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Chiavilli M, Campagnini S, Baretta T, Castagnoli C, Paperini A, Politi AM, Pellicciari L, Baccini M, Basagni B, Marignani S, Bardi D, Sodero A, Lombardi G, Guolo E, Navarro JS, Galeri S, Montesano A, Falco L, Rovaris MG, Carrozza MC, Macchi C, Mannini A, Cecchi F. Design and implementation of a Stroke Rehabilitation Registry for the systematic assessment of processes and outcomes and the development of data-driven prediction models: The STRATEGY study protocol. Front Neurol 2022; 13:919353. [PMID: 36299268 PMCID: PMC9588928 DOI: 10.3389/fneur.2022.919353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 08/09/2022] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Stroke represents the second preventable cause of death after cardiovascular disease and the third global cause of disability. In countries where national registries of the clinical quality of stroke care have been established, the publication and sharing of the collected data have led to an improvement in the quality of care and survival of patients. However, information on rehabilitation processes and outcomes is often lacking, and predictors of functional outcomes remain poorly explored. This paper describes a multicenter study protocol to implement a Stroke rehabilitation Registry, mainly based on a multidimensional assessment proposed by the Italian Society of Physical and Rehabilitation Medicine (PMIC2020), in a pilot Italian cohort of stroke survivors undergoing post-acute inpatient rehabilitation, to provide a systematic assessment of processes and outcomes and develop data-driven prediction models of functional outcomes. METHODS All patients with a diagnosis of ischemic or haemorrhagic stroke confirmed by clinical assessment, admitted to intensive rehabilitation units within 30 days from the acute event, aged 18+, and providing informed consent will be enrolled. Measures will be taken at admission (T0), at discharge (T1), and at follow-up, 3 months (T2) and 6 months (T3) after the stroke. Assessment variables include anamnestic data, clinical and nursing complexity information and measures of body structures and function, activity and participation (PMIC2020), rehabilitation interventions, adverse events and discharge data. The modified Barthel Index will be our primary outcome. In addition to classical biostatistical analysis, learning algorithms will be cross-validated to achieve data-driven prognosis prediction models. CONCLUSIONS This study will test the feasibility of a stroke rehabilitation registry in the Italian health context and provide a systematic assessment of processes and outcomes for quality assessment and benchmarking. By the development of data-driven prediction models in stroke rehabilitation, this study will pave the way for the development of decision support tools for patient-oriented therapy planning and rehabilitation outcomes maximization. CLINICAL TIAL REGISTRATION The registration on ClinicalTrials.gov is ongoing and under review. The identification number will be provided when the review process will be completed.
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Affiliation(s)
| | - Silvia Campagnini
- IRCCS Fondazione Don Carlo Gnocchi onlus, Firenze, Italy
- The Biorobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Teresa Baretta
- IRCCS Fondazione Don Carlo Gnocchi onlus, Firenze, Italy
| | | | - Anita Paperini
- IRCCS Fondazione Don Carlo Gnocchi onlus, Firenze, Italy
| | | | | | - Marco Baccini
- IRCCS Fondazione Don Carlo Gnocchi onlus, Firenze, Italy
| | | | - Sara Marignani
- IRCCS Fondazione Don Carlo Gnocchi onlus, Firenze, Italy
| | - Donata Bardi
- IRCCS Fondazione Don Carlo Gnocchi onlus, Firenze, Italy
| | - Alessandro Sodero
- IRCCS Fondazione Don Carlo Gnocchi onlus, Firenze, Italy
- NEUROFARBA Department, Neuroscience Section, University of Florence, Florence, Italy
| | - Gemma Lombardi
- IRCCS Fondazione Don Carlo Gnocchi onlus, Firenze, Italy
| | - Erika Guolo
- IRCCS Fondazione Don Carlo Gnocchi onlus, Firenze, Italy
| | | | - Silvia Galeri
- IRCCS Fondazione Don Carlo Gnocchi Onlus, Milan, Italy
| | | | - Lucia Falco
- IRCCS Fondazione Don Carlo Gnocchi Onlus, Milan, Italy
| | | | | | - Claudio Macchi
- IRCCS Fondazione Don Carlo Gnocchi onlus, Firenze, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Andrea Mannini
- IRCCS Fondazione Don Carlo Gnocchi onlus, Firenze, Italy
| | - Francesca Cecchi
- IRCCS Fondazione Don Carlo Gnocchi onlus, Firenze, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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Kim Y, Chung J, Song JY, Jang H, Jang JW, Kim S. Association between Baseline Cognitive Function and Longitudinal Functional Outcome Change after Ischemic Stroke. Dement Geriatr Cogn Disord 2022; 51:168-174. [PMID: 35447620 DOI: 10.1159/000523981] [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] [Received: 12/07/2021] [Accepted: 02/23/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Ischemic stroke can cause impairment of daily function and cognitive function. Higher cognitive function is reported in many studies to be associated with better functional outcomes; however, evidence from longitudinal study is lacking. Therefore, in the present study, the association between cognitive function and longitudinal changes of functional outcome was investigated based on stroke severity. Furthermore, whether the effect of cognitive function remained consistent after controlling for depression was investigated. METHODS The data of 423 stroke patients (292 minor strokes, 93 moderate strokes, and 38 severe strokes) were collected. Baseline Mini-Mental State Examination (MMSE) score was considered a predictor, and change of modified Rankin Scale (mRS) score during 12 months of follow-up was the outcome. First, the association between the baseline MMSE score and longitudinal change in the mRS score was analyzed using linear mixed-effects models. Fixed effects were MMSE score group, time, and MMSE score group × time interaction. Additional adjustment was made for the Geriatric Depression Scale (GDS) score. RESULTS Among the 423 subjects, the mean age was 73.5 years, and 43.4% were female. In the minor stroke group, the high MMSE score group had a decreased mRS score, and the low MMSE score group had an increased mRS score (p < 0.001). This association remained after additional adjustment of the GDS score. Association was not observed between cognitive function and functional recovery in the moderate or severe stroke group. CONCLUSION After ischemic stroke, higher baseline global cognitive function was a predictive factor for better functional recovery regardless of depression symptoms in the minor stroke group.
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Affiliation(s)
- Yeshin Kim
- Department of Neurology, Kangwon National University School of Medicine, Chuncheon, Republic of Korea,
| | - Jaekyung Chung
- Department of Neurology, Kangwon National University School of Medicine, Chuncheon, Republic of Korea
| | - Jeong Yun Song
- Department of Neurology, Kangwon National University School of Medicine, Chuncheon, Republic of Korea
| | - Hyemin Jang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Alzheimer's Disease Convergence Research Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Jae-Won Jang
- Department of Neurology, Kangwon National University School of Medicine, Chuncheon, Republic of Korea
| | - Seongheon Kim
- Department of Neurology, Kangwon National University School of Medicine, Chuncheon, Republic of Korea
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STAN A, STRILCIUC S, GHERGHEL N, COZMA A, CRISTIAN A, ILUT S, BLESNEAG A, VACARAS V, STANCA D, STAN H, MURESANU D. Aphasia after acute ischemic stroke: epidemiology and impact on tertiary care resources. BALNEO AND PRM RESEARCH JOURNAL 2021. [DOI: 10.12680/balneo.2021.465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction. This study aimed to reveal the disease burden of aphasia after acute ischemic stroke (AIS) at the national level and investigate the impact of aphasia on tertiary care resources and patient outcomes. We aimed to investigate the length of stay (LOS) and discharge modified Rankin Scale (mRS) score in aphasic, acute ischemic stroke (AIS) patients in order to estimate aphasia-related disease burden at a national level.
Material and method. The local database from the Cluj-Napoca Emergency County Hospital (CNECH), the second largest stroke center in Romania was used to export demographics, baseline clinical and laboratory data, inpatient length of stay (LOS), NIH Stroke Scale (NIHSS), and discharge modified Rankin Scale (mRS) score data for all AIS patients admitted during March 2019.
Results and discussions. Of 92 patients included in the study, 30 (32.6 %) had aphasia on admission. In a marginally significant unadjusted hierarchical multiple regression model, individuals with aphasia had a LOS of 1.86 days longer than stroke survivors without aphasia. In an adjusted version of the model, the NIHSS score at baseline was a significant predictor for LOS. In addition, the presence of aphasia was associated with a 1.49 increase in the mean mRS score. Aphasia was a marginally significant predictor for increased LOS. Presence of aphasia was more likely to produce a poor functional outcome.
Conclusions. Considering an estimated impact of approximately EUR 3 million on direct medical expenditure annually, future policymaking efforts should improve prevention of stroke and improved access to post-stroke aphasia care in Romania.
Keywords: aphasia; acute ischemic stroke; length of stay; disability, outcome,
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Affiliation(s)
- Adina STAN
- Department of Neurosciences, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Stefan STRILCIUC
- Department of Neurosciences, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Nicoleta GHERGHEL
- Emergency County Hospital Cluj-Napoca, Neurology Department, Cluj-Napoca, Romania
| | - Angela COZMA
- Department 5 Internal Medicine, 4th Medical Clinic, “Iuliu Hațieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Alexander CRISTIAN
- 3. Emergency County Hospital Cluj-Napoca, Neurology Department, Cluj-Napoca, Romania
| | - Silvina ILUT
- Department of Neurosciences, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Alina BLESNEAG
- Department of Neurosciences, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Vitalie VACARAS
- Department of Neurosciences, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Delia STANCA
- Department of Neurosciences, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Horatiu STAN
- Department of Neurosciences, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Dafin MURESANU
- Department of Neurosciences, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Kulshrestha S, Agrawal M, Singh AK, Kulshreshtha D. Post Stroke Rehabilitation Using Computer-based Cognitive Intervention (CBCI): A Systematic Review. CURRENT PSYCHIATRY RESEARCH AND REVIEWS 2020. [DOI: 10.2174/2666082216999200622135105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Cognitive impairment as a consequence of stroke is a major cause affecting
the patient’s functional independence, activity participation, daily living skills, and occupation. Almost
75% of post-stroke patients are diagnosed with significant cognitive impairment, which includes
problems with attention, orientation, memory, language, and perception. Along with effective
pharmaceutical cures, cognitive intervention as a part of rehabilitation approaches that may prevent,
delay, or treat cognitive impairment is becoming increasingly important. Many studies have reported
improvement in cognitive functions of post-stroke patients after using computer-based cognitive
intervention (CBCI). CBCI can be an effective add-on to available rehabilitation programs.
Objective:
This article provides reviews related to relevant literature and, represents a structure to
specify the efficacy of CBCI for the rehabilitation of post-stroke patients for future research.
Methods:
We searched many search engines namely MEDLINE, Web of Science, clinical key and
The Cochrane Library, for studies investigating the effect of cognitive intervention based on a computer
program for post-stroke patients. The results of selected studies were summarized. Total 19
publications from January 2007 to January 2019 are included in this review. The search terms entered
were a combination of these search areas that defined (1) the population as adults who had suffered
a stroke and cognitive dysfunction, (2) intervention search term included cognitive abilities, cognitive
training, and computer-based training; computer-based cognitive intervention for rehabilitation.
Results:
The results after computer-based training showed improvement in various cognitive functions
such as; memory, attention and executive functions of post-stroke patients. However, a significant
difference between the study groups has not been observed in all the studies. Most studies analyzed
in this research project indicated that such interventions might contribute to the improvement
of cognitive function, especially attention concentration and memory. Of the 19 kinds of research
that discussed CBCI outcomes 18 found significant improvements for one or more cognitive functions.
When the effect size for CBCI was reported, effects were large in comparison to other traditional
cognitive interventions of post-stroke patients.
Conclusion:
Studies related to cognitive functions strongly support CBCI except few have reported
a significant difference. The review of all the studies suggests that CBCI may help to change the
functional aspect of post-stroke patients by improving their cognitive functions. In this field, it is a
challenge to conduct well designed and sufficiently powered studies due to low budgets availability,
the limited number of available patients, heterogeneity of the population, and ethical considerations.
Future studies should examine all the challenges, limitations, and valuable insights into the study
and emphasize the need for a carefully designed computer-based cognitive intervention program for
the future. Future studies should target to compare CBCI with active and passive control conditions
and include a larger sample size.
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Affiliation(s)
- Sudhi Kulshrestha
- Amity Institute of Behavioral and Allied Sciences, Amity University, Lucknow, India
| | - Manju Agrawal
- Amity Institute of Behavioral and Allied Sciences, Amity University, Lucknow, India
| | - Ajai K. Singh
- Department of Neurology, Dr. Ram ManoharLohia Institute of Medical Sciences, Lucknow, India
| | - Dinkar Kulshreshtha
- Department of Neurology, Dr. Ram ManoharLohia Institute of Medical Sciences, Lucknow, India
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Stolwyk RJ. Cognitive Screening Following Stroke: Are We Following Best Evidence‐based Practice in Australian Clinical Settings? AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12191] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Mole J, Foddai E, Chan E, Xu T, Cipolotti L. Is the Brixton Spatial Anticipation Test sensitive to frontal dysfunction? Evidence from patients with frontal and posterior lesions. J Clin Exp Neuropsychol 2020; 42:531-543. [PMID: 32619157 DOI: 10.1080/13803395.2020.1776223] [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: 10/23/2022]
Abstract
INTRODUCTION The Brixton Spatial Anticipation Test is a widely used neuropsychological test, thought to assess executive functions and to be sensitive to frontal lobe lesions. Our aim was to investigate Brixton performance in patients with focal frontal or posterior lesions and healthy controls. METHOD We compared performance on the Brixton in a sample of 24 frontal patients, 18 posterior patients and 22 healthy controls. Both overall performance (total number of errors) and error types were analyzed. RESULTS We found no significant differences between frontal and posterior patients and healthy controls in overall Brixton performance. Moreover, our error analysis showed no difference between frontal patients, posterior patients and healthy controls. The only exception was that posterior patients had a greater tendency to guess and make more errors when following specific rules than healthy controls but this was no longer significant once fluid intelligence was controlled for. We also found no significant difference between the performance of patients with left lateral (n = 11), right lateral (n = 10) or superior medial (n = 18) frontal lesions and healthy controls. CONCLUSIONS The Brixton test is not sensitive to frontal lobe dysfunction. It is likely that the test draws on a range of cognitive abilities not specific to frontal lobe lesions. Hence, caution should be taken when drawing conclusions about its neural substrates.
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Affiliation(s)
- Joseph Mole
- Department of Neuropsychology, National Hospital for Neurology and Neurosurgery , London, UK.,Institute of Neurology, University College London , London, UK
| | - Eleonora Foddai
- Department of Neuropsychology, National Hospital for Neurology and Neurosurgery , London, UK
| | - Edgar Chan
- Department of Neuropsychology, National Hospital for Neurology and Neurosurgery , London, UK.,Institute of Neurology, University College London , London, UK
| | - Tianbo Xu
- Institute of Neurology, University College London , London, UK
| | - Lisa Cipolotti
- Department of Neuropsychology, National Hospital for Neurology and Neurosurgery , London, UK.,Institute of Neurology, University College London , London, UK
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Chan E, Garritsen E, Altendorff S, Turner D, Simister R, Werring DJ, Cipolotti L. Additional Queen Square (QS) screening items improve the test accuracy of the Montreal Cognitive Assessment (MoCA) after acute stroke. J Neurol Sci 2019; 407:116442. [PMID: 31677556 DOI: 10.1016/j.jns.2019.116442] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 08/28/2019] [Accepted: 08/30/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND The Montreal Cognitive Assessment (MoCA) is a popular cognitive screening tool used in stroke, but lacks sensitivity for detecting impairment in stroke-relevant domains of processing speed, non-verbal memory and executive functions. Our aim was to assess whether the test accuracy of the MoCA can be improved with additional tailored screening items targeting these three domains. METHODS We included 196 patients admitted to an acute stroke unit at the National Hospital for Neurology and Neurosurgery, Queen Square (QS), London. Participants completed the MoCA as well as a series of additional QS-screening items designed to assess speed of processing, non-verbal memory and executive functions. Performance on the MoCA and QS screening items was compared with performance on "gold standard" neuropsychological assessment. RESULTS In our sample, 22% of patients were classified as "cognitively intact" on the traditional MoCA alone (≥ 25). However, when tested on the QS-screening items, 40% of these patients failed on speed of processing, 56% failed on non-verbal memory and 26% failed on executive functions. Compared with neuropsychological assessment, the QS-screening items had good sensitivity (QS-Speed: 0.85; QS-Vis: 0.71; QS-EF: 0.73) and modest specificity (QS-Speed: 0.59; QS-Vis: 0.39; QS-EF: 0.54), regardless of stroke lateralisation. CONCLUSION Additional screening items detected impairments in speed of processing, non-verbal memory and executive functions over and above those captured using the standard MoCA. The use of these QS-screening items improves the detection of post-stroke cognitive deficits in domains not adequately covered by the standard MoCA.
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Affiliation(s)
- Edgar Chan
- National Hospital for Neurology and Neurosurgery, Dept. of Neuropsychology, London, United Kingdom; UCL Queen Square Institute of Neurology, Stroke Research Centre, London, United Kingdom.
| | - Eva Garritsen
- UCL Queen Square Institute of Neurology, Stroke Research Centre, London, United Kingdom
| | - Samantha Altendorff
- National Hospital for Neurology and Neurosurgery, Dept. of Neuropsychology, London, United Kingdom
| | - David Turner
- Comprehensive Stroke Service, University College London Hospital, London, United Kingdom
| | - Robert Simister
- UCL Queen Square Institute of Neurology, Stroke Research Centre, London, United Kingdom; Comprehensive Stroke Service, University College London Hospital, London, United Kingdom
| | - David J Werring
- UCL Queen Square Institute of Neurology, Stroke Research Centre, London, United Kingdom; Comprehensive Stroke Service, University College London Hospital, London, United Kingdom
| | - Lisa Cipolotti
- National Hospital for Neurology and Neurosurgery, Dept. of Neuropsychology, London, United Kingdom; UCL Queen Square Institute of Neurology, Stroke Research Centre, London, United Kingdom
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Stelmokas J, Rochette AD, Hogikyan R, Kitchen Andren KA, Reckow J, Sciaky A, Bieliauskas L, Alexander NB. Influence of Cognition on Length of Stay and Rehospitalization in Older Veterans Admitted for Post-Acute Care. J Appl Gerontol 2019; 39:609-617. [PMID: 31169053 DOI: 10.1177/0733464819853989] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Evaluate the relative contribution of cognitive test performance to post-acute care (PAC) length of stay (LOS) and rehospitalization while controlling for key demographic, medical, and functional outcomes. METHODS Retrospective medical record review of 160 older Veterans, including cognitive test performance (Addenbrooke's Cognitive Examination-Revised [ACE-R]), on admission to a Veterans Administration Hospital Community Living Center (CLC) PAC. RESULTS Individuals with impaired scores on the ACE-R had a longer LOS (10 median days longer; U = 2,547.00, p = .028). Of those rehospitalized, 71.4% (n = 20) screened positive for cognitive impairment. Key medical factors explained the largest amount of variance in CLC-PAC LOS (29.8%), followed by admission ADL (activities of daily living) dependency (4.6%) and ACE-R total score (3.30%). DISCUSSION Cognitive screening should be considered on PAC admission, with impairment on ACE-R predicting geriatric rehabilitation outcomes such as risk of increased LOS and rehospitalization.
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Affiliation(s)
- Julija Stelmokas
- Veterans Affairs Ann Arbor Healthcare System Mental Health Service, MI, USA.,Veterans Affairs Ann Arbor Geriatric Research Education and Clinical Center, MI, USA.,University of Michigan, Ann Arbor, USA
| | - Amber D Rochette
- Veterans Affairs Ann Arbor Healthcare System Mental Health Service, MI, USA.,Kent State University, OH, USA
| | - Robert Hogikyan
- Veterans Affairs Ann Arbor Geriatric Research Education and Clinical Center, MI, USA.,University of Michigan, Ann Arbor, USA
| | | | - Jaclyn Reckow
- Mercy Health Physician Partners, Grand Rapids, MI, USA
| | - Alexandra Sciaky
- Veterans Affairs Ann Arbor Healthcare System Mental Health Service, MI, USA
| | | | - Neil B Alexander
- Veterans Affairs Ann Arbor Geriatric Research Education and Clinical Center, MI, USA.,Kent State University, OH, USA
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Ploughman M, Eskes GA, Kelly LP, Kirkland MC, Devasahayam AJ, Wallack EM, Abraha B, Hasan SMM, Downer MB, Keeler L, Wilson G, Skene E, Sharma I, Chaves AR, Curtis ME, Bedford E, Robertson GS, Moore CS, McCarthy J, Mackay-Lyons M. Synergistic Benefits of Combined Aerobic and Cognitive Training on Fluid Intelligence and the Role of IGF-1 in Chronic Stroke. Neurorehabil Neural Repair 2019; 33:199-212. [PMID: 30816066 DOI: 10.1177/1545968319832605] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Paired exercise and cognitive training have the potential to enhance cognition by "priming" the brain and upregulating neurotrophins. METHODS Two-site randomized controlled trial. Fifty-two patients >6 months poststroke with concerns about cognitive impairment trained 50 to 70 minutes, 3× week for 10 weeks with 12-week follow-up. Participants were randomized to 1 of 2 physical interventions: Aerobic (>60% VO2peak using <10% body weight-supported treadmill) or Activity (range of movement and functional tasks). Exercise was paired with 1 of 2 cognitive interventions (computerized dual working memory training [COG] or control computer games [Games]). The primary outcome for the 4 groups (Aerobic + COG, Aerobic + Games, Activity + COG, and Activity + Games) was fluid intelligence measured using Raven's Progressive Matrices Test administered at baseline, posttraining, and 3-month follow-up. Serum neurotrophins collected at one site (N = 30) included brain-derived neurotrophic factor (BDNF) at rest (BDNFresting) and after a graded exercise test (BDNFresponse) and insulin-like growth factor-1 at the same timepoints (IGF-1rest, IGF-1response). RESULTS At follow-up, fluid intelligence scores significantly improved compared to baseline in the Aerobic + COG and Activity + COG groups; however, only the Aerobic + COG group was significantly different (+47.8%) from control (Activity + Games -8.5%). Greater IGF-1response at baseline predicted 40% of the variance in cognitive improvement. There was no effect of the interventions on BDNFresting or BDNFresponse; nor was BDNF predictive of the outcome. CONCLUSIONS Aerobic exercise combined with cognitive training improved fluid intelligence by almost 50% in patients >6 months poststroke. Participants with more robust improvements in cognition were able to upregulate higher levels of serum IGF-1 suggesting that this neurotrophin may be involved in behaviorally induced plasticity.
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Affiliation(s)
- Michelle Ploughman
- 1 Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Gail A Eskes
- 2 Dalhousie University, Halifax, Nova Scotia, Canada NL, Canada
| | - Liam P Kelly
- 1 Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Megan C Kirkland
- 1 Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | | | - Elizabeth M Wallack
- 1 Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Beraki Abraha
- 1 Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - S M Mahmudul Hasan
- 1 Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Matthew B Downer
- 1 Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Laura Keeler
- 2 Dalhousie University, Halifax, Nova Scotia, Canada NL, Canada
| | - Graham Wilson
- 2 Dalhousie University, Halifax, Nova Scotia, Canada NL, Canada
| | - Elaine Skene
- 2 Dalhousie University, Halifax, Nova Scotia, Canada NL, Canada
| | - Ishika Sharma
- 2 Dalhousie University, Halifax, Nova Scotia, Canada NL, Canada
| | - Arthur R Chaves
- 1 Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Marie E Curtis
- 1 Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Emily Bedford
- 2 Dalhousie University, Halifax, Nova Scotia, Canada NL, Canada
| | | | - Craig S Moore
- 1 Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Jason McCarthy
- 1 Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
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Shea-Shumsky NB, Schoeneberger S, Grigsby J. Executive functioning as a predictor of stroke rehabilitation outcomes. Clin Neuropsychol 2019; 33:854-872. [DOI: 10.1080/13854046.2018.1546905] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
| | | | - Jim Grigsby
- Departments of Psychology and Medicine, University of Colorado Denver, Denver, CO, USA
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11
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Park J, Lee SU, Jung SH. Prediction of post-stroke functional mobility from the initial assessment of cognitive function. NeuroRehabilitation 2018; 41:169-177. [PMID: 28505995 DOI: 10.3233/nre-171469] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Cognitive impairment is frequently seen in patients with stroke. The possible correlation between cognitive function and functional mobility has been proposed; however, the prognostic importance of early cognitive function in recovery of mobility has not been investigated in patients with stroke. OBJECTIVE The objective of this study is to investigate whether the cognitive function in the acute phase can independently predict the recovery of mobility after stroke, and to determine the cut-off value of each cognitive evaluation test for community ambulation at six months. METHODS Seventy two patients underwent four domain-specific neuropsychological evaluation tests at about two weeks after stroke; these included the word list memory test (WMT), construction praxis test (CPT), verbal fluency test (VFT) and Boston naming test (BNT). The Functional Ambulation Category (FAC) and ambulatory zone (AZ) at six months after stroke were investigated as outcome variables. The domain-specific cognitive function, along with other possible predictors for functional mobility, was analyzed with regression analysis. RESULTS The z-scores of WMT (p = 0.018) and VFT (p = 0.012) were related to the independence in ambulation. The z-scores of VFT (p = 0.006) and CPT (p = 0.009) were predictors for community ambulation, with the cut-off values of -2.215 for VFT, and of -0.845 for CPT. CONCLUSIONS Cognitive impairment in the acute phase of stroke can be an independent prognostic factor of functional mobility. Domain-specific neuropsychological evaluation tests should be considered in the acute phase of stroke to predict the recovery of functional mobility.
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Affiliation(s)
- Jihong Park
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Korea
| | - Shi-Uk Lee
- Department of Rehabilitation Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Se Hee Jung
- Department of Rehabilitation Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
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12
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Baseline Vascular Cognitive Impairment Predicts the Course of Apathetic Symptoms After Stroke: The CASPER Study. Am J Geriatr Psychiatry 2018; 26:291-300. [PMID: 29079017 DOI: 10.1016/j.jagp.2017.09.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 09/01/2017] [Accepted: 09/05/2017] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To examine the influence of vascular cognitive impairment (VCI) on the course of poststroke depression (PSD) and poststroke apathy (PSA). METHODS Included were 250 stroke patients who underwent neuropsychological and neuropsychiatric assessment 3 months after stroke (baseline) and at a 6- and 12-month follow-up after baseline. Linear mixed models tested the influence of VCI in at least one cognitive domain (any VCI) or multidomain VCI (VCI in multiple cognitive domains) at baseline and domain-specific VCI at baseline on levels of depression and apathy over time, with random effects for intercept and slope. RESULTS Almost half of the patients showed any VCI at baseline, and any VCI was associated with increasing apathy levels from baseline to the 12-month follow-up. Patients with multidomain VCI had higher apathy scores at the 6- and 12-month follow-up compared with patients with VCI in a single cognitive domain. Domain-specific analyses showed that impaired executive function and slowed information processing speed went together with increasing apathy levels from baseline to 6- and 12-month follow-up. None of the cognitive variables predicted the course of depressive symptoms. CONCLUSION Baseline VCI is associated with increasing apathy levels from baseline to the chronic stroke phase, whereas no association was found between baseline VCI and the course of depressive symptoms. Health professionals should be aware that apathy might be absent early after stroke but may evolve over time in patients with VCI.
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13
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Lim KB, Kim J, Lee HJ, Yoo J, You EC, Kang J. Correlation Between Montreal Cognitive Assessment and Functional Outcome in Subacute Stroke Patients With Cognitive Dysfunction. Ann Rehabil Med 2018; 42:26-34. [PMID: 29560321 PMCID: PMC5852226 DOI: 10.5535/arm.2018.42.1.26] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 07/11/2017] [Indexed: 12/13/2022] Open
Abstract
Objective To investigate the correlation between the Montreal Cognitive Assessment (MoCA) and functional outcome among subacute stroke patients with cognitive dysfunction. Methods Records of 61 inpatients were reviewed. Patients were divided into two groups based on their initial MoCA score. MoCA score of 11 was set as the differentiating criterion. We compared the improvements in Modified Barthel Index (MBI) from initial assessment to discharge between the two groups. Results There were no significant differences between the two groups in relation to age, duration from onset to admission, hospitalization period, or years of education. In a comparison of the results of Mini-Mental Status Examinations (MMSE) administered at admission and again at discharge, there was significantly more improvement in MMSE scores in the group with low MoCA scores than in the group with high MoCA scores. However, the group with high MoCA scores also showed high MBI scores at discharge and exhibited greater MBI improvement. Conclusion Higher initial MoCA scores (which reflect preservation of executive function) indicate better functional outcome in the subacute stroke phase.
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Affiliation(s)
- Kil-Byung Lim
- Department of Physical Medicine and Rehabilitation, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Jiyong Kim
- Department of Physical Medicine and Rehabilitation, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Hong-Jae Lee
- Department of Physical Medicine and Rehabilitation, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - JeeHyun Yoo
- Department of Physical Medicine and Rehabilitation, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Eun-Cheol You
- Department of Physical Medicine and Rehabilitation, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Joongmo Kang
- Department of Physical Medicine and Rehabilitation, Inje University Ilsan Paik Hospital, Goyang, Korea
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14
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Watt S, Crowe SF. Examining the beneficial effect of neuropsychological assessment on adult patient outcomes: a systematic review. Clin Neuropsychol 2017; 32:368-390. [DOI: 10.1080/13854046.2017.1414885] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Stephanie Watt
- School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Simon F. Crowe
- School of Psychology and Public Health, La Trobe University, Bundoora, Australia
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15
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Hung CY, Wu WT, Chang KV, Wang TG, Han DS. Predicting the length of hospital stay of post-acute care patients in Taiwan using the Chinese version of the continuity assessment record and evaluation item set. PLoS One 2017; 12:e0183612. [PMID: 28832680 PMCID: PMC5568231 DOI: 10.1371/journal.pone.0183612] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 08/08/2017] [Indexed: 11/24/2022] Open
Abstract
Background The Chinese version of the Continuity Assessment Record and Evaluation (CARE-C) item set was developed to facilitate the assessment of post-acute care (PAC) patients in Taiwan. Considering that the length of hospital stay (LOS) has a significant effect on the total healthcare cost, determining whether the CARE-C scores could predict the LOS of PAC patients is of great interest to the PAC providers. Methods This prospective trial included PAC patients with stroke or central nervous system injuries. The demographic data and CARE-C scores were collected after admission and before discharge. A multivariable stepwise linear regression model was used to identify the predictors of the LOS using age, sex, tube placement status, CARE-C component scores at admission, and score differences between admission and discharge as independent variables. Results This study included 178 patients (66 women and 112 men), with a mean age of 61.9 ± 15.6 years. Indwelling urinary catheter placement status at admission (β = 0.241, p = 0.002) was a positive predictor of the LOS, whereas age (β = −0.189, p = 0.010), core transfer subscale score at admission (β = −0.176, p = 0.020), and difference in continence subscale score (β = −0.203, p = 0.008) were negative predictors of the LOS. The model explained 14% of the total variance. Conclusions Indwelling urinary catheter placement status at admission, age, core transfer subscale score at admission, and difference in the CARE-C continence subscale score were identified as predictors of the LOS. The explanatory power of these predictors might be limited due to the regulations of Taiwan’s National Health Insurance.
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Affiliation(s)
- Chen-Yu Hung
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital BeiHu Branch, Taipei, Taiwan
| | - Wei-Ting Wu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital BeiHu Branch, Taipei, Taiwan
| | - Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital BeiHu Branch, Taipei, Taiwan
- Community and Geriatric Medicine Research Center, National Taiwan University Hospital BeiHu Branch, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Tyng-Guey Wang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Der-Sheng Han
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital BeiHu Branch, Taipei, Taiwan
- Community and Geriatric Medicine Research Center, National Taiwan University Hospital BeiHu Branch, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, College of Medicine, National Taiwan University, Taipei, Taiwan
- * E-mail:
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16
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Liu J, Wang Q, Liu F, Song H, Liang X, Lin Z, Hong W, Yang S, Huang J, Zheng G, Tao J, Chen LD. Altered functional connectivity in patients with post-stroke memory impairment: A resting fMRI study. Exp Ther Med 2017; 14:1919-1928. [PMID: 28962104 PMCID: PMC5609161 DOI: 10.3892/etm.2017.4751] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Accepted: 02/17/2017] [Indexed: 11/20/2022] Open
Abstract
Post-stroke memory dysfunction (PMD) is one of the most common forms of cognitive impairment among stroke survivors. However, only a limited number of studies have directly investigated the neural mechanisms associated with memory decline. The aim of the present study was to identify dynamic changes in the functional organization of the default mode network (DMN) and the dorsal attention network of patients with PMD. A total of 27 patients with PMD who experienced a stroke in the right hemisphere were enrolled in the current study, along with 27 healthy control subjects matched by age, sex, and educational level. A behavioral examination and functional magnetic resonance imaging scan were performed. The data were analyzed using an independent component analysis method. The results revealed a significantly increased functional connectivity between the DMN and prefrontal cortex (left middle/inferior frontal and left precentral gyri), temporal regions (left superior temporal gyrus), and bilateral and posterior cingulate gyri/precuneus (P<0.001). There was also a significantly decreased functional connectivity between the DMN and right middle temporal gyrus, left uvula, and right inferior parietal lobule, and between the dorsal attention network and prefrontal cortex (left precentral/inferior and right inferior/middle frontal gyri), right inferior parietal gyrus, and right insula (P<0.001). These results suggest that the stroke affected both the lesioned and contralesional hemispheres. The prefrontal cortex, temporal regions, insula, and posterior cingulate gyrus/precuneus serve a crucial role in memory processing.
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Affiliation(s)
- Jiao Liu
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian 350122, P.R. China.,Fujian Rehabilitation Tech Co-innovation Center, Fuzhou, Fujian 350122, P.R. China
| | - Qin Wang
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian 350122, P.R. China
| | - Feiwen Liu
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian 350122, P.R. China
| | - Haiyan Song
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian 350122, P.R. China
| | - Xiaofeng Liang
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian 350122, P.R. China
| | - Zhengkun Lin
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian 350122, P.R. China
| | - Wenjun Hong
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian 350122, P.R. China
| | - Shanli Yang
- Fujian University of Traditional Chinese Medicine Subsidiary Rehabilitation Hospital, Fuzhou, Fujian 350003, P.R. China
| | - Jia Huang
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian 350122, P.R. China.,Fujian Rehabilitation Tech Co-innovation Center, Fuzhou, Fujian 350122, P.R. China
| | - Guohua Zheng
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian 350122, P.R. China
| | - Jing Tao
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian 350122, P.R. China.,Key Laboratory of Motor Rehabilitation of Fujian, Fuzhou, Fujian 350003, P.R. China.,Fujian Provincial Rehabilitation Industrial Institution, Fuzhou, Fujian 350000, P.R. China
| | - Li-Dian Chen
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian 350122, P.R. China.,Key Laboratory of Motor Rehabilitation of Fujian, Fuzhou, Fujian 350003, P.R. China.,Fujian Provincial Rehabilitation Industrial Institution, Fuzhou, Fujian 350000, P.R. China
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17
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Chan E, Altendorff S, Healy C, Werring DJ, Cipolotti L. The test accuracy of the Montreal Cognitive Assessment (MoCA) by stroke lateralisation. J Neurol Sci 2016; 373:100-104. [PMID: 28131163 DOI: 10.1016/j.jns.2016.12.028] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 11/22/2016] [Accepted: 12/16/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND The Montreal Cognitive Assessment (MoCA) is an increasingly popular screening tool for detecting cognitive impairment post-stroke. However its' test accuracy by stroke lateralisation is as yet unknown. AIM Our aim was to investigate whether the test accuracy of the MoCA differs by stroke lateralisation across different cognitive domains. METHODS We retrospectively examined the cognitive profiles of 228 subacute stroke patients (86 Left, 142 Right), comparing MoCA-total and domain-specific scores with performance on detailed neuropsychological assessment. RESULTS The prevalence of cognitive impairment detected on neuropsychological assessment was high and relatively comparable between the right and left hemisphere stroke groups (91% and 93% respectively). Notably however, 29% of the right stroke group and 6% of the left stroke group achieved a "cognitively-intact" MoCA score (≥25). A high proportion of right stroke patients who had an overall MoCA-intact score were found to be impaired in intellectual functioning, processing speed, executive functions and non-verbal memory on neuropsychological assessment. Furthermore, a high proportion of patients who scored full-marks within a MoCA-specified domain, irrespective of their overall score, were found to have impairment on corresponding neuropsychological assessment for both stroke groups. CONCLUSIONS Particular care needs to be taken in interpreting MoCA-intact performance for right hemisphere patients due to its poor sensitivity to right hemisphere deficits. Scoring maximum points within a MoCA-specified domain also does not necessarily indicate intact cognitive functioning in that domain. Clinicians should consider supplementing their MoCA assessment with additional tools to increase the test accuracy of detecting relevant cognitive impairments post-stroke.
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Affiliation(s)
- Edgar Chan
- Neuropsychology Department, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Stroke Research Group, UCL Institute of Neurology, London, UK.
| | - Samantha Altendorff
- Neuropsychology Department, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Colm Healy
- Neuropsychology Department, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - David J Werring
- Stroke Research Group, UCL Institute of Neurology, London, UK
| | - Lisa Cipolotti
- Neuropsychology Department, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Dipartimento di Scienze Psicologiche, Pedagogiche e della Formazione, Università degli Studi di Palermo, Palermo, Italy
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18
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Boehme AK, Martin-Schild S, Marshall RS, Lazar RM. Effect of aphasia on acute stroke outcomes. Neurology 2016; 87:2348-2354. [PMID: 27765864 DOI: 10.1212/wnl.0000000000003297] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 08/24/2016] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To determine the independent effects of aphasia on outcomes during acute stroke admission, controlling for total NIH Stroke Scale (NIHSS) scores and loss of consciousness. METHODS Data from the Tulane Stroke Registry were used from July 2008 to December 2014 for patient demographics, NIHSS scores, length of stay (LOS), complications (sepsis, deep vein thrombosis), and discharge modified Rankin Scale (mRS) score. Aphasia was defined as a score >1 on question 9 on the NIHSS on admission and hemiparesis as >1 on questions 5 or 6. RESULTS Among 1,847 patients, 866 (46%) had aphasia on admission. Adjusting for NIHSS score and inpatient complications, those with aphasia had a 1.22 day longer LOS than those without aphasia, whereas those with hemiparesis (n = 1,225) did not have any increased LOS compared to those without hemiparesis. Those with aphasia had greater odds of having a complication (odds ratio [OR] 1.44, confidence interval [CI] 1.07-1.93, p = 0.0174) than those without aphasia, which was equivalent to those having hemiparesis (OR 1.47, CI 1.09-1.99, p = 0.0137). Controlling for NIHSS scores, aphasia patients had higher odds of discharge mRS 3-6 (OR 1.42 vs 1.15). CONCLUSION Aphasia is independently associated with increased LOS and complications during the acute stroke admission, adding $2.16 billion annually to US acute stroke care. The presence of aphasia was more likely to produce a poor functional outcome than hemiparesis. These data suggest that further research is necessary to determine whether establishing adaptive communication skills can mitigate its consequences in the acute stroke setting.
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Affiliation(s)
- Amelia K Boehme
- From the Department of Neurology, College of Physicians and Surgeons (A.K.B., R.S.M., R.M.L.), and Department of Epidemiology, Mailman School of Public Health (A.K.B.), Columbia University, New York, NY; and Comprehensive Stroke Center (S. M.-S.), Department of Neurology, Tulane School of Medicine, New Orleans, LA
| | - Sheryl Martin-Schild
- From the Department of Neurology, College of Physicians and Surgeons (A.K.B., R.S.M., R.M.L.), and Department of Epidemiology, Mailman School of Public Health (A.K.B.), Columbia University, New York, NY; and Comprehensive Stroke Center (S. M.-S.), Department of Neurology, Tulane School of Medicine, New Orleans, LA
| | - Randolph S Marshall
- From the Department of Neurology, College of Physicians and Surgeons (A.K.B., R.S.M., R.M.L.), and Department of Epidemiology, Mailman School of Public Health (A.K.B.), Columbia University, New York, NY; and Comprehensive Stroke Center (S. M.-S.), Department of Neurology, Tulane School of Medicine, New Orleans, LA
| | - Ronald M Lazar
- From the Department of Neurology, College of Physicians and Surgeons (A.K.B., R.S.M., R.M.L.), and Department of Epidemiology, Mailman School of Public Health (A.K.B.), Columbia University, New York, NY; and Comprehensive Stroke Center (S. M.-S.), Department of Neurology, Tulane School of Medicine, New Orleans, LA.
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19
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Vanbellingen T, Ottiger B, Pflugshaupt T, Mehrholz J, Bohlhalter S, Nef T, Nyffeler T. The Responsiveness of the Lucerne ICF-Based Multidisciplinary Observation Scale: A Comparison with the Functional Independence Measure and the Barthel Index. Front Neurol 2016; 7:152. [PMID: 27725808 PMCID: PMC5035834 DOI: 10.3389/fneur.2016.00152] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 09/02/2016] [Indexed: 11/23/2022] Open
Abstract
Background Good responsive functional outcome measures are important to measure change in stroke patients. The aim of study was to compare the internal and external responsiveness, floor and ceiling effects of the motor, cognition, and communication subscales of the Lucerne ICF-based Multidisciplinary Observation Scale (LIMOS) with the motor and cognition subscales of the Functional Independence Measure (FIM), and the Barthel Index (BI), in a large cohort of stroke patients. Methods One hundred eighteen stroke patients participated in this study. Admission and discharge score distributions of the LIMOS motor, LIMOS cognition and communication, FIM motor and FIM cognition, and BI were analyzed based on skewness and kurtosis. Floor and ceiling effects of the scales were determined. Internal responsiveness was assessed with t-tests, effect sizes (ESs), and standardized response means (SRMs). External responsiveness was investigated with linear regression analyses. Results The LIMOS motor and LIMOS cognition and communication subscales were more responsive, expressed by higher ESs (ES = 0.65, SRM = 1.17 and ES = 0.52, SRM = 1.17, respectively) as compared with FIM motor (ES = 0.54, SRM = 0.96) and FIM cognition (ES = 0.41, SRM = 0.88) and the BI (ES = 0.41, SRM = 0.65). The LIMOS subscales showed neither floor nor ceiling effects at admission and discharge (all <15%). In contrast, ceiling effects were found for the FIM motor (16%), FIM cognition (15%) at discharge and the BI at admission (22%) and discharge (43%). LIMOS motor and LIMOS cognition and communication subscales significantly correlated (p < 0.0001) with a change in the FIM motor and FIM cognition subscales, suggesting good external responsiveness. Conclusion We found that the LIMOS motor and LIMOS cognition and communication, which are ICF-based multidisciplinary standardized observation scales, might have the potential to better detect changes in functional outcome of stroke patients, compared with the FIM motor and FIM cognition and the BI.
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Affiliation(s)
- Tim Vanbellingen
- Neurology and Neurorehabilitation Center, Luzerner Kantonsspital, Luzern, Switzerland; Gerontechnology and Rehabilitation Group, University of Bern, Bern, Switzerland
| | - Beatrice Ottiger
- Neurology and Neurorehabilitation Center, Luzerner Kantonsspital , Luzern , Switzerland
| | - Tobias Pflugshaupt
- Neurology and Neurorehabilitation Center, Luzerner Kantonsspital , Luzern , Switzerland
| | - Jan Mehrholz
- Wissenschaftliches Institut, Klinik Bavaria in Kreischa GmbH , Kreischa , Germany
| | - Stephan Bohlhalter
- Neurology and Neurorehabilitation Center, Luzerner Kantonsspital , Luzern , Switzerland
| | - Tobias Nef
- Gerontechnology and Rehabilitation Group, University of Bern, Bern, Switzerland; ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Thomas Nyffeler
- Neurology and Neurorehabilitation Center, Luzerner Kantonsspital, Luzern, Switzerland; Gerontechnology and Rehabilitation Group, University of Bern, Bern, Switzerland
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20
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Royle M, Callen J, Craig M. Should There Be an Age Split for Stroke DRGs? Analysing a Large Clinical Data Set of a Principal Teaching Hospital over a Five-Year Period. Health Inf Manag 2016; 32:5-12. [PMID: 19468147 DOI: 10.1177/183335830403200103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The aim of this study was to analyse the inpatient statistics collection relating to stroke patients admitted to a major teaching hospital, with particular reference to length of stay, and to assess the adequacy of the diagnosis related group (DRG) as a predictor of length of stay. The study subjects were selected by DRG to identify all stroke inpatients admitted and discharged between 1 July 1995 and 30 June 2000. There were 1365 stroke discharges (half of whom were over 75 years of age at discharge) over the period of the study. The median length of stay was 8 days, and 67% of the subjects experienced complications and/or comorbidities. Age was significantly associated with increased length of stay of stroke patients, independent of complications or comorbidities. These findings raise the question of whether casemix-based funding should be based solely on DRGs for complicated conditions such as stroke, or whether additional measures such as age should be used for funding allocation. This study provides a model that health information managers and other researchers could use to analyse inpatient statistics collections at state, territory or national levels.
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Affiliation(s)
- Monique Royle
- Monique Royle DipAppSci(Nursing), MHIM, Clinical Information Manager, Casemix Unit, Prince of Wales Hospital, Randwick, NSW, Tel: +61 2 9980 5562
| | - Joanne Callen
- Joanne Callen BA, DipEd, MPH(Research), Head, School of Health Information Management, Faculty of Health Sciences, The University of Sydney, Lidcombe, NSW, Tel: +61 2 9351 9494
| | - Maria Craig
- Maria Craig MBBS, PhD, FRACP, MMedSc(ClinEpid), Senior Lecturer, School of Women's and Children's Health, University of New South Wales, Kensington, NSW
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21
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Woznowski-Vu A, Da Costa C, Turgeon-Provost F, Dagenais K, Roy-Mathie B, Aggban M, Preuss R. Factors Affecting Length of Stay in Adult Outpatient Physical Rehabilitation: A Scoping Review of the Literature. Physiother Can 2016; 67:329-40. [PMID: 27504032 DOI: 10.3138/ptc.2014-75] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To identify factors affecting length of stay (LOS) for adults participating in outpatient physical or occupational therapy programmes. METHOD A scoping review of the literature was conducted using the Ovid MEDLINE, EMBASE, CINAHL, AMED, and Cochrane Library databases. RESULTS A total of 19 articles were retained from the search, and 2 additional articles were retrieved from grey literature (i.e., non-published sources). Personal factors affecting LOS are age and sex, both of which had inconsistent effects on LOS, and communication, language, physical, and cognitive difficulties, for which higher levels of function were generally associated with shorter LOS. Institutional factors affecting LOS were location, interdisciplinary communication, number of disciplines involved, and type of rehabilitation setting. Finally, two clinician-related factors-fewer treatment goals and a selection of evidence-informed treatment techniques-were associated with shorter LOS. CONCLUSIONS Research on factors affecting adult outpatient rehabilitation LOS is limited and inconsistent. A preliminary list of LOS factors was produced, but this topic should be further explored with the collaboration of researchers and clinical institutions.
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Affiliation(s)
| | | | | | | | | | - Martina Aggban
- School of Physical and Occupational Therapy, McGill University
| | - Richard Preuss
- School of Physical and Occupational Therapy, McGill University; Constance Lethbridge Rehabilitation Centre, Centre de recherche interdisciplinaire en réadaptation, Montreal
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22
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Claessen MHG, Visser-Meily JMA, de Rooij NK, Postma A, van der Ham IJM. The Wayfinding Questionnaire as a Self-report Screening Instrument for Navigation-related Complaints After Stroke: Internal Validity in Healthy Respondents and Chronic Mild Stroke Patients. Arch Clin Neuropsychol 2016; 31:839-854. [PMID: 27506237 DOI: 10.1093/arclin/acw044] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2016] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE In current stroke care, cognitive problems are usually diagnosed in a stepwise manner. More specifically, screening instruments are first applied to support healthcare professionals in deciding whether a second step (an extensive assessment) would be appropriate. None of the existing screening instruments, however, takes navigation ability into account. This is problematic, as navigation impairment after stroke has been shown to be common, more so than previously thought. The Wayfinding Questionnaire (WQ) is therefore presented as a screening instrument for navigation-related complaints after stroke. The internal validity of the WQ was investigated in two samples of participants to establish the final version. METHOD AND RESULTS In Study 1, the WQ was administered in a representative sample of 356 healthy participants. Its factor structure was investigated using a principal component analysis. This procedure resulted in deletion of four items and revealed a three-factor structure: "Navigation and Orientation," "Spatial Anxiety," and "Distance Estimation". In Study 2, a confirmatory analysis was performed to directly verify the factor structure as obtained in Study 1 based on data of 158 chronic mild stroke patients. Fit indices of the confirmatory analysis indicated acceptable model fit. The reliability of the three subscales was found to be very good in both healthy participants and patients. CONCLUSIONS These studies allowed us to determine the final version of the WQ. The results indicated that the WQ is an internally valid and reliable instrument that can be interpreted using a three-factor structure in both healthy respondents and chronic mild stroke patients.
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Affiliation(s)
- Michiel H G Claessen
- Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands.,Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Johanna M A Visser-Meily
- Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Nicolien K de Rooij
- Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Albert Postma
- Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands
| | - Ineke J M van der Ham
- Department of Health, Medical and Neuropsychology, Leiden University, Leiden, The Netherlands
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23
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Bindawas SM, Mawajdeh H, Vennu V, Alhaidary H. A retrospective observational study of functional outcomes, length of stay, and discharge disposition after an inpatient stroke rehabilitation program in Saudi Arabia. Medicine (Baltimore) 2016; 95:e4432. [PMID: 27495066 PMCID: PMC4979820 DOI: 10.1097/md.0000000000004432] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Functional outcomes, length of stay (LOS), and discharge disposition have become frequent outcome measures among stroke patients after rehabilitation programs. To examine the trends of changes in functional outcomes, LOS, and discharge disposition in stroke patients discharged from an inpatient rehabilitation facility.All patients (n = 432) were admitted to a tertiary inpatient rehabilitation hospital in Riyadh, Saudi Arabia with stroke diagnoses from November 2008 to December 2014. The functional independence measure (FIM) instrument used to assess the patient's functional status. The LOS was measured as the number of days the patients spent in the hospital from the day of admission to the day of discharge. The FIM efficiency was used to measure the patient's rehabilitation progress. All of the variables of the prospectively collected data were retrospectively analyzed.There were significant changes by years in the total FIM ranging from 23 to 29 (P < 0.001) and subscores: FIM motor ranging from 20 to 26 (P < 0.001); FIM cognitive ranging from 1.8 to 3 (P < 0.001). The mean LOS remained constant, from 52 days in 2011 to 40 days in 2013. The FIM efficiency was stable between years and ranged from 0.52 to 0.72. The rates of discharge (to home) were significantly unstable and ranged from 100% in 2010 and 2011 to 92% in 2013.Our results suggest that functional outcomes in patients with stroke have improved after an inpatient stroke rehabilitation program between 2008 and 2014 even with a constant LOS. Discharge disposition has remained unstable over this period. To improve the efficiency of the stroke rehabilitation program in Saudi Arabia, there is a need to decrease the LOS and emphasize a comprehensive interdisciplinary approach.
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Affiliation(s)
- Saad M. Bindawas
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University
- Correspondence: Saad M. Bindawas, Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, P.O. Box: 10219, Riyadh-11433, Saudi Arabia (e-mail: .)
| | - Hussam Mawajdeh
- Rehabilitation Hospitals, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Vishal Vennu
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University
| | - Hisham Alhaidary
- Rehabilitation Hospitals, King Fahad Medical City, Riyadh, Saudi Arabia
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Hall MW, Hopkins RO, Long JW, Mohammad SF, Solen KA. Hypothermia-induced platelet aggregation and cognitive decline in coronary artery bypass surgery: a pilot study. Perfusion 2016; 20:157-67. [PMID: 16038388 DOI: 10.1191/0267659105pf814oa] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Hypothermia-induced platelet aggregation (HIPA) was previously reported in whole blood exposed to synthetic surfaces at 24°-32°C in one-third of normal subjects tested. Cardiopulmonary bypass, conducted with hypothermia, may lead to such aggregation, resulting in microvascular occlusion contributing to cognitive impairment. This pilot study was conducted to explore the relationship between HIPA and cognitive outcome at hospital discharge in patients undergoing coronary artery bypass graft (CABG) surgery as a first step toward a longer-term study. Patients (n=45) undergoing mild to moderate hypothermia (32°-28°8C) during CABG surgery underwent cognitive testing preoperatively and prior to hospital discharge. Tests included: visual and verbal memory, mental processing speed, executive function, language, and intellectual function. HIPA was identified using an in vitro assay in which blood flowing in polyvinychloride tubing was subjected to hypothermia, and platelet aggregates were detected using microscopy and passing the exiting blood through a 20-μm pore filter. Forty-four percent of patients exhibited HIPA. The entire cohort exhibited significant postoperative cognitive decline in verbal memory, mental processing speed and executive function. There was greater cognitive decline in the group with HIPA compared with the group not exhibiting this phenomenon. The patients with HIPA showed significant decline in four of five cognitive measures whereas patients not exhibiting this phenomenon declined in only two of five cognitive measures. HIPA appears to be associated with an added risk of cognitive decline immediately following CABG surgery employing mild to moderate hypothermia. The findings of our study suggest the long-term cognitive effects of hypothermia-induced platelet aggregation need to be explored.
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Affiliation(s)
- Matthew W Hall
- Department of Chemical Engineering, 350 CB, Brigham Young University, Provo, UT 84602, USA
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Edwards DF, Hahn MG, Baum CM, Perlmutter MS, Sheedy C, Dromerick AW. Screening Patients with Stroke for Rehabilitation Needs: Validation of the Post-Stroke Rehabilitation Guidelines. Neurorehabil Neural Repair 2016; 20:42-8. [PMID: 16467277 DOI: 10.1177/1545968305283038] [Citation(s) in RCA: 122] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. The authors assessed patients with acute stroke to determine whether the systematic use of brief screening measures would more efficiently detect cognitive and sensory impairment than standard clinical practice. Methods. Fifty-three patients admitted to an acute stroke unit were assessed within 10 days of stroke onset. Performance on the screening measures was compared to information obtained from review of the patient’s chart at discharge. Cognition, language, visual acuity, visual-spatial neglect, hearing, and depression were evaluated. Results. Formal screening detected significantly more impairments than were noted in patient charts in every domain. Only 3 patients had no impairments identified on screening; all remaining patients had at least 1 impairment detected by screening that was not documented in the chart. Thirty-five percent had 3 or more undetected impairments. Memory impairment was most likely to be noted in the chart; for all other domains tested, undocumented impairment ranged from 61% (neglect) to 97% (anomia). Conclusion. Many acute stroke patients had cognitive and perceptual deficits that were not documented in their charts. These data support the Post-Stroke Rehabilitation Guidelines for systematic assessment even when deficits are not immediately apparent. Systematic screening may improve discharge planning, rehabilitation treatment, and long-term outcome of persons with stroke.
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Affiliation(s)
- Dorothy F Edwards
- Program in Occupational Therapy, Washington University School of Medicine, and Barnes Jewish Hospital, St. Louis, MO 63108, USA.
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Park J, Lee G, Lee SU, Jung SH. The Impact of Acute Phase Domain-Specific Cognitive Function on Post-stroke Functional Recovery. Ann Rehabil Med 2016; 40:214-22. [PMID: 27152270 PMCID: PMC4855114 DOI: 10.5535/arm.2016.40.2.214] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 08/25/2015] [Indexed: 11/21/2022] Open
Abstract
Objective To assess whether the cognitive function in the acute stage evaluated by domain-specific neuropsychological assessments would be an independent predictor of functional outcome after stroke. Methods Forty patients underwent 4 domain-specific neuropsychological examinations about 3 weeks after the onset of stroke. The tests included the Boston Naming Test (BNT), the construction recall test (CRT), the construction praxis test (CPT), and the verbal fluency test (VFT). The Korean version of Modified Barthel Index (K-MBI) at 3 months and the modified Rankin Scale (mRS) at 6 months were investigated as functional outcome after stroke. Functional improvement was assessed using the change in K-MBI during the first 3 months and subjects were dichotomized into 'good status' and 'poor status' according to mRS at 6 months. The domain-specific cognitive function along with other possible predictors for functional outcome was examined using regression analysis. Results The z-score of CPT (p=0.044) and CRT (p<0.001) were independent predictors for functional improvement measured by the change in K-MBI during the first 3 months after stroke. The z-score of CPT (p=0.049) and CRT (p=0.048) were also independent predictors of functional status at post-stroke 6 months assessed by mRS. Conclusion Impairment in visuospatial construction and memory within one month after stroke can be an independent prognostic factor of functional outcome. Domain-specific neuropsychological assessments could be considered in patients with stroke in the acute phase to predict long-term functional outcome.
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Affiliation(s)
- Jihong Park
- Department of Rehabilitation Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Gangpyo Lee
- Department of Rehabilitation Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Shi-Uk Lee
- Department of Rehabilitation Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Se Hee Jung
- Department of Rehabilitation Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
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Zheng D, Sato S, Arima H, Heeley E, Delcourt C, Cao Y, Chalmers J, Anderson CS. Estimated GFR and the Effect of Intensive Blood Pressure Lowering After Acute Intracerebral Hemorrhage. Am J Kidney Dis 2016; 68:94-102. [PMID: 26948991 DOI: 10.1053/j.ajkd.2016.01.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Accepted: 01/17/2016] [Indexed: 01/04/2023]
Abstract
BACKGROUND The kidney-brain interaction has been a topic of growing interest. Past studies of the effect of kidney function on intracerebral hemorrhage (ICH) outcomes have yielded inconsistent findings. Although the second, main phase of the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT2) suggests the effectiveness of early intensive blood pressure (BP) lowering in improving functional recovery after ICH, the balance of potential benefits and harms of this treatment in those with decreased kidney function remains uncertain. STUDY DESIGN Secondary analysis of INTERACT2, which randomly assigned patients with ICH with elevated systolic BP (SBP) to intensive (target SBP<140mmHg) or contemporaneous guideline-based (target SBP<180mmHg) BP management. SETTING & PARTICIPANTS 2,823 patients from 144 clinical hospitals in 21 countries. PREDICTORS Admission estimated glomerular filtration rates (eGFRs) of patients were categorized into 3 groups based on the CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) creatinine equation: normal or high, mildly decreased, and moderately to severely decreased (>90, 60-90, and <60mL/min/1.73m(2), respectively). OUTCOMES The effect of admission eGFR on the primary outcome of death or major disability at 90 days (defined as modified Rankin Scale scores of 3-6) was analyzed using a multivariable logistic regression model. Potential effect modification of intensive BP lowering treatment by admission eGFR was assessed by interaction terms. RESULTS Of 2,623 included participants, 912 (35%) and 280 (11%) had mildly and moderately/severely decreased eGFRs, respectively. Patients with moderately/severely decreased eGFRs had the greatest risk for death or major disability at 90 days (adjusted OR, 1.82; 95% CI, 1.28-2.61). Effects of early intensive BP lowering were consistent across different eGFRs (P=0.5 for homogeneity). LIMITATIONS Generalizability issues arising from a clinical trial population. CONCLUSIONS Decreased eGFR predicts poor outcome in acute ICH. Early intensive BP lowering provides similar treatment effects in patients with ICH with decreased eGFRs.
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Affiliation(s)
- Danni Zheng
- The George Institute for Global Health, Sydney, Australia; Sydney Medical School, University of Sydney, Sydney, Australia
| | - Shoichiro Sato
- The George Institute for Global Health, Sydney, Australia
| | - Hisatomi Arima
- The George Institute for Global Health, Sydney, Australia; Sydney Medical School, University of Sydney, Sydney, Australia; Center for Epidemiologic Research in Asia, Shiga University of Medical Sciences, Otsu, Japan
| | - Emma Heeley
- The George Institute for Global Health, Sydney, Australia; Sydney Medical School, University of Sydney, Sydney, Australia
| | - Candice Delcourt
- The George Institute for Global Health, Sydney, Australia; Sydney Medical School, University of Sydney, Sydney, Australia; Royal Prince Alfred Hospital, Sydney, Australia
| | - Yongjun Cao
- The George Institute for Global Health, Sydney, Australia; Department of Neurology, The Second Affiliated Hospital of Suzhou University, Suzhou, China
| | - John Chalmers
- The George Institute for Global Health, Sydney, Australia; Sydney Medical School, University of Sydney, Sydney, Australia
| | - Craig S Anderson
- The George Institute for Global Health, Sydney, Australia; Sydney Medical School, University of Sydney, Sydney, Australia; Royal Prince Alfred Hospital, Sydney, Australia.
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Analyzing health insurance claims on different timescales to predict days in hospital. J Biomed Inform 2016; 60:187-96. [PMID: 26827621 DOI: 10.1016/j.jbi.2016.01.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 01/05/2016] [Accepted: 01/05/2016] [Indexed: 11/21/2022]
Abstract
Health insurers maintain large databases containing information on medical services utilized by claimants, often spanning several healthcare services and providers. Proper use of these databases could facilitate better clinical and administrative decisions. In these data sets, there exists many unequally spaced events, such as hospital visits. However, data mining of temporal data and point processes is still a developing research area and extracting useful information from such data series is a challenging task. In this paper, we developed a time series data mining approach to predict the number of days in hospital in the coming year for individuals from a general insured population based on their insurance claim data. In the proposed method, the data were windowed at four different timescales (bi-monthly, quarterly, half-yearly and yearly) to construct regularly spaced time series features extracted from such events, resulting in four associated prediction models. A comparison of these models indicates models using a half-yearly windowing scheme delivers the best performance on all three populations (the whole population, a senior sub-population and a non-senior sub-population). The superiority of the half-yearly model was found to be particularly pronounced in the senior sub-population. A bagged decision tree approach was able to predict 'no hospitalization' versus 'at least one day in hospital' with a Matthews correlation coefficient (MCC) of 0.426. This was significantly better than the corresponding yearly model, which achieved 0.375 for this group of customers. Further reducing the length of the analysis windows to three or two months did not produce further improvements.
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Sprint G, Cook DJ, Weeks DL, Borisov V. Predicting Functional Independence Measure Scores During Rehabilitation with Wearable Inertial Sensors. IEEE ACCESS : PRACTICAL INNOVATIONS, OPEN SOLUTIONS 2015; 3:1350-1366. [PMID: 27054054 PMCID: PMC4819996 DOI: 10.1109/access.2015.2468213] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Evaluating patient progress and making discharge decisions regarding inpatient medical rehabilitation rely upon standard clinical assessments administered by trained clinicians. Wearable inertial sensors can offer more objective measures of patient movement and progress. We undertook a study to investigate the contribution of wearable sensor data to predict discharge functional independence measure (FIM) scores for 20 patients at an inpatient rehabilitation facility. The FIM utilizes a 7-point ordinal scale to measure patient independence while performing several activities of daily living, such as walking, grooming, and bathing. Wearable inertial sensor data were collected from ecological ambulatory tasks at two time points mid-stay during inpatient rehabilitation. Machine learning algorithms were trained with sensor-derived features and clinical information obtained from medical records at admission to the inpatient facility. While models trained only with clinical features predicted discharge scores well, we were able to achieve an even higher level of prediction accuracy when also including the wearable sensor-derived features. Correlations as high as 0.97 for leave-one-out cross validation predicting discharge FIM motor scores are reported.
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Affiliation(s)
- Gina Sprint
- Department of Electrical Engineering and Computer Science, Washington State University, Pullman, WA, 99163 USA
| | - Diane J. Cook
- Department of Electrical Engineering and Computer Science, Washington State University, Pullman, WA, 99163 USA
| | | | - Vladimir Borisov
- Voiland School of Chemical and Bioengineering, Washington State University, Pullman, WA, 99163 USA
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Cipolotti L, Healy C, Chan E, MacPherson SE, White M, Woollett K, Turner M, Robinson G, Spanò B, Bozzali M, Shallice T. The effect of age on cognitive performance of frontal patients. Neuropsychologia 2015; 75:233-41. [PMID: 26102190 PMCID: PMC4542524 DOI: 10.1016/j.neuropsychologia.2015.06.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 05/01/2015] [Accepted: 06/07/2015] [Indexed: 12/19/2022]
Abstract
Age is known to affect prefrontal brain structure and executive functioning in healthy older adults, patients with neurodegenerative conditions and TBI. Yet, no studies appear to have systematically investigated the effect of age on cognitive performance in patients with focal lesions. We investigated the effect of age on the cognitive performance of a large sample of tumour and stroke patients with focal unilateral, frontal (n=68), or non-frontal lesions (n=45) and healthy controls (n=52). We retrospectively reviewed their cross sectional cognitive and imaging data. In our frontal patients, age significantly predicted the magnitude of their impairment on two executive tests (Raven's Advanced Progressive Matrices, RAPM and the Stroop test) but not on nominal (Graded Naming Test, GNT) or perceptual (Incomplete Letters) task. In our non-frontal patients, age did not predict the magnitude of their impairment on the RAPM and GNT. Furthermore, the exacerbated executive impairment observed in our frontal patients manifested itself from middle age. We found that only age consistently predicted the exacerbated executive impairment. Lesions to specific frontal areas, or an increase in global brain atrophy or white matter abnormalities were not associated with this impairment. Our results are in line with the notion that the frontal cortex plays a critical role in aging to counteract cognitive and neuronal decline. We suggest that the combined effect of aging and frontal lesions impairs the frontal cortical systems by causing its computational power to fall below the threshold needed to complete executive tasks successfully.
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Affiliation(s)
- Lisa Cipolotti
- Department of Neuropsychology, National Hospital for Neurology and Neurosurgery, London, UK; Dipartimento di Psicologia, Università di Palermo, Italy.
| | - Colm Healy
- Department of Neuropsychology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Edgar Chan
- Department of Neuropsychology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Sarah E MacPherson
- Centre for Cognitive Ageing and Cognitive Epidemiology, Human Cognitive Neuroscience, Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Mark White
- Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, UK
| | | | - Martha Turner
- Wolfson Neurorehabilitation Unit, Queen Mary's Hospital, London, UK
| | - Gail Robinson
- School of Psychology, The University of Queensland, Brisbane, Australia
| | - Barbara Spanò
- Neuroimaging Laboratory, Santa Lucia Foundation, Rome, Italy
| | - Marco Bozzali
- Neuroimaging Laboratory, Santa Lucia Foundation, Rome, Italy
| | - Tim Shallice
- Institute of Cognitive Neuroscience, University College London, UK; International School for Advanced Studies (SISSA-ISAS), Trieste, Italy
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Larson EB, Kirschner K, Bode RK, Heinemann AW, Clorfene J, Goodman R. Brief Cognitive Assessment and Prediction of Functional Outcome in Stroke. Top Stroke Rehabil 2015; 9:10-21. [PMID: 14523696 DOI: 10.1310/84yn-y640-8ueq-pdnv] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
To evaluate the ability to predict outcome with a brief measure of cognitive ability, we tested consecutive admissions who received inpatient rehabilitation for stroke with the Repeatable Battery for Assessment of Neuropsychological Symptoms (RBANS). Six months later, 34 discharged patients were contacted by telephone and were interviewed using a battery of functional outcome and quality of life measures. Multiple regression analysis showed that inpatient RBANS indexes predicted cognitive disability 6 months later. The present findings support the use of cognitive evaluations of patients with acute stroke to assist with prediction of outcome to be used in treatment planning.
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Affiliation(s)
- Eric B Larson
- Rehabilitation Institute of Chicago, and Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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Remer-Osborn J. Psychological, Behavioral, and Environmental Influences on Post-Stroke Recovery. Top Stroke Rehabil 2015. [DOI: 10.1310/f07l-lr38-n3ep-59b5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Wojner AW. Optimizing Ischemic Stroke Outcomes: An Interdisciplinary Approach to Poststroke Rehabilitation in Acute Care. Top Stroke Rehabil 2015. [DOI: 10.1310/he13-3r18-ejrm-v1ha] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Schuck SO, Whetstone A, Hill V, Levine P, Page SJ. Game-Based, Portable, Upper Extremity Rehabilitation in Chronic Stroke. Top Stroke Rehabil 2015; 18:720-7. [DOI: 10.1310/tsr1806-720] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Underestimation of cognitive impairments by the Montreal Cognitive Assessment (MoCA) in an acute stroke unit population. J Neurol Sci 2014; 343:176-9. [DOI: 10.1016/j.jns.2014.05.005] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 04/29/2014] [Accepted: 05/08/2014] [Indexed: 11/24/2022]
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Ulanet PG, Carson CM, Mellon NK, Niparko JK, Ouellette M. Correlation of neurocognitive processing subtypes with language performance in young children with cochlear implants. Cochlear Implants Int 2014; 15:230-40. [PMID: 24840711 DOI: 10.1179/1754762814y.0000000077] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVES Test data were used to explore the neurocognitive processing of a group of children with cochlear implants (CIs) whose language development is below expectations. METHODS This cross-sectional study examines the relationship between neurocognitive processing, as assessed by the Kaufman Assessment Battery for Children-Second Edition, and verbal language standard scores, assessed using either the Comprehensive Assessment of Spoken Language or the Clinical Evaluation of Language Fundamentals in 22 school-age children with CIs. Processing scores of CI recipients with language scores below expectations were compared to those of children meeting or exceeding language expectations. Multiple linear regression estimated the associations of simultaneous and sequential processing with language scores. RESULTS Though simultaneous processing scores between the two groups were similar, the mean sequential processing score (91.2) in the below expectations group (n = 13) was significantly lower (P = 0.002) than that of children (n = 9) meeting expectations (110.8). After adjusting for age at implantation, a 10-point higher sequential processing score was associated with a 7.4 higher language score (P = 0.027). DISCUSSION Simultaneous processing capacity was at least within the average range of cognitive performance, and was not associated with language performance in children with CIs. Conversely, reduced sequential processing capacity was significantly associated with lower language scores. CONCLUSION Neurocognitive skills, specifically cognitive sequencing, serial ordering, and auditory-verbal memory may be targets for therapeutic intervention. Intensive cognitive and educational habilitation and in milieu intervention may improve language learning in children with CIs.
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Quantitative electroencephalography and behavioural correlates of daytime sleepiness in chronic stroke. BIOMED RESEARCH INTERNATIONAL 2014; 2014:794086. [PMID: 24883327 PMCID: PMC4032711 DOI: 10.1155/2014/794086] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 03/18/2014] [Accepted: 04/01/2014] [Indexed: 11/17/2022]
Abstract
Sleepiness is common after stroke, but in contrast to its importance for rehabilitation, existing studies focus primarily on the acute state and often use subjective sleepiness measures only. We used quantitative electroencephalography (qEEG) to extract physiological sleepiness, as well as subjective reports, in response to motor-cognitive demand in stroke patients and controls. We hypothesised that (a) slowing of the EEG is chronically sustained after stroke; (b) increased power in lower frequencies and increased sleepiness are associated; and (c) sleepiness is modulated by motor-cognitive demand. QEEGs were recorded in 32 chronic stroke patients and 20 controls using a Karolinska Drowsiness Test protocol administered before and after a motor priming task. Subjective sleepiness was measured using the Karolinska Sleepiness Scale. The findings showed that power density was significantly increased in delta and theta frequency bands over both hemispheres in patients which were not associated with subjective sleepiness ratings. This effect was not observed in controls. The motor priming task induced differential hemispheric effects with greater increase in low-frequency bands and presumably compensatory increases in higher frequency bands. The results indicate sustained slowing in the qEEG in chronic stroke, but in contrast to healthy controls, these changes are not related to perceived sleepiness.
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Lees RA, Broomfield NM, Quinn TJ. Questionnaire assessment of usual practice in mood and cognitive assessment in Scottish stroke units. Disabil Rehabil 2013; 36:339-43. [PMID: 23672210 PMCID: PMC3913011 DOI: 10.3109/09638288.2013.791728] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Purpose National and International guidelines recommend cognition and mood assessment for all stroke survivors. However, there is no consensus on preferred screening tool or method of assessment. We aimed to describe clinical practice in cognitive and mood assessment across Scottish stroke services. Method We used a questionnaire based survey. After local piloting, we distributed the questionnaire using mixed methodologies (online and paper) across all Stroke Managed Clinical Networks in Scotland. We also distributed the questionnaire to specialist societies representing stroke physicians, nurses and allied health professionals and through the UK Stroke Forum delegate pack. Results We received 174 responses from nurses, physiotherapists, psychologists, occupational therapists and medical staff. Medical staff made up the largest group of respondents (61, 35%). Of the respondents 148 (85%) routinely assess cognition and 119 (72%) mood. A variety of tools were used (cognitive n = 45 tools; mood n = 17); Mini Mental State Examination (n = 103, 59% of respondents) and the Hospital Anxiety and Depression Scale (n = 76, 44%) were the most commonly employed tools. Conclusion Response rate was modest but included all mainland Scottish regions with active stroke services. Although the majority of responders are assessing cognition and mood there is substantial heterogeneity in measures used and certain commonly used tools are not validated or appropriate for use in stroke. We suggest development of evidence based, standardised assessment protocols. Implications for Rehabilitation
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Ellis C, Simpson AN, Bonilha H, Mauldin PD, Simpson KN. The one-year attributable cost of poststroke aphasia. Stroke 2012; 43:1429-31. [PMID: 22343643 DOI: 10.1161/strokeaha.111.647339] [Citation(s) in RCA: 101] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Little is known about the contribution of aphasia to the cost of care for patients who experience stroke. METHODS We retrospectively examined a cohort of South Carolina Medicare beneficiaries who experienced ischemic stroke in 2004 to determine the attributable cost of aphasia. Univariate analyses were used to compare demographic, comorbidity, and severity differences between individuals with poststroke aphasia and those without aphasia. Differences in payments by Medicare because of stroke were examined using a gamma-distributed generalized linear multivariate model. RESULTS Three thousand, two hundred Medicare beneficiaries experienced ischemic stroke in South Carolina in 2004, and 398 beneficiaries had poststroke aphasia. Patients with aphasia experienced longer length of stays, greater morbidity, and greater mortality than did those without aphasia. In adjusted models that controlled for relevant covariates, the attributable 1-year cost of aphasia was estimated at $1703. CONCLUSIONS Aphasia adds to the cost of stroke-related care, above the cost of stroke alone.
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Affiliation(s)
- Charles Ellis
- Medical University of South Carolina, Department of Health Sciences & Research, Charleston, SC 29425, USA.
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Abstract
The relationship between assistive technology for cognition (ATC) and cognitive function was examined using a systematic review. A literature search identified 89 publications reporting 91 studies of an ATC intervention in a clinical population. The WHO International Classification of Functioning, Disability and Health (ICF) was used to categorize the cognitive domains being assisted and the tasks being performed. Results show that ATC have been used to effectively support cognitive functions relating to attention, calculation, emotion, experience of self, higher level cognitive functions (planning and time management) and memory. The review makes three contributions: (1) It reviews existing ATC in terms of cognitive function, thus providing a framework for ATC prescription on the basis of a profile of cognitive deficits, (2) it introduces a new classification of ATC based on cognitive function, and (3) it identifies areas for future ATC research and development.
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Seidel GA, Giovannetti T, Libon DJ. Cerebrovascular disease and cognition in older adults. Curr Top Behav Neurosci 2012; 10:213-241. [PMID: 21773915 DOI: 10.1007/7854_2011_140] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The well-established association between advanced age, cerebrovascular pathology, and cognitive decline is receiving greater attention as the population attains new levels of longevity. This chapter will provide an overview of vascular anatomy and age-related cerebrovascular disorders and diseases, including stroke and degenerative dementia. The cognitive and functional sequellae of these cerebrovascular disorders will also be described in detail. Throughout this review, we will emphasize topics that have been relatively underrepresented in the literature, including age-related diseases of the cerebral small vessels, nuanced characterization of cognitive impairment associated with insidious small-vessel vascular dementia, and the real-life functional consequences of cerebrovascular changes in older adults.
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Affiliation(s)
- Gregory A Seidel
- Department of Psychology, Temple University, Philadelphia, PA, USA,
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Cognitive Functioning in the Acute Phase Poststroke: A Predictor of Discharge Destination? J Stroke Cerebrovasc Dis 2011; 20:549-55. [DOI: 10.1016/j.jstrokecerebrovasdis.2010.03.009] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2009] [Revised: 03/08/2010] [Accepted: 03/30/2010] [Indexed: 11/22/2022] Open
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Korner-Bitensky N, Barrett-Bernstein S, Bibas G, Poulin V. National survey of Canadian occupational therapists' assessment and treatment of cognitive impairment post-stroke. Aust Occup Ther J 2011; 58:241-50. [PMID: 21770959 DOI: 10.1111/j.1440-1630.2011.00943.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM This study examined variations in management of cognitive impairment post-stroke among occupational therapists and factors associated with variations in practice. METHODS Canada-wide cross-sectional telephone survey. Clinicians' practices were examined using standard patient cases (vignettes). SETTING Acute care, inpatient rehabilitation and community-based sites providing stroke rehabilitation in all Canadian provinces. PARTICIPANTS Occupational therapists (n=663) working in stroke rehabilitation as identified through provincial licensing bodies. MAIN OUTCOME MEASURES Type and frequency of cognition-related problem identification, assessment and intervention use. RESULTS Respectively, 69%, 83% and 31% of occupational therapists responding to the acute care, inpatient rehabilitation and community-based vignettes recognised cognition as a potential problem. Standardised assessment use was prevalent: 70% working in acute care, 77% in inpatient rehabilitation and 58% in community-based settings indicated using standardised assessments: 81%, 83% and 50%, respectively, indicated using general cognitive interventions. CONCLUSION The Mini-Mental State Examination was often used incorrectly to monitor patient change. Executive function, a critical component of post-stroke assessment, was rarely addressed. Interventions were most often general (e.g. incorporated in activities of daily living) rather than specific (e.g. cueing, memory aids, computer-based retraining).
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Affiliation(s)
- Nicol Korner-Bitensky
- Faculty of Medicine, School of Physical and Occupational Therapy, McGill University, 3630 PromenadesSir-William-Osler, Montreal, Quebec, Canada.
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McClure JA, Salter K, Meyer M, Foley N, Kruger H, Teasell R. Predicting length of stay in patients admitted to stroke rehabilitation with high levels of functional independence. Disabil Rehabil 2011; 33:2356-61. [PMID: 21504345 DOI: 10.3109/09638288.2011.572225] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE In Ontario, stroke patients with relatively mild functional deficits are admitted to inpatient rehabilitation programmes. Despite apparently minor impairments, many of these patients remain in rehabilitation for prolonged periods of time. The objective of the present study is to identify variables that predict length of stay (LOS) within this population of high functioning stroke patients. METHODS Stroke patients with Functional Independence Measure (FIM™) scores ≥100 admitted to a specialised inpatient rehabilitation programme in Ontario, Canada, from April 2005 to March 2008 were included in this study. Data from the National Rehabilitation Reporting System and chart review were used. Associations with LOS were examined among 25 potential predictor variables using bivariate correlations. Significantly correlated (p <0.002) variables were entered into a multiple linear regression. RESULTS Twenty-four percent (n = 134) of patients admitted during the study period were identified as presenting with mild functional deficits. These patients had a mean admission age of 63.5 (SD 14.6) years, a mean admission FIM score of 109.9 (SD 6.6) and a mean LOS of 22.3 (SD 10.5) days. FIM motor and cognitive subscale scores, Mini Mental State Exam scores and five single items assessing orientation, financial independence, and verbal, written and auditory communication ability were significantly correlated with LOS. The regression model, which included all eight variables, explained 60% of the variance associated with LOS (r = 0.80). CONCLUSIONS For patients admitted to stroke rehabilitation programmes with mild functional impairment, 60% of the variance in LOS can be explained by a small number of variables indicative of deficits in the areas of motor function, cognition and communication.
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Affiliation(s)
- J Andrew McClure
- Aging, Rehabilitation & Geriatric Care Program, Lawson Health Research Institute, Parkwood Hospital site, London, Ontario, Canada.
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Prescribing Practices of Anticholinergic Medications and Their Association With Cognition in an Extended Care Setting. J Appl Gerontol 2010. [DOI: 10.1177/0733464810384592] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The current study examined prescribing patterns of anticholinergic (AC) medications and their association with cognitive function in 450 nondemented and nondelirious older adults hospitalized in a postacute extended care center. Participants completed a brief neuropsychological battery that included measures of general mental status, memory, judgment, and executive functioning as part of standard clinical care. An AC burden score was calculated for each participant based on medications taken the day of the testing using the Anticholinergic Drug Scale. Although use of AC medications was common, the majority of participants were taking medications with only minimal AC properties. AC burden and total number of AC medications were negatively correlated with age. AC burden was not associated with lower performance on any of the cognitive measures. In sum, current prescribing practices of AC medications are not associated with negative cognitive effects in a sample of older adults hospitalized in an extended care center.
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Broomfield NM, Laidlaw K, Hickabottom E, Murray MF, Pendrey R, Whittick JE, Gillespie DC. Post-stroke depression: the case for augmented, individually tailored cognitive behavioural therapy. Clin Psychol Psychother 2010; 18:202-17. [DOI: 10.1002/cpp.711] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Gialanella B, Prometti P. Rehabilitation length of stay in patients suffering from aphasia after stroke. Top Stroke Rehabil 2010; 16:437-44. [PMID: 20139046 DOI: 10.1310/tsr1606-437] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND AND PURPOSE Few studies have assessed the relationship between aphasia and rehabilitation length of stay (LOS). The aim of the current prospective study was to evaluate LOS in patients with aphasia and its relation to functional improvement. METHODS The study was performed in 252 patients admitted for rehabilitation follow-up of their first stroke (126 patients with aphasia and hemiparesis [aphasia group] and 126 patients with hemiparesis but without aphasia [control group]). All patients were submitted to clinical, neurological, and neuropsychological examinations. The following tests were performed: Aachen Aphasia Test, Albert's test, anosognosia scale, Cumulative Illness Rating Scale (CIRS), Fugl-Meyer Scale, and FIM. RESULTS LOS was 50.7 and 46.7 days in the aphasia and control groups, respectively. There was no statistically significant difference in the LOS between aphasia and control groups (p = .056). A longer LOS was correlated with low admission aphasia score (r = -0.19). The increase in motor FIM per day obtained by therapy (LOS-Eff) was 0.54 +/- 0.3 in the aphasia group and 0.75 +/- 0.5 in the control group. The LOS-Eff was significantly poorer in the aphasia group (p = .000). A high LOS-Eff was correlated with high aphasia score (r = 0.31). In multivariate regression analyses, aphasia was an important predictor of LOS-Eff (beta = 0.18). CONCLUSIONS In patients with aphasia, LOS is few days longer and LOS-Eff is significantly poorer compared to patients without aphasia. Aphasia is a significant independent predictor of LOS-Eff at discharge.
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Affiliation(s)
- Bernardo Gialanella
- Unità Operativa di Recupero e Rieducazione Funzionale Fondazione Salvatore Maugeri Clinica del Lavoro e della Riabilitazione, IRCCS, Istituto Scientifico di Lumezzane, Brescia, Italy
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Higginson CI, Johnson-Greene D, Langrall S. Neurocognitive predictors of performance on a telephone task following stroke. J Clin Exp Neuropsychol 2009; 32:528-35. [DOI: 10.1080/13803390903310982] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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