence and a potential central mechanism for the future use of EA and MRI-navigated rTMS for PSD. Clinical trial registration NCT05516680, ClinicalTrials.gov (registered in August 2022).
Collapse
Affiliation(s)
- Hai Lu
- Department of Traditional Chinese Medicine, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
| | - Yang Wang
- Department of Traditional Chinese Medicine, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
| | - Diwen Shen
- Department of Medical Psychology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
| | - Jianguo Ruan
- Department of Traditional Chinese Medicine, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
| | - Jiaming Lu
- Department of Radiology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
| | - Linlin Wang
- Department of Traditional Chinese Medicine, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
| | - Yang Song
- Department of Traditional Chinese Medicine, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
| | - Jia Fan
- Department of Human Biology, University of Cape Town, Cape Town, South Africa
| | - Dongna Li
- Department of Traditional Chinese Medicine, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
| | - Lijing Shi
- Department of Traditional Chinese Medicine, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
| | - Meng Xia
- Alberta College of Acupuncture & Traditional Chinese Medicine, Calgary, AB, Canada
| | - Tianshu Xu
- Department of Traditional Chinese Medicine, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
| |
Collapse
|
17
|
Zhang Z, Lim MJR. Incident Dementia After Spontaneous Intracerebral Hemorrhage. J Alzheimers Dis 2024; 99:41-51. [PMID: 38640161 DOI: 10.3233/jad-240111] [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] [Indexed: 04/21/2024]
Abstract
Post-stroke cognitive impairment and dementia (PSCID) is a complication that affects long-term functional outcomes after stroke. Studies on dementia after long-term follow-up in stroke have focused predominantly on ischemic stroke, which may be different from the development of dementia after spontaneous intracerebral hemorrhage (ICH). In this review, we summarize the existing data and hypotheses on the development of dementia after spontaneous ICH, review the management of post-ICH dementia, and suggest areas for future research. Dementia after spontaneous ICH has a cumulative incidence of up to 32.0-37.4% at 5 years post-ICH. Although the pathophysiology of post-ICH dementia has not been fully understood, two main theoretical frameworks can be considered: 1) the triggering role of ICH (both primary and secondary brain injury) in precipitating cognitive decline and dementia; and 2) the contributory role of pre-existing brain pathology (including small vessel disease and neurodegenerative pathology), reduced cognitive reserve, and genetic factors predisposing to cognitive dysfunction. These pathophysiological pathways may have synergistic effects that converge on dysfunction of the neurovascular unit and disruptions in functional connectivity leading to dementia post-ICH. Management of post-ICH dementia may include screening and monitoring, cognitive therapy, and pharmacotherapy. Non-invasive brain stimulation is an emerging therapeutic modality under investigation for safety and efficacy. Our review highlights that there remains a paucity of data and standardized reporting on incident dementia after spontaneous ICH. Further research is imperative for determining the incidence, risk factors, and pathophysiology of post-ICH dementia, in order to identify new therapies for the treatment of this debilitating condition.
Collapse
Affiliation(s)
- Zheting Zhang
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | | |
Collapse
|
18
|
Ghaziani E, Christensen SS, Arens CH, Wæhrens EE. Addressing ADL ability in people with poststroke cognitive impairments: A Danish survey of clinical practice. Scand J Occup Ther 2024; 31:2318204. [PMID: 38382558 DOI: 10.1080/11038128.2024.2318204] [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: 11/16/2023] [Accepted: 02/09/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND In Denmark, stroke represents a leading disability cause. While people with difficulties in performing activities of daily living (ADL) due to poststroke cognitive impairments are often referred to occupational therapy, limited knowledge is available on the nature of these services. AIM/OBJECTIVE To explore how Danish occupational therapists describe their practice when addressing decreased ADL ability in people with poststroke cognitive impairments in hospital and municipality settings. MATERIAL AND METHODS National, cross-sectorial, web-based public survey. RESULTS 244 occupational therapists accessed the survey; 172 were included in the analysis. Most respondents could indicate the theory guiding their reasoning; half used standardised assessments. Regarding intervention, restorative and acquisitional models were preferred; specific strategies were identified. Intensity: 30-45 min 3-4 times/week in hospitals; 30-60 min 1-2 times/week in municipalities. CONCLUSIONS Therapists report to be guided by theory in their reasoning. Standardised assessments are used to a higher extend than previously reported. Still, the results invite critical reflections on correct use of assessment instruments, content and intensity of interventions, and how therapists keep themselves updated. SIGNIFICANCE The results document the need for practice improvements and may inform the definition of standard care in future trials.
Collapse
Affiliation(s)
- E Ghaziani
- Department of Physical and Occupational Therapy, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Brain and Spinal Cord Injury, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - S S Christensen
- Department of Physical and Occupational Therapy, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - C H Arens
- Department of Physical and Occupational Therapy, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - E E Wæhrens
- Occupation-Centered Occupational Therapy, The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Occupational Science, User Perspectives and Community-based Interventions, Department of Public Health, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
19
|
Costa Novo J, Rieffel E, Velarde GC, Costa F, Barros P, Veloso M, Costa H, Paredes L, Gregório T, Rodrigues M, Calvão-Pires P, Campolargo A, Battistella V. Shorter Reperfusion Time in Stroke is Associated with Better Cognition. Can J Neurol Sci 2023:1-6. [PMID: 38052728 DOI: 10.1017/cjn.2023.321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
BACKGROUND Cognitive changes that result from cerebrovascular disease contribute to a poor functional outcome with reduced quality of life. Among patients undergoing endovascular therapy (EVT), we aim to assess cognitive function and evaluate the impact of reperfusion time in cognitive performance. METHODS Patients with acute right anterior circulation strokes that underwent EVT between January 2018 and August 2020 at Centro Hospitalar de Vila Nova de Gaia/Espinho, participated in the study. Modified treatment in cerebral infarction (mTICI) assessed the level of recanalization. Cognitive evaluation was assessed with Addenbrooke's Cognitive Examination revised (ACE-R). Multiple linear regression analyses were used to determine the association between time for recanalization and ACE-R. The level of significance adopted was 0.05. RESULTS The mean age of participants was 71.5 (interquartile range [IQR] 62.0-78.2) years, and 50% (22) were women. The median time after stroke was 28.6 months (IQR 18.94-31.55). All patients in our sample had a successful level of recanalization with EVT (mTICI ≥ 2b). Time for recanalization showed an inverse association with the ACE-R (b = -0.0207, P = 0.0203). Also the mRS at 3 months had an inverse association with cognition (b = -5.2803, p = 0.0095). Level of education had a strong and direct relationship with ACE-R results (b = 3.0869, p < 0.0001). CONCLUSIONS Longer time between stroke symptoms and recanalization with EVT in patients with right hemisphere ischemic stroke lead to lower ACE-R scores. Measures to improve door-to-recanalization time are also important for cognitive performance after ischemic stroke.
Collapse
Affiliation(s)
- Joana Costa Novo
- Neurology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Evelyne Rieffel
- Psychology department, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Francisca Costa
- Imagiology Department - Neurorradiology, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Pedro Barros
- Neurology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
- Stroke Unit, Neurology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Miguel Veloso
- Neurology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
- Stroke Unit, Neurology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Henrique Costa
- Neurology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
- Stroke Unit, Neurology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Ludovina Paredes
- Stroke Unit, Neurology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
- Internal Medicine Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Tiago Gregório
- Stroke Unit, Neurology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
- Internal Medicine Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Marta Rodrigues
- Imagiology Department - Neurorradiology, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Pedro Calvão-Pires
- Imagiology Department - Neurorradiology, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Ana Campolargo
- Physical Medicine and Rehabilitation Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Valéria Battistella
- Neurology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
- Stroke Unit, Neurology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| |
Collapse
|
20
|
Elendu C, Amaechi DC, Elendu TC, Ibhiedu JO, Egbunu EO, Ndam AR, Ogala F, Ologunde T, Peterson JC, Boluwatife AI, Okongko AO, Fatoye JO, Akpovona OL, Onyekweli SO, Temitope AY, Achimugu AO, Temilade AV. Stroke and cognitive impairment: understanding the connection and managing symptoms. Ann Med Surg (Lond) 2023; 85:6057-6066. [PMID: 38098605 PMCID: PMC10718363 DOI: 10.1097/ms9.0000000000001441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 10/17/2023] [Indexed: 12/17/2023] Open
Abstract
Stroke is a leading cause of long-term disability worldwide, and cognitive impairment is a common consequence of stroke. Understanding the connection between stroke and cognitive impairment is crucial for effectively managing symptoms and improving patients' quality of life. This abstract provides an overview of the relationship between stroke and cognitive impairment and explores strategies for managing cognitive symptoms in stroke survivors. A comprehensive review of relevant literature was conducted to examine the association between stroke and cognitive impairment. Various factors contributing to cognitive impairment after stroke were explored, including the location and severity of the stroke, vascular risk factors, and underlying mechanisms. Evidence-based strategies for managing cognitive symptoms in stroke survivors were also analyzed, such as cognitive rehabilitation, pharmacological interventions, and lifestyle modifications. The review revealed a strong link between stroke and cognitive impairment. The location and severity of the stroke play a significant role in determining the specific cognitive deficits experienced by individuals. Vascular risk factors, including hypertension, diabetes, and atrial fibrillation, contribute to cognitive decline after stroke. Mechanisms such as cerebral hypoperfusion, white matter damage, and neuroinflammation also play a role. Cognitive rehabilitation programs have shown promising results in improving cognitive function, while certain medications may help manage specific cognitive symptoms. Lifestyle modifications like physical exercise and a healthy diet have been associated with better cognitive outcomes in stroke survivors.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Faith Ogala
- King’s College Hospital NHS Foundation Trust, Denmark Hill, London, UK
| | - Tunde Ologunde
- King’s College Hospital NHS Foundation Trust, Denmark Hill, London, UK
| | | | | | | | | | - Otite L. Akpovona
- King’s College Hospital NHS Foundation Trust, Denmark Hill, London, UK
| | | | | | | | | |
Collapse
|
21
|
Kusec A, Milosevich E, Williams OA, Chiu EG, Watson P, Carrick C, Drozdowska BA, Dillon A, Jennings T, Anderson B, Dawes H, Thomas S, Kuppuswamy A, Pendlebury ST, Quinn TJ, Demeyere N. Long-term psychological outcomes following stroke: the OX-CHRONIC study. BMC Neurol 2023; 23:426. [PMID: 38036966 PMCID: PMC10688008 DOI: 10.1186/s12883-023-03463-5] [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: 05/19/2023] [Accepted: 11/10/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Stroke survivors rate longer-term (> 2 years) psychological recovery as their top priority, but data on how frequently psychological consequences occur is lacking. Prevalence of cognitive impairment, depression/anxiety, fatigue, apathy and related psychological outcomes, and whether rates are stable in long-term stroke, is unknown. METHODS N = 105 long-term stroke survivors (M [SD] age = 72.92 [13.01]; M [SD] acute NIH Stroke Severity Score = 7.39 [6.25]; 59.0% Male; M [SD] years post-stroke = 4.57 [2.12]) were recruited (potential N = 208). Participants completed 3 remote assessments, including a comprehensive set of standardized cognitive neuropsychological tests comprising domains of memory, attention, language, and executive function, and questionnaires on emotional distress, fatigue, apathy and other psychological outcomes. Ninety participants were re-assessed one year later. Stability of outcomes was assessed by Cohen's d effect size estimates and percent Minimal Clinically Important Difference changes between time points. RESULTS On the Montreal Cognitive Assessment 65.3% scored < 26. On the Oxford Cognitive Screen 45.9% had at least one cognitive impairment. Attention (27.1%) and executive function (40%) were most frequently impaired. 23.5% and 22.5% had elevated depression/anxiety respectively. Fatigue (51.4%) and apathy (40.5%) rates remained high, comparable to estimates in the first-year post-stroke. Attention (d = -0.12; 85.8% stable) and depression (d = 0.09, 77.1% stable) were the most stable outcomes. Following alpha-adjustments, only perceptuomotor abilities (d = 0.69; 40.4% decline) and fatigue (d = -0.33; 45.3% decline) worsened over one year. Cognitive impairment, depression/anxiety, fatigue and apathy all correlated with worse quality of life. CONCLUSION Nearly half of participants > 2 years post-event exhibited psychological difficulties including domains of cognition, mood, and fatigue, which impact long-term quality of life. Stroke is a chronic condition with highly prevalent psychological needs, which require monitoring and intervention development.
Collapse
Affiliation(s)
- Andrea Kusec
- Department of Experimental Psychology, University of Oxford, Anna Watts Building, Radcliffe Observatory Quarter, Oxford, UK
| | - Elise Milosevich
- Department of Experimental Psychology, University of Oxford, Anna Watts Building, Radcliffe Observatory Quarter, Oxford, UK
| | - Owen A Williams
- Department of Experimental Psychology, University of Oxford, Anna Watts Building, Radcliffe Observatory Quarter, Oxford, UK
| | - Evangeline G Chiu
- Department of Experimental Psychology, University of Oxford, Anna Watts Building, Radcliffe Observatory Quarter, Oxford, UK
| | - Pippa Watson
- Department of Experimental Psychology, University of Oxford, Anna Watts Building, Radcliffe Observatory Quarter, Oxford, UK
| | - Chloe Carrick
- Department of Experimental Psychology, University of Oxford, Anna Watts Building, Radcliffe Observatory Quarter, Oxford, UK
| | - Bogna A Drozdowska
- School of Cardiovascular & Metabolic Health, University of Glasgow, Glasgow, UK
| | - Avril Dillon
- Department of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | | | - Bloo Anderson
- Patient and Public Involvement Representative, Oxford, UK
| | - Helen Dawes
- NIHR Exeter Biomedical Research Centre, University of Exeter, Medical School Building, St Luke's Campus, Magdalen Road, Exeter, UK
| | - Shirley Thomas
- School of Medicine, Queen's Medical Centre, University of Nottingham, Nottingham, UK
| | - Annapoorna Kuppuswamy
- Institute of Neurology Department of Clinical and Movement Neurosciences, University College London, 33 Queen Square, London, UK
- Department of Biomedical Sciences, University of Leeds, Leeds, UK
| | - Sarah T Pendlebury
- Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Terence J Quinn
- School of Cardiovascular & Metabolic Health, University of Glasgow, Glasgow, UK
| | - Nele Demeyere
- Department of Experimental Psychology, University of Oxford, Anna Watts Building, Radcliffe Observatory Quarter, Oxford, UK.
- Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK.
| |
Collapse
|
22
|
Villa BR, Bhatt D, Wolff MD, Addo-Osafo K, Epp JR, Teskey GC. Repeated episodes of postictal hypoxia are a mechanism for interictal cognitive impairments. Sci Rep 2023; 13:15474. [PMID: 37726428 PMCID: PMC10509159 DOI: 10.1038/s41598-023-42741-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 09/14/2023] [Indexed: 09/21/2023] Open
Abstract
Comorbidities during the period between seizures present a significant challenge for individuals with epilepsy. Despite their clinical relevance, the pathophysiology of the interictal symptomatology is largely unknown. Postictal severe hypoxia (PIH) in those brain regions participating in the seizure has been indicated as a mechanism underlying several negative postictal manifestations. It is unknown how repeated episodes of PIH affect interictal symptoms in epilepsy. Using a rat model, we observed that repeated seizures consistently induced episodes of PIH that become increasingly severe with each seizure occurrence. Additionally, recurrent seizure activity led to decreased levels of oxygen in the hippocampus during the interictal period. However, these reductions were prevented when we repeatedly blocked PIH using either the COX-inhibitor acetaminophen or the L-type calcium channel antagonist nifedipine. Moreover, we found that interictal cognitive deficits caused by seizures were completely alleviated by repeated attenuation of PIH events. Lastly, mitochondrial dysfunction may contribute to the observed pathological outcomes during the interictal period. These findings provide evidence that seizure-induced hypoxia may play a crucial role in several aspects of epilepsy. Consequently, developing and implementing treatments that specifically target and prevent PIH could potentially offer significant benefits for individuals with refractory epilepsy.
Collapse
Affiliation(s)
- Bianca R Villa
- Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, T2N 4N1, Canada.
- Department of Cell Biology and Anatomy, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada.
| | - Dhyey Bhatt
- Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, T2N 4N1, Canada
- Department of Cell Biology and Anatomy, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - Marshal D Wolff
- Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, T2N 4N1, Canada
- Department of Cell Biology and Anatomy, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - Kwaku Addo-Osafo
- Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, T2N 4N1, Canada
- Department of Cell Biology and Anatomy, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - Jonathan R Epp
- Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, T2N 4N1, Canada
- Department of Cell Biology and Anatomy, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - G Campbell Teskey
- Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, T2N 4N1, Canada
- Department of Cell Biology and Anatomy, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
- Cumming School of Medicine, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, T2N 4N1, Canada
| |
Collapse
|
23
|
Faroqi-Shah Y. A reconceptualization of sentence production in post-stroke agrammatic aphasia: the synergistic processing bottleneck model. FRONTIERS IN LANGUAGE SCIENCES 2023; 2:1118739. [PMID: 39175803 PMCID: PMC11340809 DOI: 10.3389/flang.2023.1118739] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/24/2024]
Abstract
The language production deficit in post-stroke agrammatic aphasia (PSA-G) tends to result from lesions to the left inferior frontal gyrus (LIFG) and is characterized by a triad of symptoms: fragmented sentences, errors in functional morphology, and a dearth of verbs. Despite decades of research, the mechanisms underlying production patterns in PSA-G have been difficult to characterize. Two major impediments to progress may have been the view that it is a purely morphosyntactic disorder and the (sometimes overzealous) application of linguistic theory without interceding psycholinguistic evidence. In this paper, empirical evidence is examined to present an integrated portrait of language production in PSA-G and to evaluate the assumption of a syntax-specific syndrome. In light of extant evidence, it is proposed that agrammatic language production results from a combination of morphosyntactic, phonomotor, and processing capacity limitations that cause a cumulative processing bottleneck at the point of articulatory planning. This proposed Synergistic Processing Bottleneck model of PSA-G presents a testable framework for future research. The paper ends with recommendations for future research on PSA-G.
Collapse
Affiliation(s)
- Yasmeen Faroqi-Shah
- Department of Hearing and Speech Sciences, University of Maryland, College Park, MD, USA
| |
Collapse
|
24
|
Veerbeek JM, Hutter C, Ottiger B, Micheletti S, Riedi S, Bianchi E, Maaijwee N, Vanbellingen T, Nyffeler T. Profiling Daily Life Performance Recovery in the Early Subacute Phase After Stroke Using a Graphical Modeling Approach. J Am Heart Assoc 2023; 12:e030472. [PMID: 37581392 PMCID: PMC10492950 DOI: 10.1161/jaha.123.030472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 06/09/2023] [Indexed: 08/16/2023]
Abstract
Background Laboratory-based assessments have shown that stroke recovery is heterogeneous between patients and affected domains such as motor and language function. However, laboratory-based assessments are not ecologically valid and do not necessarily reflect patients' daily life performance. Therefore, we aimed to give an innovative view on stroke recovery by profiling daily life performance recovery across domains in patients with early subacute stroke and determine their interrelatedness, taking stroke localization into account. Methods and Results Daily life performance was observed at neurorehabilitation admission and weekly thereafter until discharge, using a scale containing 7 daily life domains. Graphical modeling was applied to investigate the conditional independence between recovery of these domains depending on stroke localization. There were 592 patients analyzed. Four clusters of interrelated domains were identified within the first 6 weeks poststroke. The first cluster included recovery in learning and applying knowledge, general tasks and demands, and domestic life. The second cluster comprised recovery in self-care and general tasks and demands. The third cluster included recovery in mobility and self-care; it incorporated interpersonal interactions and relationships in left supratentorial stroke, and learning and applying knowledge in right supratentorial stroke. The final cluster included only communication recovery. Conclusions Daily life recovery dynamics early poststroke show that although impairments in body functions are anatomically determined, their impact on performance is comparable. Second, some, but by no means all, domains show an interrelated recovery. Domains requiring cognitive abilities are especially interrelated and seem to be essential for concomitant recovery in mobility and domestic life.
Collapse
Affiliation(s)
| | - Clemens Hutter
- Chair for Mathematical Information ScienceETH ZurichZurichSwitzerland
| | | | | | - Simone Riedi
- Department of Computer ScienceETH ZurichZurichSwitzerland
| | - Enrico Bianchi
- Department of Computer ScienceETH ZurichZurichSwitzerland
| | | | - Tim Vanbellingen
- NeurocenterLuzerner KantonsspitalLucerneSwitzerland
- ARTORG Center for Biomedical Engineering Research, Gerontechnology and Rehabilitation GroupUniversity BernBernSwitzerland
| | - Thomas Nyffeler
- NeurocenterLuzerner KantonsspitalLucerneSwitzerland
- ARTORG Center for Biomedical Engineering Research, Gerontechnology and Rehabilitation GroupUniversity BernBernSwitzerland
- Department of NeurologyInselspital, Bern University Hospital, University of BernSwitzerland
| |
Collapse
|
25
|
Xu M, Qian L, Wang S, Cai H, Sun Y, Thakor N, Qi X, Sun Y. Brain network analysis reveals convergent and divergent aberrations between mild stroke patients with cortical and subcortical infarcts during cognitive task performing. Front Aging Neurosci 2023; 15:1193292. [PMID: 37484690 PMCID: PMC10358837 DOI: 10.3389/fnagi.2023.1193292] [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: 03/24/2023] [Accepted: 06/09/2023] [Indexed: 07/25/2023] Open
Abstract
Although consistent evidence has revealed that cognitive impairment is a common sequela in patients with mild stroke, few studies have focused on it, nor the impact of lesion location on cognitive function. Evidence on the neural mechanisms underlying the effects of mild stroke and lesion location on cognitive function is limited. This prompted us to conduct a comprehensive and quantitative study of functional brain network properties in mild stroke patients with different lesion locations. Specifically, an empirical approach was introduced in the present work to explore the impact of mild stroke-induced cognitive alterations on functional brain network reorganization during cognitive tasks (i.e., visual and auditory oddball). Electroencephalogram functional connectivity was estimated from three groups (i.e., 40 patients with cortical infarctions, 48 patients with subcortical infarctions, and 50 healthy controls). Using graph theoretical analysis, we quantitatively investigated the topological reorganization of functional brain networks at both global and nodal levels. Results showed that both patient groups had significantly worse behavioral performance on both tasks, with significantly longer reaction times and reduced response accuracy. Furthermore, decreased global and local efficiency were found in both patient groups, indicating a mild stroke-related disruption in information processing efficiency that is independent of lesion location. Regarding the nodal level, both divergent and convergent node strength distribution patterns were revealed between both patient groups, implying that mild stroke with different lesion locations would lead to complex regional alterations during visual and auditory information processing, while certain robust cognitive processes were independent of lesion location. These findings provide some of the first quantitative insights into the complex neural mechanisms of mild stroke-induced cognitive impairment and extend our understanding of underlying alterations in cognition-related brain networks induced by different lesion locations, which may help to promote post-stroke management and rehabilitation.
Collapse
Affiliation(s)
- Mengru Xu
- Key Laboratory for Biomedical Engineering of Ministry of Education of China, Department of Biomedical Engineering, Zhejiang University, Hangzhou, China
| | - Linze Qian
- Key Laboratory for Biomedical Engineering of Ministry of Education of China, Department of Biomedical Engineering, Zhejiang University, Hangzhou, China
| | - Sujie Wang
- Key Laboratory for Biomedical Engineering of Ministry of Education of China, Department of Biomedical Engineering, Zhejiang University, Hangzhou, China
| | - Huaying Cai
- Department of Neurology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yi Sun
- Department of Neurology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Nitish Thakor
- Department of Biomedical Engineering, National University of Singapore, Singapore, Singapore
| | - Xuchen Qi
- Department of Neurosurgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Department of Neurosurgery, Shaoxing People's Hospital, Shaoxing, China
| | - Yu Sun
- Key Laboratory for Biomedical Engineering of Ministry of Education of China, Department of Biomedical Engineering, Zhejiang University, Hangzhou, China
- Department of Neurology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
- State Key Laboratory of Brain-Machine Intelligence, Zhejiang University, Hangzhou, China
| |
Collapse
|
26
|
Chi X, Fan X, Fu G, Liu Y, Zhang Y, Shen W. Research trends and hotspots of post-stroke cognitive impairment: a bibliometric analysis. Front Pharmacol 2023; 14:1184830. [PMID: 37324494 PMCID: PMC10267734 DOI: 10.3389/fphar.2023.1184830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 05/16/2023] [Indexed: 06/17/2023] Open
Abstract
Background: Post-stroke cognitive impairment (PSCI) is a major complication of stroke that affects more than one-third of stroke survivors, threatening their quality of life and increasing the risk of disability and death. Although various studies have described the etiology, epidemiology, and risk factors of PSCI, there are a limited number of comprehensive and accurate reports on research trends and hotspots in this field. Therefore, this review aimed to evaluate research trends, hotspots, and frontiers in PSCI using bibliometric analysis. Methods: We screened the literature spanning 20 years in the Web of Science Core Collection: Science Citation Index Expanded (SCI-Expanded) database from 1 January 2003 to 31 December 2022. We included all eligible literature reports based on our comprehensive search strategy, inclusion criteria, and exclusion criteria. The analysis of annual publications, countries/regions, institutions, journals, co-cited references, and keywords was conducted using CiteSpace and VOSviewer, and the hotspots and major findings of PSCI were summarized. Results: A total of 1,024 publications were included in this review. We found that the number of publications on PSCI increased annually. These publications were published in 75 countries or regions by over 400 institutions. Although Chinese institutions had the highest number of publications, their international influence was limited. The United States showed a strong influence in the field. The journal "Stroke" published the most publications (57) with a high impact factor and was considered the most co-cited journal. The most frequently cited references focused on the prevalence, incidence, neuropsychological assessment scales, criteria, and guidelines of PSCI. The strongest citation burst keywords for PSCI were "neurotrophic factor" and "synaptic plasticity", which were regarded as research focuses and research hotspots, respectively. Conclusion: This review provided a comprehensive summary of the literature of PSCI, identified the authoritative and frequently cited literature and journals, clarified the trends in PSCI research, and highlighted the hotspots in this field. Currently, studies on the mechanisms and treatment of PSCI are limited, and we hope that this review has effectively highlighted the research trajectory of PSCI and will lay the foundation for more innovative research in the future.
Collapse
Affiliation(s)
| | | | | | | | | | - Wei Shen
- *Correspondence: Yunling Zhang, ; Wei Shen,
| |
Collapse
|
27
|
Baraka A, Meda J, Nyundo A. Predictors of post-stroke cognitive impairment at three-month following first episode of stroke among patients attended at tertiary hospitals in Dodoma, central Tanzania: A protocol of a prospective longitudinal observational study metadata. PLoS One 2023; 18:e0273200. [PMID: 36862705 PMCID: PMC9980770 DOI: 10.1371/journal.pone.0273200] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 02/03/2023] [Indexed: 03/03/2023] Open
Abstract
INTRODUCTION Neurocognitive deficits after stroke are a common manifestation and pose a significant impact on the quality of life for patients and families; however, little attention is given to the burden and associated impact of cognitive impairment following stroke. The study aims to determine the prevalence and predictors of post-stroke cognitive impairment (PSCI) among adult stroke patients admitted to tertiary hospitals in Dodoma, Tanzania. METHODOLOGY A prospective longitudinal study is conducted at tertiary hospitals in the Dodoma region, central Tanzania. Participants with the first stroke confirmed by CT/MRI brain aged ≥ 18 years who meet the inclusion criteria are enrolled and followed up. Baseline socio-demographic and clinical factors are identified during admission, while other clinical variables are determined during the three-month follow-up period. Descriptive statistics are used to summarize data; continuous data will be reported as Mean (SD) or Median (IQR), and categorical data will be summarized using proportions and frequencies. Univariate and multivariate logistic regression analysis will be used to determine predictors of PSCI.
Collapse
Affiliation(s)
- Alphonce Baraka
- Department of Internal Medicine, School of Medicine & Dentistry, The University Dodoma, Dodoma, Tanzania
- Department of Internal Medicine, The Benjamin Mkapa Hospital, Dodoma, Tanzania
| | - John Meda
- Department of Internal Medicine, School of Medicine & Dentistry, The University Dodoma, Dodoma, Tanzania
- Department of Cardiology, The Benjamin Mkapa Hospital, Dodoma, Tanzania
| | - Azan Nyundo
- Department of Psychiatry and Mental Health, School of Medicine, The University of Dodoma, Dodoma, Tanzania
- Division of Psychiatry, Department of Internal Medicine, The Benjamin Mkapa Hospital, Dodoma, Tanzania
- * E-mail: ,
| |
Collapse
|
28
|
Rader L, Thelen N, Fimm B. Validation of a Nonverbal Version of the Questionnaire of Experienced Attention Deficits (FEDA). ZEITSCHRIFT FÜR NEUROPSYCHOLOGIE 2023. [DOI: 10.1024/1016-264x/a000371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Abstract: Although objective attention deficits have been well established in aphasia patients, there is little evidence of subjective attention deficits since these are mostly assessed with rating scales and questionnaires that are often confounded by the language deficits of aphasic patients. To overcome this limitation, we developed a nonverbal version of the Questionnaire of Experienced Attention Deficits (FEDA) and assessed its preliminary reliability and validity in 70 healthy controls and 18 aphasia patients. An exploratory factor analysis revealed a two-factorial structure with good model fit in confirmatory factor analysis as well as good internal consistency (ω = .89) and discriminant validity. We consider the NFEDA to be a valuable diagnostic tool to assess subjective attention deficits in patients with language impairments such as aphasia.
Collapse
Affiliation(s)
- Lena Rader
- Institute of Medical Psychology and Medical Sociology, University Hospital RWTH Aachen, Germany
- Clinic for Neurology, Department of Neuropsychology, University Hospital RWTH Aachen, Germany
| | - Nadine Thelen
- Clinic for Cardiology, Angiology and Internal Intensive Care Medicine, University Hospital RWTH Aachen, Germany
| | - Bruno Fimm
- Clinic for Neurology, Department of Neuropsychology, University Hospital RWTH Aachen, Germany
| |
Collapse
|
29
|
Droś J, Kowalska K, Pasińska P, Klimkowicz-Mrowiec A. Transient cognitive impairment in the acute phase of stroke - prevalence, risk factors and influence on long-term prognosis in population of patients with stroke (research study - part of the PROPOLIS study). BMC Neurol 2023; 23:75. [PMID: 36803740 PMCID: PMC9936649 DOI: 10.1186/s12883-023-03120-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 02/14/2023] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND Cognitive impairment is a common complication of the acute phase of stroke, which can be transient and resolve while still in the hospital. This study evaluated the prevalence and risk factors for transient cognitive impairment and their impact on long-term prognosis in a population of acute-phase stroke patients. METHODS Consecutive patients admitted to a stroke unit with acute stroke or transient ischemic attack were screened twice for cognitive impairment using the parallel version of Montreal Cognitive Assessment: the first time between the first and third day and the second time between the fourth and seventh day of hospitalization. If the second test score increased by two or more points, transient cognitive impairment was diagnosed. Patients were scheduled for follow-up visits three and 12 months after stroke. Outcome assessment included place of discharge, current functional status, dementia, or death. RESULTS Four hundred forty-seven patients were included in the study, 234 (52.35%) were diagnosed with transient cognitive impairment. Delirium was the only independent risk factor for transient cognitive impairment (OR 2.417, 95%CI 1.096-5.333, p = 0.029). In the analysis of effects on three- and twelve-month prognosis, patients with transient cognitive impairment had a lower risk of hospital or institution stay 3 months after stroke compared with patients with permanent cognitive impairment (OR 0.396, 95%CI 0.217-0.723, p = 0.003). There was no significant effect on mortality, disability or risk of dementia. CONCLUSIONS Transient cognitive impairment, which often occurs in the acute phase of stroke, does not increase the risk of long-term complications.
Collapse
Affiliation(s)
- Jakub Droś
- grid.5522.00000 0001 2162 9631Doctoral School in Medical and Health Sciences, Jagiellonian University Medical College, Kraków, Poland
| | | | - Paulina Pasińska
- grid.5522.00000 0001 2162 9631Department of Medical Didactics, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Aleksandra Klimkowicz-Mrowiec
- Department of Internal Medicine and Gerontology, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland.
| |
Collapse
|
30
|
Shahouzaie N, Farzadfar MT, Jamali J, Sobhani-Rad D. The impact of subcortical stroke-related aphasia on executive functions and working memory. APPLIED NEUROPSYCHOLOGY. ADULT 2023:1-7. [PMID: 36745708 DOI: 10.1080/23279095.2023.2174437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Aphasia is a common post-stroke disorder characterized by impairments in speaking, listening, reading, and writing. Although cognitive impairments have been well studied in cortical aphasia, deficits associated with subcortical aphasia remain to be elucidated. The current study aimed to assess executive functions (EF) and working memory (WM) in patients with subcortical aphasia, and investigate the relationship between language abilities and cognition deficits. Participants of this research included patients with thalamus lesions (n = 9; mean age = 53.89 years) and healthy individuals (n = 9; mean age = 54.33 years). Assessment materials were the Mini-Mental State Examination (MMSE), Persian Western Aphasia Battery (P-WAB-1), digit span subtest of Adult Wechsler Test (WAIS-R), and Wisconsin Card Sorting Test (WCST). Obtained results revealed significant differences in all components of EF, as well as in WM forward and backward digit spans between patients and healthy individuals. However, investigating the relationship between MMSE and AQ scores and components of EF and WM revealed no significant difference. In conclusion, the findings of the present research indicated defects in cognitive functions, including WM and EF, in patients with subcortical stroke. Accordingly, it is crucial to provide optimal rehabilitation therapies for the improvement of language and cognitive problems upon subcortical aphasia.
Collapse
Affiliation(s)
- Nasrin Shahouzaie
- Department of Speech Therapy, School of Rehabilitation, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Mohammad Taghi Farzadfar
- Department of Neurology, Mashhad University of Medical Sciences, Ghaem Medical Center, Mashhad, Iran
| | - Jamshid Jamali
- Department of Biostatistics, School of Health, Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Davood Sobhani-Rad
- Department of Speech Therapy, School of Paramedical and Rehabilitation Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
| |
Collapse
|
31
|
Matsuzono K, Suzuki M, Anan Y, Ozawa T, Mashiko T, Koide R, Tanaka R, Fujimoto S. Spontaneous Echo Contrast in the Left Atrium and Aortic-Arch Atheroma, Detected by Transesophageal Echocardiography, Was Negatively Correlated with Cognitive Function. J Alzheimers Dis 2023; 91:673-681. [PMID: 36463447 DOI: 10.3233/jad-220763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
BACKGROUND The relationship between transesophageal echocardiography findings and cognitive function. OBJECTIVE This study aimed to establish an association between transesophageal echocardiography findings and cognitive function in stroke survivors. METHODS A single-center study was conducted between April 1, 2017 and March 31, 2022. All subjects that were included had a past history of ischemic stroke and were admitted after >21 days from onset. The participants underwent cognitive function tests including a Mini-Mental State Examination, Revised Hasegawa Dementia Scale, Frontal Assessment Battery, and transesophageal echocardiography. RESULTS The results of 126 participants were analyzed. The cognitive function of participants with a spontaneous echo contrast (+) in the left atrium including appendage or of those with an aorta-arch plaque with a maximum thickness ≥4 mm significantly worse while neither the patent foramen ovale nor the branch extending plaque influenced cognitive function (The median cognitive scores of the spontaneous echo contrast (-) versus (+) were 26 versus 22, p < 0.01**, 26 versus 21, p < 0.001***, and 14 versus 11, p < 0.01**. Those of the aortic-arch plaque max thickness (<4 mm) versus (≥4 mm) were 26 versus 25, p < 0.05*, 27 versus 24, p < 0.05*, and 15 versus 13, p < 0.05*). CONCLUSION Our findings show that spontaneous echo contrast in the left atrium and aortic-arch atheroma detected by transesophageal echocardiography, were negatively associated with cognitive function.
Collapse
Affiliation(s)
- Kosuke Matsuzono
- Division of Neurology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Masayuki Suzuki
- Division of Neurology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Yuhei Anan
- Division of Neurology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Tadashi Ozawa
- Division of Neurology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Takafumi Mashiko
- Division of Neurology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Reiji Koide
- Division of Neurology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Ryota Tanaka
- Division of Neurology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Shigeru Fujimoto
- Division of Neurology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| |
Collapse
|
32
|
The efficacy of therapist-supported acceptance and commitment therapy-based bibliotherapy for psychological distress after stroke: a single-case multiple-baseline study. Behav Cogn Psychother 2023; 51:87-104. [PMID: 36214628 DOI: 10.1017/s135246582200042x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Psychological distress is common after stroke, and affects recovery. However, there are few evidence-based psychological treatments. This study evaluates a bibliotherapy-based approach to its amelioration. AIMS To investigate a stroke-specific self-management book, based on acceptance and commitment therapy (ACT), as a therapist-supported intervention for psychological distress after stroke. METHOD The design was a single case, randomised non-concurrent multiple-baseline design (MBD). Sixteen stroke survivors, eight males and eight females (mean age 60.6 years), participated in an MBD with three phases: A (randomised-duration baseline); B (intervention); and follow-up (at 3 weeks). During the baseline, participants received therapist contact only. In the bibliotherapy intervention, participants received bi-weekly therapist support. The primary measures of psychological distress (General Health Questionaire-12; GHQ-12) and quality of life (Satisfaction with Life Scale; SWLS) were completed weekly. Secondary measures of mood, wellbeing and illness impact were completed pre- and post-intervention. RESULTS Omnibus whole-group TAU-U analysis was statistically significant for each primary measure with a moderate effect size on both (0.6 and 0.3 for GHQ-12 and SWLS, respectively). Individual TAU-U analyses demonstrated that the majority of individuals exhibited positive change. All the secondary measures showed significant pre-post improvements. Eighty-one per cent of participants reported the book was helpful and 81% also found the ACT-based sections helpful. Relative risk calculations showed finding the book helpful was associated with improvement in GHQ-12 and SWLS scores. CONCLUSIONS ACT-based bibliotherapy, with therapist support, is a promising intervention for psychological difficulties after stroke.
Collapse
|
33
|
Zanin A, Reinholdsson M, Abzhandadze T. Association of cognitive function very early after stroke with subjective cognitive complaints after 3 months, a register-based study. PLoS One 2023; 18:e0283667. [PMID: 36989313 PMCID: PMC10057757 DOI: 10.1371/journal.pone.0283667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 03/14/2023] [Indexed: 03/30/2023] Open
Abstract
OBJECTIVE Cognitive deficits are commonly observed after stroke and have been associated with the cognitive decline and development of dementia in later stages. This study aimed to investigate whether cognition screened at acute stroke units could explain subjective cognitive complaints 3 months after stroke and evaluate how the severity of stroke and age could influence this association. METHODS In this register-based longitudinal study, data were retrieved from three Swedish registers between November 2014 and June 2019. Information on subjective cognitive complaints (SCC) was collected from the Riksstroke 3-month follow-up form, which were used to analyze the primary outcomes. Cognitive function screened using the Montreal Cognitive Assessment (MoCA) at acute stroke units was expressed as the primary independent variable. RESULTS Of the 1977 patients included in the study, 58% were males, the median age was 73 years, and 63% had a minor stroke. A total of 60% of patients had impaired cognition at acute stroke units (MoCA score, <26), of whom 40.3% reported at least 1 cognitive problem after 3 months. In adjusted binary regression analysis models, patients with normal cognitive function had lower odds for SCCs. This pattern was observed regardless of age and in patients with a minor stroke. CONCLUSIONS Intact cognition early after stroke was related to decreased odds of subjective cognitive complaints at the 3-month follow-up. This study highlights the importance of both early cognitive screening after stroke and subjective cognitive complaints, which have been shown to be associated with cognitive decline. Furthermore, we suggest the importance of discussing cognitive function with patients during regular follow-up in primary care, usually 3 months after stroke.
Collapse
Affiliation(s)
- Alice Zanin
- Faculty of Psychology, University of Padua, Padua, Italy
- Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Malin Reinholdsson
- Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Tamar Abzhandadze
- Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| |
Collapse
|
34
|
Skidmore ER, Eskes G, Brodtmann A. Executive Function Poststroke: Concepts, Recovery, and Interventions. Stroke 2023; 54:20-29. [PMID: 36542071 DOI: 10.1161/strokeaha.122.037946] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Executive function is frequently impaired among people who have sustained stroke. This review provides an overview of definitions, concepts, and measures. The review also summarizes current best evidence examining executive function impairment and recovery trajectories after stroke, correlates of change over time, and emerging intervention research. Finally, this review provides recommendations for research and clinical practices, as well as priorities for future executive function research.
Collapse
Affiliation(s)
- Elizabeth R Skidmore
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, PA (E.R.S.)
| | - Gail Eskes
- Departments of Psychiatry and Psychology and Neuroscience, Dalhousie University, Nova Scotia, Canada (G.E.)
| | - Amy Brodtmann
- Cognitive Health Initiative, Central Clinical School, Monash University, Melbourne, Australia (A.B.)
| |
Collapse
|
35
|
Xu M, Wu Z, Wu B, Hu Y, Duan Q, Wang H, He J. Lactate dehydrogenase-to albumin ratio (LAR) is associated with early-onset cognitive impairment after acute ischemic stroke. J Clin Neurosci 2022; 106:61-65. [DOI: 10.1016/j.jocn.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 09/29/2022] [Accepted: 10/01/2022] [Indexed: 11/15/2022]
|
36
|
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
|
37
|
Associations of Peak-Width Skeletonized Mean Diffusivity and Post-Stroke Cognition. Life (Basel) 2022; 12:life12091362. [PMID: 36143398 PMCID: PMC9504440 DOI: 10.3390/life12091362] [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: 07/29/2022] [Revised: 08/26/2022] [Accepted: 08/29/2022] [Indexed: 12/02/2022] Open
Abstract
Post-stroke cognitive impairment is common and can have major impact on life after stroke. Peak-width of Skeletonized Mean Diffusivity (PSMD) is a diffusion imaging marker of white matter microstructure and is also associated with cognition. Here, we examined associations between PSMD and post-stroke global cognition in an ongoing study of mild ischemic stroke patients. We studied cross-sectional associations between PSMD and cognition at both 3-months (N = 229) and 1-year (N = 173) post-stroke, adjusted for premorbid IQ, sex, age, stroke severity and disability, as well as the association between baseline PSMD and 1-year cognition. At baseline, (mean age = 65.9 years (SD = 11.1); 34% female), lower Montreal Cognitive Assessment (MoCA) scores were associated with older age, lower premorbid IQ and higher stroke severity, but not with PSMD (βstandardized = −0.116, 95% CI −0.241, 0.009; p = 0.069). At 1-year, premorbid IQ, older age, higher stroke severity and higher PSMD (βstandardized = −0.301, 95% CI −0.434, −0.168; p < 0.001) were associated with lower MoCA. Higher baseline PSMD was associated with lower 1-year MoCA (βstandardized = −0.182, 95% CI −0.308, −0.056; p = 0.005). PSMD becomes more associated with global cognition at 1-year post-stroke, possibly once acute effects have settled. Additionally, PSMD in the subacute phase after a mild stroke could help predict long-term cognitive impairment.
Collapse
|
38
|
Bellomo T, Fokas J, Tsao N, Anderson C, Becker C, Gioscia-Ryan R, Meurer W. Ethical Considerations during the Informed Consent Process for Acute Ischemic Stroke in International Clinical Trials. Ethics Hum Res 2022; 44:14-25. [PMID: 35802793 DOI: 10.1002/eahr.500133] [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] [Indexed: 06/15/2023]
Abstract
We sought to investigate the experiences of researchers in existing active-control trials in acute ischemic stroke comparing investigational therapy to tissue plasminogen activator (tPA) in order to identify the approaches and challenges in obtaining informed consent. Out of 401 articles evaluated, 14 trials met inclusion criteria. Trial representatives were contacted to complete a survey concerning the consent process. None of the 14 trials published materials related to the informed consent process. Trials with 75% to 100% of patients directly consented had shorter door-to-treatment (DTT) times than trials that directly consented less than 50% of patients. Trials that had translators available (for recruiting participants who were not native speakers in the local language) and translated consent documents had longer DTT times. The study findings suggest that differences in the standards of informed consent internationally may allow more patients with moderate strokes to provide direct consent without delaying DTT time. Future trials should emphasize transparency to the public and scientific community in the informed consent process.
Collapse
Affiliation(s)
- Tiffany Bellomo
- Vascular surgery resident at the Massachusetts General Hospital
| | - Jennifer Fokas
- Neurology resident at McGaw Medical Center of Northwestern University
| | - Noah Tsao
- Medical student at the University of Rochester
| | | | | | | | - William Meurer
- Associate professor of emergency medicine at the University of Michigan
| |
Collapse
|
39
|
Iosa M, Demeyere N, Abbruzzese L, Zoccolotti P, Mancuso M. Principal Component Analysis of Oxford Cognitive Screen in Patients With Stroke. Front Neurol 2022; 13:779679. [PMID: 35711263 PMCID: PMC9197217 DOI: 10.3389/fneur.2022.779679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 04/26/2022] [Indexed: 11/13/2022] Open
Abstract
Cognitive deficits occur in most patients with stroke and are the important predictors of adverse long-term outcome. Early identification is fundamental to plan the most appropriate care, including rehabilitation and discharge decisions. The Oxford Cognitive Screen (OCS) is a simple, valid, and reliable tool for the assessment of cognitive deficits in patients with stroke. It contains 10 subtests, providing 14 scores referring to 5 theoretically derived cognitive domains: attention, language, number, praxis, and memory. However, an empirical verification of the domain composition of the OCS subtests in stroke data is still lacking in the literature. A principal component analysis (PCA) was performed on 1,973 patients with stroke who were enrolled in OCS studies in the UK and in Italy. A number of six main components were identified relating to the domains of language and arithmetic, memory, visuomotor ability, orientation, spatial exploration, and executive functions. Bootstrapped split-half reliability analysis on patients and comparison between patients and 498 healthy participants, as that between patients with left and right hemisphere damage, confirmed the results obtained by the principal component analysis. A clarification about the contribution of each score to the theoretical original domains and to the components identified by the PCA is provided with the aim to foster the usability of OCS for both clinicians and researchers.
Collapse
Affiliation(s)
- Marco Iosa
- Department of Psychology, Sapienza University of Rome, Rome, Italy.,IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Nele Demeyere
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom
| | | | - Pierluigi Zoccolotti
- Department of Psychology, Sapienza University of Rome, Rome, Italy.,IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Mauro Mancuso
- Tuscany Rehabilitation Clinic, Arezzo, Italy.,Physical and Rehabilitative Medicine Unit, NHS-USL Tuscany South-Est, Grosseto, Italy
| |
Collapse
|
40
|
Ganesh A, Barber PA. The Cognitive Sequelae of Transient Ischemic Attacks-Recent Insights and Future Directions. J Clin Med 2022; 11:2637. [PMID: 35566762 PMCID: PMC9104376 DOI: 10.3390/jcm11092637] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 05/02/2022] [Accepted: 05/05/2022] [Indexed: 02/05/2023] Open
Abstract
There is now considerable evidence that Transient Ischemic Attack (TIA) carries important sequelae beyond the risk of recurrent stroke, particularly with respect to peri-event and post-event cognitive dysfunction and subsequent cognitive decline. The occurrence of a TIA could provide an important window in understanding the relationship of early mixed vascular-neurodegenerative cognitive decline, and by virtue of their clinical relevance as a "warning" event, TIAs could also furnish the opportunity to act preventatively not only for stroke prevention but also for dementia prevention. In this review, we discuss the current state of the literature regarding the cognitive sequelae associated with TIA, reviewing important challenges in the field. In particular, we discuss definitional and methodological challenges in the study of TIA-related cognitive impairment, confounding factors in the cognitive evaluation of these patients, and provide an overview of the evidence on both transient and long-term cognitive impairment after TIA. We compile recent insights from clinical studies regarding the predictors and mediators of cognitive decline in these patients and highlight important future directions for work in this area.
Collapse
Affiliation(s)
- Aravind Ganesh
- Calgary Stroke Program, Departments of Clinical Neurosciences, University of Calgary Cumming School of Medicine, Calgary, AB T2N 4N1, Canada;
- Department of Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, AB T2N 4N1, Canada
- Hotchkiss Brain Institute, University of Calgary Cumming School of Medicine, Calgary, AB T2N 4N1, Canada
| | - Philip A. Barber
- Calgary Stroke Program, Departments of Clinical Neurosciences, University of Calgary Cumming School of Medicine, Calgary, AB T2N 4N1, Canada;
- Department of Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, AB T2N 4N1, Canada
- Hotchkiss Brain Institute, University of Calgary Cumming School of Medicine, Calgary, AB T2N 4N1, Canada
- Department of Radiology, University of Calgary Cumming School of Medicine, Calgary, AB T2N 4N1, Canada
| |
Collapse
|
41
|
A New Nomogram Model for Individualized Prediction of Cognitive Impairment in Patients with Acute Ischemic Stroke. J Stroke Cerebrovasc Dis 2022; 31:106515. [PMID: 35490470 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106515] [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: 12/28/2021] [Revised: 03/24/2022] [Accepted: 04/11/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Cognitive impairment is a common symptom after ischemic stroke. Such symptom can cause effect on rehabilitation of patients and their quality of life and. As stroke rapidly growth on nowadays, a reliable scoring tool to detect the risk of cognitive impairment after stroke is now being put on the first place. METHODS We enrolled patients with acute ischemic stroke (AIS) as samples and hospitalized all at the First Affiliated Hospital of Soochow University between October 2018 and June 2020. All patients were assessed by the Montreal Cognitive Assessment (MoCA) scales and MoCA score < 26 was defined as standard to have having cognitive impairment. All patients were randomly (7:3) divided into two cohorts: the primary ones and the validated ones. Based on multivariate logistic model, the independent predictors of cognitive impairment in the acute phase were identified. The predictive nomogram was generated and evaluated by Harrell's concordance index (C-index) and calibration plot both in two cohorts, respectively. RESULTS A total of 191 patients were enrolled, of whom 135 comprised the primary cohort and 56 comprised the validated cohort. Gender, age, baseline NIHSS score, hyperhomocysteinemia (HHcy) and multiple lesions were independently associated with acute cognitive impairment after stroke and included to construct the nomogram. The nomogram derived from the primary cohort had an Area Under Curve (AUC) of 0.773 and the validated ones had an AUC of 0.859. Calibration plot revealed adequate fit of the nomogram in predictive value. CONCLUSION The new nomogram based on gender, age, baseline NIHSS score, HHcy and multiple lesions gave rise to an accurate and comprehensive prediction for cognitive impairment in AIS patients. After further validation, it could potentially be a reliable forecasting tool.
Collapse
|
42
|
Houlton J, Zubkova OV, Clarkson AN. Recovery of Post-Stroke Spatial Memory and Thalamocortical Connectivity Following Novel Glycomimetic and rhBDNF Treatment. Int J Mol Sci 2022; 23:ijms23094817. [PMID: 35563207 PMCID: PMC9101131 DOI: 10.3390/ijms23094817] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 04/22/2022] [Accepted: 04/25/2022] [Indexed: 12/10/2022] Open
Abstract
Stroke-induced cognitive impairments remain of significant concern, with very few treatment options available. The involvement of glycosaminoglycans in neuroregenerative processes is becoming better understood and recent advancements in technology have allowed for cost-effective synthesis of novel glycomimetics. The current study evaluated the therapeutic potential of two novel glycomimetics, compound A and G, when administered systemically five-days post-photothrombotic stroke to the PFC. As glycosaminoglycans are thought to facilitate growth factor function, we also investigated the combination of our glycomimetics with intracerebral, recombinant human brain-derived neurotrophic factor (rhBDNF). C56BL/6J mice received sham or stroke surgery and experimental treatment (day-5), before undergoing the object location recognition task (OLRT). Four-weeks post-surgery, animals received prelimbic injections of the retrograde tracer cholera toxin B (CTB), before tissue was collected for quantification of thalamo-PFC connectivity and reactive astrogliosis. Compound A or G treatment alone modulated a degree of reactive astrogliosis yet did not influence spatial memory performance. Contrastingly, compound G+rhBDNF treatment significantly improved spatial memory, dampened reactive astrogliosis and limited stroke-induced loss of connectivity between the PFC and midline thalamus. As rhBDNF treatment had negligible effects, these findings support compound A acted synergistically to enhance rhBDNF to restrict secondary degeneration and facilitate functional recovery after PFC stroke.
Collapse
Affiliation(s)
- Josh Houlton
- Department of Anatomy, Brain Health Research Centre and Brain Research New Zealand, University of Otago, Dunedin 9054, New Zealand;
| | - Olga V. Zubkova
- The Ferrier Research Institute, Gracefield Research Centre, Victoria University of Wellington, 69 Gracefield Road, Lower Hutt 5040, New Zealand;
| | - Andrew N. Clarkson
- Department of Anatomy, Brain Health Research Centre and Brain Research New Zealand, University of Otago, Dunedin 9054, New Zealand;
- Correspondence: ; Tel./Fax: +64-3-279-7326
| |
Collapse
|
43
|
Borgnis F, Baglio F, Pedroli E, Rossetto F, Uccellatore L, Oliveira JAG, Riva G, Cipresso P. Available Virtual Reality-Based Tools for Executive Functions: A Systematic Review. Front Psychol 2022; 13:833136. [PMID: 35478738 PMCID: PMC9036486 DOI: 10.3389/fpsyg.2022.833136] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 03/17/2022] [Indexed: 12/01/2022] Open
Abstract
Introduction Executive dysfunctions constitute a significant public health problem: their high impact on everyday life makes it a priority to identify early strategies for evaluating and rehabilitating these disorders in a real-life context. The ecological limitation of traditional neuropsychological tests and several difficulties in administering tests or training in real-life scenarios have paved the way to use Virtual Reality-based tools to evaluate and rehabilitate Executive Functions (EFs) in real-life. Objective This work aims to conduct a systematic review to provide a detailed description of the VR-based tools currently developed for the evaluation and rehabilitation of EFs. Methods We systematically searched for original manuscripts regarding VR tools and EFs by looking for titles and abstracts in the PubMed, Scopus, PsycInfo, and Web of Science databases up to November 2021 that contained the following keywords “Virtual Reality” AND “Executive function*.” Results and Conclusion We analyzed 301 articles, of which 100 were included. Our work shows that available VR-based tools appear promising solutions for an ecological assessment and treatment of EFs in healthy subjects and several clinical populations.
Collapse
Affiliation(s)
- Francesca Borgnis
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
- Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
| | | | - Elisa Pedroli
- Applied Technology for Neuro-Psychology Lab, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
- Faculty of Psychology, eCampus University, Milan, Italy
| | | | - Lidia Uccellatore
- Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
| | | | - Giuseppe Riva
- Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
- Applied Technology for Neuro-Psychology Lab, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Pietro Cipresso
- Applied Technology for Neuro-Psychology Lab, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
- Department of Psychology, University of Turin, Turin, Italy
- *Correspondence: Pietro Cipresso
| |
Collapse
|
44
|
van Kessel E, Krijnen EA, IJpelaar S, Wajer IMCH, Ruis C, Seute T, De Vos FYFL, Verhoeff JJC, Robe PA, van Zandvoort MJE, Snijders TJ. Complications, compliance and undertreatment do not explain the relationship between cognition and survival in diffuse glioma patients. Neurooncol Pract 2022; 9:284-298. [PMID: 35855455 PMCID: PMC9290897 DOI: 10.1093/nop/npac027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Cognitive deficits occur in all different grades of glioma. In a recent study, we found these deficits to be independently, and possibly causally, related to survival in diffuse gliomas. In this study, we investigated whether the relationship between cognition and survival was mediated by three different factors: undertreatment, complications of treatment, and compliance. We hypothesized that patients with cognitive impairment may undergo less intensive treatment, be less compliant, and suffer more from complications, resulting in shortened survival for cognitively impaired patients. Methods In a retrospective cohort study of patients undergoing awake craniotomy between operative neuropsychological assessments in five cognitive domains. We used Structural Equation Modeling to perform mediation analyses. Mediation analyses are analyses to evaluate whether a variable is a factor in the causal chain, referred to as an intermediate factor. Results In total 254 patients were included, of whom 111 patients were LGG patients and 143 were HGG patients. The most frequently impaired domain was memory (37.8% ≤–2 SD) in HGG and attention and executive functioning in LGG (33.3≤–1.5 SD). We confirmed the significant association between different cognitive domains and survival. These associations could not be explained by one of the aforementioned intermediate factors. Conclusions This suggests that other mechanisms should be involved in the relation between cognition and survival. Hypothetically, cognitive functioning can act as a marker for diffuse infiltration of the tumor or cognitive functioning and survival could be determined by overlapping germline and somatic tumoral molecular-genetic factors.
Collapse
Affiliation(s)
- Emma van Kessel
- University Medical Center Utrecht/UMC Utrecht Brain Center, Department of Neurology & Neurosurgery, Utrecht, The Netherlands
| | - Eva A Krijnen
- University Medical Center Utrecht/UMC Utrecht Brain Center, Department of Neurology & Neurosurgery, Utrecht, The Netherlands
| | - Suzanne IJpelaar
- University Medical Center Utrecht/UMC Utrecht Brain Center, Department of Neurology & Neurosurgery, Utrecht, The Netherlands
| | - Irene M C Huenges Wajer
- University Medical Center Utrecht/UMC Utrecht Brain Center, Department of Neurology & Neurosurgery, Utrecht, The Netherlands
- Helmholtz Institute, Utrecht University, Experimental Psychology, Heidelberglaan, Utrecht, The Netherlands
| | - Carla Ruis
- University Medical Center Utrecht/UMC Utrecht Brain Center, Department of Neurology & Neurosurgery, Utrecht, The Netherlands
- Helmholtz Institute, Utrecht University, Experimental Psychology, Heidelberglaan, Utrecht, The Netherlands
| | - Tatjana Seute
- University Medical Center Utrecht/UMC Utrecht Brain Center, Department of Neurology & Neurosurgery, Utrecht, The Netherlands
| | - Filip Y F L De Vos
- University Medical Center Utrecht/UMC Utrecht Brain Center, Department of Medical Oncology, Utrecht, The Netherlands
| | - Joost J C Verhoeff
- University Medical Center Utrecht/UMC Utrecht Brain Center, Department of Radiation Oncology, Utrecht, The Netherlands
| | - Pierre A Robe
- University Medical Center Utrecht/UMC Utrecht Brain Center, Department of Neurology & Neurosurgery, Utrecht, The Netherlands
| | - Martine J E van Zandvoort
- University Medical Center Utrecht/UMC Utrecht Brain Center, Department of Neurology & Neurosurgery, Utrecht, The Netherlands
- Helmholtz Institute, Utrecht University, Experimental Psychology, Heidelberglaan, Utrecht, The Netherlands
| | - Tom J Snijders
- University Medical Center Utrecht/UMC Utrecht Brain Center, Department of Neurology & Neurosurgery, Utrecht, The Netherlands
| |
Collapse
|
45
|
Speranza L, Pulcrano S, Perrone-Capano C, di Porzio U, Volpicelli F. Music affects functional brain connectivity and is effective in the treatment of neurological disorders. Rev Neurosci 2022; 33:789-801. [PMID: 35325516 DOI: 10.1515/revneuro-2021-0135] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 02/25/2022] [Indexed: 11/15/2022]
Abstract
In a million years, under the pressure of natural selection, hominins have acquired the abilities for vocal learning, music, and language. Music is a relevant human activity, highly effective in enhancing sociality, is a universal experience common to all known human cultures, although it varies in rhythmic and melodic complexity. It has been part of human life since the beginning of our history, or almost, and it strengthens the mother-baby relation even within the mother's womb. Music engages multiple cognitive functions, and promotes attention, concentration, imagination, creativity, elicits memories and emotions, and stimulates imagination, and harmony of movement. It changes the chemistry of the brain, by inducing the release of neurotransmitters and hormones (dopamine, serotonin, and oxytocin) and activates the reward and prosocial systems. In addition, music is also used to develop new therapies necessary to alleviate severe illness, especially neurological disorders, and brain injuries.
Collapse
Affiliation(s)
- Luisa Speranza
- Department of Neuroscience, Albert Einstein College of Medicine, New York, NY 10461, USA
| | - Salvatore Pulcrano
- Institute of Genetics and Biophysics, "Adriano Buzzati-Traverso", C.N.R., 80131 Naples, Italy.,Department of Pharmacy, School of Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy
| | - Carla Perrone-Capano
- Institute of Genetics and Biophysics, "Adriano Buzzati-Traverso", C.N.R., 80131 Naples, Italy.,Department of Pharmacy, School of Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy
| | - Umberto di Porzio
- Institute of Genetics and Biophysics, "Adriano Buzzati-Traverso", C.N.R., 80131 Naples, Italy
| | - Floriana Volpicelli
- Department of Pharmacy, School of Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy
| |
Collapse
|
46
|
Chen L, Chen Y, Wu L, Fu W, Wu L, Fu W. Efficacy of acupuncture on cognitive function in poststroke depression: study protocol for a randomized, placebo-controlled trial. Trials 2022; 23:85. [PMID: 35090538 PMCID: PMC8796526 DOI: 10.1186/s13063-022-06011-7] [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: 12/03/2020] [Accepted: 01/08/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction Poststroke depression (PSD) is the most common mental complication after stroke and has a serious impact on functional outcomes and quality of life. Antidepressants are the first-line treatment for PSD, but many reported side effects remain. Clinical research has shown that acupuncture has a positive effect on PSD. This trial aims to study the efficacy and safety of acupuncture for PSD and to explore its effect on cognitive function. It is hypothesized that acupuncture treatment improves depressive symptoms, cognitive behavior, and negative emotion processing bias in PSD. Methods In this randomized, placebo-controlled, single-blinded trial, fifty-six people with PSD will be randomly allocated into the intervention (n=28) or control (n=28) groups. The intervention group will receive acupuncture treatment, and the control group will receive sham acupuncture treatment, in 20 sessions over 4 weeks. The primary outcome is the change from baseline in the Hamilton Depression Scale-17 (HAMD-17) scores at week 4. Secondary outcomes include the Wisconsin Card Sorting Test (WCST) and latency and amplitude of P1, N170, and P3 of the event-related potentials (ERPs) components to assess the changes in cognitive function and electroencephalography. Outcomes are assessed at baseline and post intervention. Discussion Acupuncture therapy could become an alternative treatment for PSD, and it is expected that this trial will provide reliable clinical evidence for the future use of acupuncture for the treatment of PSD. Trial registration Chinese Clinical Trial Registry ChiCTR1900026948. Registered on 27 October 2019. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06011-7.
Collapse
Affiliation(s)
- Ling Chen
- Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China.,Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yi Chen
- Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China.,Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Lihua Wu
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Wen Fu
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Luanmian Wu
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Wenbin Fu
- Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China. .,Guangzhou University of Chinese Medicine, Guangzhou, China. .,Shenzhen Bao'an Research Center for Acupuncture and Moxibustion, Guangdong Province, Shenzhen, China. .,Sanming Project of Medicine in Shenzhen, Guangdong Province, Shenzhen, China.
| |
Collapse
|
47
|
Koton S, Pike JR, Johansen M, Knopman DS, Lakshminarayan K, Mosley T, Patole S, Rosamond WD, Schneider ALC, Sharrett AR, Wruck L, Coresh J, Gottesman RF. Association of Ischemic Stroke Incidence, Severity, and Recurrence With Dementia in the Atherosclerosis Risk in Communities Cohort Study. JAMA Neurol 2022; 79:271-280. [PMID: 35072712 PMCID: PMC8787684 DOI: 10.1001/jamaneurol.2021.5080] [Citation(s) in RCA: 56] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
IMPORTANCE Ischemic stroke is associated with increased risk of dementia, but the association of stroke severity and recurrence with risk of impaired cognition is not well known. OBJECTIVE To examine the risk of dementia after incident ischemic stroke and assess how it differed by stroke severity and recurrence. DESIGN, SETTING, AND PARTICIPANTS The Atherosclerosis Risk in Communities (ARIC) study is an ongoing prospective cohort of 15 792 community-dwelling individuals from 4 US states (Mississippi, Maryland, Minnesota, and North Carolina). Among them, 15 379 participants free of stroke and dementia at baseline (1987 to 1989) were monitored through 2019. Data were analyzed from April to October 2021. Associations between dementia and time-varying ischemic stroke incidence, frequency, and severity were studied across an average of 4.4 visits over a median follow-up of 25.5 years with Cox proportional hazards models adjusted for sociodemographic characteristics, apolipoprotein E, and vascular risk factors. EXPOSURES Incident and recurrent ischemic strokes were classified by expert review of hospital records, with severity defined by the National Institutes of Health Stroke Scale (NIHSS; minor, ≤5; mild, 6-10; moderate, 11-15; and severe, ≥16). MAIN OUTCOMES AND MEASURES Dementia cases adjudicated through expert review of in-person evaluations, informant interviews, telephone assessments, hospitalization codes, and death certificates. In participants with stroke, dementia events in the first year after stroke were not counted. RESULTS At baseline, the mean (SD) age of participants was 54.1 (5.8) years, and 8485 of 15 379 participants (55.2%) were women. A total of 4110 participants (26.7%) were Black and 11 269 (73.3%) were White. A total of 1378 ischemic strokes (1155 incident) and 2860 dementia cases were diagnosed 1 year or more after incident stroke in participants with stroke, or at any point after baseline in participants without stroke, were identified through December 31, 2019. NIHSS scores were available for 1184 of 1378 ischemic strokes (85.9%). Risk of dementia increased with both the number and severity of strokes. Compared with no stroke, risk of dementia by adjusted hazard ratio was 1.76 (95% CI, 1.49-2.00) for 1 minor to mild stroke, 3.47 (95% CI, 2.23-5.40) for 1 moderate to severe stroke, 3.48 (95% CI, 2.54-4.76) for 2 or more minor to mild strokes, and 6.68 (95% CI, 3.77-11.83) for 2 or more moderate to severe strokes. CONCLUSIONS AND RELEVANCE In this study, risk of dementia significantly increased after ischemic stroke, independent of vascular risk factors. Results suggest a dose-response association of stroke severity and recurrence with risk of dementia.
Collapse
Affiliation(s)
- Silvia Koton
- Department of Nursing, The Stanley Steyer School of Health Professions, Tel Aviv University, Tel Aviv, Israel,Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, Maryland
| | | | - Michelle Johansen
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Kamakshi Lakshminarayan
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis
| | - Thomas Mosley
- Department of Medicine, University of Mississippi Medical Center, Jackson
| | - Shalom Patole
- Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, Maryland
| | - Wayne D. Rosamond
- Department of Epidemiology, University of North Carolina, Chapel Hill
| | | | - A. Richey Sharrett
- Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, Maryland
| | - Lisa Wruck
- Duke Clinical Research Institute, Durham, North Carolina
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, Maryland
| | - Rebecca F. Gottesman
- Stroke Branch, National Institute of Neurological Disorders and Stroke Intramural Research Program, National Institutes of Health, Bethesda, Maryland
| |
Collapse
|
48
|
van Kessel E, Schuit E, Huenges Wajer IMC, Ruis C, De Vos FYFL, Verhoeff JJC, Seute T, van Zandvoort MJE, Robe PA, Snijders TJ. Added Value of Cognition in the Prediction of Survival in Low and High Grade Glioma. Front Neurol 2021; 12:773908. [PMID: 34867763 PMCID: PMC8639204 DOI: 10.3389/fneur.2021.773908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 10/14/2021] [Indexed: 11/26/2022] Open
Abstract
Background: Diffuse gliomas, which are at WHO grade II-IV, are progressive primary brain tumors with great variability in prognosis. Our aim was to investigate whether pre-operative cognitive functioning is of added value in survival prediction in these patients. Methods: In a retrospective cohort study of patients undergoing awake craniotomy between 2010 and 2019 we performed pre-operative neuropsychological assessments in five cognitive domains. Their added prognostic value on top of known prognostic factors was assessed in two patient groups [low- (LGG) and high-grade gliomas (HGG]). We compared Cox proportional hazards regression models with and without the cognitive domain by means of loglikelihood ratios tests (LRT), discriminative performance measures (by AUC), and risk classification [by Integrated Discrimination Index (IDI)]. Results: We included 109 LGG and 145 HGG patients with a median survival time of 1,490 and 511 days, respectively. The domain memory had a significant added prognostic value in HGG as indicated by an LRT (p-value = 0.018). The cumulative AUC for HGG with memory included was.78 (SD = 0.017) and without cognition 0.77 (SD = 0.018), IDI was 0.043 (0.000–0.102). In LGG none of the cognitive domains added prognostic value. Conclusions: Our findings indicated that memory deficits, which were revealed with the neuropsychological examination, were of additional prognostic value in HGG to other well-known predictors of survival.
Collapse
Affiliation(s)
- Emma van Kessel
- University Medical Center Utrecht/UMC Utrecht Brain Center, Department of Neurology & Neurosurgery, Utrecht University, Utrecht, Netherlands
| | - Ewoud Schuit
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Irene M C Huenges Wajer
- University Medical Center Utrecht/UMC Utrecht Brain Center, Department of Neurology & Neurosurgery, Utrecht University, Utrecht, Netherlands.,Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, Netherlands
| | - Carla Ruis
- University Medical Center Utrecht/UMC Utrecht Brain Center, Department of Neurology & Neurosurgery, Utrecht University, Utrecht, Netherlands.,Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, Netherlands
| | - Filip Y F L De Vos
- University Medical Center Utrecht/UMC Utrecht Brain Center, Department of Medical Oncology, Utrecht University, Utrecht, Netherlands
| | - Joost J C Verhoeff
- University Medical Center Utrecht/UMC Utrecht Brain Center, Department of Radiation Oncology, Utrecht University, Utrecht, Netherlands
| | - Tatjana Seute
- University Medical Center Utrecht/UMC Utrecht Brain Center, Department of Neurology & Neurosurgery, Utrecht University, Utrecht, Netherlands
| | - Martine J E van Zandvoort
- University Medical Center Utrecht/UMC Utrecht Brain Center, Department of Neurology & Neurosurgery, Utrecht University, Utrecht, Netherlands.,Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, Netherlands
| | - Pierre A Robe
- University Medical Center Utrecht/UMC Utrecht Brain Center, Department of Neurology & Neurosurgery, Utrecht University, Utrecht, Netherlands
| | - Tom J Snijders
- University Medical Center Utrecht/UMC Utrecht Brain Center, Department of Neurology & Neurosurgery, Utrecht University, Utrecht, Netherlands
| |
Collapse
|
49
|
Demeyere N, Williams OA, Milosevich E, Chiu EG, Drozdowska BA, Dillon A, Dawes H, Thomas S, Kuppuswamy A, Pendlebury ST, J Quinn T. Long-term psychological consequences of stroke (OX-CHRONIC): A longitudinal study of cognition in relation to mood and fatigue after stroke: Protocol. Eur Stroke J 2021; 6:428-437. [PMID: 35342816 PMCID: PMC8948513 DOI: 10.1177/23969873211046120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 08/25/2021] [Indexed: 12/18/2022] Open
Abstract
Background The long-term psychological consequences of stroke and how cognitive problems change over time after the first-year following stroke remain unclear. Particularly, trajectories of domain-specific and domain-general cognitive functions and how cognition interacts with mood, fatigue and quality of life are not well described. Aims To determine the prevalence, trajectories and wider impact of domain-specific cognitive impairment in long-term stroke survivors, in relation to mood, fatigue and quality of life. Methods Participants who previously took part in the Oxford Cognitive Screening study, completed the 6-month follow-up with cognitive, mood, fatigue and quality of life assessments and agreed to be contacted for future research will be recruited into OX-CHRONIC. The eligible cohort is between 2- and 9-years post-stroke. Cognition will be assessed with a detailed neuropsychological battery, alongside questionnaire measures of mood, fatigue, activities of daily life and quality of life measures at two timepoints, 1 year apart. Additionally, medical records will be accessed to extract further clinical information about the stroke and patients may opt-in to wear an activity monitor for 1 week to provide fine-grained measures of sleep and activity. The study protocol and study materials were approved by the national ethics committee (REC Ref: 19/SC/0520). Planned outputs OX-CHRONIC will provide detailed data on the evolving cognitive profiles of stroke survivors over several years post-stroke. Estimates of long-term prevalence as well as the effect of changes in cognitive profiles on mood, fatigue and quality of life will be examined. This study is funded by a Priority Programme Grant from the Stroke Association (SA PPA 18/100032).
Collapse
Affiliation(s)
- Nele Demeyere
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Owen A Williams
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Elise Milosevich
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Evangeline G Chiu
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Bogna A Drozdowska
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Avril Dillon
- Centre for Movement, Occupational and Rehabilitation Sciences, Oxford Institute of Nursing, Midwifery and Allied Health Research, Oxford Brookes University, Oxford, UK
| | - Helen Dawes
- Centre for Movement, Occupational and Rehabilitation Sciences, Oxford Institute of Nursing, Midwifery and Allied Health Research, Oxford Brookes University, Oxford, UK
| | - Shirley Thomas
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Annapoorna Kuppuswamy
- Department of Clinical and Movement Neurosciences, Institute of Neurology, University College London, London, UK
| | - Sarah T Pendlebury
- Wolfson Centre for Prevention of Stroke and Dementia, Wolfson Building, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre and Departments of General (Internal) Medicine and Gerantology, John Radcliffe Hospital, Oxford, UK
| | - Terence J Quinn
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| |
Collapse
|
50
|
Segura E, Grau-Sánchez J, Sanchez-Pinsach D, De la Cruz M, Duarte E, Arcos JL, Rodríguez-Fornells A. Designing an app for home-based enriched Music-supported Therapy in the rehabilitation of patients with chronic stroke: a pilot feasibility study. Brain Inj 2021; 35:1585-1597. [PMID: 34554859 DOI: 10.1080/02699052.2021.1975819] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE After completing formal stroke rehabilitation programs, most patients do not achieve full upper limb motor function recovery. Music-supported Therapy (MST) can improve motor functionality post stroke through musical training. We designed a home-based enriched Music-supported Therapy (eMST) program to provide patients with chronic stroke the opportunity of continuing rehabilitation by themselves. We developed an app to conduct the eMST sessions at home with a MIDI-piano and percussion instruments. Here, we tested the feasibility of the eMST intervention using the novel app. METHOD This is a pilot study where five patients with chronic stroke underwent a 10-week intervention of 3 sessions per week. Patients answered feasibility questionnaires throughout the intervention to modify aspects of the rehabilitation program and the app according to their feedback. Upper limb motor functions were evaluated pre- and post-intervention as well as speed and force tapping during daily piano performance. RESULTS Patients clinically improved in upper limb motor function achieving the Minimal Detectable Change (MDC) or Minimal Clinically Important Difference (MCID) in most of motor tests. The app received high usability ratings post-intervention. CONCLUSION The eMST program is a feasible intervention for patients with chronic stroke and its efficacy should be assessed in a clinical trial.
Collapse
Affiliation(s)
- Emma Segura
- Department of Cognition, Development and Educational Psychology, University of Barcelona, Barcelona, Spain.,Cognition and Brain Plasticity Unit, Bellvitge Biomedical Research Institute, Barcelona, Spain
| | - Jennifer Grau-Sánchez
- Department of Cognition, Development and Educational Psychology, University of Barcelona, Barcelona, Spain.,Cognition and Brain Plasticity Unit, Bellvitge Biomedical Research Institute, Barcelona, Spain.,Escola Universitària d'Infermeria i Teràpia Ocupacional, Autonomous University of Barcelona, Terrassa, Barcelona, Spain
| | - David Sanchez-Pinsach
- Artificial Intelligence Research Institute, Spanish National Research Council, Bellaterra, Barcelona, Spain
| | - Myriam De la Cruz
- Cognition and Brain Plasticity Unit, Bellvitge Biomedical Research Institute, Barcelona, Spain.,Department of Equity in Brain Health, Global Brain Health Institute (GBHI), University of California, San Francisco (UCSF), California, USA.,Department of Cellular Biology, Physiology and Inmunology, Neuroscience Institute, Autonomous University of Barcelona, Barcelona, Spain.,Department of Internal Medicine, Health Sciences Faculty, Technical University of Ambato, Tungurahua, Ecuador
| | - Esther Duarte
- Department of Physical and Rehabilitation Medicine, Hospital de l'Esperança, Barcelona, Spain.,Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Josep Lluis Arcos
- Artificial Intelligence Research Institute, Spanish National Research Council, Bellaterra, Barcelona, Spain
| | - Antoni Rodríguez-Fornells
- Department of Cognition, Development and Educational Psychology, University of Barcelona, Barcelona, Spain.,Cognition and Brain Plasticity Unit, Bellvitge Biomedical Research Institute, Barcelona, Spain.,Institució Catalana de Recerca i Estudis Avançats, Barcelona, Spain
| |
Collapse
|