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Akinci M, Burak M, Kasal FZ, Özaslan EA, Huri M, Kurtaran ZA. The Effects of Combined Virtual Reality Exercises and Robot Assisted Gait Training on Cognitive Functions, Daily Living Activities, and Quality of Life in High Functioning Individuals With Subacute Stroke. Percept Mot Skills 2024; 131:756-769. [PMID: 38418444 DOI: 10.1177/00315125241235420] [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: 03/01/2024]
Abstract
Stroke is a global health concern causing significant mortality. Survivors face physical, cognitive, and emotional challenges, affecting their life satisfaction and social participation. Robot-assisted gait training with virtual reality, like Lokomat, is a promising rehabilitation tool. We investigated its impact on cognitive status, activities of daily living, and quality of life in individuals with stroke. Between September 2022 and August 2023, we exposed 34 first stroke patients (8 women, 26 men; M age = 59.15, SD = 11.09; M height = 170.47, SD = 8.13 cm; M weight = 75.97; SD = 10.87 kg; M days since stroke = 70.44, SD = 33.65) in the subacute stage (3-6 months post-stroke) to Lokomat exercise. Participant exclusion criteria were Lokamat exercise inability, disabilities incompatible with intended measurements, and any cognitive limitations. The Control Group (CG) received conventional physiotherapy, while the Lokomat Group (LG) received both conventional physiotherapy and robot-assisted gait training with virtual reality, administered by an occupational therapist. Evaluations were conducted by a physiotherapist who was unaware of the participants' group assignments and included assessments with the Montreal Cognitive Assessment, Lawton Brody Instrumental Activities of Daily Living Scale, and Stroke Specific Quality of Life Scale (SS-QoL). Both groups demonstrated an improved quality of life, but the LG outperformed the CG with regard to SS-QoL (p = .01) on measures of Energy (p = .002) and Mobility (p = .005). Both groups showed improvements in cognitive functioning (p < .001) with no between-group difference, and in activities of daily living (p < .05) for which the LG was superior to the CG (p = .023). Thus, adding robot-assisted gait training with Lokomat and virtual reality improved self-reported quality of life and daily activities at levels beyond conventional physiotherapy for patients in the subacute stroke phase. An incremental impact on cognitive functions was not evident, possibly due to rapid cognitive recovery or this was undetected by limited cognitive testing.
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Affiliation(s)
- Murat Akinci
- Department of Physical Therapy and Rehabilitation, Ankara City Hospital, Ankara, Turkey
| | - Mustafa Burak
- Department of Physical Therapy and Rehabilitation, Faculty of Health Sciences, Firat University, Elazığ, Turkey
| | | | - Ezgi Aydın Özaslan
- Department of Physical Therapy and Rehabilitation, Ankara City Hospital, Ankara, Turkey
| | - Meral Huri
- Department of Occupational Therapy, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Zeynep Aydan Kurtaran
- Department of Physical Therapy and Rehabilitation, Ankara City Hospital, Ankara, Turkey
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Hua Z, Ma D. Association between social participation and memory function among Chinese stroke survivors: The mediating role of depressive symptoms. Neuropsychol Rehabil 2024:1-16. [PMID: 38563790 DOI: 10.1080/09602011.2024.2336960] [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: 12/19/2023] [Accepted: 03/25/2024] [Indexed: 04/04/2024]
Abstract
Although the association between social participation and memory function has been documented in other populations, whether it exists among stroke survivors is unclear. Additionally, the mechanisms underlying this association are largely unknown. We attempted to examine the association between social participation and memory function in stroke survivors and the possible mediating role of depressive symptoms. A total of 614 stroke survivors (mean age: 64.73 years) drawn from a nationally representative survey in China were investigated. Based on the descriptive statistics, a Pearson's correlation and bootstrapping-based mediation analysis were executed. The results indicated that an increase in social participation was associated with a decrease in depressive symptoms (r = -0.100, p < 0.05) and an increase in memory function (r = 0.162, p < 0.01). Moreover, memory function was significantly negatively related to depressive symptoms (r = -0.243, p < 0.01). In addition, after controlling for sociodemographic factors, depressive symptoms partially mediated the effects of social participation on memory function. Due to the cross-sectional research design, causal relationships cannot be verified between the study variables. However, interventions aimed at aiding stroke survivors in memory impairment recovery may consider strategies to enhance social participation and mitigate depressive symptoms.
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Affiliation(s)
- Zhiya Hua
- School of Government, Shanghai University of Political Science and Law, Shanghai, People's Republic of China
| | - Dandan Ma
- School of Sociology and Political Science, Shanghai University, Shanghai, People's Republic of China
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Maggio MG, Baglio F, Arcuri F, Borgnis F, Contrada M, Diaz MDM, Leochico CF, Neira NJ, Laratta S, Suchan B, Tonin P, Calabrò RS. Cognitive telerehabilitation: an expert consensus paper on current evidence and future perspective. Front Neurol 2024; 15:1338873. [PMID: 38426164 PMCID: PMC10902044 DOI: 10.3389/fneur.2024.1338873] [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: 11/15/2023] [Accepted: 01/16/2024] [Indexed: 03/02/2024] Open
Abstract
The progressive improvement of the living conditions and medical care of the population in industrialized countries has led to improvement in healthcare interventions, including rehabilitation. From this perspective, Telerehabilitation (TR) plays an important role. TR consists of the application of telemedicine to rehabilitation to offer remote rehabilitation services to the population unable to reach healthcare. TR integrates therapy-recovery-assistance, with continuity of treatments, aimed at neurological and psychological recovery, involving the patient in a family environment, with an active role also of the caregivers. This leads to reduced healthcare costs and improves the continuity of specialist care, as well as showing efficacy for the treatment of cognitive disorders, and leading to advantages for patients and their families, such as avoiding travel, reducing associated costs, improving the frequency, continuity, and comfort of performing the rehabilitation in its own spaces, times and arrangements. The aim of this consensus paper is to investigate the current evidence on the use and effectiveness of TR in the cognitive field, trying to also suggest some recommendations and future perspectives. To the best of our knowledge, this is the first consensus paper among multiple expert researchers that comprehensively examines TR in different neurological diseases. Our results supported the efficacy and feasibility of TR with good adherence and no adverse events among patients. Our consensus summarizes the current evidence for the application of cognitive TR in neurological populations, highlighting the potential of this tool, but also the limitations that need to be explored further.
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Affiliation(s)
| | | | - Francesco Arcuri
- S. Anna Institute and Research in Advanced Neurorehabilitation, Crotone, Italy
| | | | - Marianna Contrada
- S. Anna Institute and Research in Advanced Neurorehabilitation, Crotone, Italy
| | | | - Carl Froilan Leochico
- University of the Philippines Manila, Manila, Philippines
- St. Luke’s Medical Center, Quezon City, Philippines
| | | | - Stefania Laratta
- S. Anna Institute and Research in Advanced Neurorehabilitation, Crotone, Italy
| | - Boris Suchan
- Department of Neuropsychology, Institute of Cognitive Neuroscience, Faculty of Psychology, Ruhr-Universität Bochum, Bochum, Germany
| | - Paolo Tonin
- S. Anna Institute and Research in Advanced Neurorehabilitation, Crotone, Italy
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Mohammed S, Haidar J, Ayele BA, Yifru YM. Post-stroke limitations in daily activities: experience from a tertiary care hospital in Ethiopia. BMC Neurol 2023; 23:364. [PMID: 37814255 PMCID: PMC10561502 DOI: 10.1186/s12883-023-03419-9] [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: 03/12/2023] [Accepted: 10/05/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND The disability of stroke patients remains an important global health problem; yet information on the extent of restriction from basic and instrumental activities of daily living is limited, particularly in lower-and middle-income (LMIC) countries. Therefore, we examined the issue under the caption, since it is the first step in planning several rehabilitation services. METHOD A facility-based cross-sectional study was done to assess the magnitude and predictors of post-stroke limitations in basic activities of daily living (BADL) using the Barthel Index (BI) scale and instrumental activities of daily living (IADL) using the Frenchay Activities Index (FAI) scale among patients who visited Tikur Anbessa Specialized Hospital in Addis Ababa, Ethiopia, Neurology Clinic from April-October, 2022. All patients having a diagnosis of stroke for more than six months duration were enrolled. Descriptive and inferential statistical analyses were done, and measures of estimated crude and adjusted odds ratio with 95% CI were constructed and a p-value less than 0.05 was considered statistically significant. The results are presented in figures and tables. RESULTS A total of 150 stroke patients were enrolled in the present study. The mean age of participants was 53 (14.9) years with slight male preponderance (51.3%). Ischemic stroke was present in 106 (70.7%) of them, while 44 (29.3%) had hemorrhagic stroke. Of this, 57 (38%) and 115 (79.3%) of them had limitations in basic and instrumental ADL, respectively. Comorbid cardiac disease (AOR = 6.9; 95%CI = 1.3-37.5) and regular substance use (AOR = 11.1; 95%CI = 1.1-115) were associated with limitations in BADL, while an increase in age (AOR = 1.1; 95%CI = 1.04-1.15) was associated with severe limitations in BADL. Initial stroke severity (AOR = 7.3; 95%CI = 1.2-44.7) was associated with limitations in IADL, whereas depression (AOR = 5.1; 95%CI = 1.1-23.2) was identified as a predictor of severe limitation in IADL. CONCLUSION Limitation in activities of daily living (ADL) after stroke is common among Ethiopian patients. Therefore, screening for post-stroke limitations in daily activities is essential for further management and rehabilitative plans.
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Affiliation(s)
- Salhadin Mohammed
- Internal Medicine Department, Neurology Unit, School of Medicine, College of Health Sciences, Wollo University, Dese, Ethiopia.
| | - Jemal Haidar
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Biniyam A Ayele
- Neurology Department, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Yared Mamushet Yifru
- Neurology Department, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Murphy D, Cornford E, Higginson A, Norman A, Long R, Noad R. Oxford cognitive screen: A critical review and independent psychometric evaluation. J Neuropsychol 2023; 17:491-504. [PMID: 37186035 DOI: 10.1111/jnp.12318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 04/03/2023] [Indexed: 05/17/2023]
Abstract
The Oxford cognitive screen (OCS) is a stroke-specific cognitive screening assessment. Although the test developers have provided psychometric information for the assessment, the OCS has received minimal external scrutiny, with which to triangulate the underpinning psychometrics. The purpose of this study is to provide a critical review and independent validation of the OCS. This study analysed data from an anonymised clinical database, which consisted of 316 patients who were assessed using the OCS on an Acute Stroke Unit. The rates of impairment on tests of memory and receptive communication were lower than expectation, suggesting that these subtests may be relatively insensitive. Patients with aphasia were more likely to be unable to categorised as impaired on non-language tests, suggesting that they remain sensitive to language processing or non-dominant hand usage. Some of the subtests of the OCS achieve high retest reliability, which makes them good candidates for measuring cognitive change over time. Although the OCS has many advantages, it is also important to adequately consider its limitations, that is insensitivity to memory problems, the potential confounding impact of non-dominant hand usage, and the potential that some tests may sample overall cognitive ability instead of domain-specific functioning.
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Affiliation(s)
- Donnchadh Murphy
- University of Plymouth, Plymouth, UK
- Livewell Southwest, Plymouth, UK
| | | | | | | | - Rebecca Long
- University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Rupert Noad
- University of Plymouth, Plymouth, UK
- University Hospitals Plymouth NHS Trust, Plymouth, UK
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Tasseel-Ponche S, Roussel M, Toba MN, Sader T, Barbier V, Delafontaine A, Meynier J, Picard C, Constans JM, Schnitzler A, Godefroy O, Yelnik AP. Dual-task versus single-task gait rehabilitation after stroke: the protocol of the cognitive-motor synergy multicenter, randomized, controlled superiority trial (SYNCOMOT). Trials 2023; 24:172. [PMID: 36890548 PMCID: PMC9994785 DOI: 10.1186/s13063-023-07138-x] [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: 07/07/2022] [Accepted: 02/07/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Gait disorders and cognitive impairments are prime causes of disability and institutionalization after stroke. We hypothesized that relative to single-task gait rehabilitation (ST GR), cognitive-motor dual-task (DT) GR initiated at the subacute stage would be associated with greater improvements in ST and DT gait, balance, and cognitive performance, personal autonomy, disability, and quality of life in the short, medium and long terms after stroke. METHODS This multicenter (n=12), two-arm, parallel-group, randomized (1:1), controlled clinical study is a superiority trial. With p<0.05, a power of 80%, and an expected loss to follow-up rate of 10%, the inclusion of 300 patients will be required to evidence a 0.1-m.s-1 gain in gait speed. Trial will include adult patients (18-90 years) in the subacute phase (0 to 6 months after a hemispheric stroke) and who are able to walk for 10 m (with or without a technical aid). Registered physiotherapists will deliver a standardized GR program (30 min three times a week, for 4 weeks). The GR program will comprise various DTs (phasic, executive function, praxis, memory, and spatial cognition tasks during gait) in the DT (experimental) group and gait exercises only in the ST (control) group. The primary outcome measure is gait speed 6 months after inclusion. The secondary outcomes are post-stroke impairments (National Institutes of Health Stroke Scale and the motor part of the Fugl-Meyer Assessment of the lower extremity), gait speed (10-m walking test), mobility and dynamic balance (timed up-and-go test), ST and DT cognitive function (the French adaptation of the harmonization standards neuropsychological battery, and eight cognitive-motor DTs), personal autonomy (functional independence measure), restrictions in participation (structured interview and the modified Rankin score), and health-related quality of life (on a visual analog scale). These variables will be assessed immediately after the end of the protocol (probing the short-term effect), 1 month thereafter (the medium-term effect), and 5 months thereafter (the long-term effect). DISCUSSION The main study limitation is the open design. The trial will focus on a new GR program applicable at various stages after stroke and during neurological disease. TRIAL REGISTRATION NCT03009773 . Registered on January 4, 2017.
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Affiliation(s)
- Sophie Tasseel-Ponche
- Department of Physical Medicine and Rehabilitation, Amiens University Hospital, Amiens, France. .,Laboratory of Functional Neurosciences, UR UPJV 4559, Jules Verne University of Picardie, Amiens, France.
| | - Martine Roussel
- Laboratory of Functional Neurosciences, UR UPJV 4559, Jules Verne University of Picardie, Amiens, France.,Department of Neurology, Amiens University Hospital, Amiens, France
| | - Monica N Toba
- Laboratory of Functional Neurosciences, UR UPJV 4559, Jules Verne University of Picardie, Amiens, France
| | - Thibaud Sader
- Department of Physical Medicine and Rehabilitation, Amiens University Hospital, Amiens, France
| | - Vincent Barbier
- Department of Physical Medicine and Rehabilitation, Amiens University Hospital, Amiens, France
| | - Arnaud Delafontaine
- Department of Physical Medicine and Rehabilitation, Amiens University Hospital, Amiens, France
| | - Jonathan Meynier
- Clinical Research and Innovation Directorate, Amiens University Hospital, Amiens, France
| | - Carl Picard
- Clinical Research and Innovation Directorate, Amiens University Hospital, Amiens, France
| | | | - Alexis Schnitzler
- PRM Department, Hôpital Lariboisière-F.Widal AP-HP, Paris, France.,INSERM U1153 - CRESS EpiAgeing, Paris University, Hôtel-Dieu, Paris, France
| | - Olivier Godefroy
- Laboratory of Functional Neurosciences, UR UPJV 4559, Jules Verne University of Picardie, Amiens, France.,Department of Neurology, Amiens University Hospital, Amiens, France
| | - Alain Pierre Yelnik
- PRM Department, Hôpital Lariboisière-F.Widal AP-HP, Paris, France.,UMR 9010, Paris University, Centre Borelli, Paris, France
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Cherkos K, Jember G, Mihret T, Fentanew M. Prevalence and Associated Factors of Cognitive Impairment Among Stroke Survivors at Comprehensive Specialized Hospitals in Northwest Ethiopia: Multi-Centered Cross-Sectional Study. Vasc Health Risk Manag 2023; 19:265-277. [PMID: 37138791 PMCID: PMC10150733 DOI: 10.2147/vhrm.s405357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 04/22/2023] [Indexed: 05/05/2023] Open
Abstract
Background Deficit in cognitive impairment is the most serious of the stroke sequelae. Post-stroke cognitive impairment is associated with impaired daily living activities and decreased capacity for independent living and functional performance. As a result, the purpose of this study was to determine the prevalence and associated factors of cognitive impairment among stroke survivors at comprehensive specialized hospitals in Ethiopia's Amhara region by 2022. Methods A multi-centered cross-sectional study was designed at an institution. During the study period. Data was gathered by conducting structured questionnaire interviews with participants and reviewing medical charts with trained data collectors. The participants were chosen using a systematic random sampling technique. The Montreal cognitive assessment basic was used to assess cognitive impairment. Descriptive statistics, binary and multivariate logistic regression methods were used to analyze the data. The Hosmer-Lemeshow goodness-of-fit test was used to assess the fitness of the model. The AOR with a P value of 0.05 at 95% CI was reported, and variables were considered statistically significant. Results This study enrolled 422 stroke survivors. Overall, 58.3% of stroke survivors had cognitive impairment (95% CI 53.4-63.0%). The study participants' age with AOR; 7.12 (4.40-11.45), being hypertensive with AOR; 7.52 (3.46-16.35), arriving at the hospital after 24 hours with AOR; 4.33 (1.49-12.05), less than three months after stroke with AOR; 4.83 (3.95-12.19), dominant hemisphere lesion with AOR; 4.83 (3.95-12.19) and being illiterate with AOR; 5.26 (4.43-18.64) were found significant factors. Conclusion Cognitive impairment was discovered to be relatively common among stroke survivors in this study. More than half of stroke survivors who attended comprehensive specialized hospitals during the study period were found to have cognitive impairment. Age, hypertension, arriving at the hospital after 24 hours, less than three months after stroke, dominant hemisphere lesion, and illiterate educational status were all significant factors in cognitive impairment.
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Affiliation(s)
- Kassahun Cherkos
- Department of Physiotherapy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Gashaw Jember
- Department of Physiotherapy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tewodros Mihret
- Department of Physiotherapy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Molla Fentanew
- Department of Physiotherapy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Correspondence: Molla Fentanew, University of Gondar, P.O. Box. 196, Gondar, Ethiopia, Tel +251935686860, Email
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Yan S, Li Y, Lu J, Tian T, Zhang G, Zhou Y, Wu D, Zhang S, Zhu W. Structural and functional alterations within the Papez circuit in subacute stroke patients. Brain Imaging Behav 2022; 16:2681-2689. [PMID: 36222964 DOI: 10.1007/s11682-022-00727-5] [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] [Accepted: 09/08/2022] [Indexed: 11/26/2022]
Abstract
Beyond causing local injury, stroke disrupts structural and functional organization of the brain networks, exposing patients to a high risk of cognitive impairment by affecting the neural network activity. However, the impact of these pathological changes on cognition-related neural circuits is not well understood. In this study, we mainly focused on structures and directed functional connectivity within the Papez circuit in subacute stroke patients. Forty-five stroke patients and thirty-four age-, sex-matched healthy controls were included in our study. The Papez circuit gray matter were measured to explore ischemia-induced structural alterations. And Granger causality analysis with the hippocampus as seed regions was performed to identify alterations of directional functional connectivity within the neural circuit. We also explored the associations between cerebral changes with cognitive status. Compared with healthy controls, stroke patients revealed marked atrophy in gray matter of the Papez circuit, including ipsilateral hippocampus, amygdala, thalamus, and caudal anterior cingulate gyrus. Additionally, there are alterations in the directed functional connections between the bilateral hippocampus and cingulate gyrus within the Papez circuit. These altered effective connectivities were correlated with cognitive function after cerebrovascular event. Taken together, in the early post-stroke period, disruptions of the Papez circuit in both architecture and directed functional connectivity have already occurred and might affect the cognitive function. These findings have prompted researchers to better understand the potential mechanisms underlying vascular cognitive impairment and to investigate new therapeutic targets that could reduce cognitive burden.
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Affiliation(s)
- Su Yan
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1095, Jiefang Avenue, Wuhan, 430030, China
| | - Yuanhao Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1095, Jiefang Avenue, Wuhan, 430030, China
| | - Jun Lu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1095, Jiefang Avenue, Wuhan, 430030, China
- Department of CT & MRI, The First Affiliated Hospital, College of Medicine, Shihezi University, 107 North Second Road, Shihezi, China
| | - Tian Tian
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1095, Jiefang Avenue, Wuhan, 430030, China
| | - Guiling Zhang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1095, Jiefang Avenue, Wuhan, 430030, China
| | - Yiran Zhou
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1095, Jiefang Avenue, Wuhan, 430030, China
| | - Di Wu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1095, Jiefang Avenue, Wuhan, 430030, China
| | - Shun Zhang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1095, Jiefang Avenue, Wuhan, 430030, China
| | - Wenzhen Zhu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1095, Jiefang Avenue, Wuhan, 430030, China.
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Benke T, Bodner T, Wiesen D, Karnath HO. The Amnestic Syndrome of Posterior Cerebral Artery Infarction. Eur J Neurol 2022; 29:2987-2995. [PMID: 35708171 PMCID: PMC9541518 DOI: 10.1111/ene.15449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 05/24/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Little is known about the character and underlying lesions of ischemic amnesia. We therefore studied episodic memory functions and brain lesions in 84 patients with acute ischemic infarcts in the supply territory of the posterior cerebral artery (PCA). We also aimed to learn how the neural memory systems are organized. METHODS Standard neuropsychological tests were used to assess verbal and figural memory. Patients were split in memory-impaired and memory-intact. Lesions were demarcated, normalized and anatomically labeled, using standard mapping procedures. RESULTS Of the 84 patients more than 80% had an amnestic syndrome, mostly with combined, less often with figural or verbal memory impairment. Amnesia in subjects with left hemispheric lesions was more frequent and more severe, with significantly lower scores on the verbal memory test. Normal performance or figural amnesia were prevalent after right hemispheric lesions. However, no amnesia subtype was strictly tied to left- or right-sided brain damage. Hippocampal and thalamic lesions were common, but 30% of lesions were extrahippocampal located in the ventral occipito-temporal cortex and long occipital white matter tracts. Most amnestic-patients lacked awareness for their memory impairment. CONCLUSIONS Memory impairment is a key clinical manifestation of acute PCA stroke. Amnesia is more frequent and more severe after left stroke, suggesting a left hemisphere dominance of the two memory systems. Domain specific memory appears not strictly lateralized, since deficits in verbal and figural memory were found after lesions of both sides. Extrahippocampal lesions may also cause memory impairment.
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Affiliation(s)
- Thomas Benke
- Clinic of Neurology, Medical University Innsbruck, Austria
| | - Thomas Bodner
- Clinic of Neurology, Medical University Innsbruck, Austria
| | - Daniel Wiesen
- Division of Neuropsychology, Center of Neurology, Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Hans-Otto Karnath
- University of Tübingen, Departments of Cognitive and General Neurology, Tübingen, Germany
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Accelerated Long-Term Forgetting: Prolonged Delayed Recognition as Sensitive Measurement for Different Profiles of Long-Term Memory and Metacognitive Confidence in Stroke Patients. J Int Neuropsychol Soc 2022; 28:327-336. [PMID: 33952379 DOI: 10.1017/s1355617721000527] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Deficits in episodic memory are frequently reported after ischemic stroke. In standard clinical care, episodic memory is assessed after a 20-30 min delay, with abnormal memory decay over this period being characterized as rapid forgetting (RF). Previous studies have shown abnormal forgetting over a prolonged interval (days to weeks) despite normal acquisition, referred to as accelerated long-term forgetting (ALF). METHOD We examined whether ALF is present in stroke patients (N = 91) using immediate testing (T1), testing after a short delay (20-30 min, T2), and testing after a prolonged delay (one week, T3). Based on performance compared to matched controls (N = 85), patients were divided into (1) patients without forgetting, (2) patients with RF between T1 and T2, and (3) patients with ALF at T3. Furthermore, confidence ratings were assessed. RESULTS ALF was present in a moderate amount of stroke patients (17%), but ALF was even more prevalent in our stroke sample than RF after a 20-30 min delay (which was found in only 13% of our patients). Patients reported a lower confidence for their responses, independent of their actual performance. CONCLUSIONS Adding a one-week delayed measurement may potentially assist in identifying patients with memory decrements that may otherwise go undetected.
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Abstract
INTRODUCTION The syndromes of mild cognitive impairment (MCI) or mild neurocognitive disorder (MiND), often prodromal to dementia (Major Neurocognitive Disorder), are characterized by acquired clinically significant changes in one or more cognitive domains despite preserved independence. Mild impairment has significant medicolegal consequences for an affected person and their care system. We review the more common etiologies of MiND and provide a systematic review of its medicolegal implications. METHODS We conducted a systematic review of the peer-reviewed English literature on medicolegal aspects of MCI or MiND using comprehensive search terms and expanding our review to include sources cited by these reports. RESULTS Impairment of memory, executive function, social cognition, judgment, insight or abstraction can alter an individual's abilities in a variety of areas that include decision making, informed consent, designation of a surrogate decision-maker such as a health care proxy, understanding and management of financial affairs, execution of a will, or safe driving. CONCLUSION Even mild cognitive impairment can have significant behavioral consequences. Clinicians can assist care partners and persons with MCI or MiND by alerting them to the medicolegal concerns that often accompany cognitive decline. Early recognition and discussion can help a care system manage medicolegal risk more effectively and promote thoughtful advance planning.
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Affiliation(s)
- Anca Bejenaru
- Department of Psychiatry and Behavioral Health, Christiana Care, Wilmington, DE, USA
| | - James M Ellison
- Department of Psychiatry and Behavioral Health, Christiana Care, Wilmington, DE, USA.,Department of Family and Community Medicine, Christiana Care, Wilmington, DE, USA.,Department of Psychiatry & Human Behavior, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
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A Brief Period of Wakeful Rest after Learning Enhances Verbal Memory in Stroke Survivors. J Int Neuropsychol Soc 2021; 27:929-938. [PMID: 33423703 DOI: 10.1017/s1355617720001307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Accumulating evidence suggests that wakeful rest (a period of minimal cognitive stimulation) enhances memory in clinical populations with memory impairment. However, no study has previously examined the efficacy of this technique in stroke survivors, despite the high prevalence of post-stroke memory difficulties. We aimed to investigate whether wakeful rest enhances verbal memory in stroke survivors and healthy controls. METHOD Twenty-four stroke survivors and 24 healthy controls were presented with two short stories; one story was followed by a 10-minute period of wakeful rest and the other was followed by a 10-minute visual interference task. A mixed factorial analysis of variance (ANOVA) with pairwise comparisons was used to compare participants' story retention at two time points. RESULTS After 15-30 minutes, stroke survivors (p = .002, d = .73), and healthy controls (p = .001, d = .76) retained more information from the story followed by wakeful rest, compared with the story followed by an interference task. While wakeful rest remained the superior condition in healthy controls after 7 days (p = .01, d = .58), the beneficial effect was not maintained in stroke survivors (p = .35, d = .19). CONCLUSIONS Wakeful rest is a promising technique, which significantly enhanced verbal memory after 15-30 minutes in both groups; however, no significant benefit of wakeful rest was observed after 7 days in stroke survivors. Preliminary findings suggest that wakeful rest enhances early memory consolidation processes by protecting against the effects of interference after learning in stroke survivors.
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Yao YY, Wei ZJ, Zhang YC, Li X, Gong L, Zhou JW, Wang Y, Zhang YY, Wang RP. Functional Disability After Ischemic Stroke: A Community-Based Cross-Sectional Study in Shanghai, China. Front Neurol 2021; 12:649088. [PMID: 34512499 PMCID: PMC8427524 DOI: 10.3389/fneur.2021.649088] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 07/13/2021] [Indexed: 01/03/2023] Open
Abstract
Objective: This study aimed to understand the demographics, functional disabilities, cognitive impairment, and depressive mood among stroke patients and to explore the correlation between functional disability and the other health conditions so as to provide some data for community rehabilitation among stroke patients. Methods: A cross-sectional study was conducted to investigate the functional status of ischemic stroke patients with stroke history between 1 month and 2 years by applying the modified Rankin Scale (mRS). Data were collected during October 2016 and January 2017 from 11 communities in two districts of Shanghai, China. We used face-to-face questionnaire interviews to collect information on sociodemographics, vascular risks associated with stroke, cognitive function [Mini-Mental State Examination (MMSE)], and depression [Patient Health Questionnaire-9 (PHQ-9)]; and we applied SPSS 24.0 for data analysis. Results: In this study, 305 patients with ischemic stroke were finally recruited, including 189 (61.97%) men, with an average age of 67 years. According to the mRS score, ischemic stroke patients were divided into patients without symptoms (controls, mRS = 0), patients without obvious disability (mRS = 1), and patients with mild to severe disability (mRS = 2-5). Ischemic stroke patients with different mRS levels demonstrated significant differences in age, tobacco smoke exposure, previous stroke history, cognitive function, and depression status. Compared with patients without symptoms (mRS = 0), patients with mRS = 1 had a lower MMSE score [odds ratio (OR): 0.48, 95% confidence interval (CI): 0.26-0.90]; and patients with mRS = 2-5 had a lower MMSE score [OR = 0.16, 95% CI: 0.08-0.33], had a higher PHQ-9 score [OR = 5.36, 95% CI: 2.19-13.11], and were more likely to have previous stroke history [OR = 2.18, 95% CI: 1.01-4.79]. Conclusion: Lower degrees of functional independence are related to cognitive impairment, as well as the previous stroke history and depression status.
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Affiliation(s)
- Ying-Ye Yao
- Department of Neurology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Zi-Jun Wei
- Department of Neurology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yue-Chan Zhang
- Department of Neurology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiang Li
- Department of Neurology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Liu Gong
- Department of Neurology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Department of Neurology, Shanghai Baoshan Integrated Traditional Chinese and Western Medicine Hospital, Shanghai, China
| | - Jia-Wei Zhou
- Department of Neurology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yu Wang
- Department of Neurology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yun-Yun Zhang
- Department of Neurology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Rui-Ping Wang
- Clinical Research Center, Shanghai Skin Diseases Hospital, Tongji University, Shanghai, China
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14
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Jung J, Laverick R, Nader K, Brown T, Morris H, Wilson M, Auer DP, Rotshtein P, Hosseini AA. Altered hippocampal functional connectivity patterns in patients with cognitive impairments following ischaemic stroke: A resting-state fMRI study. NEUROIMAGE-CLINICAL 2021; 32:102742. [PMID: 34266772 PMCID: PMC8527045 DOI: 10.1016/j.nicl.2021.102742] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 06/06/2021] [Accepted: 06/21/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Ischemic stroke with cognitive impairment is a considerable risk factor for developing dementia. Identifying imaging markers of cognitive impairment following ischemic stroke will help to develop prevention strategies against post-stroke dementia. METHODS We investigated the hippocampal functional connectivity (FC) pattern following ischemic stroke, using resting-state fMRI (rs-fMRI). Thirty-three cognitively impaired patients after ischemic stroke and sixteen age-matched controls with no known history of neurological disorder were recruited for the study. No patient had a direct ischaemic insult to hippocampus on the examination of brain imaging. Seven subfields of hippocampus were used as seeds region for FC analyses. RESULTS Across all hippocampal subfields, FC with the inferior parietal lobule was reduced in stroke patients as compared with healthy controls. This decreased FC included both supramarginal gyrus and angular gyrus. The FC of hippocampal subfields with cerebellum was increased. Importantly, the degree of the altered FC between hippocampal subfields and inferior parietal lobule was associated with their impaired memory function. CONCLUSION Our results demonstrated that decreased hippocampal-inferior parietal lobule connectivity was associated with cognitive impairment in patients with ischemic stroke. These findings provide novel insights into the role of hippocampus in cognitive impairment following ischemic stroke.
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Affiliation(s)
- JeYoung Jung
- School of Psychology, University of Nottingham, UK
| | | | - Kurdow Nader
- University Hospital Birmingham NHS Trust, Birmingham, UK
| | - Thomas Brown
- Division of Clinical Neuroscience, University of Nottingham, UK
| | - Haley Morris
- Division of Clinical Neuroscience, University of Nottingham, UK
| | | | - Dorothee P Auer
- NIHR Nottingham BRC, University of Nottingham, UK; Division of Clinical Neuroscience, University of Nottingham, UK
| | | | - Akram A Hosseini
- School of Psychology, University of Birmingham, UK; Division of Clinical Neuroscience, University of Nottingham, UK; Department of Neurology, Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, UK.
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15
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Developing of Focal Ischemia in the Hippocampus or the Amygdala Reveals a Regional Compensation Rule for Fear Memory Acquisition. eNeuro 2021; 8:ENEURO.0398-20.2021. [PMID: 33785521 PMCID: PMC8174052 DOI: 10.1523/eneuro.0398-20.2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 03/17/2021] [Accepted: 03/18/2021] [Indexed: 11/21/2022] Open
Abstract
Circuit compensation is often observed in patients with acute ischemic stroke, suggesting the importance of the interaction between brain regions. Also, contextual fear memory is an association between multisensory contexts and fearful stimuli, for which the interaction between the hippocampus and the amygdala is believed to be critical. To understand how focal ischemia in one region could influence the other region, we used a modified photo-thrombosis to induce focal ischemia in the hippocampus or the amygdala or both in freely-moving rats. We found that the learning curve and short-term memory (STM) were not affected in the rats although focal ischemia was induced 5 h before learning in either the hippocampus or the amygdala; these were impaired by the induction of ischemia in both the regions. Furthermore, the learning curve and STM were impaired when ischemia was induced 24 h before learning in either the hippocampus or the amygdala when the synaptic transmission was altered in one region because of ischemia in the other region. These results suggest that the circuit compensation between the hippocampus and the amygdala is critical for fear memory acquisition.
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16
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Sagnier S, Catheline G, Munsch F, Bigourdan A, Poli M, Debruxelles S, Renou P, Olindo S, Rouanet F, Dousset V, Tourdias T, Sibon I. Severity of Small Vessel Disease Biomarkers Reduces the Magnitude of Cognitive Recovery after Ischemic Stroke. Cerebrovasc Dis 2021; 50:456-463. [PMID: 33827075 DOI: 10.1159/000513916] [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: 09/07/2020] [Accepted: 12/16/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The objective of this study was to evaluate the impact of radiological biomarkers suggestive of cerebral small vessel disease (SVD) on the evolution of cognitive performances after an ischemic stroke (IS). METHODS We studied patients with a supratentorial IS recruited consecutively to a prospective monocentric longitudinal study. A cognitive assessment was performed at baseline, 3 months, and 1 year and was based on a Montreal Cognitive Assessment, an Isaacs set test of verbal fluency (IST), and a Zazzo's cancellation task (ZCT) for the evaluation of attentional functions and processing speed. The following cerebral SVD biomarkers were detected on a 3-T brain MRI performed at baseline: white matter hyperintensities (WMHs), deep and lobar microbleeds, enlarged perivascular spaces in basal ganglia and centrum semiovale, previous small deep infarcts, and cortical superficial siderosis (cSS). Generalized linear mixed models were used to evaluate the relationship between these biomarkers and changes in cognitive performances. RESULTS A total of 199 patients (65 ± 13 years, 68% male) were analyzed. Overall, the cognitive performances improved, more significantly in the first 3 months. Severe WMH was identified in 34% of the patients, and focal cSS in 3.5%. Patients with severe WMH and focal cSS had overall worse cognitive performances. Those with severe WMH had less improvement over time for IST (β = -0.16, p = 0.02) and the number of errors to ZCT (β = 0.19, p = 0.02), while those with focal cSS had less improvement over time for ZCT completion time (β = 0.14, p = 0.01) and number of errors (β = 0.17, p = 0.008), regardless of IS volume and location, gray matter volume, demographic confounders, and clinical and cardiovascular risk factors. CONCLUSION The severity of SVD biomarkers, encompassing WMH and cSS, seems to reduce the magnitude of cognitive recovery after an IS. The detection of such SVD biomarkers early after stroke might help to identify patients with a cognitive vulnerability and a higher risk of poststroke cognitive impairment.
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Affiliation(s)
- Sharmila Sagnier
- UMR 5287 CNRS, Université de Bordeaux, EPHE PSL Research University, Bordeaux, France.,CHU de Bordeaux, Unité Neuro-Vasculaire, Bordeaux, France
| | - Gwenaëlle Catheline
- UMR 5287 CNRS, Université de Bordeaux, EPHE PSL Research University, Bordeaux, France
| | - Fanny Munsch
- Beth Israel Deaconess Medical Center, Harvard University, Boston, Massachusetts, USA
| | | | - Mathilde Poli
- CHU de Bordeaux, Unité Neuro-Vasculaire, Bordeaux, France
| | | | - Pauline Renou
- CHU de Bordeaux, Unité Neuro-Vasculaire, Bordeaux, France
| | | | | | - Vincent Dousset
- INSERM-U1215, Neurocentre Magendie, Bordeaux, France.,CHU de Bordeaux, Neuroimagerie Diagnostique et Thérapeutique, Bordeaux, France
| | - Thomas Tourdias
- INSERM-U1215, Neurocentre Magendie, Bordeaux, France.,CHU de Bordeaux, Neuroimagerie Diagnostique et Thérapeutique, Bordeaux, France
| | - Igor Sibon
- UMR 5287 CNRS, Université de Bordeaux, EPHE PSL Research University, Bordeaux, France.,CHU de Bordeaux, Unité Neuro-Vasculaire, Bordeaux, France
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17
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Maresca G, Maggio MG, De Luca R, Manuli A, Tonin P, Pignolo L, Calabrò RS. Tele-Neuro-Rehabilitation in Italy: State of the Art and Future Perspectives. Front Neurol 2020; 11:563375. [PMID: 33101176 PMCID: PMC7554582 DOI: 10.3389/fneur.2020.563375] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 08/26/2020] [Indexed: 11/20/2022] Open
Abstract
Current research suggests that the management of neurological diseases, both in adults and children, requires an ever increasing commitment of resources for the national healthcare system (NHS). In Italy, due to the aging of the population, increase in chronicity and morbidity of pathologies, and presence of islands and rural areas, health needs to be supported by innovative technologies. Telemedicine is a method of providing healthcare services at distance, remotely connecting health professionals and patients (or two professionals). In Italy, telemedicine is under development, and the NHS has not yet exploited and independently developed all the possibilities that telemedicine offers. Tele-rehabilitation consists in the use of information and communication technologies for the remote support of rehabilitation services. By allowing “home care,” it represents a valid support during the home rehabilitation process. This review is aimed at evaluating the role of telerehabilitation in Italy, with regard to the motor and cognitive rehabilitation programs applied to neurological pathologies, in both pediatric and adult patients. We screened the studies published between 2010 and 2019 on PubMed, Scopus, Cochrane, and Web of Sciences databases. Using the PICO model, the search combined the terms “telerehabilitation”; “neurological disorders”; “neurodegenerative disease,” “motor telerehabilitation”; “cognitive rehabilitation.” This review showed that telerehabilitation is a promising healthcare tool, as it guarantees continuity of care over time (after discharge) and in space (from hospital to patient's home), especially in patients with stroke. Furthermore, it allows to increase the frequency and intensity of rehabilitation programs, provide individualized rehabilitation treatment in comfortable and familiar environment for patient, monitor and evaluate patients' needs and progress, stimulate patient motivation and achieve better patient satisfaction, verify the results achieved by the patients, and potentially reduce the service costs. Unfortunately, almost all neurorehabilitation studies are characterized by small samples and wide variability of results, and would benefit from standardized procedures, aims and targets. Future telerehabilitation trials should include cost-effectiveness analysis associated with clinical outcomes to better assess the validity of this promising tool.
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Affiliation(s)
| | | | | | | | - Paolo Tonin
- S. Anna Institute, Research in Advanced Neurorehabilitation, Crotone, Italy
| | - Loris Pignolo
- S. Anna Institute, Research in Advanced Neurorehabilitation, Crotone, Italy
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18
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Veldsman M, Cheng HJ, Ji F, Werden E, Khlif MS, Ng KK, Lim JKW, Qian X, Yu H, Zhou JH, Brodtmann A. Degeneration of structural brain networks is associated with cognitive decline after ischaemic stroke. Brain Commun 2020; 2:fcaa155. [PMID: 33376984 PMCID: PMC7751023 DOI: 10.1093/braincomms/fcaa155] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 08/02/2020] [Accepted: 08/14/2020] [Indexed: 12/12/2022] Open
Abstract
Over one-third of stroke patients has long-term cognitive impairment. The likelihood of cognitive dysfunction is poorly predicted by the location or size of the infarct. The macro-scale damage caused by ischaemic stroke is relatively localized, but the effects of stroke occur across the brain. Structural covariance networks represent voxelwise correlations in cortical morphometry. Atrophy and topographical changes within such distributed brain structural networks may contribute to cognitive decline after ischaemic stroke, but this has not been thoroughly investigated. We examined longitudinal changes in structural covariance networks in stroke patients and their relationship to domain-specific cognitive decline. Seventy-three patients (mean age, 67.41 years; SD = 12.13) were scanned with high-resolution magnetic resonance imaging at sub-acute (3 months) and chronic (1 year) timepoints after ischaemic stroke. Patients underwent a number of neuropsychological tests, assessing five cognitive domains including attention, executive function, language, memory and visuospatial function at each timepoint. Individual-level structural covariance network scores were derived from the sub-acute grey-matter probabilistic maps or changes in grey-matter probability maps from sub-acute to chronic using data-driven partial least squares method seeding at major nodes in six canonical high-order cognitive brain networks (i.e. dorsal attention, executive control, salience, default mode, language-related and memory networks). We then investigated co-varying patterns between structural covariance network scores within canonical distributed brain networks and domain-specific cognitive performance after ischaemic stroke, both cross-sectionally and longitudinally, using multivariate behavioural partial least squares correlation approach. We tested our models in an independent validation data set with matched imaging and behavioural testing and using split-half validation. We found that distributed degeneration in higher-order cognitive networks was associated with attention, executive function, language, memory and visuospatial function impairment in sub-acute stroke. From the sub-acute to the chronic timepoint, longitudinal structural co-varying patterns mirrored the baseline structural covariance networks, suggesting synchronized grey-matter volume decline occurred within established networks over time. The greatest changes, in terms of extent of distributed spatial co-varying patterns, were in the default mode and dorsal attention networks, whereas the rest were more focal. Importantly, faster degradation in these major cognitive structural covariance networks was associated with greater decline in attention, memory and language domains frequently impaired after stroke. Our findings suggest that sub-acute ischaemic stroke is associated with widespread degeneration of higher-order structural brain networks and degradation of these structural brain networks may contribute to longitudinal domain-specific cognitive dysfunction.
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Affiliation(s)
- Michele Veldsman
- Department of Experimental Psychology, Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, UK
| | - Hsiao-Ju Cheng
- Department of Medicine, Center for Sleep and Cognition, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Fang Ji
- Department of Medicine, Center for Sleep and Cognition, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Emilio Werden
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
| | - Mohamed Salah Khlif
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
| | - Kwun Kei Ng
- Department of Medicine, Center for Sleep and Cognition, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Joseph K W Lim
- Department of Medicine, Center for Sleep and Cognition, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Xing Qian
- Department of Medicine, Center for Sleep and Cognition, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Haoyong Yu
- Department of Biomedical Engineering, Faculty of Engineering, National University of Singapore, Singapore, Singapore
| | - Juan Helen Zhou
- Department of Medicine, Center for Sleep and Cognition, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Amy Brodtmann
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
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19
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Ramsey A, Blake ML. Speech-Language Pathology Practices for Adults With Right Hemisphere Stroke: What Are We Missing? AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 29:741-759. [PMID: 32330389 DOI: 10.1044/2020_ajslp-19-00082] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Purpose Limited evidence exists to guide the assessment and treatment of cognitive-communication disorders associated with right hemisphere stroke. The purpose of this study was to obtain information about speech-language pathologists' (SLPs') clinical practices and decision making for this population to understand what practices are being used and identify gaps in clinical practice. Method A survey was distributed via online ASHA Communities for the Special Interest Groups and other social media platforms. Respondents included 143 SLPs from across the United States representing 3-50 years of experience and a wide range of practice settings. Survey questions probed assessment practices including how tests are selected, what tests are used to diagnose specific deficits, and how confident SLPs were in their diagnoses. Treatment decisions were queried for a small set of disorders. Results SLPs routinely assess cognitive disorders using standardized tests. Communication disorders are less likely to be formally assessed. Three core right cerebral hemisphere deficits-anosognosia, aprosodia, and pragmatic deficits-are either not assessed or assessed only through observation by 80% of SLPs. Evidence-based treatments are commonly used for disorders of attention, awareness, and aprosodia. Conclusion Communication disorders are less likely to be formally assessed than cognitive disorders, creating a critical gap in care that cannot be filled by other allied health professionals. Suggestions for free or low-cost resources for evaluating pragmatics, prosody, and awareness are provided to aid SLPs in filling this gap. Supplemental Material https://doi.org/10.23641/asha.12159597.
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Affiliation(s)
- Ashley Ramsey
- Department of Communication Sciences & Disorders, University of Houston, TX
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20
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Escobar I, Xu J, Jackson CW, Perez-Pinzon MA. Altered Neural Networks in the Papez Circuit: Implications for Cognitive Dysfunction after Cerebral Ischemia. J Alzheimers Dis 2020; 67:425-446. [PMID: 30584147 PMCID: PMC6398564 DOI: 10.3233/jad-180875] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Cerebral ischemia remains a leading cause of mortality worldwide. Although the incidence of death has decreased over the years, surviving patients may suffer from long-term cognitive impairments and have an increased risk for dementia. Unfortunately, research aimed toward developing therapies that can improve cognitive outcomes following cerebral ischemia has proved difficult given the fact that little is known about the underlying processes involved. Nevertheless, mechanisms that disrupt neural network activity may provide valuable insight, since disturbances in both local and global networks in the brain have been associated with deficits in cognition. In this review, we suggest that abnormal neural dynamics within different brain networks may arise from disruptions in synaptic plasticity processes and circuitry after ischemia. This discussion primarily concerns disruptions in local network activity within the hippocampus and other extra-hippocampal components of the Papez circuit, given their role in memory processing. However, impaired synaptic plasticity processes and disruptions in structural and functional connections within the Papez circuit have important implications for alterations within the global network, as well. Although much work is required to establish this relationship, evidence thus far suggests there is a link. If pursued further, findings may lead toward a better understanding of how deficits in cognition arise, not only in cerebral ischemia, but in other neurological diseases as well.
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Affiliation(s)
- Iris Escobar
- Department of Neurology, Cerebral Vascular Disease Research Laboratories, University of Miami Miller School of Medicine, Miami, FL, USA.,Neuroscience Program, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jing Xu
- Department of Neurology, Cerebral Vascular Disease Research Laboratories, University of Miami Miller School of Medicine, Miami, FL, USA.,Neuroscience Program, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Charles W Jackson
- Department of Neurology, Cerebral Vascular Disease Research Laboratories, University of Miami Miller School of Medicine, Miami, FL, USA.,Neuroscience Program, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Miguel A Perez-Pinzon
- Department of Neurology, Cerebral Vascular Disease Research Laboratories, University of Miami Miller School of Medicine, Miami, FL, USA.,Neuroscience Program, University of Miami Miller School of Medicine, Miami, FL, USA
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21
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Orfila JE, Dietz RM, Rodgers KM, Dingman A, Patsos OP, Cruz-Torres I, Grewal H, Strnad F, Schroeder C, Herson PS. Experimental pediatric stroke shows age-specific recovery of cognition and role of hippocampal Nogo-A receptor signaling. J Cereb Blood Flow Metab 2020; 40:588-599. [PMID: 30762478 PMCID: PMC7026845 DOI: 10.1177/0271678x19828581] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Ischemic stroke is a leading cause of death worldwide and clinical data suggest that children may recover from stroke better than adults; however, supporting experimental data are lacking. We used our novel mouse model of experimental juvenile ischemic stroke (MCAO) to characterize age-specific cognitive dysfunction following ischemia. Juvenile and adult mice subjected to 45-min MCAO, and extracellular field recordings of CA1 neurons were performed to assess hippocampal synaptic plasticity changes after MCAO, and contextual fear conditioning was performed to evaluate memory and biochemistry used to analyze Nogo-A expression. Juvenile mice showed impaired synaptic plasticity seven days after MCAO, followed by full recovery by 30 days. Memory behavior was consistent with synaptic impairments and recovery after juvenile MCAO. Nogo-A expression increased in ipsilateral hippocampus seven days after MCAO compared to contralateral and sham hippocampus. Further, inhibition of Nogo-A receptors reversed MCAO-induced synaptic impairment in slices obtained seven days after juvenile MCAO. Adult MCAO-induced impairment of LTP was not associated with increased Nogo-A. This study demonstrates that stroke causes functional impairment in the hippocampus and recovery of behavioral and synaptic function is more robust in the young brain. Nogo-A receptor activity may account for the impairments seen following juvenile ischemic injury.
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Affiliation(s)
- James E Orfila
- Department of Anesthesiology, University of Colorado School of Medicine, Aurora, CO, USA.,Neuronal Injury & Plasticity Program, University of Colorado School of Medicine, Aurora, CO, USA
| | - Robert M Dietz
- Neuronal Injury & Plasticity Program, University of Colorado School of Medicine, Aurora, CO, USA.,Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Krista M Rodgers
- Department of Anesthesiology, University of Colorado School of Medicine, Aurora, CO, USA.,Neuronal Injury & Plasticity Program, University of Colorado School of Medicine, Aurora, CO, USA
| | - Andra Dingman
- Neuronal Injury & Plasticity Program, University of Colorado School of Medicine, Aurora, CO, USA.,Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Olivia P Patsos
- Department of Anesthesiology, University of Colorado School of Medicine, Aurora, CO, USA.,Neuronal Injury & Plasticity Program, University of Colorado School of Medicine, Aurora, CO, USA
| | - Ivelisse Cruz-Torres
- Department of Anesthesiology, University of Colorado School of Medicine, Aurora, CO, USA.,Neuronal Injury & Plasticity Program, University of Colorado School of Medicine, Aurora, CO, USA
| | - Himmat Grewal
- Department of Anesthesiology, University of Colorado School of Medicine, Aurora, CO, USA.,Neuronal Injury & Plasticity Program, University of Colorado School of Medicine, Aurora, CO, USA
| | - Frank Strnad
- Department of Anesthesiology, University of Colorado School of Medicine, Aurora, CO, USA.,Neuronal Injury & Plasticity Program, University of Colorado School of Medicine, Aurora, CO, USA
| | - Christian Schroeder
- Department of Anesthesiology, University of Colorado School of Medicine, Aurora, CO, USA.,Neuronal Injury & Plasticity Program, University of Colorado School of Medicine, Aurora, CO, USA
| | - Paco S Herson
- Department of Anesthesiology, University of Colorado School of Medicine, Aurora, CO, USA.,Neuronal Injury & Plasticity Program, University of Colorado School of Medicine, Aurora, CO, USA.,Department of Pharmacology, University of Colorado School of Medicine, Aurora, CO, USA
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22
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Physical and cognitive training attenuate hippocampal ischemia-induced memory impairments in rat. Brain Res Bull 2020; 155:202-210. [DOI: 10.1016/j.brainresbull.2019.10.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 10/15/2019] [Accepted: 10/19/2019] [Indexed: 01/22/2023]
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Khabirov F, Khaibullin T, Granatov E, Akhmetova G, Akhmetzyanov N. Comparison of the efficacy of Cellex and Cortexin in patients in the early recovery period of ischemic stroke. Zh Nevrol Psikhiatr Im S S Korsakova 2020; 120:11-15. [DOI: 10.17116/jnevro202012012211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Salis C, Murray L, Vonk JMJ. Systematic review of subjective memory measures to inform assessing memory limitations after stroke and stroke-related aphasia. Disabil Rehabil 2019; 43:1488-1506. [PMID: 31559870 DOI: 10.1080/09638288.2019.1668485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
AIM Primary aims of this systematic review were to: (1) identify the range of subjective memory measures used in the stroke and stroke-related aphasia literature and (2) critically appraise their psychometric properties as well as (3) the methodological qualities of studies that included them, (4) investigate whether such measures provide an accurate reflection of memory impairments (i.e., in comparison to norms from age-matched, neurotypical participants), (5) document the representation of individuals with stroke-related aphasia, and (6) examine the extent to which subjective memory measures correlate with objective memory measures. METHODS Systematic review of the literature from 1970 to June 2019 using a comprehensive range of relevant search terms in EMBASE, Medline, PsychINFO, SCOPUS, and Web of Science. Eligibility criteria were for studies to include adults who had suffered of clinical stroke, to report a subjective memory measure that was completed by the stroke survivors, to be reported in a peer-reviewed journal, and to be published in English or Dutch. Quality appraisal was carried out for the included studies as well as the subjective memory measures they employed. RESULTS A total of 7,077 titles or abstracts were screened, with 41 studies included in the quantitative and qualitative synthesis. Twenty-six subjective memory measures were used in the included studies. The critical appraisal of their psychometric properties and the methodological quality of the included studies revealed significant shortcomings; for example, neurotypical participants were included in only 14 of the 41 studies. When statistical comparisons were made, different outcomes arose. Only eight studies statistically compared subjective with objective memory measures. CONCLUSIONS This literature domain currently provides an unclear picture as to how memory limitations affect participation in stroke and stroke-related aphasia.IMPLICATIONS FOR REHABILITATIONA broad range of subjective memory measures have been used to determine stroke survivors' perceptions of their everyday memory issues.Because of psychometric weaknesses such as inadequate reliability and cross-cultural validity among subjective memory measures, there remains a need to carefully review a given measure's properties to determine if it is appropriate for use with a given stroke survivor.Stroke survivors with aphasia have been infrequently included or inadequately described in studies of subjective memory measures, and thus how these individuals perceive their everyday memory abilities requires further investigation.Although the relationship between subjective and objective memory measures has been infrequently investigated by stroke researchers, both types of measures should be considered as they likely offer complementary rather than redundant information about stroke survivors' memory abilities.
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Affiliation(s)
- Christos Salis
- Speech and Language Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Laura Murray
- Communication Sciences and Disorders, Western University, London, ON Canada
| | - Jet M J Vonk
- Department of Neurology, Columbia University, New York, NY, USA
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25
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Evans FA, Wong D, Lawson DW, Withiel TD, Stolwyk RJ. What are the most common memory complaints following stroke? A frequency and exploratory factor analysis of items from the Everyday Memory Questionnaire-Revised. Clin Neuropsychol 2019; 34:498-511. [DOI: 10.1080/13854046.2019.1652349] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Felicity A. Evans
- Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia
- Monash-Epworth Rehabilitation Research Centre, Richmond, Victoria, Australia
| | - Dana Wong
- Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia
- Department of Psychology and Counselling, School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - David W. Lawson
- Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia
- Monash-Epworth Rehabilitation Research Centre, Richmond, Victoria, Australia
| | - Toni D. Withiel
- Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia
- Allied Health, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Renerus J. Stolwyk
- Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia
- Monash-Epworth Rehabilitation Research Centre, Richmond, Victoria, Australia
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26
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Tang EYH, Price C, Stephan BCM, Robinson L, Exley C. Post-stroke memory deficits and barriers to seeking help: views of patients and carers. Fam Pract 2019; 36:506-510. [PMID: 30452613 DOI: 10.1093/fampra/cmy109] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Memory and cognitive deficits post stroke are common and associated with increased risk of future dementia. Rehabilitation tends to focus on physical recovery; however, once in the community, it is unclear what happens in the longer term to the stroke-survivor with new memory difficulties. OBJECTIVE The aim of this qualitative study was to examine in stroke-survivors what factors influence contact with health professionals. METHOD Semi-structured interviews were conducted with stroke-survivors and their family carers where memory difficulties were reported at 6 months post stroke. A topic guide was used which sought to critically examine participants care experience following their stroke diagnosis. All participants were interviewed at baseline (around 6 months post stroke) and offered an interview at around 12 months post stroke. All interviews were conducted in the North East of England. All transcripts were coded and thematically analysed. RESULTS Ten stroke-survivors (age range 72-84 years) were interviewed alongside five carers at baseline; eight stroke-survivors and four carers agreed to a follow-up interview. Three main barriers were identified: (i) fear of a dementia diagnosis; (ii) denial or minimization of symptoms leading to adaptation and (iii) obstacles to seeking help in the community. CONCLUSIONS With an ageing population and increase in stroke-survival, the burden of post-stroke cognitive impairment and dementia will only increase. Stroke-survivors and their family carers in this study have identified issues that may hinder their presentation to health care professionals at a personal and organizational level. Health professionals need to be aware of these potential issues when planning services for stroke-survivors.
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Affiliation(s)
- Eugene Y H Tang
- Institute of Health and Society, Newcastle University, Baddiley-Clark, Richardson Road, Newcastle upon Tyne, UK.,Newcastle University Institute of Ageing, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
| | - Christopher Price
- Institute of Neuroscience, Stroke Research Group, Newcastle University, Newcastle, UK
| | - Blossom C M Stephan
- Institute of Health and Society, Newcastle University, Baddiley-Clark, Richardson Road, Newcastle upon Tyne, UK.,Newcastle University Institute of Ageing, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
| | - Louise Robinson
- Institute of Health and Society, Newcastle University, Baddiley-Clark, Richardson Road, Newcastle upon Tyne, UK.,Newcastle University Institute of Ageing, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
| | - Catherine Exley
- Faculty of Health and Life Sciences, Northumberland Building, Northumbria University, Newcastle upon Tyne, UK
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27
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Olabarrieta-Landa L, Pugh M, Calderón Chagualá A, Perrin PB, Arango-Lasprilla JC. Trajectories of memory, language, and visuoperceptual problems in people with stroke during the first year and controls in Colombia. Disabil Rehabil 2019; 43:324-330. [PMID: 31167580 DOI: 10.1080/09638288.2019.1622799] [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: 10/26/2022]
Abstract
AIM Neuropsychological normative data for Latin America have been recently published, and for Colombia, in particular, but longitudinal neuropsychological outcomes after stroke have not yet been examined in this global region. The purpose of the current study was to compare functioning of individuals with stroke in Colombia, South America during the first year post-stroke to healthy controls across neuropsychological assessments of memory, language, and visuoperceptual impairments. METHOD A sample of 50 individuals with stroke (mean age = 51.58) and 50 matched healthy controls (mean age = 51.54) from Colombia were included in this study. Because of a lack of access to health services, individuals with stroke did not receive any inpatient or outpatient cognitive or behavioral rehabilitation. Participants were assessed on 10 visuoperceptual, language, and memory tasks at 3, 6, and 12 months. RESULTS Trajectories of neuropsychological performance were significantly worse among individuals with stroke than healthy controls across every index. Further, hierarchical linear models suggested that although both individuals with stroke and controls generally improved over time on these assessments, the improvements among individuals with stroke were often of no greater magnitude than the improvements seen in controls, suggesting extremely low levels of rehabilitation gains in Colombia. Only three of the 10 neuropsychological assessments did a significant time*group interaction occur, suggesting greater gains for the stroke group than controls. CONCLUSION These findings suggest profound disparities in post-stroke cognitive functioning in Colombia compared to other more developed global region and underscore the importance of comprehensive cognitive rehabilitation services for individuals with stroke in Colombia and other similar global regions. Implications for rehabilitation Because this study found only negligible cognitive improvements beyond practice effects over the first year after stroke in Colombia among individuals without access to acute rehabilitation, it is imperative that comprehensive cognitive rehabilitation services be implemented immediately during the acute rehabilitation period. Memory, language, and visuoperceptual training strategies can be implemented for people with stroke in underserved global regions as part of the standard of care for stroke rehabilitation. Cognitive rehabilitation strategies should be adapted into Spanish and pilot tested in Latin America to ensure cultural equivalence. Culturally competent cognitive rehabilitation strategies should be tailored based on varied educational and literacy levels.
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Affiliation(s)
- Laiene Olabarrieta-Landa
- BioCruces Bizkaia Health Research Institute, Cruces University Hospital Barakaldo, Bizkaia, Spain
| | - Mickeal Pugh
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Paul B Perrin
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Juan Carlos Arango-Lasprilla
- BioCruces Bizkaia Health Research Institute, Cruces University Hospital Barakaldo, Bizkaia, Spain.,IKERBASQUE, Basque Foundation for Science, Bilbao, Spain.,Department of Cell Biology and Histology, University of the Basque Country UPV/EHU, Leioa, Spain
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28
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Orfila JE, Grewal H, Dietz RM, Strnad F, Shimizu T, Moreno M, Schroeder C, Yonchek J, Rodgers KM, Dingman A, Bernard TJ, Quillinan N, Macklin WB, Traystman RJ, Herson PS. Delayed inhibition of tonic inhibition enhances functional recovery following experimental ischemic stroke. J Cereb Blood Flow Metab 2019; 39:1005-1014. [PMID: 29283314 PMCID: PMC6547193 DOI: 10.1177/0271678x17750761] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The current study focuses on the ability to improve cognitive function after stroke with interventions administered at delayed/chronic time points. In light of recent studies demonstrating delayed GABA antagonists improve motor function, we utilized electrophysiology, biochemistry and neurobehavioral methods to investigate the role of α5 GABAA receptors on hippocampal plasticity and functional recovery following ischemic stroke. Male C57Bl/6 mice were exposed to 45 min transient middle cerebral artery occlusion and analysis of synaptic and functional deficits performed 7 or 30 days after recovery. Our findings indicate that hippocampal long-term potentiation (LTP) is impaired 7 days after stroke and remain impaired for at least 30 days. We demonstrate that ex vivo administration of L655,708 reversed ischemia-induced plasticity deficits and importantly, in vivo administration at delayed time-points reversed stroke-induced memory deficits. Western blot analysis of hippocampal tissue reveals proteins responsible for GABA synthesis are upregulated (GAD65/67 and MAOB), increasing GABA in hippocampal interneurons 30 days after stroke. Thus, our data indicate that both synaptic plasticity and memory impairments observed after stroke are caused by excessive tonic GABA activity, making inhibition of specific GABA activity at delayed timepoints a potential therapeutic approach to improve functional recovery and reverse cognitive impairments after stroke.
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Affiliation(s)
- James E Orfila
- 1 Department of Anesthesiology, University of Colorado, Aurora, CO, USA.,2 Neuronal Injury Program, University of Colorado, Aurora, CO, USA
| | - Himmat Grewal
- 1 Department of Anesthesiology, University of Colorado, Aurora, CO, USA.,2 Neuronal Injury Program, University of Colorado, Aurora, CO, USA
| | - Robert M Dietz
- 2 Neuronal Injury Program, University of Colorado, Aurora, CO, USA.,3 Department of Pediatrics, University of Colorado, Aurora, CO, USA
| | - Frank Strnad
- 1 Department of Anesthesiology, University of Colorado, Aurora, CO, USA.,2 Neuronal Injury Program, University of Colorado, Aurora, CO, USA
| | - Takeru Shimizu
- 1 Department of Anesthesiology, University of Colorado, Aurora, CO, USA.,2 Neuronal Injury Program, University of Colorado, Aurora, CO, USA
| | - Myriam Moreno
- 1 Department of Anesthesiology, University of Colorado, Aurora, CO, USA.,2 Neuronal Injury Program, University of Colorado, Aurora, CO, USA
| | - Christian Schroeder
- 1 Department of Anesthesiology, University of Colorado, Aurora, CO, USA.,2 Neuronal Injury Program, University of Colorado, Aurora, CO, USA
| | - Joan Yonchek
- 1 Department of Anesthesiology, University of Colorado, Aurora, CO, USA
| | - Krista M Rodgers
- 1 Department of Anesthesiology, University of Colorado, Aurora, CO, USA
| | - Andra Dingman
- 3 Department of Pediatrics, University of Colorado, Aurora, CO, USA
| | | | - Nidia Quillinan
- 1 Department of Anesthesiology, University of Colorado, Aurora, CO, USA.,2 Neuronal Injury Program, University of Colorado, Aurora, CO, USA
| | - Wendy B Macklin
- 4 Department of Cell and Developmental Biology, University of Colorado, Aurora, CO, USA
| | - Richard J Traystman
- 1 Department of Anesthesiology, University of Colorado, Aurora, CO, USA.,2 Neuronal Injury Program, University of Colorado, Aurora, CO, USA.,5 Department of Pharmacology, School of Medicine, University of Colorado, Aurora, CO, USA
| | - Paco S Herson
- 1 Department of Anesthesiology, University of Colorado, Aurora, CO, USA.,2 Neuronal Injury Program, University of Colorado, Aurora, CO, USA.,5 Department of Pharmacology, School of Medicine, University of Colorado, Aurora, CO, USA
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29
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Liu G, Tan X, Dang C, Tan S, Xing S, Huang N, Peng K, Xie C, Tang X, Zeng J. Regional Shape Abnormalities in Thalamus and Verbal Memory Impairment After Subcortical Infarction. Neurorehabil Neural Repair 2019; 33:476-485. [PMID: 31081462 DOI: 10.1177/1545968319846121] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. Subcortical infarcts can result in verbal memory impairment, but the potential underlying mechanisms remain unknown. Objective. We investigated the spatiotemporal deterioration patterns of brain structures in patients with subcortical infarction and identified the regions that contributed to verbal memory impairment. Methods. Cognitive assessment and structural magnetic resonance imaging were performed 1, 4, and 12 weeks after stroke onset in 28 left-hemisphere and 22 right-hemisphere stroke patients with subcortical infarction. Whole-brain volumetric analysis combined with a further-refined shape analysis was conducted to analyze longitudinal morphometric changes in brain structures and their relationship to verbal memory performance. Results. Between weeks 1 and 12, significant volume decreases in the ipsilesional basal ganglia, inferior white matter, and thalamus were found in the left-hemisphere stroke group. Among those 3 structures, only the change rate of the thalamus volume was significantly correlated with that in immediate recall. For the right-hemisphere stroke group, only the ipsilesional basal ganglia survived the week 1 to week 12 group comparison, but its change rate was not significantly correlated with the verbal memory change rate. Shape analysis of the thalamus revealed atrophies of the ipsilesional thalamic subregions connected to the prefrontal, temporal, and premotor cortices in the left-hemisphere stroke group and positive correlations between the rates of those atrophies and the change rate in immediate recall. Conclusions. Secondary damage to the thalamus, especially to the left subregions connected to specific cortices, may be associated with early verbal memory impairment following an acute subcortical infarct.
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Affiliation(s)
- Gang Liu
- 1 The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Xiaoqing Tan
- 2 Southern University of Science and Technology, Shenzhen, Guangdong, China.,3 Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Chao Dang
- 1 The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Shuangquan Tan
- 1 The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Shihui Xing
- 1 The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Nianwei Huang
- 2 Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Kangqiang Peng
- 4 Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, China
| | - Chuanmiao Xie
- 4 Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, China
| | - Xiaoying Tang
- 2 Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Jinsheng Zeng
- 1 The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
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30
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Zortea M, de Jou GI, de Salles JF. Memory monitoring and memory control in chronic stroke patients Dissociated processes. Dement Neuropsychol 2019; 13:44-52. [PMID: 31073379 PMCID: PMC6497022 DOI: 10.1590/1980-57642018dn13-010005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Memory problems are common in stroke patients, although little is known about how accurately chronic stroke patients can monitor and control memory processes. Objective The performance of memory and metamemory in stroke patients and healthy controls were investigated, as well as dissociation between performances. Methods 10 adults with right hemisphere lesion (mean [M] age=53.2 [SD=9.7]), 10 with left hemisphere lesion (M age=60.4 [SD=6.6]) and 20 healthy participants (M age=56.5 [SD=9.3] with no neurological disease, matched for sex, age and years of education participated in a multiple-case design study. Participants completed a metamemory experimental paradigm, as well as immediate and delayed word recall and recognition tasks. Results Data indicated that 10 out of the 20 patients presented significantly lower scores compared to controls, two of which had global deficits (functional association). Functional dissociations between memory monitoring (judgments of learning, JOL), control (allocation of study time) and capacity (cued-recall task) among patients were found for eight cases, suggesting these processes are independent. Conclusion These findings reveal stroke patients may have specific metamemory impairment and can contribute to the understanding of cognitive models of metamemory processing.
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Affiliation(s)
- Maxciel Zortea
- PhD, Graduate Program in Medical Sciences, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, RS, Brazil
| | - Graciela Inchausti de Jou
- PhD, Graduate Program in Psychology, Institute of Psychology, Universidade Federal do Rio Grande do Sul, RS, Brazil
| | - Jerusa Fumagalli de Salles
- PhD, Graduate Program in Psychology, Institute of Psychology, Universidade Federal do Rio Grande do Sul, RS, Brazil
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31
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Rosenbaum Halevi D, Bursaw AW, Karamchandani RR, Alderman SE, Breier JI, Vahidy FS, Aden JK, Cai C, Zhang X, Savitz SI. Cognitive deficits in acute mild ischemic stroke and TIA and effects of rt-PA. Ann Clin Transl Neurol 2019; 6:466-474. [PMID: 30911570 PMCID: PMC6414481 DOI: 10.1002/acn3.719] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 10/21/2018] [Accepted: 12/06/2018] [Indexed: 12/16/2022] Open
Abstract
Introduction It is unknown if treatment with rt-PA in mild acute ischemic stroke (MIS) is associated with improvement in long term cognition. Methods Forty-five patients with suspected acute mild stroke or transient ischemic attacks with NIHSS ≤6 were enrolled in a prospective cohort. Cognitive testing was performed within 24 h of symptom onset. Follow-up assessment was performed at Day 90 on 25 patients. Prestroke baseline cognition was based on age, years of education (YrE), history of cognitive impairment, and the Fazekas score. Results Eighty-five percent patients with suspected MIS or TIA showed cognitive abnormalities within 24 h of onset. There was no significant difference in age, sex, Fazekas score, or YrE between rt-PA versus No-rt-PA groups (N = 8 vs. 17).Two sample t-test for change in performance in the WMS-III sub-tests (follow-up - baseline) ± SD, indicated a difference between rt-PA 0.74 ± 0.77 and no-rt-PA groups -0.02 ± 0.83 (P = 0.044). Logistic regression for predicting normal status using the mental control subtest, at follow-up showed an OR 8.96, CI 0.98-82.12 (P = 0.05) favoring the rt-PA group. Improvement in Mental Control at 90 days occurred in patients with low white matter disease compared to high white matter disease, 0.60 ± 0.46 (P = 0.048). A statistical trend was observed and suggested an improvement on SDMT and Trail Making tests, 1.43 ± 0.8 (P = 0.077). Conclusion Suspected MIS and TIA patients have cognitive impairment within 24 h of onset. rt-PA administration might be associated with improvement on some cognitive tests at 90 days.
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Affiliation(s)
- David Rosenbaum Halevi
- Department of Neurology and Institute for Stroke and Cerebrovascular Disease UTHealth Houston Texas
| | | | | | | | | | - Farhaan S Vahidy
- Department of Neurology and Institute for Stroke and Cerebrovascular Disease UTHealth Houston Texas
| | - James K Aden
- Institute for Surgical Research Joint Base San Antonio San Antonio Texas
| | - Chunyan Cai
- Department of Neurology and Institute for Stroke and Cerebrovascular Disease UTHealth Houston Texas
| | - Xu Zhang
- Department of Neurology and Institute for Stroke and Cerebrovascular Disease UTHealth Houston Texas
| | - Sean I Savitz
- Department of Neurology and Institute for Stroke and Cerebrovascular Disease UTHealth Houston Texas
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32
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Ouvrard C, Berr C, Meillon C, Ribet C, Goldberg M, Zins M, Amieva H. Norms for standard neuropsychological tests from the FrenchCONSTANCEScohort. Eur J Neurol 2019; 26:786-793. [DOI: 10.1111/ene.13890] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 12/18/2018] [Indexed: 10/27/2022]
Affiliation(s)
- C. Ouvrard
- University Bordeaux Inserm Bordeaux Population Health Research Center UMR 1219 F‐33000 Bordeaux France
| | - C. Berr
- Neuropsychiatry Epidemiological and Clinical Research Inserm U1061 University Montpellier Montpellier France
| | - C. Meillon
- University Bordeaux Inserm Bordeaux Population Health Research Center UMR 1219 F‐33000 Bordeaux France
| | - C. Ribet
- UMS 011 Inserm‐UVSQ Population‐based Epidemiological Cohorts Unit Villejuif France
| | - M. Goldberg
- UMS 011 Inserm‐UVSQ Population‐based Epidemiological Cohorts Unit Villejuif France
- Paris Descartes University Paris France
| | - M. Zins
- UMS 011 Inserm‐UVSQ Population‐based Epidemiological Cohorts Unit Villejuif France
- Paris Descartes University Paris France
| | - H. Amieva
- University Bordeaux Inserm Bordeaux Population Health Research Center UMR 1219 F‐33000 Bordeaux France
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33
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Baumgartner P, El Amki M, Bracko O, Luft AR, Wegener S. Sensorimotor stroke alters hippocampo-thalamic network activity. Sci Rep 2018; 8:15770. [PMID: 30361495 PMCID: PMC6202365 DOI: 10.1038/s41598-018-34002-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 10/10/2018] [Indexed: 01/06/2023] Open
Abstract
Many stroke survivors experience persisting episodic memory disturbances. Since hippocampal and para-hippocampal areas are usually spared from the infarcted area, alterations of memory processing networks remote from the ischemic brain region might be responsible for the observed clinical symptoms. To pinpoint changes in activity of hippocampal connections and their role in post-stroke cognitive impairment, we induced ischemic stroke by occlusion of the middle cerebral artery (MCAO) in adult rats and analyzed the functional and structural consequences using activity-dependent manganese (Mn2+) enhanced MRI (MEMRI) along with behavioral and histopathological analysis. MCAO caused stroke lesions of variable extent along with sensorimotor and cognitive deficits. Direct hippocampal injury occurred in some rats, but was no prerequisite for cognitive impairment. In healthy rats, injection of Mn2+ into the entorhinal cortex resulted in distribution of the tracer within the hippocampal subfields into the lateral septal nuclei. In MCAO rats, Mn2+ accumulated in the ipsilateral thalamus. Histopathological analysis revealed secondary thalamic degeneration 28 days after stroke. Our findings provide in vivo evidence that remote sensorimotor stroke modifies the activity of hippocampal-thalamic networks. In addition to potentially reversible alterations in signaling of these connections, structural damage of the thalamus likely reinforces dysfunction of hippocampal-thalamic circuitries.
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Affiliation(s)
- Philipp Baumgartner
- Department of Neurology, University Hospital and University of Zurich, Zurich, 8006, Switzerland
| | - Mohamad El Amki
- Department of Neurology, University Hospital and University of Zurich, Zurich, 8006, Switzerland
| | - Oliver Bracko
- Department of Neurology, University Hospital and University of Zurich, Zurich, 8006, Switzerland.,Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY14853, United States
| | - Andreas R Luft
- Department of Neurology, University Hospital and University of Zurich, Zurich, 8006, Switzerland
| | - Susanne Wegener
- Department of Neurology, University Hospital and University of Zurich, Zurich, 8006, Switzerland.
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34
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Park DK, Byun KH, Yang D. Which Neural Tract Plays a Major Role in Memory Impairment After Multiple Cerebral Infarcts? A Case Report. Ann Rehabil Med 2018; 42:617-620. [PMID: 30180532 PMCID: PMC6129710 DOI: 10.5535/arm.2018.42.4.617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 10/12/2017] [Indexed: 02/07/2023] Open
Abstract
Injury to the thalamocortical tract (one in the Papez circuit) that leads to memory impairment following brain injury is very rare. In this study, we present a case of partial injury to the thalamocortical tract that causes memory impairment after concurrent thalamic and hippocampal infarct. A 20-year-old male complained of memory impairment 1 month after partial injury to the thalamocortical tract. Using a probabilistic diffusing tensor tractography, it was found that the right thalamocortical tract was thinner than the left thalamocortical tract. However, all other neural tracts including the fornix, cingulum, and mammillothalamic tract were intact on both hemispheres. Therefore, the memory impairment in this patient was considered as being due to thalamic infarct based on the observation that the fornix from hippocampal infarct was intact. This case suggests that the assessment of lesions in the neural tracts of the Papez circuit might be useful for understanding the mechanism of memory impairment following cerebral infarction.
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Affiliation(s)
- Dae Kwon Park
- Department of Physical Medicine and Rehabilitation, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Ki Hyun Byun
- Department of Physical Medicine and Rehabilitation, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Dongseok Yang
- Department of Physical Medicine and Rehabilitation, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
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35
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Jones KM, Bhattacharjee R, Krishnamurthi R, Blanton S, Barker-Collo S, Theadom A, Thrift AG, Wolf SL, Venketasubramanian N, Parmar P, Maujean A, Ranta A, Cadilhac D, Sanya EO, MacKay-Lyons M, Pandian JD, Arora D, Obiako RO, Saposnik G, Balalla S, Bornstein NM, Langhorne P, Norrving B, Brown N, Brainin M, Taylor D, Feigin VL. Determining the feasibility and preliminary efficacy of a stroke instructional and educational DVD in a multinational context: a randomized controlled pilot study. Clin Rehabil 2018; 32:1086-1097. [PMID: 29843517 DOI: 10.1177/0269215518777565] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess the feasibility of conducting a randomized controlled trial of an instructional and educational stroke DVD and determine the feasibility and preliminary efficacy of this intervention in a multinational context. DESIGN Non-funded, pilot randomized controlled trial of intervention versus usual care. SETTING International, multicentre, community-based. PARTICIPANTS Community-living adults up to three years post stroke with moderate to severe disability and their nominated informal caregivers. INTERVENTIONS Intervention patients viewed and practised rehabilitation techniques demonstrated in the DVD over six weeks. MAIN MEASURES Trial feasibility by number of active recruitment sites, recruitment efficiency, randomization and follow-up. Intervention feasibility by patient and caregiver impressions. Preliminary efficacy by the quality of life - 5-level EuroQol-5D (EQ-5D) health status measure, General Health Questionnaire and Centre for Epidemiological Studies-Depression at two months. RESULTS In total, 14 recruitment sites were established across eight countries. Recruitment was achieved at nine (64%) sites. Over 16 months, 66 participants were recruited (mean (SD) age = 63.5 (12.47) years) and randomized to intervention ( n = 34) and control ( n = 32) groups. In total, 54 (82%) completed a follow-up assessment. Patient and/or caregiver comments about the benefits and barriers to accessing the intervention were mixed. There were no significant between-group differences in outcomes at two months ( P > 0.05). CONCLUSION Conducting a multinational trial of a stroke DVD requires full funding. The intervention was acceptable to some patients and their caregivers, yet a generalized education approach did not fully meet their needs and/or expectations. A more individualized method may be required to meet peoples' changing needs during stroke recovery.
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Affiliation(s)
- Kelly M Jones
- 1 National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
| | - Rohit Bhattacharjee
- 1 National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
| | - Rita Krishnamurthi
- 1 National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
| | - Sarah Blanton
- 2 Division of Physical Therapy, Department of Rehabilitation Medicine, School of Medicine, Emory University, Atlanta, GA, USA
| | | | - Alice Theadom
- 1 National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
| | - Amanda G Thrift
- 4 Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Steven L Wolf
- 2 Division of Physical Therapy, Department of Rehabilitation Medicine, School of Medicine, Emory University, Atlanta, GA, USA
| | | | - Priya Parmar
- 1 National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
| | - Annick Maujean
- 6 RECOVER Injury Research Centre, The University of Queensland, Brisbane, QLD, Australia
| | - Annemarei Ranta
- 7 Department of Neurology, Wellington Regional Hospital, University of Otago, Wellington, New Zealand
| | - Dominique Cadilhac
- 4 Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Emmanuel O Sanya
- 8 Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | | | - Jeyaraj D Pandian
- 10 Stroke Unit, Department of Neurology, Christian Medical College, Ludhiana, India
| | - Deepti Arora
- 10 Stroke Unit, Department of Neurology, Christian Medical College, Ludhiana, India
| | - Reginald O Obiako
- 11 Department of Medicine, Ahmadu Bello University Teaching Hospital, Shika Zaria, Nigeria
| | - Gustavo Saposnik
- 12 Stroke Outcomes Research Center, Division of Neurology, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Shivanthi Balalla
- 1 National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand.,13 School of Public Health and Psychosocial Studies, Auckland University of Technology, Auckland, New Zealand
| | - Natan M Bornstein
- 14 Department of Neurology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Peter Langhorne
- 15 Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Bo Norrving
- 16 Department of Clinical Sciences, Neurology, Lund University, Lund, Sweden
| | - Nita Brown
- 17 Stroke Foundation of New Zealand, Wellington, New Zealand
| | - Michael Brainin
- 18 Department of Clinical Neurosciences and Preventive Medicine, Danube University Krems, Krems an der Donau, Austria.,19 Karl Landsteiner University of Health Sciences, Krems an der Donau, Austria
| | - Denise Taylor
- 1 National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand.,20 Health & Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
| | - Valery L Feigin
- 1 National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
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De Luca R, Leonardi S, Spadaro L, Russo M, Aragona B, Torrisi M, Maggio MG, Bramanti A, Naro A, De Cola MC, Calabrò RS. Improving Cognitive Function in Patients with Stroke: Can Computerized Training Be the Future? J Stroke Cerebrovasc Dis 2018; 27:1055-1060. [DOI: 10.1016/j.jstrokecerebrovasdis.2017.11.008] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 09/19/2017] [Accepted: 11/05/2017] [Indexed: 12/29/2022] Open
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Kulesh AA, Shestakov VV. Post-Stroke Cognitive Impairments and the Potential for Treatment with Cellex. ACTA ACUST UNITED AC 2017. [DOI: 10.1007/s11055-017-0490-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Sagnier S, Catheline G, Dilharreguy B, Munsch F, Bigourdan A, Poli M, Debruxelles S, Olindo S, Renou P, Rouanet F, Dousset V, Tourdias T, Sibon I. Admission Brain Cortical Volume. Stroke 2017. [DOI: 10.1161/strokeaha.117.017646] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Sharmila Sagnier
- From the Unité Neuro-vasculaire (S.S., M.P., S.D., S.O., P.R., F.R., I.S.) and Neuroradiologie (F.M., A.B., V.D., T.T.), CHU de Bordeaux, France; UMR 5287 CNRS, Université de Bordeaux, EPHE PSL Research University, France (S.S., G.C., B.D., I.S.); and INSERM-U862, Neurocentre Magendie, Bordeaux, France (F.M., A.B., V.D., T.T.)
| | - Gwenaëlle Catheline
- From the Unité Neuro-vasculaire (S.S., M.P., S.D., S.O., P.R., F.R., I.S.) and Neuroradiologie (F.M., A.B., V.D., T.T.), CHU de Bordeaux, France; UMR 5287 CNRS, Université de Bordeaux, EPHE PSL Research University, France (S.S., G.C., B.D., I.S.); and INSERM-U862, Neurocentre Magendie, Bordeaux, France (F.M., A.B., V.D., T.T.)
| | - Bixente Dilharreguy
- From the Unité Neuro-vasculaire (S.S., M.P., S.D., S.O., P.R., F.R., I.S.) and Neuroradiologie (F.M., A.B., V.D., T.T.), CHU de Bordeaux, France; UMR 5287 CNRS, Université de Bordeaux, EPHE PSL Research University, France (S.S., G.C., B.D., I.S.); and INSERM-U862, Neurocentre Magendie, Bordeaux, France (F.M., A.B., V.D., T.T.)
| | - Fanny Munsch
- From the Unité Neuro-vasculaire (S.S., M.P., S.D., S.O., P.R., F.R., I.S.) and Neuroradiologie (F.M., A.B., V.D., T.T.), CHU de Bordeaux, France; UMR 5287 CNRS, Université de Bordeaux, EPHE PSL Research University, France (S.S., G.C., B.D., I.S.); and INSERM-U862, Neurocentre Magendie, Bordeaux, France (F.M., A.B., V.D., T.T.)
| | - Antoine Bigourdan
- From the Unité Neuro-vasculaire (S.S., M.P., S.D., S.O., P.R., F.R., I.S.) and Neuroradiologie (F.M., A.B., V.D., T.T.), CHU de Bordeaux, France; UMR 5287 CNRS, Université de Bordeaux, EPHE PSL Research University, France (S.S., G.C., B.D., I.S.); and INSERM-U862, Neurocentre Magendie, Bordeaux, France (F.M., A.B., V.D., T.T.)
| | - Mathilde Poli
- From the Unité Neuro-vasculaire (S.S., M.P., S.D., S.O., P.R., F.R., I.S.) and Neuroradiologie (F.M., A.B., V.D., T.T.), CHU de Bordeaux, France; UMR 5287 CNRS, Université de Bordeaux, EPHE PSL Research University, France (S.S., G.C., B.D., I.S.); and INSERM-U862, Neurocentre Magendie, Bordeaux, France (F.M., A.B., V.D., T.T.)
| | - Sabrina Debruxelles
- From the Unité Neuro-vasculaire (S.S., M.P., S.D., S.O., P.R., F.R., I.S.) and Neuroradiologie (F.M., A.B., V.D., T.T.), CHU de Bordeaux, France; UMR 5287 CNRS, Université de Bordeaux, EPHE PSL Research University, France (S.S., G.C., B.D., I.S.); and INSERM-U862, Neurocentre Magendie, Bordeaux, France (F.M., A.B., V.D., T.T.)
| | - Stéphane Olindo
- From the Unité Neuro-vasculaire (S.S., M.P., S.D., S.O., P.R., F.R., I.S.) and Neuroradiologie (F.M., A.B., V.D., T.T.), CHU de Bordeaux, France; UMR 5287 CNRS, Université de Bordeaux, EPHE PSL Research University, France (S.S., G.C., B.D., I.S.); and INSERM-U862, Neurocentre Magendie, Bordeaux, France (F.M., A.B., V.D., T.T.)
| | - Pauline Renou
- From the Unité Neuro-vasculaire (S.S., M.P., S.D., S.O., P.R., F.R., I.S.) and Neuroradiologie (F.M., A.B., V.D., T.T.), CHU de Bordeaux, France; UMR 5287 CNRS, Université de Bordeaux, EPHE PSL Research University, France (S.S., G.C., B.D., I.S.); and INSERM-U862, Neurocentre Magendie, Bordeaux, France (F.M., A.B., V.D., T.T.)
| | - François Rouanet
- From the Unité Neuro-vasculaire (S.S., M.P., S.D., S.O., P.R., F.R., I.S.) and Neuroradiologie (F.M., A.B., V.D., T.T.), CHU de Bordeaux, France; UMR 5287 CNRS, Université de Bordeaux, EPHE PSL Research University, France (S.S., G.C., B.D., I.S.); and INSERM-U862, Neurocentre Magendie, Bordeaux, France (F.M., A.B., V.D., T.T.)
| | - Vincent Dousset
- From the Unité Neuro-vasculaire (S.S., M.P., S.D., S.O., P.R., F.R., I.S.) and Neuroradiologie (F.M., A.B., V.D., T.T.), CHU de Bordeaux, France; UMR 5287 CNRS, Université de Bordeaux, EPHE PSL Research University, France (S.S., G.C., B.D., I.S.); and INSERM-U862, Neurocentre Magendie, Bordeaux, France (F.M., A.B., V.D., T.T.)
| | - Thomas Tourdias
- From the Unité Neuro-vasculaire (S.S., M.P., S.D., S.O., P.R., F.R., I.S.) and Neuroradiologie (F.M., A.B., V.D., T.T.), CHU de Bordeaux, France; UMR 5287 CNRS, Université de Bordeaux, EPHE PSL Research University, France (S.S., G.C., B.D., I.S.); and INSERM-U862, Neurocentre Magendie, Bordeaux, France (F.M., A.B., V.D., T.T.)
| | - Igor Sibon
- From the Unité Neuro-vasculaire (S.S., M.P., S.D., S.O., P.R., F.R., I.S.) and Neuroradiologie (F.M., A.B., V.D., T.T.), CHU de Bordeaux, France; UMR 5287 CNRS, Université de Bordeaux, EPHE PSL Research University, France (S.S., G.C., B.D., I.S.); and INSERM-U862, Neurocentre Magendie, Bordeaux, France (F.M., A.B., V.D., T.T.)
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Pastötter B, Eberle H, Aue I, Bäuml KHT. Retrieval Practice Fails to Insulate Episodic Memories against Interference after Stroke. Front Psychol 2017; 8:1074. [PMID: 28701985 PMCID: PMC5487472 DOI: 10.3389/fpsyg.2017.01074] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 06/12/2017] [Indexed: 12/03/2022] Open
Abstract
Recent work in cognitive psychology showed that retrieval practice of previously studied information can insulate this information against retroactive interference from subsequently studied other information in healthy individuals. The present study examined whether this beneficial effect of interference reduction is also present in patients with stroke. Twenty-two patients with stroke, 4.6 months post injury on average, and 22 healthy controls participated in the experiment. In each of two experimental sessions, participants first studied a list of items (list 1) and then underwent a practice phase in which the list 1 items were either restudied or retrieval practiced. Participants then either studied a second list of items (list 2) or fulfilled an unrelated distractor task. Recall of the two lists’ items was assessed in a final criterion test. Results showed that, in healthy controls, additional study of list 2 items impaired final recall of list 1 items in the restudy condition but not in the retrieval practice condition. In contrast, in patients with stroke, list 2 learning impaired final list 1 recall in both conditions. The results indicate that retrieval practice insulated the tested information against retroactive interference in healthy controls, but failed to do so in patients with stroke. Possible implications of the findings for the understanding of long-term memory impairment after stroke are discussed.
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Affiliation(s)
- Bernhard Pastötter
- Department of Experimental Psychology, Regensburg UniversityRegensburg, Germany
| | - Hanna Eberle
- Department of Experimental Psychology, Regensburg UniversityRegensburg, Germany.,Department of Neuropsychology, Bezirksklinikum RegensburgRegensburg, Germany
| | - Ingo Aue
- Department of Neuropsychology, Bezirksklinikum RegensburgRegensburg, Germany
| | - Karl-Heinz T Bäuml
- Department of Experimental Psychology, Regensburg UniversityRegensburg, Germany
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Brain-Derived Neurotrophic Factor (BDNF) Val66met (rs6265) Polymorphism Associated with Global and Multi-Domain Cognitive Impairment in Ischemic Stroke Patients. ACTA ACUST UNITED AC 2017. [DOI: 10.1007/s41470-017-0001-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Yoon JA, Kim DY, Sohn MK, Lee J, Lee SG, Lee YS, Han EY, Joo MC, Oh GJ, Han J, Park M, Park KP, Noh KH, Chang WH, Shin YI, Kim YH. Factors associated with improvement or decline in cognitive function after an ischemic stroke in Korea: the Korean stroke cohort for functioning and rehabilitation (KOSCO) study. BMC Neurol 2017; 17:9. [PMID: 28073355 PMCID: PMC5223558 DOI: 10.1186/s12883-016-0780-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 12/07/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We conducted a prospective cohort study to investigate prevalence of poststroke cognitive impairment at 3 and 12 months after stroke onset and identify clinical and demographic factors associated with improvement or decline in cognitive function between 3 months and 12 months. METHODS We analyzed the cognitive assessments of total patients and patients older than 65 years separately. All patients with an ischemic stroke were divided into normal cognitive group (NCG) and impaired cognition group (ICG) by using a cutoff score on the Korean Mini-Mental State Examination (K-MMSE). Patients were additionally classified into 3 subgroups according to the changes in their K-MMSE scores between 3 and 12 months: Stable group with K-MMSE scores changes ranging from -2 to +2 points (-2 ≤ △MMSE ≤ +2); converter group with increase more than 3 points (3 ≤ △MMSE); and reverter group with decrease more than 3 points (-3 ≤ △MMSE). We also analyzed factors affecting cognitive change from 3 months to 12 months among the 3 groups including baseline medical record, stroke and treatment characteristics, and various functional assessments after 3 months. RESULTS This study included 2,625 patients with the first time ischemic stroke. Among these patients, 1,735 (66.1%) were classified as NCG, while 890 patients (33.9%) were belonged to the ICG at 3 month. Within the NCG, 1,460 patients (82.4%) were stable group, 93 patients (5.4%) were converter group, and 212 patients (12.2%) were reverter group at 12 months onset. Within the ICG group, 472 patients (53.0%) were stable group, 321 patients (36.1%) were converter group, and 97 patients (10.9%) were reverter group. When different factors were investigated, the three subgroups in NCG and ICG showed significant different factors affecting cognitive function from 3 to 12 month. CONCLUSIONS The prevalence of cognitive impairment showed difference between 3,12 months. To analyze the cognitive change from 3 month to 12 month, the proportion stable group was dominant in NCG and converter group was higher in ICG. By investigating the influencing factors from each group, we were able to identify the predictors including the age factor.
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Affiliation(s)
- Jin A Yoon
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Research Institute of Convergence for Biomedical Science and Technology, 20, Geumo-ro, Mulgeum, Yangsan, 626-770, South Korea
| | - Deog Young Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea
| | - Min Kyun Sohn
- Department of Rehabilitation Medicine, School of Medicine, Chungnam National University, 282 Munhwa-ro, Jung-gu, Daejeon, 301-721, Republic of Korea
| | - Jongmin Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine, 120-1 Neungdong-ro, Hwayang-dong, Gwangjin-gu, Seoul, 143-729, Republic of Korea
| | - Sam-Gyu Lee
- Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School, 42 Jebong-ro, Donggu, Gwangju, 501-757, Republic of Korea
| | - Yang-Soo Lee
- Department of Rehabilitation Medicine, Kyung-pook National University College of Medicine, 130 Dongdeok-ro, Jung-gu, Daegu, 700-721, Republic of Korea
| | - Eun Young Han
- Department of Rehabilitation Medicine, Jeju University Hospital, University of Jeju College of Medicine, 15 Aran 13-gil, Jeju, 690-767, Republic of Korea
| | - Min Cheol Joo
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine, 895 Muwang-ro, Iksan, Jeonlabuk-do, 570-711, Republic of Korea
| | - Gyung-Jae Oh
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine, 895 Muwang-ro, Iksan, Jeonlabuk-do, 570-711, Republic of Korea
| | - Junhee Han
- Research And Statistical Support, Research Institute of Convergence for Biomedical Science and Technology, Pusan National University Yangsan Hospital, 20, Geumo-ro, Mulgeum-eu, Yangsan, 626-770, South Korea
| | - Minsu Park
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Research Institute of Convergence for Biomedical Science and Technology, 20, Geumo-ro, Mulgeum, Yangsan, 626-770, South Korea
| | - Kyung Pil Park
- Department of Neurology, Pusan National University College of Medicine, Pusan National University Yangsan Hospital, 20, Geumo-ro, Mulgeum-eu, Yangsan, 626-770, South Korea
| | - Kyung-Ha Noh
- Department of Neurology, Pusan National University College of Medicine, Pusan National University Yangsan Hospital, 20, Geumo-ro, Mulgeum-eu, Yangsan, 626-770, South Korea
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Gangnam-gu, Seoul, 135-710, Republic of Korea
| | - Yong-Il Shin
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Research Institute of Convergence for Biomedical Science and Technology, 20, Geumo-ro, Mulgeum, Yangsan, 626-770, South Korea. .,Department of Rehabilitation Medicine, Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, 20, Geumo-ro, Mulgeum, Yangsan, 626-770, South Korea.
| | - Yun-Hee Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Gangnam-gu, Seoul, 135-710, Republic of Korea.
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das Nair R, Cogger H, Worthington E, Lincoln NB. Cognitive rehabilitation for memory deficits after stroke. Cochrane Database Syst Rev 2016; 9:CD002293. [PMID: 27581994 PMCID: PMC6457594 DOI: 10.1002/14651858.cd002293.pub3] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Memory problems are a common cognitive complaint following stroke and can potentially affect ability to complete functional activities. Cognitive rehabilitation programmes either attempt to retrain lost or poor memory functions, or teach patients strategies to cope with them.Some studies have reported positive results of cognitive rehabilitation for memory problems, but the results obtained from previous systematic reviews have been less positive and they have reported inconclusive evidence. This is an update of a Cochrane review first published in 2000 and most recently updated in 2007. OBJECTIVES To determine whether participants who have received cognitive rehabilitation for memory problems following a stroke have better outcomes than those given no treatment or a placebo control.The outcomes of interest were subjective and objective assessments of memory function, functional ability, mood, and quality of life. We considered the immediate and long-term outcomes of memory rehabilitation. SEARCH METHODS We used a comprehensive electronic search strategy to identify controlled studies indexed in the Cochrane Stroke Group Trials Register (last searched 19 May 2016) and in the Cochrane Central Register of Controlled Trials (CENTRAL2016, Issue 5), MEDLINE (2005 to 7 March 2016), EMBASE 2005 to 7 March 2016), CINAHL (2005 to 5 February 2016), AMED (2005 to 7 March 2016), PsycINFO (2005 to 7 March 2016), and nine other databases and registries. Start dates for the electronic databases coincided with the last search for the previous review. We handsearched reference lists of primary studies meeting the inclusion criteria and review articles to identify further eligible studies. SELECTION CRITERIA We selected randomised controlled trials in which cognitive rehabilitation for memory problems was compared to a control condition. We included studies where more than 75% of the participants had experienced a stroke, or if separate data were available from those with stroke in mixed aetiology studies. Two review authors independently selected trials for inclusion, which was then confirmed through group discussion. DATA COLLECTION AND ANALYSIS We assessed study risk of bias and extracted data. We contacted the investigators of primary studies for further information where required. We conducted data analysis and synthesis in accordance with the Cochrane Handbook for Systematic Reviews of Interventions. We performed a 'best evidence' synthesis based on the risk of bias of the primary studies included. Where there were sufficient numbers of similar outcomes, we calculated and reported standardised mean differences (SMD) using meta-analysis. MAIN RESULTS We included 13 trials involving 514 participants. There was a significant effect of treatment on subjective reports of memory in the short term (standard mean difference (SMD) 0.36, 95% confidence interval (CI) 0.08 to 0.64, P = 0.01, moderate quality of evidence), but not the long term (SMD 0.31, 95% CI -0.02 to 0.64, P = 0.06, low quality of evidence). The SMD for the subjective reports of memory had small to moderate effect sizes.The results do not show any significant effect of memory rehabilitation on performance in objective memory tests, mood, functional abilities, or quality of life.No information was available on adverse events. AUTHORS' CONCLUSIONS Participants who received cognitive rehabilitation for memory problems following a stroke reported benefits from the intervention on subjective measures of memory in the short term (i.e. the first assessment point after the intervention, which was a minimum of four weeks). This effect was not, however, observed in the longer term (i.e. the second assessment point after the intervention, which was a minimum of three months). There was, therefore, limited evidence to support or refute the effectiveness of memory rehabilitation. The evidence was limited due to the poor quality of reporting in many studies, lack of consistency in the choice of outcome measures, and small sample sizes. There is a need for more robust, well-designed, adequately powered, and better-reported trials of memory rehabilitation using common standardised outcome measures.
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Affiliation(s)
- Roshan das Nair
- University of NottinghamDivision of Rehabilitation and AgeingB98, B Floor Medical SchoolQueen's Medical CentreNottinghamUKNG7 2UH
| | - Heather Cogger
- University of NottinghamDivision of Rehabilitation and AgeingB98, B Floor Medical SchoolQueen's Medical CentreNottinghamUKNG7 2UH
| | | | - Nadina B Lincoln
- University of NottinghamDivision of Rehabilitation and AgeingB98, B Floor Medical SchoolQueen's Medical CentreNottinghamUKNG7 2UH
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De Luca R, Calabrò RS, Bramanti P. Cognitive rehabilitation after severe acquired brain injury: current evidence and future directions. Neuropsychol Rehabil 2016; 28:879-898. [DOI: 10.1080/09602011.2016.1211937] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Rosaria De Luca
- Behavioral and NeuroRobotic Rehabilitation Laboratory, IRCCS Centro Neurolesi “Bonino Pulejo”, Messina, Italy
| | - Rocco Salvatore Calabrò
- Behavioral and NeuroRobotic Rehabilitation Laboratory, IRCCS Centro Neurolesi “Bonino Pulejo”, Messina, Italy
| | - Placido Bramanti
- Behavioral and NeuroRobotic Rehabilitation Laboratory, IRCCS Centro Neurolesi “Bonino Pulejo”, Messina, Italy
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Mullick AA, Subramanian SK, Levin MF. Emerging evidence of the association between cognitive deficits and arm motor recovery after stroke: A meta-analysis. Restor Neurol Neurosci 2016; 33:389-403. [PMID: 26410581 PMCID: PMC4923759 DOI: 10.3233/rnn-150510] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Purpose: Motor and cognitive impairments are common and often coexist in patients with stroke. Although evidence is emerging about specific relationships between cognitive deficits and upper-limb motor recovery, the practical implication of these relationships for rehabilitation is unclear. Using a structured review and meta-analyses, we examined the nature and strength of the associations between cognitive deficits and upper-limb motor recovery in studies of patients with stroke. Methods: Motor recovery was defined using measures of upper limb motor impairment and/or activity limitations. Studies were included if they reported on at least one measure of cognitive function and one measure of upper limb motor impairment or function. Results: Six studies met the selection criteria. There was a moderate association (r = 0.43; confidence interval; CI:0.09– 0.68, p = 0.014) between cognition and overall arm motor recovery. Separate meta-analyses showed a moderately strong association between executive function and motor recovery (r = 0.48; CI:0.26– 0.65; p < 0.001), a weak positive correlation between attention and motor recovery (r = 0.25; CI:0.04– 0.45; p = 0.023), and no correlation between memory and motor recovery (r = 0.42; CI:0.16– 0.79; p = 0.14). Conclusion: These results imply that information on the presence of cognitive deficits should be considered while planning interventions for clients in order to design more personalized interventions tailored to the individual for maximizing upper-limb recovery.
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Affiliation(s)
- Aditi A Mullick
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada.,Feil and Oberfeld Research Center, Jewish Rehabilitation Hospital, Center for Interdisciplinary Research in Rehabilitation of Greater Montreal, Laval, Canada
| | - Sandeep K Subramanian
- Feil and Oberfeld Research Center, Jewish Rehabilitation Hospital, Center for Interdisciplinary Research in Rehabilitation of Greater Montreal, Laval, Canada.,Département de neurosciences, Université de Montréal, Montreal, Canada
| | - Mindy F Levin
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada.,Feil and Oberfeld Research Center, Jewish Rehabilitation Hospital, Center for Interdisciplinary Research in Rehabilitation of Greater Montreal, Laval, Canada
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Kulesh AA, Shestakov VV. Post-stroke cognitive impairment and the possibility of treatment with cellex. Zh Nevrol Psikhiatr Im S S Korsakova 2016; 116:38-42. [DOI: 10.17116/jnevro20161165138-42] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Munsch F, Sagnier S, Asselineau J, Bigourdan A, Guttmann CR, Debruxelles S, Poli M, Renou P, Perez P, Dousset V, Sibon I, Tourdias T. Stroke Location Is an Independent Predictor of Cognitive Outcome. Stroke 2015; 47:66-73. [PMID: 26585396 DOI: 10.1161/strokeaha.115.011242] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 10/20/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE On top of functional outcome, accurate prediction of cognitive outcome for stroke patients is an unmet need with major implications for clinical management. We investigated whether stroke location may contribute independent prognostic value to multifactorial predictive models of functional and cognitive outcomes. METHODS Four hundred twenty-eight consecutive patients with ischemic stroke were prospectively assessed with magnetic resonance imaging at 24 to 72 hours and at 3 months for functional outcome using the modified Rankin Scale and cognitive outcome using the Montreal Cognitive Assessment (MoCA). Statistical maps of functional and cognitive eloquent regions were derived from the first 215 patients (development sample) using voxel-based lesion-symptom mapping. We used multivariate logistic regression models to study the influence of stroke location (number of eloquent voxels from voxel-based lesion-symptom mapping maps), age, initial National Institutes of Health Stroke Scale and stroke volume on modified Rankin Scale and MoCA. The second part of our cohort was used as an independent replication sample. RESULTS In univariate analyses, stroke location, age, initial National Institutes of Health Stroke Scale, and stroke volume were all predictive of poor modified Rankin Scale and MoCA. In multivariable analyses, stroke location remained the strongest independent predictor of MoCA and significantly improved the prediction compared with using only age, initial National Institutes of Health Stroke Scale, and stroke volume (area under the curve increased from 0.697-0.771; difference=0.073; 95% confidence interval, 0.008-0.155). In contrast, stroke location did not persist as independent predictor of modified Rankin Scale that was mainly driven by initial National Institutes of Health Stroke Scale (area under the curve going from 0.840 to 0.835). Similar results were obtained in the replication sample. CONCLUSIONS Stroke location is an independent predictor of cognitive outcome (MoCA) at 3 months post stroke.
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Affiliation(s)
- Fanny Munsch
- From the Université de Bordeaux, Bordeaux, France (F.M., C.R.G., V.D., I.S., T.T.); Neuroimagerie diagnostique et thérapeutique (F.M., A.B., V.D., T.T.), Unité neurovasculaire (S.S., S.D., M.P., P.R., I.S.), and Pôle de santé publique, Unité de Soutien Méthodologique à la Recherche Clinique et Epidémiologique (J.A., P.P.), CHU de Bordeaux, Bordeaux, France; INSERM, U862, Neurocentre Magendie, Bordeaux, France (F.M., V.D., T.T.); Center for Neurological Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (C.R.G.); and INCIA, Bordeaux, France (I.S.)
| | - Sharmila Sagnier
- From the Université de Bordeaux, Bordeaux, France (F.M., C.R.G., V.D., I.S., T.T.); Neuroimagerie diagnostique et thérapeutique (F.M., A.B., V.D., T.T.), Unité neurovasculaire (S.S., S.D., M.P., P.R., I.S.), and Pôle de santé publique, Unité de Soutien Méthodologique à la Recherche Clinique et Epidémiologique (J.A., P.P.), CHU de Bordeaux, Bordeaux, France; INSERM, U862, Neurocentre Magendie, Bordeaux, France (F.M., V.D., T.T.); Center for Neurological Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (C.R.G.); and INCIA, Bordeaux, France (I.S.)
| | - Julien Asselineau
- From the Université de Bordeaux, Bordeaux, France (F.M., C.R.G., V.D., I.S., T.T.); Neuroimagerie diagnostique et thérapeutique (F.M., A.B., V.D., T.T.), Unité neurovasculaire (S.S., S.D., M.P., P.R., I.S.), and Pôle de santé publique, Unité de Soutien Méthodologique à la Recherche Clinique et Epidémiologique (J.A., P.P.), CHU de Bordeaux, Bordeaux, France; INSERM, U862, Neurocentre Magendie, Bordeaux, France (F.M., V.D., T.T.); Center for Neurological Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (C.R.G.); and INCIA, Bordeaux, France (I.S.)
| | - Antoine Bigourdan
- From the Université de Bordeaux, Bordeaux, France (F.M., C.R.G., V.D., I.S., T.T.); Neuroimagerie diagnostique et thérapeutique (F.M., A.B., V.D., T.T.), Unité neurovasculaire (S.S., S.D., M.P., P.R., I.S.), and Pôle de santé publique, Unité de Soutien Méthodologique à la Recherche Clinique et Epidémiologique (J.A., P.P.), CHU de Bordeaux, Bordeaux, France; INSERM, U862, Neurocentre Magendie, Bordeaux, France (F.M., V.D., T.T.); Center for Neurological Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (C.R.G.); and INCIA, Bordeaux, France (I.S.)
| | - Charles R Guttmann
- From the Université de Bordeaux, Bordeaux, France (F.M., C.R.G., V.D., I.S., T.T.); Neuroimagerie diagnostique et thérapeutique (F.M., A.B., V.D., T.T.), Unité neurovasculaire (S.S., S.D., M.P., P.R., I.S.), and Pôle de santé publique, Unité de Soutien Méthodologique à la Recherche Clinique et Epidémiologique (J.A., P.P.), CHU de Bordeaux, Bordeaux, France; INSERM, U862, Neurocentre Magendie, Bordeaux, France (F.M., V.D., T.T.); Center for Neurological Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (C.R.G.); and INCIA, Bordeaux, France (I.S.)
| | - Sabrina Debruxelles
- From the Université de Bordeaux, Bordeaux, France (F.M., C.R.G., V.D., I.S., T.T.); Neuroimagerie diagnostique et thérapeutique (F.M., A.B., V.D., T.T.), Unité neurovasculaire (S.S., S.D., M.P., P.R., I.S.), and Pôle de santé publique, Unité de Soutien Méthodologique à la Recherche Clinique et Epidémiologique (J.A., P.P.), CHU de Bordeaux, Bordeaux, France; INSERM, U862, Neurocentre Magendie, Bordeaux, France (F.M., V.D., T.T.); Center for Neurological Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (C.R.G.); and INCIA, Bordeaux, France (I.S.)
| | - Mathilde Poli
- From the Université de Bordeaux, Bordeaux, France (F.M., C.R.G., V.D., I.S., T.T.); Neuroimagerie diagnostique et thérapeutique (F.M., A.B., V.D., T.T.), Unité neurovasculaire (S.S., S.D., M.P., P.R., I.S.), and Pôle de santé publique, Unité de Soutien Méthodologique à la Recherche Clinique et Epidémiologique (J.A., P.P.), CHU de Bordeaux, Bordeaux, France; INSERM, U862, Neurocentre Magendie, Bordeaux, France (F.M., V.D., T.T.); Center for Neurological Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (C.R.G.); and INCIA, Bordeaux, France (I.S.)
| | - Pauline Renou
- From the Université de Bordeaux, Bordeaux, France (F.M., C.R.G., V.D., I.S., T.T.); Neuroimagerie diagnostique et thérapeutique (F.M., A.B., V.D., T.T.), Unité neurovasculaire (S.S., S.D., M.P., P.R., I.S.), and Pôle de santé publique, Unité de Soutien Méthodologique à la Recherche Clinique et Epidémiologique (J.A., P.P.), CHU de Bordeaux, Bordeaux, France; INSERM, U862, Neurocentre Magendie, Bordeaux, France (F.M., V.D., T.T.); Center for Neurological Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (C.R.G.); and INCIA, Bordeaux, France (I.S.)
| | - Paul Perez
- From the Université de Bordeaux, Bordeaux, France (F.M., C.R.G., V.D., I.S., T.T.); Neuroimagerie diagnostique et thérapeutique (F.M., A.B., V.D., T.T.), Unité neurovasculaire (S.S., S.D., M.P., P.R., I.S.), and Pôle de santé publique, Unité de Soutien Méthodologique à la Recherche Clinique et Epidémiologique (J.A., P.P.), CHU de Bordeaux, Bordeaux, France; INSERM, U862, Neurocentre Magendie, Bordeaux, France (F.M., V.D., T.T.); Center for Neurological Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (C.R.G.); and INCIA, Bordeaux, France (I.S.)
| | - Vincent Dousset
- From the Université de Bordeaux, Bordeaux, France (F.M., C.R.G., V.D., I.S., T.T.); Neuroimagerie diagnostique et thérapeutique (F.M., A.B., V.D., T.T.), Unité neurovasculaire (S.S., S.D., M.P., P.R., I.S.), and Pôle de santé publique, Unité de Soutien Méthodologique à la Recherche Clinique et Epidémiologique (J.A., P.P.), CHU de Bordeaux, Bordeaux, France; INSERM, U862, Neurocentre Magendie, Bordeaux, France (F.M., V.D., T.T.); Center for Neurological Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (C.R.G.); and INCIA, Bordeaux, France (I.S.)
| | - Igor Sibon
- From the Université de Bordeaux, Bordeaux, France (F.M., C.R.G., V.D., I.S., T.T.); Neuroimagerie diagnostique et thérapeutique (F.M., A.B., V.D., T.T.), Unité neurovasculaire (S.S., S.D., M.P., P.R., I.S.), and Pôle de santé publique, Unité de Soutien Méthodologique à la Recherche Clinique et Epidémiologique (J.A., P.P.), CHU de Bordeaux, Bordeaux, France; INSERM, U862, Neurocentre Magendie, Bordeaux, France (F.M., V.D., T.T.); Center for Neurological Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (C.R.G.); and INCIA, Bordeaux, France (I.S.)
| | - Thomas Tourdias
- From the Université de Bordeaux, Bordeaux, France (F.M., C.R.G., V.D., I.S., T.T.); Neuroimagerie diagnostique et thérapeutique (F.M., A.B., V.D., T.T.), Unité neurovasculaire (S.S., S.D., M.P., P.R., I.S.), and Pôle de santé publique, Unité de Soutien Méthodologique à la Recherche Clinique et Epidémiologique (J.A., P.P.), CHU de Bordeaux, Bordeaux, France; INSERM, U862, Neurocentre Magendie, Bordeaux, France (F.M., V.D., T.T.); Center for Neurological Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (C.R.G.); and INCIA, Bordeaux, France (I.S.).
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Salis C, Kelly H, Code C. Assessment and treatment of short-term and working memory impairments in stroke aphasia: a practical tutorial. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2015; 50:721-736. [PMID: 26123369 DOI: 10.1111/1460-6984.12172] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Accepted: 02/17/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND Aphasia following stroke refers to impairments that affect the comprehension and expression of spoken and/or written language, and co-occurring cognitive deficits are common. In this paper we focus on short-term and working memory impairments that impact on the ability to retain and manipulate auditory-verbal information. Evidence from diverse paradigms (large group studies, case studies) report close links between short-term/working memory and language functioning in aphasia. This evidence leads to the hypothesis that treating such memory impairments would improve language functioning. This link has only recently been acknowledged in aphasia treatment but has not been embraced widely by clinicians. AIMS To examine the association between language, and short-term and working memory impairments in aphasia. To describe practical ways of assessing short-term and working memory functioning that could be used in clinical practice. To discuss and critically appraise treatments of short-term and working memory reported in the literature. METHODS & PROCEDURES Taking a translational research approach, this paper provides clinicians with current evidence from the literature and practical information on how to assess and treat short-term and working memory impairments in people with aphasia. Published treatments of short-term and/or working memory in post-stroke aphasia are discussed through a narrative review. MAIN CONTRIBUTIONS This paper provides the following. A theoretical rationale for adopting short-term and working memory treatments in aphasia. It highlights issues in differentially diagnosing between short-term, working memory disorders and other concomitant impairments, e.g. apraxia of speech. It describes short-term and working memory assessments with practical considerations for use with people with aphasia. It also offers a description of published treatments in terms of participants, treatments and outcomes. Finally, it critically appraises the current evidence base relating to the treatment of short-term and working memory treatments. CONCLUSIONS The links between short-term/working memory functioning and language in aphasia are generally acknowledged. These strongly indicate the need to incorporate assessment of short-term/working memory functioning for people with aphasia. While the supportive evidence for treatment is growing and appears to highlight the benefits of including short-term/working memory in aphasia treatment, the quality of the evidence in its current state is poor. However, because of the clinical needs of people with aphasia and the prevalence of short-term/working memory impairments, incorporating related treatments through practice-based evidence is advocated.
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Affiliation(s)
- Christos Salis
- Newcastle University, Speech & Language Sciences, Newcastle upon Tyne, UK
| | - Helen Kelly
- University College Cork, Department of Speech & Hearing Sciences, School of Clinical Therapies, Cork, Ireland
| | - Chris Code
- University of Exeter, Department of Psychology, College of Life and Environmental Sciences, Exeter, UK
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Abstract
Background: Vascular dementia is extremely common and contributes to stroke-associated morbidity and mortality. The study of vascular dementia may help to plan preventive interventions. Aims: To study the frequency of cognitive impairment after stroke in a series of consecutive patients with acute stroke, along with factors which influence it. Methods: Fifty adults with acute infarct or hemorrhage (as seen on computed tomography of the brain) were included in the study. The National Institute of Health Stroke Scale (NIHSS) and Barthel’s Index scores were done. Cognitive testing was done by PGI Battery of Brain Dysfunction (PGI-BBD) and Short Form of the Informant Questionnaire on Cognitive Decline in the Elderly (SIQCODE). Statistical analysis was by Student’s t-test, Chi-square test, Fisher’s exact test, and Mann-Whitney U test. Results: Mean age of patients was 61.82 years; males and ischemic strokes predominated. Dementia was seen in 30%, cognitive impairment no dementia (CIND) in 42%, and normal cognition in 28% patients. Factors associated with vascular cognitive impairment included old age, male sex, low education, hemorrhages, recurrent or severe stroke, silent infarcts, severe cortical atrophy, and left hemispheric or subcortical involvement. Conclusions: Up to 72% of patients have some form of cognitive impairment after a stroke. Secondary stroke prevention could reduce the incidence of vascular dementia.
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Affiliation(s)
| | - Charu Gauba
- Neurosciences, Indraprastha Apollo Hospitals
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Post-stroke memory impairment among patients with vascular mild cognitive impairment. BMC Neurol 2014; 14:244. [PMID: 25927318 PMCID: PMC4300833 DOI: 10.1186/s12883-014-0244-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 12/11/2014] [Indexed: 11/30/2022] Open
Abstract
Background The American Stroke Association/American Heart Association recommended the criteria for diagnosis of vascular cognitive impairment and memory impairment (MI) is a feature in the classification of vascular mild cognitive impairment (VaMCI). VaMCI patients with MI may differ in terms of infarct location or demographic features, so we evaluated the clinical characteristics associated with MI in patients with VaMCI. Methods A prospective multicenter study enrolled 353 acute ischemic stroke patients who underwent evaluation using the Korean Vascular Cognitive Impairment Harmonization Standard Neuropsychological Protocol at three months after onset. The association between MI and demographic features, stroke risk factors, and infarct location was assessed. Results VaMCI was diagnosed in 141 patients, and 58 (41.1%) exhibited MI. Proportions of men and of left side infarcts were higher in VaMCI with MI than those without (75.9 vs. 57.8%, P = 0.03, 66.7 vs. 47%, P = 0.02). Multiple logistic analyses revealed that male sex (odds ratio [OR] 3.07, 95% confidence interval [95% CI] 1.12-8.42), left-side infarcts (OR 3.14, 95% CI 1.37-7.20), and basal ganglia/internal capsule infarcts (OR 4.53, 95% CI 1.55-13.22) were associated with MI after adjusting other demographic variables, vascular risk factors, and subtypes of stroke. Conclusions MI is associated with sex and infarct location in VaMCI patients.
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50
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Spreij LA, Visser-Meily JMA, van Heugten CM, Nijboer TCW. Novel insights into the rehabilitation of memory post acquired brain injury: a systematic review. Front Hum Neurosci 2014; 8:993. [PMID: 25566021 PMCID: PMC4267268 DOI: 10.3389/fnhum.2014.00993] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 11/22/2014] [Indexed: 11/24/2022] Open
Abstract
Objective: Acquired Brain Injury (ABI) frequently results in memory impairment causing significant disabilities in daily life and is therefore a critical target for cognitive rehabilitation. Current understanding of brain plasticity has led to novel insights in remediation-oriented approaches for the rehabilitation of memory deficits. We will describe 3 of these approaches that have emerged in the last decade: Virtual Reality (VR) training, Computer-Based Cognitive Retraining (CBCR) and Non-Invasive Brain Stimulation (NBS) and evaluate its effectiveness. Methods: A systematic literature search was completed in regard to studies evaluating interventions aiming to improve the memory function after ABI. Information concerning study content and reported effectiveness were extracted. Quality of the studies and methods were evaluated. Results: A total of 786 studies were identified, 15 studies met the inclusion criteria. Three of those studies represent the VR technique, 7 studies represent CBCR and 5 studies NBS. All 3 studies found a significant improvement of the memory function after VR-based training, however these studies are considered preliminary. All 7 studies have shown that CBCR can be effective in improving memory function in patients suffering from ABI. Four studies of the 5 did not find significant improvement of the memory function after the use of NBS in ABI patients. Conclusion: On the basis of this review, CBCR is considered the most promising novel approach of the last decade because of the positive results in improving memory function post ABI. The number of studies representing VR were limited and the methodological quality low, therefore the results should be considered preliminary. The studies representing NBS did not detect evidence for the use of NBS in improving memory function.
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Affiliation(s)
- Lauriane A Spreij
- Department of Experimental Psychology, Helmholtz Institute, Utrecht University Utrecht, Netherlands
| | - Johanna M A Visser-Meily
- Brain Center Rudolf Magnus, Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht, and De Hoogstraat Rehabilitation Utrecht, Netherlands
| | - Caroline M van Heugten
- Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences, Maastricht University Maastricht, Netherlands
| | - Tanja C W Nijboer
- Department of Experimental Psychology, Helmholtz Institute, Utrecht University Utrecht, Netherlands ; Brain Center Rudolf Magnus, Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht, and De Hoogstraat Rehabilitation Utrecht, Netherlands
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