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Tsiakiri A, Plakias S, Vlotinou P, Terzoudi A, Serdari A, Tsiptsios D, Karakitsiou G, Psatha E, Kitmeridou S, Karavasilis E, Aggelousis N, Vadikolias K, Christidi F. Predictive Markers of Post-Stroke Cognitive Recovery and Depression in Ischemic Stroke Patients: A 6-Month Longitudinal Study. Eur J Investig Health Psychol Educ 2024; 14:3056-3072. [PMID: 39727508 DOI: 10.3390/ejihpe14120200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2024] [Revised: 11/12/2024] [Accepted: 12/10/2024] [Indexed: 12/28/2024] Open
Abstract
The growing number of stroke survivors face physical, cognitive, and psychosocial impairments, making stroke a significant contributor to global disability. Various factors have been identified as key predictors of post-stroke outcomes. The aim of this study was to develop a standardized predictive model that integrates various demographic and clinical factors to better predict post-stroke cognitive recovery and depression in patients with ischemic stroke (IS). We included IS patients during both the acute phase and six months post-stroke and considered neuropsychological measures (screening scales, individual tests, functional cognitive scales), stroke severity and laterality, as well as functional disability measures. The study identified several key predictors of post-stroke cognitive recovery and depression in IS patients. Higher education and younger age were associated with better cognitive recovery. Lower stroke severity, indicated by lower National Institutes of Health Stroke Scale (NIHSS) scores, also contributed to better cognitive outcomes. Patients with lower modified Rankin Scale (mRS) scores showed improved performance on cognitive tests and lower post-stroke depression scores. The study concluded that age, education, stroke severity and functional status are the most critical predictors of cognitive recovery and post-stroke emotional status in IS patients. Tailoring rehabilitation strategies based on these predictive markers can significantly improve patient outcomes.
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Affiliation(s)
- Anna Tsiakiri
- Department of Neurology, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Spyridon Plakias
- Department of Physical Education and Sport Science, University of Thessaly, 42100 Trikala, Greece
| | - Pinelopi Vlotinou
- Department of Occupational Therapy, University of West Attica, 12243 Athens, Greece
| | - Aikaterini Terzoudi
- Department of Neurology, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Aspasia Serdari
- Department of Child and Adolescent, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Dimitrios Tsiptsios
- Department of Neurology, Democritus University of Thrace, 68100 Alexandroupolis, Greece
- 3rd Department of Neurology, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Georgia Karakitsiou
- Department of Psychiatry, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Evlampia Psatha
- Department of Radiology, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Sofia Kitmeridou
- Department of Neurology, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Efstratios Karavasilis
- Medical Physics Laboratory, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Nikolaos Aggelousis
- Department of Physical Education and Sport Science, Democritus University of Thrace, 69100 Komotini, Greece
| | | | - Foteini Christidi
- Department of Neurology, Democritus University of Thrace, 68100 Alexandroupolis, Greece
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Camenzind M, Göbel N, Eberhard-Moscicka A, Knobel S, Hegi H, Single M, Kaufmann B, Schumacher R, Nyffeler T, Nef T, Müri R. The phenomenology of pareidolia in healthy subjects and patients with left- or right-hemispheric stroke. Heliyon 2024; 10:e27414. [PMID: 38468958 PMCID: PMC10926141 DOI: 10.1016/j.heliyon.2024.e27414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 02/21/2024] [Accepted: 02/28/2024] [Indexed: 03/13/2024] Open
Abstract
Pareidolia are perceptions of recognizable images or meaningful patterns where none exist. In recent years, this phenomenon has been increasingly studied in healthy subjects and patients with neurological or psychiatric diseases. The current study examined pareidolia production in a group of 53 stroke patients and 82 neurologically healthy controls who performed a natural images task. We found a significant reduction of absolute pareidolia production in left- and right-hemispheric stroke patients, with right-hemispheric patients producing overall fewest pareidolic output. Responses were categorized into 28 distinct categories, with 'Animal', 'Human', 'Face', and 'Body parts' being the most common, accounting for 72% of all pareidolia. Regarding the percentages of the different categories of pareidolia, we found a significant reduction for the percentage of "Body parts" pareidolia in the left-hemispheric patient group as compared to the control group, while the percentage of this pareidolia type was not significantly reduced in right-hemispheric patients compared to healthy controls. These results support the hypothesis that pareidolia production may be influenced by local-global visual processing with the left hemisphere being involved in local and detailed analytical visual processing to a greater extent. As such, a lesion to the right hemisphere, that is believed to be critical for global visual processing, might explain the overall fewest pareidolic output produced by the right-hemispheric patients.
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Affiliation(s)
- M. Camenzind
- Perception and Eye Movement Laboratory, Departments of Neurology and BioMedical Research, Inselspital, Bern University Hospital and University of Bern, Switzerland
| | - N. Göbel
- Perception and Eye Movement Laboratory, Departments of Neurology and BioMedical Research, Inselspital, Bern University Hospital and University of Bern, Switzerland
- Research and Analysis Services, University Hospital Basel and University of Basel, Basel, Switzerland
| | - A.K. Eberhard-Moscicka
- Perception and Eye Movement Laboratory, Departments of Neurology and BioMedical Research, Inselspital, Bern University Hospital and University of Bern, Switzerland
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Switzerland
- Department of Psychology, University of Bern, Bern, Switzerland
| | - S.E.J. Knobel
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - H. Hegi
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - M. Single
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - B.C. Kaufmann
- Neurocenter, Luzerner Kantonsspital, Lucerne, Switzerland
| | - R. Schumacher
- Perception and Eye Movement Laboratory, Departments of Neurology and BioMedical Research, Inselspital, Bern University Hospital and University of Bern, Switzerland
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - T. Nyffeler
- Neurocenter, Luzerner Kantonsspital, Lucerne, Switzerland
| | - T. Nef
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Switzerland
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - R.M. Müri
- Perception and Eye Movement Laboratory, Departments of Neurology and BioMedical Research, Inselspital, Bern University Hospital and University of Bern, Switzerland
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Switzerland
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
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Kusec A, Milosevich E, Williams OA, Chiu EG, Watson P, Carrick C, Drozdowska BA, Dillon A, Jennings T, Anderson B, Dawes H, Thomas S, Kuppuswamy A, Pendlebury ST, Quinn TJ, Demeyere N. Long-term psychological outcomes following stroke: the OX-CHRONIC study. BMC Neurol 2023; 23:426. [PMID: 38036966 PMCID: PMC10688008 DOI: 10.1186/s12883-023-03463-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 11/10/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Stroke survivors rate longer-term (> 2 years) psychological recovery as their top priority, but data on how frequently psychological consequences occur is lacking. Prevalence of cognitive impairment, depression/anxiety, fatigue, apathy and related psychological outcomes, and whether rates are stable in long-term stroke, is unknown. METHODS N = 105 long-term stroke survivors (M [SD] age = 72.92 [13.01]; M [SD] acute NIH Stroke Severity Score = 7.39 [6.25]; 59.0% Male; M [SD] years post-stroke = 4.57 [2.12]) were recruited (potential N = 208). Participants completed 3 remote assessments, including a comprehensive set of standardized cognitive neuropsychological tests comprising domains of memory, attention, language, and executive function, and questionnaires on emotional distress, fatigue, apathy and other psychological outcomes. Ninety participants were re-assessed one year later. Stability of outcomes was assessed by Cohen's d effect size estimates and percent Minimal Clinically Important Difference changes between time points. RESULTS On the Montreal Cognitive Assessment 65.3% scored < 26. On the Oxford Cognitive Screen 45.9% had at least one cognitive impairment. Attention (27.1%) and executive function (40%) were most frequently impaired. 23.5% and 22.5% had elevated depression/anxiety respectively. Fatigue (51.4%) and apathy (40.5%) rates remained high, comparable to estimates in the first-year post-stroke. Attention (d = -0.12; 85.8% stable) and depression (d = 0.09, 77.1% stable) were the most stable outcomes. Following alpha-adjustments, only perceptuomotor abilities (d = 0.69; 40.4% decline) and fatigue (d = -0.33; 45.3% decline) worsened over one year. Cognitive impairment, depression/anxiety, fatigue and apathy all correlated with worse quality of life. CONCLUSION Nearly half of participants > 2 years post-event exhibited psychological difficulties including domains of cognition, mood, and fatigue, which impact long-term quality of life. Stroke is a chronic condition with highly prevalent psychological needs, which require monitoring and intervention development.
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Affiliation(s)
- Andrea Kusec
- Department of Experimental Psychology, University of Oxford, Anna Watts Building, Radcliffe Observatory Quarter, Oxford, UK
| | - Elise Milosevich
- Department of Experimental Psychology, University of Oxford, Anna Watts Building, Radcliffe Observatory Quarter, Oxford, UK
| | - Owen A Williams
- Department of Experimental Psychology, University of Oxford, Anna Watts Building, Radcliffe Observatory Quarter, Oxford, UK
| | - Evangeline G Chiu
- Department of Experimental Psychology, University of Oxford, Anna Watts Building, Radcliffe Observatory Quarter, Oxford, UK
| | - Pippa Watson
- Department of Experimental Psychology, University of Oxford, Anna Watts Building, Radcliffe Observatory Quarter, Oxford, UK
| | - Chloe Carrick
- Department of Experimental Psychology, University of Oxford, Anna Watts Building, Radcliffe Observatory Quarter, Oxford, UK
| | - Bogna A Drozdowska
- School of Cardiovascular & Metabolic Health, University of Glasgow, Glasgow, UK
| | - Avril Dillon
- Department of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | | | - Bloo Anderson
- Patient and Public Involvement Representative, Oxford, UK
| | - Helen Dawes
- NIHR Exeter Biomedical Research Centre, University of Exeter, Medical School Building, St Luke's Campus, Magdalen Road, Exeter, UK
| | - Shirley Thomas
- School of Medicine, Queen's Medical Centre, University of Nottingham, Nottingham, UK
| | - Annapoorna Kuppuswamy
- Institute of Neurology Department of Clinical and Movement Neurosciences, University College London, 33 Queen Square, London, UK
- Department of Biomedical Sciences, University of Leeds, Leeds, UK
| | - Sarah T Pendlebury
- Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Terence J Quinn
- School of Cardiovascular & Metabolic Health, University of Glasgow, Glasgow, UK
| | - Nele Demeyere
- Department of Experimental Psychology, University of Oxford, Anna Watts Building, Radcliffe Observatory Quarter, Oxford, UK.
- Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK.
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Sánchez-Herrera-Baeza P, Cano-de-la-Cuerda R, Serrada-Tejeda S, Fernández-Vázquez D, Navarro-López V, González-Alted C, Miangolarra-Page JC. Influence of Age, Gender and Education Level on Executive Functions and Functioning in People with Stroke. Biomedicines 2023; 11:1603. [PMID: 37371698 DOI: 10.3390/biomedicines11061603] [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: 05/06/2023] [Revised: 05/24/2023] [Accepted: 05/30/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Alterations in mental functions are among the most frequent manifestations of stroke that have a direct impact on the patient's functionality. The objective of this study was to analyze the relationship of sociodemographic variables with the executive functions (EFs) of participants with right middle cerebral artery (MCA) stroke. METHODS A cross-sectional observational case-control study was conducted at the State Center for Brain Damage in Madrid, Spain. Fifty-eight subjects were recruited and divided into two groups. Each participant was administered the following: the FIM+FAM Functional Assessment Measure, the Lawton and Brody scale, The Trail-Making Test, the Zoo Map Test and the Hanoi Tower. RESULTS Statistically significant differences (p < 0.05) were identified between participants with ischemic stroke and control in functional and EF functions, as well as between participants with hemorrhagic stroke and control. No statistically significant differences were found in the experimental group between subjects who had sustained ischemic and hemorrhagic stroke. No significant associations were identified between the variables age, gender and education level in relation to functionality and executive functions (p > 0.05) in people with stroke. CONCLUSION People who have suffered a right cerebral artery stroke have deficiencies in the EFS, resulting in poorer performance of the activity of daily living, compared to healthy subjects of the same age, gender and education level. In the correlational analysis of the stroke participants, no significant associations were identified between the variables gender, age and education level in relation to functionality and EF.
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Affiliation(s)
- Patricia Sánchez-Herrera-Baeza
- Department of Physical Therapy, Occupational Therapy, Rehabilitation, and Physical Medicine, Faculty of Health Sciences, Rey Juan Carlos University, 28922 Madrid, Spain
| | - Roberto Cano-de-la-Cuerda
- Department of Physical Therapy, Occupational Therapy, Rehabilitation, and Physical Medicine, Faculty of Health Sciences, Rey Juan Carlos University, 28922 Madrid, Spain
| | - Sergio Serrada-Tejeda
- Department of Physical Therapy, Occupational Therapy, Rehabilitation, and Physical Medicine, Faculty of Health Sciences, Rey Juan Carlos University, 28922 Madrid, Spain
| | - Diego Fernández-Vázquez
- Department of Physical Therapy, Occupational Therapy, Rehabilitation, and Physical Medicine, Faculty of Health Sciences, Rey Juan Carlos University, 28922 Madrid, Spain
| | - Víctor Navarro-López
- Department of Physical Therapy, Occupational Therapy, Rehabilitation, and Physical Medicine, Faculty of Health Sciences, Rey Juan Carlos University, 28922 Madrid, Spain
| | - Carlos González-Alted
- Centro de Referencia Estatal a la Atención del Daño Cerebral (CEADAC), C/del Río Bullaque, 1, 28034 Madrid, Spain
| | - Juan Carlos Miangolarra-Page
- Department of Physical Therapy, Occupational Therapy, Rehabilitation, and Physical Medicine, Faculty of Health Sciences, Rey Juan Carlos University, 28922 Madrid, Spain
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Deijle IA, Van Wegen EEH, Van den Berg-Vos RM, Kwakkel G. Is Cardiorespiratory Fitness Independently Associated with Fatigue in Patients with Transient Ischemic Attack or Minor Stroke? Brain Sci 2023; 13:brainsci13040561. [PMID: 37190526 DOI: 10.3390/brainsci13040561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/20/2023] [Accepted: 03/25/2023] [Indexed: 03/29/2023] Open
Abstract
Fatigue is a common complaint and a disabling symptom among patients following transient ischemic attack (TIA) or minor stroke. In patients with stroke, decreased cardiorespiratory fitness (CRF) is believed to be related to increased severity of post-stroke fatigue (PSF). However, this association between PSF and CRF in patients with TIA or minor stroke has been less investigated, and currently there is no proven treatment for PSF. We aimed to determine the association between PSF and CRF in patients with TIA or minor stroke and to find out whether this association was distorted by confounders. A cross-sectional association study was conducted among a total of 119 patients with TIA or minor stroke. PSF was measured by the Fatigue Severity Scale (FSS) and CRF was quantified by maximal exercise capacity (V̇O2max). The FSS showed a significant association with V̇O2max (ß = −0.061, SE: 0.022; p = 0.007). This association was confounded by anxiety (ß = −0.044, SE: 0.020; p = 0.028) and depression (ß = −0.030, SE: 0.022; p = 0.177) as measured by the subscales of the Hospital Anxiety and Depression Scale (HADS). After controlling for HADS scores on depression and anxiety, the univariate relationship between V̇O2max and FSS was no longer significant. These results suggest that the association between PSF and CRF in patients with TIA or minor stroke is weak and significantly confounded by the factors of depression and anxiety.
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Yang X, Yun Y, Wang P, Zhao J, Sun X. Upregulation of RCAN1.4 by HIF1α alleviates OGD-induced inflammatory response in astrocytes. Ann Clin Transl Neurol 2022; 9:1224-1240. [PMID: 35836352 PMCID: PMC9380140 DOI: 10.1002/acn3.51624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 06/03/2022] [Accepted: 06/28/2022] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE Ischemic stroke is a leading cause of human mortality and long-term disability worldwide. As one of the main forms of regulator of calcineurin 1 (RCAN1), the contribution of RCAN1.4 in diverse biological and pathological conditions has been implicated. But the role of RCAN1.4 in ischemic stroke progression remains elusive. This study is to explore the expression changes and roles of RCAN1.4 in ischemic stroke as well as the underlying mechanisms for these changes and effects of RCAN1.4 in ischemic stroke. METHODS Middle cerebral artery occlusion model in C57BL/6J mice and oxygen-glucose deprivation (OGD) model in primary astrocytes were performed to induce the cerebral ischemic stroke. The expression pattern of RCAN1.4 was assessed using real-time quantitative PCR and western blotting in vivo and in vitro. Mechanistically, the underlying mechanism for the elevation of RCAN1.4 in the upstream was investigated. Lentiviruses were administrated, and the effect of RCAN1.4 in postischemic inflammation was clearly clarified. RESULTS Here we uncovered that RCAN1.4 was dramatically increased in mouse ischemic brains and OGD-induced primary astrocytes. HIF1α, activated upon OGD, significantly upregulated RCAN1.4 gene expression through specifically binding to the RCAN1.4 promoter region and activating its promoter activity. The functional hypoxia-responsive element (HRE) was located between -254 and -245 bp in the RCAN1.4 promoter region. Moreover, elevated RCAN1.4 alleviated the release of pro-inflammatory cytokines TNFα, IL1β, IL6 and reduced expression of iNOS, COX2 in primary astrocytes upon OGD, whereas RCAN1.4 silencing has the opposite effect. Of note, RCAN1.4 overexpression inhibited OGD-induced NF-κB activation in primary astrocytes, leading to decreased degradation of IκBα and reduced nuclear translocation of NF-κB/p65. INTERPRETATION Our results reveal a novel mechanism underscoring the upregulation of RCAN1.4 by HIF1α and the protective effect of RCAN1.4 against postischemic inflammation, suggesting its significance as a promising therapeutic target for ischemic stroke treatment.
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Affiliation(s)
- Xiaxin Yang
- Department of NeurologyQilu Hospital of Shandong UniversityJinanShandong ProvinceChina
| | - Yan Yun
- Department of RadiologyQilu Hospital of Shandong UniversityJinanShandong ProvinceChina
| | - Pin Wang
- NHC Key Laboratory of OtorhinolaryngologyQilu Hospital of Shandong UniversityJinanShandong ProvinceChina
- Department of OtorhinolaryngologyQilu Hospital of Shandong UniversityJinanShandong ProvinceChina
| | - Juan Zhao
- NHC Key Laboratory of OtorhinolaryngologyQilu Hospital of Shandong UniversityJinanShandong ProvinceChina
- Department of OtorhinolaryngologyQilu Hospital of Shandong UniversityJinanShandong ProvinceChina
| | - Xiulian Sun
- NHC Key Laboratory of OtorhinolaryngologyQilu Hospital of Shandong UniversityJinanShandong ProvinceChina
- Brain Research InstituteQilu Hospital of Shandong UniversityJinanShandong ProvinceChina
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health CommissionQilu Hospital of Shandong UniversityJinanShandong ProvinceChina
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Quinn CM, Kasibante J, Namudde A, Bangdiwala AS, Kabahubya M, Nakasujja N, Lofgren S, Elliott A, Boulware DR, Meya DB, Cresswell FV. Neurocognitive outcomes of tuberculous meningitis in a primarily HIV-positive Ugandan cohort. Wellcome Open Res 2022; 6:208. [PMID: 35949653 PMCID: PMC9334841 DOI: 10.12688/wellcomeopenres.16967.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2022] [Indexed: 11/20/2022] Open
Abstract
Background: The toll of tuberculous meningitis (TBM) in both mortality and disability is considerable, but advancements in rehabilitation have the potential to improve the functional abilities and the quality of survivors' lives. However, the typical phenotype of neurocognitive impairment in TBM survivors remains unstudied in HIV-predominant populations in sub-Saharan Africa. Methods: We tested 36 survivors of TBM in Uganda with a comprehensive battery of neurocognitive assessments at 8 and 24 weeks after diagnosis, and compared results to a representative cohort of HIV-uninfected Ugandans. Results: While participants had a broad range of impairments at eight weeks, there was marked improvement by 24 weeks, when a phenotype of impairment including deficits in motor functioning, verbal learning and memory, processing speed, and executive function emerged. These deficits were present despite good clinician-rated functional status. The majority (23/27, 85%) had evidence of moderate to severe depression at week 8, and at week 24 (18/24, 75%). Conclusion: These findings highlight the need for more comprehensive neurocognitive assessment in the survivors of TBM, and further investment in and study of rehabilitation, including management of depression, to improve long-term outcomes in this population.
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Affiliation(s)
- Carson M Quinn
- School of Medicine, University of California San Francisco Medical Center, San Francisco, CA, USA
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - John Kasibante
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Alice Namudde
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Mable Kabahubya
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Noeline Nakasujja
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Psychiatry, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Sarah Lofgren
- Division of Infectious Diseases and International Medicine, University of Minnesota, Minneapolis, Minnesota, 55455, USA
| | - Alison Elliott
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
- Medical Research Council/Uganda Virus Research-Institute Uganda Research Unit on AIDS, Entebbe, Uganda
| | - David R Boulware
- Division of Infectious Diseases and International Medicine, University of Minnesota, Minneapolis, Minnesota, 55455, USA
| | - David B Meya
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Fiona V Cresswell
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
- Division of Global Health and Infection, Brighton and Sussex Medical School, University of Sussex, UK
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Upper extremity motor abilities and cognitive capability mediate the causal dependency between somatosensory capability and daily function in stroke individuals. Sci Rep 2022; 12:690. [PMID: 35027612 PMCID: PMC8758771 DOI: 10.1038/s41598-021-04491-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 12/17/2021] [Indexed: 11/24/2022] Open
Abstract
Stroke individuals’ daily function has been demonstrated to be influenced by their somatosensory capability, cognitive capability, and upper extremity (UE) motor abilities. However, the structural relationships among these abilities on stroke individuals’ independence in daily function remain unclear. We analyzed the pretest measures of 153 stroke individuals in outpatient rehabilitation settings by structural equation modeling to determine the structural relationship among somatosensory capability, UE muscle strength, UE motor function, and cognitive capability that influences independence in daily function. The standardized results indicated somatosensory capability negatively influenced UE muscle strength, but positively influenced UE muscle strength mediated by UE motor function. UE muscle strength, then, positively influenced individuals’ independence in daily function. On the other hand, somatosensory capability positively influenced cognitive capability, which marginally and positively affected the performance of independence in daily function. To the best of our knowledge, this is the first study to demonstrate the influence of somatosensory capability on the daily function is mediated mainly by motor functions and marginally by cognitive capability. This structural model may allow future clinical therapists to design more effective task-related training protocols to promote the independence in daily function for stroke individuals.
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Kotlęga D, Peda B, Drozd A, Zembroń-Łacny A, Stachowska E, Gramacki J, Szczuko M. Prostaglandin E2, 9S-, 13S-HODE and resolvin D1 are strongly associated with the post-stroke cognitive impairment. Prostaglandins Other Lipid Mediat 2021; 156:106576. [PMID: 34119645 DOI: 10.1016/j.prostaglandins.2021.106576] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 05/18/2021] [Accepted: 06/07/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND Inflammatory derivatives of free fatty acids are involved in the development of neuroinflammation and cognitive dysfunctions. The study aim was to establish the influence of eicosanoids on the cognitive status of stroke patients. METHODS 73 stroke patients were prospectively evaluated towards the neuropsychological cognitive functions on the 7th day after stroke and after follow-up of 6 months. Eicosanoids levels were measured in all patients and compared to stroke-free controls (n = 30). RESULTS Prostaglandin E2 was negatively correlated with Montreal Cognitive Assessment (MOCA) test on the 7th day after stroke. The level of 9-hydroxyoctadecadienoic acid (9S-HODE) was significantly higher in patients with cognitive dysfunctions in MOCA test compared to the others (group I mean ± SD: 0.040 ± 0.035 vs. group II: 0.0271 ± 0.016). In the initial neuropsychological assessment maresin 1-, 5-hydroxyeicosatetraenoic acid (HETE), 12S-HETE and 15S-HETE were negatively correlated with California Verbal Learning Test (CVLT) and thus with cognitive functions, while in the follow-up examination negative correlations were identified for prostaglandin E2, meresin 1, leukotriene B4, 13S HODE, 9S-HODE; the only positive correlation was observed in 15S-HETE. Other neuropsychological tests showed a beneficial impact of resolvin D1 and a negative role of prostaglandin E2 was observed in the first examination and in the follow-up. Resolvin D1 and the group of all analyzed eicosanoids predict changes in cognitive functions. CONCLUSIONS Eicosanoids can play a role in the neuroinflammation. They can affect the cognitive status at the stroke onset and have a predictive value for post-stroke cognitive decline. Prostaglandin E2, 9S-, 13S-HODE and resolvin D1 are the most important inflammatory free fatty acid derivatives in the cognitive functions in stroke. Eicosanoids predict post-stroke cognitive functions.
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Affiliation(s)
| | - Barbara Peda
- Department of Neurology, District Hospital, Glogow, Poland.
| | - Arleta Drozd
- Department of Human Nutrition and Metabolomics, Pomeranian Medical University in Szczecin, Poland.
| | - Agnieszka Zembroń-Łacny
- Department of Applied and Clinical Physiology, Collegium Medicum, University of Zielona Gora, Poland.
| | - Ewa Stachowska
- Department of Human Nutrition and Metabolomics, Pomeranian Medical University in Szczecin, Poland.
| | - Jarosław Gramacki
- Centre of Information Technologies, University of Zielona Gora, 65-417 Zielona Gora, Poland.
| | - Małgorzata Szczuko
- Department of Human Nutrition and Metabolomics, Pomeranian Medical University in Szczecin, Poland.
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Buvarp D, Rafsten L, Abzhandadze T, Sunnerhagen KS. A prospective cohort study on longitudinal trajectories of cognitive function after stroke. Sci Rep 2021; 11:17271. [PMID: 34446763 PMCID: PMC8390476 DOI: 10.1038/s41598-021-96347-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 08/04/2021] [Indexed: 11/09/2022] Open
Abstract
The study aimed to determine longitudinal trajectories of cognitive function during the first year after stroke. The Montreal Cognitive Assessment (MoCA) was used to screen cognitive function at 36-48 h, 3-months, and 12-months post-stroke. Individuals who shared similar trajectories were classified by applying the group-based trajectory models. Data from 94 patients were included in the analysis. Three cognitive functioning groups were identified by the trajectory models: high [14 patients (15%)], medium [58 (62%)] and low [22 (23%)]. For the high and medium groups, cognitive function improved at 12 months, but this did not occur in the low group. After age, sex and education matching to the normative MoCA from the Swedish population, 52 patients (55%) were found to be cognitively impaired at baseline, and few patients had recovered at 12 months. The impact on memory differs between cognitive functioning groups, whereas the impact on activities of daily living was not different. Patients with the poorest cognitive function did not improve at one-year poststroke and were prone to severe memory problems. These findings may help to increase focus on long-term rehabilitation plans for those patients, and more accurately assess their needs and difficulties experienced in daily living.
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Affiliation(s)
- Dongni Buvarp
- Rehabilitation Medicine Research Group, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.
| | - Lena Rafsten
- Rehabilitation Medicine Research Group, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
- Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Tamar Abzhandadze
- Rehabilitation Medicine Research Group, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
- Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Katharina S Sunnerhagen
- Rehabilitation Medicine Research Group, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
- Sahlgrenska University Hospital, Gothenburg, Sweden
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11
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Quinn CM, Kasibante J, Namudde A, Bangdiwala AS, Kabahubya M, Nakasujja N, Lofgren S, Elliott A, Boulware DR, Meya DB, Cresswell FV. Neurocognitive outcomes of HIV-associated tuberculous meningitis. Wellcome Open Res 2021; 6:208. [PMID: 35949653 PMCID: PMC9334841 DOI: 10.12688/wellcomeopenres.16967.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2021] [Indexed: 12/15/2022] Open
Abstract
Background: The toll of tuberculous meningitis (TBM) in both mortality and disability is considerable, but advancements in rehabilitation have the potential to improve the functional abilities and the quality of survivors' lives. However, the typical phenotype of neurocognitive impairment in TBM survivors remains unstudied in HIV-predominant populations in sub-Saharan Africa. Methods: We tested 36 survivors of TBM in Uganda with a comprehensive battery of neurocognitive assessments at 8 and 24 weeks after diagnosis, and compared results to a representative cohort of HIV-uninfected Ugandans. Results: While participants had a broad range of impairments at eight weeks, there was marked improvement by 24 weeks, when a phenotype of impairment including deficits in motor functioning, verbal learning and memory, processing speed, and executive function emerged. These deficits were present despite good clinician-rated functional status. The majority (23/27, 85%) had evidence of moderate to severe depression at week 8, and at week 24 (18/24, 75%). Conclusion: These findings highlight the need for more comprehensive neurocognitive assessment in the survivors of TBM, and further investment in and study of rehabilitation, including management of depression, to improve long-term outcomes in this population.
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Affiliation(s)
- Carson M Quinn
- School of Medicine, University of California San Francisco Medical Center, San Francisco, CA, USA
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - John Kasibante
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Alice Namudde
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Mable Kabahubya
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Noeline Nakasujja
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Psychiatry, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Sarah Lofgren
- Division of Infectious Diseases and International Medicine, University of Minnesota, Minneapolis, Minnesota, 55455, USA
| | - Alison Elliott
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
- Medical Research Council/Uganda Virus Research-Institute Uganda Research Unit on AIDS, Entebbe, Uganda
| | - David R Boulware
- Division of Infectious Diseases and International Medicine, University of Minnesota, Minneapolis, Minnesota, 55455, USA
| | - David B Meya
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Fiona V Cresswell
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
- Division of Global Health and Infection, Brighton and Sussex Medical School, University of Sussex, UK
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12
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Kotlęga D, Peda B, Palma J, Zembroń-Łacny A, Gołąb-Janowska M, Masztalewicz M, Nowacki P, Szczuko M. Free Fatty Acids Are Associated with the Cognitive Functions in Stroke Survivors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126500. [PMID: 34208689 PMCID: PMC8296333 DOI: 10.3390/ijerph18126500] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/06/2021] [Accepted: 06/13/2021] [Indexed: 11/16/2022]
Abstract
Ischemic stroke is a leading cause of motor impairment and psychosocial disability. Although free fatty acids (FFA) have been proven to affect the risk of stroke and potentially dementia, the evidence of their impact on cognitive functions in stroke patients is lacking. We aimed to establish such potential relationships. Seventy-two ischemic stroke patients were prospectively analysed. Their cognitive functions were assessed seven days post-stroke and six months later as follow-up (n = 41). Seven days post-stroke analysis of serum FFAs levels showed direct correlations between Cognitive Verbal Learning Test (CVLT) and the following FFAs: C20:4n6 arachidonic acid and C20:5n3 eicosapentaenoic acid, while negative correlations were observed for C18:3n3 linolenic acid (ALA), C18:4 n3 stearidonic acid and C23:0 tricosanoic acid. Follow-up examination with CVLT revealed positive correlations with C15:0 pentadecanoid acid, C18:3n6 gamma linoleic acid, SDA, C23:0 tricosanoic acid and negative correlations with C14:0 myristic acid and C14:1 myristolenic acids. Several tests (Trail Making Test, Stroop Dots Trail, Digit Span Test and Verbal Fluency Test) were directly correlated mainly with C14:0 myristic acid and C14:1 myristolenic acid, while corresponding negatively with C18:1 vaccinic acid, C20:3n3 cis-11-eicosatrienoic acid, C22:1/C20:1 cis11- eicosanic acid and C20:2 cis-11-eicodienoic acid. No correlations between Montreal Cognitive Assessment (MOCA) test performed on seventh day, and FFAs levels were found. Saturated fatty acids play a negative role in long-term cognitive outcomes in stroke patients. The metabolic cascade of polyunsaturated fatty acids (n3 PUFA) and the synthesis of (AA) can be involved in pathogenesis of stroke-related cognitive impairment.
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Affiliation(s)
- Dariusz Kotlęga
- Department of Neurology, District Hospital, 67-200 Glogow, Poland;
- Correspondence:
| | - Barbara Peda
- Department of Neurology, District Hospital, 67-200 Glogow, Poland;
| | - Joanna Palma
- Department of Human Nutrition and Metabolomics, Pomeranian Medical University, 71-460 Szczecin, Poland; (J.P.); (M.S.)
| | - Agnieszka Zembroń-Łacny
- Department of Applied and Clinical Physiology, Collegium Medicum, University of Zielona Gora, 65-001 Zielona Góra, Poland;
| | - Monika Gołąb-Janowska
- Department of Neurology, Pomeranian Medical University, 71-252 Szczecin, Poland; (M.G.-J.); (M.M.); (P.N.)
| | - Marta Masztalewicz
- Department of Neurology, Pomeranian Medical University, 71-252 Szczecin, Poland; (M.G.-J.); (M.M.); (P.N.)
| | - Przemysław Nowacki
- Department of Neurology, Pomeranian Medical University, 71-252 Szczecin, Poland; (M.G.-J.); (M.M.); (P.N.)
| | - Małgorzata Szczuko
- Department of Human Nutrition and Metabolomics, Pomeranian Medical University, 71-460 Szczecin, Poland; (J.P.); (M.S.)
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13
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Merriman NA, Gillan D, Pender N, Williams DJ, Horgan F, Sexton E, Johnston M, Bennett KE, Donnelly NA, Wren MA, Hickey A. The StrokeCog study: development and description of a cognition-focused psychological intervention to address cognitive impairment following stroke. Psychol Health 2020; 36:792-809. [PMID: 32924891 DOI: 10.1080/08870446.2020.1820009] [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
OBJECTIVE To describe the process of developing a cognitive rehabilitation intervention for patients with post-stroke cognitive impairment (PSCI) and to describe the intervention prior to evaluation in a pilot randomised controlled trial (RCT). Method: The Medical Research Council framework, 'Developing and evaluating complex interventions', was used to develop the cognitive rehabilitation intervention. We conducted a combined analysis of the existing evidence base for PSCI rehabilitation alongside qualitative exploration of the perspectives of stroke survivors, their families, and healthcare professionals providing stroke care, on the necessary components for a cognitive rehabilitation intervention for PSCI. The Template for Intervention Description and Replication checklist was used as a structural framework for the description of the intervention. Results: The intervention comprises a five-week intervention integrating group-based activities, supported by a clinical neuropsychologist, with home-based activities to encourage self-efficacy through the practice of adjustment and compensatory strategies learned in the group format to achieve the patients' identified goals in managing their PSCI. Conclusion: A cognitive rehabilitation intervention for patients with PSCI has been developed and described. We are in the process of developing a structured intervention manual to standardise the content and delivery of the intervention for further testing in a pilot RCT.
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Affiliation(s)
- Niamh A Merriman
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Diane Gillan
- Department of Psychology, Beaumont Hospital, Dublin, Ireland
| | - Niall Pender
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland.,Department of Psychology, Beaumont Hospital, Dublin, Ireland
| | - David J Williams
- Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland.,Department of Geriatric and Stroke Medicine, Beaumont Hospital, Dublin, Ireland
| | - Frances Horgan
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Eithne Sexton
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Marie Johnston
- Aberdeen Health Psychology Group, University of Aberdeen, Aberdeen, UK
| | - Kathleen E Bennett
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Nora-Ann Donnelly
- Social Research Division, Economic and Social Research Institute, Dublin, Ireland
| | - Maev-Ann Wren
- Social Research Division, Economic and Social Research Institute, Dublin, Ireland
| | - Anne Hickey
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
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14
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Oliveira J, Gamito P, Lopes B, Silva AR, Galhordas J, Pereira E, Ramos E, Silva AP, Jorge Á, Fantasia A. Computerized cognitive training using virtual reality on everyday life activities for patients recovering from stroke. Disabil Rehabil Assist Technol 2020; 17:298-303. [PMID: 32255695 DOI: 10.1080/17483107.2020.1749891] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: Recent studies argue that the use of virtual reality tasks depicting activities daily living may be effective means for cognitive rehabilitation. The aim of this study was to test an ecologically oriented approach in virtual reality resembling the demands of everyday life activities for cognitive rehabilitation following stroke. Materials and Methods: The sample comprised 30 sub-acute stroke patients recovering from stroke in a rehabilitation hospital. They were assessed in a single-arm pre-post intervention study on global cognition, executive functions, memory and attention abilities. The intervention consisted of virtual reality in a multidomain cognitive training approach depicting everyday life tasks (preparing food, choosing clothes, shopping, etc.). Results: Improvements were found in the assessed cognitive domains at 6 to 10 post-treatment sessions. In-depth analysis through reliable change scores has suggested larger treatment effects on global cognition. Conclusions: Overall results suggest that the use of virtual reality-based exercises on everyday life activities may be a useful cognitive rehabilitation approach to provide short-term gains in cognition following stroke.Implications for rehabilitationVirtual reality-based cognitive rehabilitation resembling everyday life activities may provide short-term gains in cognition of stroke patients;Consistent improvements in executive functions may require higher treatment dosage than for improvements in global cognition.
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Affiliation(s)
- Jorge Oliveira
- EPCV, Universidade Lusófona de Humanidades e Tecnologias (ULHT), Lisbon, Portugal.,HEI-Lab, Universidade Lusófona de Humanidades e Tecnologias (ULHT), Lisbon, Portugal
| | - Pedro Gamito
- EPCV, Universidade Lusófona de Humanidades e Tecnologias (ULHT), Lisbon, Portugal.,HEI-Lab, Universidade Lusófona de Humanidades e Tecnologias (ULHT), Lisbon, Portugal
| | - Beatriz Lopes
- EPCV, Universidade Lusófona de Humanidades e Tecnologias (ULHT), Lisbon, Portugal
| | - Ana Rute Silva
- EPCV, Universidade Lusófona de Humanidades e Tecnologias (ULHT), Lisbon, Portugal
| | - João Galhordas
- Serviço de Psicologia, Centro de Medicina de Reabilitação de Alcoitão (CMRA), Alcabideche, Portugal
| | - Eduarda Pereira
- Serviço de Psicologia, Centro de Medicina de Reabilitação de Alcoitão (CMRA), Alcabideche, Portugal
| | - Elisabete Ramos
- Serviço de Psicologia, Centro de Medicina de Reabilitação de Alcoitão (CMRA), Alcabideche, Portugal
| | - Ana Paula Silva
- Serviço de Psicologia, Centro de Medicina de Reabilitação de Alcoitão (CMRA), Alcabideche, Portugal
| | - Áurea Jorge
- Serviço de Psicologia, Centro de Medicina de Reabilitação de Alcoitão (CMRA), Alcabideche, Portugal
| | - António Fantasia
- Serviço de Psicologia, Centro de Medicina de Reabilitação de Alcoitão (CMRA), Alcabideche, Portugal
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15
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Abstract
BACKGROUND Recent evidence has shown that cognitive dysfunction is associated with a history of binge drinking in adolescents who do not have an alcohol use disorder. Most previous studies with adults, however, have failed to show a link between cognitive dysfunction and subdiagnostic binge drinking, nor have any studies investigated the additive cognitive effect of binge drinking to ischemic stroke. OBJECTIVE To examine whether a pattern of cognitive dysfunction, especially executive and memory dysfunction, in patients with a first-ever ischemic stroke is associated with a history of subdiagnostic binge drinking. METHODS We studied 206 first-ever ischemic stroke patients (18-65 years) and 50 healthy, demographically comparable adults-both groups with no alcohol use disorder. After exclusion by matching, 189 patients and 39 healthy participants were included in our study (228 participants). The binge-drinking group included 76 participants; the non-binge-drinking group included 152. A multivariate analysis of covariance was used to compare nine cognitive functions between the two groups, with age, education, and stroke severity used as covariates. RESULTS Binge drinking had a significant negative effect on executive functions (P<0.001). The non-binge-drinking group outperformed the binge-drinking group on the Stroop Test (P=0.001), Trail Making Test (P=0.002), and a phonemic fluency test (P=0.005). The Binge×Stroke Severity interaction (P=0.037) indicated that a history of binge drinking increased the negative effect of stroke on executive functions. CONCLUSIONS Subdiagnostic binge drinking may exacerbate the adverse effects of ischemic stroke on executive dysfunction.
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16
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Mahon S, Faulkner J, Barker-Collo S, Krishnamurthi R, Jones K, Feigin V. Slowed Information Processing Speed at Four Years Poststroke: Evidence and Predictors from a Population-Based Follow-up Study. J Stroke Cerebrovasc Dis 2019; 29:104513. [PMID: 31784380 DOI: 10.1016/j.jstrokecerebrovasdis.2019.104513] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 10/05/2019] [Accepted: 11/01/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND PURPOSE Slowed Information Processing Speed (IPS) is a commonly reported cognitive deficit following stroke, affecting up to 50% to 70 % of stroke survivors. IPS has a major influence on poststroke cognitive dysfunction, affecting quality of life and increasing dependence on others. Few studies have examined predictors of slow IPS after stroke, and there is a paucity of data in terms of long-term prevalence. This study examined baseline predictors associated with long-term slow IPS in a population-based stroke incidence cohort, 4 years after stroke onset. METHODS Adults with stroke (n = 133, m = 71.1 ± 13.5 years) completed the Symbol Digit Modalities Test (SDMT) at 4 years poststroke. Baseline predictors were obtained within 2 weeks of the acute event. Multivariate regression linear and logistic models were used to identify baseline predictors (reported as OR with 95%CI) and prevalence of impaired IPS at 4-years. RESULTS 51% of people with stroke had low scores on the SDMT as indicated by a score of -1.0 SD to -2.5 SD (ranging from low to very low respectively). There were significant associations between slow IPS at 4-years after controlling for age and education level and the following baseline factors: older age (>75 years) (OR 3.03, 95% CI .9-9.3,P = .05), previous stroke (OR 2.74, 95% CI 1.0-7.4,P = .05), high cholesterol (OR 2.72, 95% CI 1.3-5.4,p = .01), hypertension (OR 1.82, 95% CI 0.9-3.6,p = .05), and presence of coronary artery disease (OR 3.35, 95% CI 1.6-9.6,P = .01), or arrhythmia (OR 4.40, 95% CI 1.5-12.4,P = .01). CONCLUSIONS Even after 4-years poststroke, slowed IPS is highly prevalent, with comorbid vascular risk factors significantly contributing to persistent impaired IPS. Early identification of adults who are at higher risk of deficits in IPS is vital to targeting the timely delivery of cognitive rehabilitation interventions, improving overall outcomes.
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Affiliation(s)
- Susan Mahon
- National Institute for Stroke and Applied Neurosciences, Faculty of Health and Environmental Studies, Auckland University of Technology, Auckland, New Zealand; School of Public Health and Psychosocial Studies, Auckland University of Technology, Auckland, New Zealand.
| | - Josh Faulkner
- National Institute for Stroke and Applied Neurosciences, Faculty of Health and Environmental Studies, Auckland University of Technology, Auckland, New Zealand
| | | | - Rita Krishnamurthi
- National Institute for Stroke and Applied Neurosciences, Faculty of Health and Environmental Studies, Auckland University of Technology, Auckland, New Zealand
| | - Kelly Jones
- National Institute for Stroke and Applied Neurosciences, Faculty of Health and Environmental Studies, Auckland University of Technology, Auckland, New Zealand
| | - Valery Feigin
- National Institute for Stroke and Applied Neurosciences, Faculty of Health and Environmental Studies, Auckland University of Technology, Auckland, New Zealand
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17
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Hickey A, Merriman NA, Bruen C, Mellon L, Bennett K, Williams D, Pender N, Doyle F. Psychological interventions for managing cognitive impairment after stroke. Hippokratia 2019. [DOI: 10.1002/14651858.cd013406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Anne Hickey
- Royal College of Surgeons in Ireland; Department of Psychology; 123 St Stephen's Green Dublin Ireland
| | - Niamh A Merriman
- Royal College of Surgeons in Ireland; Department of Psychology; 123 St Stephen's Green Dublin Ireland
| | - Carlos Bruen
- Royal College of Surgeons in Ireland; Department of Psychology; 123 St Stephen's Green Dublin Ireland
| | - Lisa Mellon
- Royal College of Surgeons in Ireland; Department of Psychology; 123 St Stephen's Green Dublin Ireland
| | - Kathleen Bennett
- Royal College of Surgeons in Ireland; Division of Population Health Sciences; Dublin Ireland
| | - David Williams
- Royal College of Surgeons in Ireland; RCSI Geriatric Medicine - Beaumont Hospital; Dublin Ireland
| | - Niall Pender
- Beaumont Hospital; Department of Psychology; Dublin Ireland 9
| | - Frank Doyle
- Royal College of Surgeons in Ireland; Department of Psychology; 123 St Stephen's Green Dublin Ireland
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18
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Attention Deficits in Stroke Patients: The Role of Lesion Characteristics, Time from Stroke, and Concomitant Neuropsychological Deficits. Behav Neurol 2019; 2019:7835710. [PMID: 31263512 PMCID: PMC6556322 DOI: 10.1155/2019/7835710] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Accepted: 04/08/2019] [Indexed: 01/08/2023] Open
Abstract
Attention impairments are frequent in stroke patients with important consequences on the rehabilitation outcomes and quality of life. The aim of the study was to perform a comprehensive assessment of selective and intensive attention processes in a large population of brain-damaged patients, evaluating the influence of the side and site of the brain lesion, the time from stroke, and the concomitant presence of aphasia or neglect. We assessed 204 patients with a first unilateral brain lesion and 42 healthy individuals with three subtests of the Test of Attentional Performance (TAP): Alertness, Go-No Go, and Divided Attention. 44.4% of patients had an impairment in both intensive and selective aspects of attention, 5.6% had deficits only in the intensive component, and 31.8% had deficits only in selective tasks. More than 80% of the patients fell below the cut-off point on at least one task. Patients with a right hemispheric lesion (RHL) were more impaired than patients with a left hemispheric lesion (LHL) especially in tonic and phasic alertness. Patients with total anterior infarcts (TACI) presented the worst profile compared to other stroke subtypes, with a difference between total and lacunar subtypes in the Alertness test, independent of the presence of warning. Patients in the chronic phase had shorter RTs than acute patients only in the Alertness test. In patients with LHL, the presence of aphasia was associated with a greater deficit in selective attention. In patients with RHL, the presence of unilateral neglect was associated with impaired alertness and selective attention. Attention deficits are common after a unilateral first stroke. In keeping with the hierarchical organization of attention functions, results confirm the important role of the right hemisphere for the intensive components of attention, also highlighting the involvement of left hemisphere functioning for the selective aspects, possibly indicating a role of its linguistic functions.
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Rogers JM, Duckworth J, Middleton S, Steenbergen B, Wilson PH. Elements virtual rehabilitation improves motor, cognitive, and functional outcomes in adult stroke: evidence from a randomized controlled pilot study. J Neuroeng Rehabil 2019; 16:56. [PMID: 31092252 PMCID: PMC6518680 DOI: 10.1186/s12984-019-0531-y] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 05/03/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Virtual reality technologies show potential as effective rehabilitation tools following neuro-trauma. In particular, the Elements system, involving customized surface computing and tangible interfaces, produces strong treatment effects for upper-limb and cognitive function following traumatic brain injury. The present study evaluated the efficacy of Elements as a virtual rehabilitation approach for stroke survivors. METHODS Twenty-one adults (42-94 years old) with sub-acute stroke were randomized to four weeks of Elements virtual rehabilitation (three weekly 30-40 min sessions) combined with treatment as usual (conventional occupational and physiotherapy) or to treatment as usual alone. Upper-limb skill (Box and Blocks Test), cognition (Montreal Cognitive Assessment and selected CogState subtests), and everyday participation (Neurobehavioral Functioning Inventory) were examined before and after inpatient training, and one-month later. RESULTS Effect sizes for the experimental group (d = 1.05-2.51) were larger compared with controls (d = 0.11-0.86), with Elements training showing statistically greater improvements in motor function of the most affected hand (p = 0.008), and general intellectual status and executive function (p ≤ 0.001). Proportional recovery was two- to three-fold greater than control participants, with superior transfer to everyday motor, cognitive, and communication behaviors. All gains were maintained at follow-up. CONCLUSION A course of Elements virtual rehabilitation using goal-directed and exploratory upper-limb movement tasks facilitates both motor and cognitive recovery after stroke. The magnitude of training effects, maintenance of gains at follow-up, and generalization to daily activities provide compelling preliminary evidence of the power of virtual rehabilitation when applied in a targeted and principled manner. TRIAL REGISTRATION this pilot study was not registered.
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Affiliation(s)
- Jeffrey M Rogers
- The University of Sydney, Faculty of Health Sciences, Sydney, NSW, Australia.
| | | | - Sandy Middleton
- Nursing Research Institute, St Vincent's Health Australia and Australian Catholic University, Sydney, NSW, Australia
| | - Bert Steenbergen
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Peter H Wilson
- Centre for Disability and Development Research (CeDDR) and School of Behavioural and Health Science, Australian Catholic University, Melbourne, VIC, Australia
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20
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Rodrigues JDC, Becker N, Beckenkamp CL, Miná CS, de Salles JF, Bandeira DR. Psychometric properties of cognitive screening for patients with cerebrovascular diseases A systematic review. Dement Neuropsychol 2019; 13:31-43. [PMID: 31073378 PMCID: PMC6497015 DOI: 10.1590/1980-57642018dn13-010004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Screening instruments are ideal for acute clinical settings because they are easy to apply, fast, inexpensive and sensitive for specific samples. However, there is a need to verify the psychometric properties of screening in stroke patients. Objective This study investigated the psychometric properties (methodological procedures) of cognitive screening for patients with cerebrovascular diseases. Methods A systematic review of papers published on PsycINFO, Web of Knowledge, PubMed and Science Direct (2005 to 2016) was performed. Results A total of 55 articles remained after applying exclusion criteria. The samples ranged from 20 to 657 patients. Most articles evaluated elderly individuals with four to 13 years of education who had experienced ischemic or hemorrhagic stroke. There was a tendency to find evidence of validity for criteria and to analyze the sensitivity/specificity of the instruments. Although the studies frequently used the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) to seek evidence of validity and reliability, the use of these instruments among stroke patients has been criticized due to their psychometric properties and the neuropsychological functions evaluated. Conclusion Although there is no gold standard screen for assessing adults post-stroke, instruments devised specifically for this population have shown promise. This review helps both researchers and clinicians to select the most appropriate screen for identifying cognitive impairment in adults post-stroke.
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Affiliation(s)
| | - Natália Becker
- Psicóloga, Mestre e Doutoranda em Psicologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | | | - Camila Schorr Miná
- Psicóloga, Mestranda em Neurociências, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Jerusa Fumagalli de Salles
- Professora Associada do Instituto de Psicologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Denise Ruschel Bandeira
- Professora Titular do Instituto de Psicologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
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Merriman NA, Sexton E, McCabe G, Walsh ME, Rohde D, Gorman A, Jeffares I, Donnelly NA, Pender N, Williams DJ, Horgan F, Doyle F, Wren MA, Bennett KE, Hickey A. Addressing cognitive impairment following stroke: systematic review and meta-analysis of non-randomised controlled studies of psychological interventions. BMJ Open 2019; 9:e024429. [PMID: 30819706 PMCID: PMC6398645 DOI: 10.1136/bmjopen-2018-024429] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Cognitive impairment is a pervasive outcome of stroke, reported in over half of patients 6 months post-stroke and is associated with increased disability and a poorer quality of life. Despite the prevalence of post-stroke cognitive impairment, the efficacy of existing psychological interventions for the rehabilitation of cognitive impairment following stroke has yet to be established. The aim of this study is to identify psychological interventions from non-randomised studies that intended to improve post-stroke cognitive function and establish their efficacy. DESIGN Systematic review and meta-analysis of non-randomised studies of psychological interventions addressing post-stroke cognitive impairment. DATA SOURCES Electronic searches were performed in the Pubmed, EMBASE and PsycINFO databases, the search dating from inception to February 2017. ELIGIBILITY CRITERIA All non-randomised controlled studies and quasi-randomised controlled trials examining psychological interventions to improve cognitive function following stroke were included, such as feasibility studies, pilot studies, experimental studies, and quasi-experimental studies. The primary outcome was cognitive function. The prespecified secondary outcomes were functional abilities in daily life and quality of life. METHODS The current meta-analyses combined the findings of seven controlled studies, examining the efficacy of psychological interventions compared with treatment-as-usual controls or active controls, and 13 one-group pre-post studies. RESULTS Results indicated an overall small effect on cognition across the controlled studies (Hedges' g=0.38, 95% CI=0.06 to 0.7) and a moderate effect on cognition across the one-group pre-post studies (Hedges' g=0.51, 95% CI=0.3 to 0.73). Specific cognitive domains, such as memory and attention also demonstrated a benefit of psychological interventions. CONCLUSIONS This review provides support for the potential of psychological interventions to improve overall cognitive function post-stroke. Limitations of the study, in terms of risk of bias and quality of included studies, and future research directions are explored. PROSPERO REGISTRATION NUMBER CRD42017069714.
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Affiliation(s)
- Niamh A Merriman
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Eithne Sexton
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Grainne McCabe
- Library, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Mary E Walsh
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Daniela Rohde
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Ashleigh Gorman
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Isabelle Jeffares
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Nora-Ann Donnelly
- Social Research Division, Economic and Social Research Institute, Dublin, Ireland
| | - Niall Pender
- Department of Psychology, Beaumont Hospital, Dublin, Ireland
| | - David J Williams
- Department of Geriatric and Stroke Medicine, Beaumont Hospital, Dublin, Ireland
- Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Frances Horgan
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Frank Doyle
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Maev-Ann Wren
- Social Research Division, Economic and Social Research Institute, Dublin, Ireland
| | - Kathleen E Bennett
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Anne Hickey
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
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General and Domain-Specific Effectiveness of Cognitive Remediation after Stroke: Systematic Literature Review and Meta-Analysis. Neuropsychol Rev 2018; 28:285-309. [DOI: 10.1007/s11065-018-9378-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 06/21/2018] [Indexed: 12/26/2022]
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Leitner D, Miller H, Libben M. Assessing the predictive value of a neuropsychological model on concurrent function in acute stroke recovery and rehabilitation. Clin Neuropsychol 2018; 33:831-853. [DOI: 10.1080/13854046.2018.1487586] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Damian Leitner
- Department of Psychology, University of British Columbia Okanagan, Kelowna, Canada
| | - Harry Miller
- Department of Psychology, Kelowna General Hospital, Kelowna, Canada
| | - Maya Libben
- Department of Psychology, University of British Columbia Okanagan, Kelowna, Canada
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Executive functioning and daily living of individuals with chronic stroke: measurement and implications. Int J Rehabil Res 2018; 41:122-127. [DOI: 10.1097/mrr.0000000000000272] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
OBJECTIVES The aim of this work was to study the change in different cognitive domains after stroke during a 2-year follow-up. METHOD We evaluated both neuropsychologically and neurologically a consecutive cohort of working-age patients with a first-ever stroke at baseline (within the first weeks), 6 months, and 2 years after stroke-onset. A total of 153 patients participated in all examinations and were compared to 50 healthy controls. RESULTS Forty-nine percent of the patients were cognitively impaired at baseline, 41% at 6 months, and 39% at 2-year follow-up. We analyzed seven cognitive domains (impairment rates at baseline and 2-year follow-up): psychomotor speed (34%; 23%), executive functions (27%; 17%), visual memory (21%; 4%), visuospatial function (20%; 14%), verbal memory (18%; 12%), basic language processing (baseline 11%; 6 months 5%), and reasoning (2 years 14%). The patients who were cognitively impaired at baseline improved more within 6 months, than either the controls or cognitively intact patients in all cognitive domains (all p<.05). Later on, between 6 months and 2 years, the domain-specific change scores did not differ between patients who were cognitively intact and impaired at 6 months. Also, the cognitive status (intact or impaired) remained the same in 90% of patients between 6-month and 2-year follow-ups. At 2 years, half of the patients, who were categorized cognitively impaired, were rated as well-recovered according to neurological evaluation. CONCLUSIONS Most of the cognitive improvement took place within 6 months. Long-lasting cognitive impairment was common even after good neurological recovery. An early neuropsychological examination is essential in evaluating cognitive dysfunction and need for rehabilitation. (JINS, 2018, 24, 117-127).
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Merriman NA, Sexton E, Donnelly NA, McCabe G, Walsh ME, Rohde D, Gorman A, Jeffares I, Pender N, Williams D, Horgan F, Doyle F, Wren MA, Bennett KE, Hickey A. Managing cognitive impairment following stroke: protocol for a systematic review of non-randomised controlled studies of psychological interventions. BMJ Open 2018; 8:e019001. [PMID: 29326188 PMCID: PMC5781105 DOI: 10.1136/bmjopen-2017-019001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION Stroke is one of the primary causes of death and disability worldwide, leaving a considerable proportion of survivors with persistent cognitive and functional deficits. Despite the prevalence of poststroke cognitive impairment, there is no established treatment aimed at improving cognitive function following a stroke. Therefore, the aims of this systematic review are to identify psychological interventions intended to improve poststroke cognitive function and establish their efficacy. METHODS AND ANALYSIS A systematic review of non-randomised controlled studies that investigated the efficacy of psychological interventions aimed at improving cognitive function in stroke survivors will be conducted. Electronic searches will be performed in the PubMed, Embase and PsycINFO databases, the search dating from the beginning of the index to February 2017. Reference lists of all identified relevant articles will be reviewed to identify additional studies not previously identified by the electronic search. Potential grey literature will be reviewed using Google Scholar. Titles and abstracts will be assessed for eligibility by one reviewer, with a random sample of 50% independently double-screened by second reviewers. Any discrepancies will be resolved through discussion, with referral to a third reviewer where necessary. Risk of bias will be assessed with the Risk of Bias in Non-randomized Studies of Interventions tool. Meta-analyses will be performed if studies are sufficiently homogeneous. This review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The quality of the evidence regarding cognitive function will be assessed according to the Grading of Recommendations Assessment, Development and Evaluation. ETHICS AND DISSEMINATION This systematic review will collect secondary data only and as such ethical approval is not required. Findings will be disseminated through presentations and peer-reviewed publication. This review will provide information on the effectiveness of psychological interventions for poststroke cognitive impairment, identifying which psychological interventions are effective for improving poststroke cognitive function. PROSPERO REGISTRATION NUMBER CRD42017069714.
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Affiliation(s)
- Niamh A Merriman
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Eithne Sexton
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Grainne McCabe
- Royal College of Surgeons in Ireland Library, Dublin, Ireland
| | - Mary E Walsh
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Daniela Rohde
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Ashleigh Gorman
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Isabelle Jeffares
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Niall Pender
- Department of Psychology, Beaumont Hospital, Dublin, Ireland
| | - David Williams
- Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
- Department of Geriatric and Stroke Medicine, Beaumont Hospital, Dublin, Ireland
| | - Frances Horgan
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Frank Doyle
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Maev-Ann Wren
- Economic and Social Research Institute, Dublin, Ireland
| | - Kathleen E Bennett
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Anne Hickey
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
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Karimian N, Asgari K, Neshat Doost HT, Oreizi HR, Najafi MR. Investigating patterns of memory impairment in ischemic stroke in an iranian population. APPLIED NEUROPSYCHOLOGY-ADULT 2017; 25:458-463. [PMID: 28880682 DOI: 10.1080/23279095.2017.1329144] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Up until the date of this research, studies have examined poststroke cognitive impairments in attention, memory, and executive functions. In this study, we investigated the occurrence of memory problems in various patterns of memory in ischemic stroke patients in an attempt to determine specific memory profiles of the patients. The goal was to determine the severity and patterns of memory impairments in ischemic stroke patients and to identify specific profiles of memory impairments in stroke patients, in order to help therapists to develop more appropriate memory rehabilitation programs for the patients. The sample consisted of 35 patients with ischemic stroke. Thirty-five individuals who were matched with the patients were selected as the control group. Demographic questionnaires, subscales of the Wechsler Memory Scale-III (WMS-III), including logical memory I and II and visual reproduction I and II, digit span from the Wechsler Adult Intelligence Scale-R (WAIS-R), and the Corsi span test were administered to both of the patients and control groups. Multivariate analysis of covariance (MANCOVA) was carried out to unveil possible differences in memory between the two groups. The mean scores of different memory patterns were significantly higher in the control group comparing to the patient group (p < 0.05). Among different aspects of memory, visual long-term memory and visual short-term memory had the largest effect sizes. Substantial impairments were also found in visual short-term memory, visuospatial short-term memory, and visual long-term memory. The findings suggest that the stroke patients have identifiable patterns of memory impairment.
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Affiliation(s)
- Negar Karimian
- a Department of Psychology , University of Isfahan , Isfahan , Iran
| | - Karim Asgari
- a Department of Psychology , University of Isfahan , Isfahan , Iran
| | | | | | - Mohammad Reza Najafi
- b Department of Neurology , Isfahan University of Medical Sciences , Isfahan , Iran
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Bath PM, Scutt P, Blackburn DJ, Ankolekar S, Krishnan K, Ballard C, Burns A, Mant J, Passmore P, Pocock S, Reckless J, Sprigg N, Stewart R, Wardlaw JM, Ford GA, PODCAST Trial Investigators. Intensive versus Guideline Blood Pressure and Lipid Lowering in Patients with Previous Stroke: Main Results from the Pilot 'Prevention of Decline in Cognition after Stroke Trial' (PODCAST) Randomised Controlled Trial. PLoS One 2017; 12:e0164608. [PMID: 28095412 PMCID: PMC5240987 DOI: 10.1371/journal.pone.0164608] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 09/28/2016] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Stroke is associated with the development of cognitive impairment and dementia. We assessed the effect of intensive blood pressure (BP) and/or lipid lowering on cognitive outcomes in patients with recent stroke in a pilot trial. METHODS In a multicentre, partial-factorial trial, patients with recent stroke, absence of dementia, and systolic BP (SBP) 125-170 mmHg were assigned randomly to at least 6 months of intensive (target SBP <125 mmHg) or guideline (target SBP <140 mmHg) BP lowering. The subset of patients with ischaemic stroke and total cholesterol 3.0-8.0 mmol/l were also assigned randomly to intensive (target LDL-cholesterol <1.3 mmol/l) or guideline (target LDL-c <3.0 mmol/l) lipid lowering. The primary outcome was the Addenbrooke's Cognitive Examination-Revised (ACE-R). RESULTS We enrolled 83 patients, mean age 74.0 (6.8) years, and median 4.5 months after stroke. The median follow-up was 24 months (range 1-48). Mean BP was significantly reduced with intensive compared to guideline treatment (difference -10·6/-5·5 mmHg; p<0·01), as was total/LDL-cholesterol with intensive lipid lowering compared to guideline (difference -0·54/-0·44 mmol/l; p<0·01). The ACE-R score during treatment did not differ for either treatment comparison; mean difference for BP lowering -3.6 (95% CI -9.7 to 2.4), and lipid lowering 4.4 (95% CI -2.1 to 10.9). However, intensive lipid lowering therapy was significantly associated with improved scores for ACE-R at 6 months, trail making A, modified Rankin Scale and Euro-Qol Visual Analogue Scale. There was no difference in rates of dementia or serious adverse events for either comparison. CONCLUSION In patients with recent stroke and normal cognition, intensive BP and lipid lowering were feasible and safe, but did not alter cognition over two years. The association between intensive lipid lowering and improved scores for some secondary outcomes suggests further trials are warranted. TRIAL REGISTRATION ISRCTN ISRCTN85562386.
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Affiliation(s)
- Philip M. Bath
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom
| | - Polly Scutt
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom
| | - Daniel J. Blackburn
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, United Kingdom
| | - Sandeep Ankolekar
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom
- Department of Neurology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom
| | - Kailash Krishnan
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom
| | - Clive Ballard
- Wolfson Centre for Age-Related Diseases, King’s College London, Guy’s Campus, London, United Kingdom
| | - Alistair Burns
- Faculty of Medical and Human Sciences, Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, United Kingdom
| | - Jonathan Mant
- General Practice & Primary Care Research Unit, University of Cambridge, Addenbrooke’s Hospital, Cambridge, United Kingdom
| | - Peter Passmore
- Institute of Clinical Sciences, Queens University, Belfast, Royal Victoria Hospital, Belfast, United Kingdom
| | - Stuart Pocock
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - John Reckless
- Department of Endocrinology, Royal United Hospital, Bath, United Kingdom
| | - Nikola Sprigg
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom
| | - Rob Stewart
- Department of Psychological Medicine, King's College London (Institute of Psychiatry, Psychology and Neuroscience), London, United Kingdom
| | - Joanna M. Wardlaw
- Centre for Clinical Brain Sciences, Western General Hospital, Edinburgh, United Kingdom
| | - Gary A. Ford
- Medical Sciences Division, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
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Abstract
Background: Neuropsychological deficits occur in over half of the stroke survivors and are associated with the reduced functioning and a decline in quality of life. However, the trajectory of recovery and predictors of neuropsychological outcomes over the first year post stroke are poorly understood.Method: Neuropsychological performance, assessed using the CNS-Vital signs, was examined at 1 month, 6 months and 12 months after ischaemic stroke (IS) in a sample drawn from a population-based study (N = 198).Results: While mean scores across neuropsychological domains at each time-point fell in the average range, one in five individuals produced very low-range scores for verbal memory, attention and psychomotor speed. Significant improvements were seen for executive functioning, psychomotor speed and cognitive flexibility within 6 months post stroke, but no gains were noted from 6 to 12 months. Stroke-related neurological deficits and depression at baseline significantly contributed to the prediction of neuropsychological function at 12 month follow-up.Conclusions: In a significant minority of IS survivors, focal deficits are evident in psychomotor speed, verbal memory, executive functions and attention. Significant improvements in these domains were only evident in the first 6 months post stroke. Initial stroke-related neurological deficits and concurrent depression may be the best predictors of later cognitive functioning.
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Mullick AA, Subramanian SK, Levin MF. Emerging evidence of the association between cognitive deficits and arm motor recovery after stroke: A meta-analysis. Restor Neurol Neurosci 2016; 33:389-403. [PMID: 26410581 PMCID: PMC4923759 DOI: 10.3233/rnn-150510] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Purpose: Motor and cognitive impairments are common and often coexist in patients with stroke. Although evidence is emerging about specific relationships between cognitive deficits and upper-limb motor recovery, the practical implication of these relationships for rehabilitation is unclear. Using a structured review and meta-analyses, we examined the nature and strength of the associations between cognitive deficits and upper-limb motor recovery in studies of patients with stroke. Methods: Motor recovery was defined using measures of upper limb motor impairment and/or activity limitations. Studies were included if they reported on at least one measure of cognitive function and one measure of upper limb motor impairment or function. Results: Six studies met the selection criteria. There was a moderate association (r = 0.43; confidence interval; CI:0.09– 0.68, p = 0.014) between cognition and overall arm motor recovery. Separate meta-analyses showed a moderately strong association between executive function and motor recovery (r = 0.48; CI:0.26– 0.65; p < 0.001), a weak positive correlation between attention and motor recovery (r = 0.25; CI:0.04– 0.45; p = 0.023), and no correlation between memory and motor recovery (r = 0.42; CI:0.16– 0.79; p = 0.14). Conclusion: These results imply that information on the presence of cognitive deficits should be considered while planning interventions for clients in order to design more personalized interventions tailored to the individual for maximizing upper-limb recovery.
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Affiliation(s)
- Aditi A Mullick
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada.,Feil and Oberfeld Research Center, Jewish Rehabilitation Hospital, Center for Interdisciplinary Research in Rehabilitation of Greater Montreal, Laval, Canada
| | - Sandeep K Subramanian
- Feil and Oberfeld Research Center, Jewish Rehabilitation Hospital, Center for Interdisciplinary Research in Rehabilitation of Greater Montreal, Laval, Canada.,Département de neurosciences, Université de Montréal, Montreal, Canada
| | - Mindy F Levin
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada.,Feil and Oberfeld Research Center, Jewish Rehabilitation Hospital, Center for Interdisciplinary Research in Rehabilitation of Greater Montreal, Laval, Canada
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Hayes S, Donnellan C, Stokes E. Executive dysfunction and balance function post-stroke: A cross-sectional study. Physiotherapy 2015; 102:64-70. [PMID: 26031841 DOI: 10.1016/j.physio.2015.03.3719] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 03/20/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES This study investigated the: (1) prevalence of executive dysfunction (ED); (2) demographic and clinical differences between participants with ED and without ED and; (3) independent association between executive function (EF) and balance post-stroke. DESIGN Prospective observational cross-sectional study. SETTING Four large acute hospitals. PARTICIPANTS Convenience sample of people with first stroke. MAIN OUTCOME Balance function. SECONDARY OUTCOMES EF, stroke severity, depression and global cognition. METHODS Descriptive statistics were used to report the prevalence of ED post-stroke. Comparisons of demographic and clinical characteristics were made between participants with ED and participants without ED using independent t-tests. Hierarchical multiple linear regression analysis determined the association between EF and balance post-stroke. RESULTS Participant (n=100) age ranged from 31 to 98 years, time since stroke ranged from 4 to 180 days and the participants reported formal education ranging from 7 to 21 years. Participants with ED had more severe strokes (BADS) [median (IQR) vs. median (IQR), p-value] [(44 (16) vs. (51 (7), p<0.01], poorer global cognition [24 (6) vs. 29 (2), p<0.01] and poorer balance [29 (40) vs. 46.5 (17), p<0.01] in comparison with participants without ED. Age (β=-0.24, p<0.05), years in education, (β=-0.21, p<0.05), stroke severity (β=0.71, p<0.01), time since stroke, (β=-0.17, p<0.01) and EF (β=0.19, p<0.05) were independently associated with balance post-stroke. The total variance in balance explained by the model was 72%. CONCLUSIONS ED is independently associated with balance post-stroke. Physiotherapists should consider this when developing rehabilitation strategies to improve balance post-stroke.
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Affiliation(s)
- Sara Hayes
- Department of Clinical Therapies, University of Limerick, Limerick, Ireland.
| | - Claire Donnellan
- School of Medicine, Royal College of Surgeons in Ireland, Medical University in Bahrain, Al Sayh, Bahrain.
| | - Emma Stokes
- Discipline of Physiotherapy, Trinity Centre for Health Sciences, St. James's Hospital, Dublin 8, Ireland.
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Su CY, Wuang YP, Lin YH, Su JH. The role of processing speed in post-stroke cognitive dysfunction. Arch Clin Neuropsychol 2015; 30:148-60. [PMID: 25618135 DOI: 10.1093/arclin/acu057] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The association between speed of information processing and cognition has been extensively validated in normal aging and other neurocognitive disorders. Our aim was to determine whether such a relationship exists in stroke. Thirty patients and 30 age- and education-matched healthy individuals were administered a comprehensive battery of neuropsychological tests divided into the following six cognitive domains: processing speed (PS), verbal memory, visual memory, visuoperceptual function, language, and cognitive flexibility. The results demonstrate that stroke patients were characterized by cognitive deficits in almost all of these domains, but have the most pronounced deficits in PS. After adjusting for symbol digit modalities test score, all significant group differences in cognitive functioning disappeared. However, group differences remained significant after controlling for the influence of other cognitive factors. These findings suggest that decreased PS appears to underlie post-stroke cognitive dysfunction and may serve as a potential target for intervention.
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Affiliation(s)
- Chwen-Yng Su
- Department of Occupational Therapy, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yee-Pay Wuang
- Department of Occupational Therapy, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yueh-Hsien Lin
- Special Education Center, National Taiwan Normal University, Taipei, Taiwan
| | - Jui-Hsing Su
- Department of Rehabilitation Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan
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Wheeler HM, Mlynash M, Inoue M, Tipirnini A, Liggins J, Bammer R, Lansberg MG, Kemp S, Zaharchuk G, Straka M, Albers GW. The growth rate of early DWI lesions is highly variable and associated with penumbral salvage and clinical outcomes following endovascular reperfusion. Int J Stroke 2015; 10:723-9. [PMID: 25580662 DOI: 10.1111/ijs.12436] [Citation(s) in RCA: 133] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2014] [Accepted: 10/29/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND The degree of variability in the rate of early diffusion-weighted imaging expansion in acute stroke has not been well characterized. AIM We hypothesized that patients with slowly expanding diffusion-weighted imaging lesions would have more penumbral salvage and better clinical outcomes following endovascular reperfusion than patients with rapidly expanding diffusion-weighted imaging lesions. METHODS In the first part of this substudy of DEFUSE 2, growth curves were constructed for patients with >90% reperfusion and <10% reperfusion. Next, the initial growth rate was determined in all patients with a clearly established time of symptom onset, assuming a lesion volume of 0 ml just prior to symptom onset. Patients who achieved reperfusion (>50% reduction in perfusion-weighted imaging after endovascular therapy) were categorized into tertiles according to their initial diffusion-weighted imaging growth rates. For each tertile, penumbral salvage [comparison of final volume to the volume of perfusion-weighted imaging (Tmax > 6 s)/diffusion-weighted imaging mismatch prior to endovascular therapy], favorable clinical response (National Institutes of Health Stroke Scale improvement of ≥8 points or 0-1 at 30 days), and good functional outcome (90-day modified Rankin score of ≤2) were calculated. A multivariate model assessed whether infarct growth rates were an independent predictor of clinical outcomes. RESULTS Sixty-five patients were eligible for this study; the median initial growth rate was 3·1 ml/h (interquartile range 0·7-10·7). Target mismatch patients (n = 42) had initial growth rates that were significantly slower than the growth rates in malignant profile (n = 9 patients, P < 0·001). In patients who achieved reperfusion (n = 38), slower early diffusion-weighted imaging growth rates were associated with better clinical outcomes (P < 0·05) and a trend toward more penumbral salvage (n = 31, P = 0·103). A multivariate model demonstrated that initial diffusion-weighted imaging growth rate was an independent predictor of achieving a 90-day modified Rankin score of ≤2. CONCLUSIONS The growth rate of early diffusion-weighted imaging lesions in acute stroke patients is highly variable; malignant profile patients have higher growth rates than patients with target mismatch. A slower rate of early diffusion-weighted imaging growth is associated with a greater degree of penumbral salvage and improved clinical outcomes following endovascular reperfusion.
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Affiliation(s)
- Hayley M Wheeler
- Stanford Stroke Center, Stanford University School of Medicine, Stanford, CA, USA
| | - Michael Mlynash
- Stanford Stroke Center, Stanford University School of Medicine, Stanford, CA, USA
| | - Manabu Inoue
- Stanford Stroke Center, Stanford University School of Medicine, Stanford, CA, USA
| | - Aaryani Tipirnini
- Stanford Stroke Center, Stanford University School of Medicine, Stanford, CA, USA
| | - John Liggins
- Stanford Stroke Center, Stanford University School of Medicine, Stanford, CA, USA
| | - Roland Bammer
- Stanford Stroke Center, Stanford University School of Medicine, Stanford, CA, USA
| | - Maarten G Lansberg
- Stanford Stroke Center, Stanford University School of Medicine, Stanford, CA, USA
| | - Stephanie Kemp
- Stanford Stroke Center, Stanford University School of Medicine, Stanford, CA, USA
| | - Greg Zaharchuk
- Stanford Stroke Center, Stanford University School of Medicine, Stanford, CA, USA
| | - Matus Straka
- Stanford Stroke Center, Stanford University School of Medicine, Stanford, CA, USA
| | - Gregory W Albers
- Stanford Stroke Center, Stanford University School of Medicine, Stanford, CA, USA
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Hayes S, Donnellan C, Stokes E. Executive dysfunction post-stroke: an insight into the perspectives of physiotherapists. Disabil Rehabil 2014; 37:1817-24. [DOI: 10.3109/09638288.2014.980915] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Cognitive reserve in stroke and traumatic brain injury patients. Neurol Sci 2014; 35:1513-8. [PMID: 25053460 DOI: 10.1007/s10072-014-1897-z] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 07/16/2014] [Indexed: 01/05/2023]
Abstract
Cognitive reserve (CR) is defined as the ability to cope with brain damage due to pre-existing cognitive processes or to the development of new compensatory processes. Existing research on CR is mostly based on the study of neurodegenerative disorders, such as Alzheimer's disease. Recently, however, this construct has also been applied to other neurological conditions, including multiple sclerosis, Parkinson's disease, epilepsy, stroke, and traumatic brain injury. The present review provides an overview of the studies that have investigated the influence of CR on neuropsychological outcome in stroke and traumatic brain injury patients. We performed a selective search on MEDLINE, CINAHL, and Web of Science Core Collection, using specific keywords including "cognitive reserve", "stroke", and "traumatic brain injury". The review is organized as follows: the first section focuses on works investigating the effect of CR on neuropsychological outcomes in post-stroke patients; the second section discusses studies which support the CR theory in traumatic brain injury. This review suggests that the study of CR in adult brain injury is still insufficient. Future research should investigate the role of other variables, like cognitive and social activities, as markers of CR in patients with brain injury, functional brain correlates of CR in brain activity, and the effect of CR on brain injury rehabilitative outcomes.
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Abstract
Vascular risk factors and cerebrovascular disease are common causes of dementia. Shared risk factors for vascular dementia and Alzheimer's disease, as well as frequent coexistence of these pathologies in cognitively impaired older people, suggests convergence of the aetiology, prevention and management of the commonest dementias affecting older people. In light of this understanding, the cognitive impairment associated with cerebrovascular disease is an increasingly important and recognised area of the medicine of older people. Although the incidence of cerebrovascular events is declining in many populations, the overall burden associated with brain vascular disease will continue to increase associated with population ageing. A spectrum of cognitive disorders related to cerebrovascular disease is now recognised. Cerebrovascular disease in older people is associated with specific clinical and imaging findings. Although prevention remains the cornerstone of management, the diagnosis of brain vascular disease is important because of the potential to improve clinical outcomes through clear diagnosis, enhanced control of risk factors, lifestyle interventions and secondary prevention. Specific pharmacological intervention may also be indicated for some patients with cognitive impairment and cerebrovascular disease. However the evidence base to guide intervention remains relatively sparse.
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Xu XD, Ren HY, Prakash R, Vijayadas, Kumar R. Outcomes of neuropsychological interventions of stroke. Ann Indian Acad Neurol 2014; 16:319-28. [PMID: 24101809 PMCID: PMC3788273 DOI: 10.4103/0972-2327.116909] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 07/12/2013] [Accepted: 07/17/2013] [Indexed: 11/23/2022] Open
Abstract
The reported prevalence of cognitive deficits within the first month of stroke ranges widely from 10% to 82%, depending primarily on the criteria used to define cognitive impairment and on the selected patient population. These cognitive defects progress toward impairment over a course of time if left untreated. Among the most common cognitive deficits are the attentional, the visuoperceptual, the memory and executive function deficits. As these impairments are being increasingly recognized in the scientific communities, more and more studies are being devoted to the outcomes of various therapies for these disorders. In this review, we focus on the outcomes of various therapies for these cognitive disorders over time. We reviewed all the possible medical databases using key words for individual cognitive deficit treatment outcomes. All the possible studies including randomized controlled trials, pre-post design studies, case series and single case reports were included in this study. On the basis of present literature review, we conclude that the evidence is definitively positive only for outcomes of attentional and visuoperceptive skill deficits. On the other hand, there have been very few studies to conclude for effectiveness of various therapies for memory and executive function outcomes.
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Affiliation(s)
- Xiao-Di Xu
- Department of Neurology, Liaocheng People's Hospital, Shandong, China
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Tu Q, Ding B, Yang X, Bai S, Tu J, Liu X, Wang R, Tao J, Jin H, Wang Y, Tang X. The current situation on vascular cognitive impairment after ischemic stroke in Changsha. Arch Gerontol Geriatr 2013; 58:236-47. [PMID: 24148887 DOI: 10.1016/j.archger.2013.09.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Revised: 09/26/2013] [Accepted: 09/28/2013] [Indexed: 11/19/2022]
Abstract
The objectives of the study were to explore the prevalence and effects of vascular cognitive impairment (VCI) among ischemic stroke patients and to provide a basis for prevention and treatment strategies. A stratified cluster random sampling method was performed, and 689 ischemic stroke patients (over 40 years of age) were enrolled. All of the patients had received a neuropsychological assessment battery to assess cognitive function and self-designed questionnaires to collect relevant information. According to the cognitive status, the patients were divided into two groups, a case group and a control group. The caregivers of the patients were given a questionnaire concerning the awareness of and attitudes toward VCI. In this study, we determined that the prevalence of VCI was 41.8%. Aging, paraventricular white matter lesion (WML), macroangiopathy, high levels of alcohol, a lack of hobbies, and excessive sleep were risk factors for vascular cognitive impairment no dementia (VCIND). A high level of education, manual-work, low level of alcohol use, regular health checks, a vegetable-based diet, and more fruit and milk were protective factors for VCIND. Living alone, hyperlipidemia, transient ischemic attack, a family history of stroke, and brain atrophy were risk factors of vascular dementia (VD). A high educational level, a vegetable-based diet, and tea were protective factors for VD. The general public awareness of VCI was found to be insufficient, and there was a prejudice toward and lack of funding for the care of VCI patients. The prevalence of VCI is high in ischemic stroke patients, and there are different impact factors at different stages. Despite the high prevalence of VCI, the general public awareness is limited. Appropriate prevention measures should be developed to reduce the prevalence of VCI.
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Affiliation(s)
- Qiuyun Tu
- Department of Geriatrics, The Third Xiangya Hospital of Central South University, Changsha 410013, China
| | - Binrong Ding
- Department of Geriatrics, The Third Xiangya Hospital of Central South University, Changsha 410013, China
| | - Xia Yang
- Department of Geriatrics, The Third Xiangya Hospital of Central South University, Changsha 410013, China
| | - Song Bai
- Department of Geriatrics, The Third Xiangya Hospital of Central South University, Changsha 410013, China
| | - Junshi Tu
- Department of Rehabilitation Therapy, Zhongshan School of Medicine in Sun Yat-Sen University, 510080, China
| | - Xiao Liu
- Department of Geriatrics, The Third Xiangya Hospital of Central South University, Changsha 410013, China
| | - Ranran Wang
- Department of Geriatrics, The Third Xiangya Hospital of Central South University, Changsha 410013, China
| | - Jinghua Tao
- Department of Geriatrics, The Third Xiangya Hospital of Central South University, Changsha 410013, China
| | - Hui Jin
- Department of Geriatrics, The Third Xiangya Hospital of Central South University, Changsha 410013, China
| | - Yiqun Wang
- Department of Geriatrics, The Third Xiangya Hospital of Central South University, Changsha 410013, China
| | - Xiangqi Tang
- Department of Neurology, The Second Xiangya Hospital of Central South University, Changsha 410011, China.
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Gawron N, Łojek E, Kijanowska-Haładyna B, Nestorowicz J, Harasim A, Pluta A, Sobańska M. Cognitive patterns of normal elderly subjects are consistent with frontal cortico-subcortical and fronto-parietal neuropsychological models of brain aging. APPLIED NEUROPSYCHOLOGY-ADULT 2013; 21:195-209. [PMID: 25084844 DOI: 10.1080/09084282.2013.789965] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Three neuropsychological theories have been developed according to a possible existence of a similar pattern of cognitive decline in elderly individuals and patients with brain damage. The respective neuropsychological theories attribute age-related deficits to: (a) dysfunction of the frontal lobes, (b) temporo-parietal dysfunction, or (c) decline of right-hemisphere functions. In the present study, we examined which of these theories best explains the cognitive patterns of normal elderly subjects older than 80 years of age (old elderly). Thirty normal old elderly subjects, 14 patients with subcortical vascular dementia, 14 with mild Alzheimer's disease, 15 with damage of the right hemisphere of the brain, and 20 young elderly controls participated. A test battery covering the main cognitive domains was administered to all participants. A hierarchical cluster analysis revealed five groups of individuals with different cognitive patterns across the whole sample. Old elderly subjects were assigned to four groups according to: (a) preserved overall cognitive performance, (b) processing speed decline, (c) attention decline, or (d) executive impairment. The results of the study are most congruent with models emphasizing frontal-lobe cortical-subcortical and fronto-parietal changes in old age. The results also indicate considerable heterogeneity in the cognitive patterns of normal old elderly adults.
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Affiliation(s)
- Natalia Gawron
- a Faculty of Psychology , University of Warsaw , Warsaw , Poland
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Makin SDJ, Turpin S, Dennis MS, Wardlaw JM. Cognitive impairment after lacunar stroke: systematic review and meta-analysis of incidence, prevalence and comparison with other stroke subtypes. J Neurol Neurosurg Psychiatry 2013; 84:893-900. [PMID: 23457225 PMCID: PMC3717603 DOI: 10.1136/jnnp-2012-303645] [Citation(s) in RCA: 170] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cognitive impairment and dementia are common after stroke. It is unclear if risk differs between ischaemic stroke subtypes. Lacunar strokes might be less likely to affect cognition than more severe, larger cortical strokes, except that lacunar strokes are associated with cerebral small vessel disease (SVD), which is the commonest vascular cause of dementia. METHODS We searched MEDLINE and PsychINFO for studies of mild cognitive impairment (MCI) or dementia after lacunar or cortical ischaemic stroke. We calculated the OR for cognitive impairment/dementia in lacunar versus non-lacunar stroke, and their incidence and prevalence in lacunar stroke as a pooled proportion. FINDINGS We identified 24 relevant studies of 7575 patients, including 2860 with lacunar stroke; 24% had MCI or dementia post stroke. Similar proportions of patients with lacunar and non-lacunar stroke (16 studies, n=6478) had MCI or dementia up to 4 years after stroke (OR 0.72 (95% CI 0.43 to 1.20)). The prevalence of dementia after lacunar stroke (six studies, n=1421) was 20% (95% CI 9 to 33) and the incidence of MCI or dementia (four studies, n=275) was 37% (95% CI 23 to 53). Data were limited by short follow-up, subtype classification methods and confounding. INTERPRETATION Cognitive impairment appears to be common after lacunar strokes despite their small size, suggesting that associated SVD may increase their impact. New prospective studies are required with accurate stroke subtyping to assess long term outcomes while accounting for confounders.
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Affiliation(s)
- Stephen David James Makin
- Division of Clinical Neurosciences, University of Edinburgh, Bramwell Dott Building, Western General Hospital, Crewe Road, Edinburgh EH4 2XU, UK.
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Chin Y, Kishi M, Sekino M, Nakajo F, Abe Y, Terazono Y, Hiroyuki O, Kato F, Koizumi S, Gachet C, Hisatsune T. Involvement of glial P2Y₁ receptors in cognitive deficit after focal cerebral stroke in a rodent model. J Neuroinflammation 2013; 10:95. [PMID: 23890321 PMCID: PMC3733849 DOI: 10.1186/1742-2094-10-95] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Accepted: 07/19/2013] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Neuroinflammation is associated with many conditions that lead to dementia, such as cerebrovascular disorders or Alzheimer's disease. However, the specific role of neuroinflammation in the progression of cognitive deficits remains unclear. To understand the molecular mechanisms underlying these events we used a rodent model of focal cerebral stroke, which causes deficits in hippocampus-dependent cognitive function. METHODS Cerebral stroke was induced by middle cerebral artery occlusion (MCAO). Hippocampus-dependent cognitive function was evaluated by a contextual fear conditioning test. The glial neuroinflammatory responses were investigated by immunohistochemical evaluation and diffusion tensor MRI (DTI). We used knockout mice for P2Y₁ (P2Y₁KO), a glial ADP/ATP receptor that induces the release of proinflammatory cytokines, to examine the links among P2Y₁-mediated signaling, the neuroinflammatory response, and cognitive function. RESULTS Declines in cognitive function and glial neuroinflammatory response were observed after MCAO in both rats and mice. Changes in the hippocampal tissue were detected by DTI as the mean diffusivity (MD) value, which corresponded with the cognitive decline at 4 days, 1 week, 3 weeks, and 2 months after MCAO. Interestingly, the P2Y₁KO mice with MCAO showed a decline in sensory-motor function, but not in cognition. Furthermore, the P2Y₁KO mice showed neither a hippocampal glial neuroinflammatory response (as assessed by immunohistochemistry) nor a change in hippocampal MD value after MCAO. In addition, wild-type mice treated with a P2Y₁-specific antagonist immediately after reperfusion did not show cognitive decline. CONCLUSION Our findings indicate that glial P2Y₁ receptors are involved in the hippocampal inflammatory response. The findings from this study may contribute to the development of a therapeutic strategy for brain infarction, targeting the P2Y₁ receptor.
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Affiliation(s)
- Yo Chin
- Department of Integrated Biosciences, The University of Tokyo, 5-1-5 Kashiwanoha, Kashiwa, Chiba 277-8562, Japan
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Brait VH, Martin KR, Corlett A, Broughton BRS, Kim HA, Thundyil J, Drummond GR, Arumugam TV, Pritchard MA, Sobey CG. Over-expression of DSCR1 protects against post-ischemic neuronal injury. PLoS One 2012; 7:e47841. [PMID: 23144708 PMCID: PMC3483156 DOI: 10.1371/journal.pone.0047841] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Accepted: 09/21/2012] [Indexed: 01/27/2023] Open
Abstract
Background and Purpose The Down syndrome candidate region 1 (DSCR1) gene is located on human chromosome 21 and its protein is over-expressed in brains of Down syndrome individuals. DSCR1 can modulate the activity of calcineurin, a phosphatase abundant in the brain, but its influence on stroke outcome is not clear. We compared stroke outcome in wildtype (WT) and transgenic (DSCR1-TG) mice which over-express isoform 1 of human DSCR1. Methods Transient cerebral ischemia was produced by occlusion of the middle cerebral artery for 0.5 h. After 23.5 h reperfusion, we assessed neurological impairment, brain infarct and edema volume, leukocyte infiltration and markers of inflammation. Intrinsic resistance to apoptosis following glucose deprivation was also assessed in primary cultures of WT and DSCR1-TG neurons. Results In contrast to WT, DSCR1-TG mice had an improved neurological deficit score, greater grip strength, attenuated infarct volume and brain swelling, and lacked hippocampal lesions after stroke. Expression of mouse DSCR1-1, but not DSCR1-4, mRNA and protein was increased by ischemia in both WT and DSCR1-TG. Brain calcineurin activity was increased to a similar degree after ischemia in each genotype. DSCR1-TG mice had fewer infiltrating neutrophils and activated microglia compared with WT, in association with an attenuated upregulation of several pro-inflammatory genes. Neurons from DSCR1-TG mice were more resistant than WT neurons to apoptotic cell death following 24 h of glucose deprivation. Conclusions Over-expression of DSCR1 in mice improves outcome following stroke. Mechanisms underlying this protection may involve calcineurin-independent, anti-inflammatory and anti-apoptotic effects mediated by DSCR1 in neurons.
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Affiliation(s)
- Vanessa H. Brait
- Vascular Biology and Immunopharmacology Group, Department of Pharmacology, Monash University, Clayton, Victoria, Australia
| | - Katherine R. Martin
- Department of Biochemistry and Molecular Biology, Monash University, Clayton, Victoria, Australia
| | - Alicia Corlett
- Department of Biochemistry and Molecular Biology, Monash University, Clayton, Victoria, Australia
| | - Brad R. S. Broughton
- Vascular Biology and Immunopharmacology Group, Department of Pharmacology, Monash University, Clayton, Victoria, Australia
| | - Hyun Ah Kim
- Vascular Biology and Immunopharmacology Group, Department of Pharmacology, Monash University, Clayton, Victoria, Australia
| | - John Thundyil
- School of Biomedical Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Grant R. Drummond
- Vascular Biology and Immunopharmacology Group, Department of Pharmacology, Monash University, Clayton, Victoria, Australia
| | - Thiruma V. Arumugam
- School of Biomedical Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Melanie A. Pritchard
- Department of Biochemistry and Molecular Biology, Monash University, Clayton, Victoria, Australia
- * E-mail:
| | - Christopher G. Sobey
- Vascular Biology and Immunopharmacology Group, Department of Pharmacology, Monash University, Clayton, Victoria, Australia
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Aben L, Heijenbrok-Kal MH, van Loon EMP, Groet E, Ponds RWHM, Busschbach JJV, Ribbers GM. Training Memory Self-efficacy in the Chronic Stage After Stroke. Neurorehabil Neural Repair 2012; 27:110-7. [DOI: 10.1177/1545968312455222] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. Stroke patients with a low memory self-efficacy (MSE) report more memory complaints than patients with a high MSE. Objective. The aim of this study was to examine the effect of a memory-training program on MSE in the chronic phase after stroke and to identify which patients benefit most from the MSE training program. Methods. In a randomized controlled trial, the effectiveness of the MSE training program (experimental group) was compared with a peer support program (control group) in chronic stroke patients. The primary outcome was MSE, measured using the Metamemory-In-Adulthood Questionnaire. Secondary outcomes included depression, quality of life, and objective verbal memory capacity. Changes in outcomes over the intervention period were compared between both groups. Demographic and clinical variables were studied as potential predictors of MSE outcome in the experimental group. Results. In total, 153 patients were included: mean age = 58 years (standard deviation [SD] = 9.7), 54.9% male, and mean of 54 months (SD = 37) after stroke. Of these, 77 were assigned to the training and 76 to the control group. Improvement of MSE ( B = 0.40; P = .019) was significantly greater in the training than in the control group. No significant differences were found for the secondary outcomes. An increase in MSE after training was predicted by a younger age ( B = −0.033; P = .006) and a better memory capacity ( B = 0.043; P = .009), adjusted for baseline MSE. Conclusions. MSE can be improved by the MSE training program for stroke patients. Younger patients and patients with a better memory capacity benefit most from the MSE training program (Dutch Trial Register: NTR-TC 1656).
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Affiliation(s)
- Laurien Aben
- Erasmus MC, Rotterdam, the Netherlands
- Rijndam Rehabilitation Centre, Rotterdam, the Netherlands
| | | | | | - Erny Groet
- Heliomare Rehabilitation Centre, Wijk aan Zee, the Netherlands
| | | | | | - Gerard M. Ribbers
- Erasmus MC, Rotterdam, the Netherlands
- Rijndam Rehabilitation Centre, Rotterdam, the Netherlands
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van Almenkerk S, Depla MFIA, Smalbrugge M, Eefsting JA, Hertogh CMPM. Institutionalized stroke patients: status of functioning of an under researched population. J Am Med Dir Assoc 2012; 13:634-9. [PMID: 22705032 DOI: 10.1016/j.jamda.2012.05.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2012] [Revised: 05/11/2012] [Accepted: 05/11/2012] [Indexed: 12/13/2022]
Abstract
OBJECTIVES In view of the development of an integrated care and treatment program for institutionalized stroke patients tailored to their needs, we aimed to explore their status of functioning in the physical, cognitive, emotional, communicative and social domains. In addition, we explored the relation between status of functioning and stroke characteristics. DESIGN A cross-sectional, observational study. SETTING Dutch nursing homes (NHs). PARTICIPANTS Residents with stroke as main diagnosis for NH-admission, who experienced a stroke ≥3 months ago and stayed ≥1 month in a long term care ward. MEASUREMENTS Attending physicians provided information about stroke subtype, stroke location and time post-stroke. Status of functioning was measured through an observation list comprising the Barthel Index, the Neuropsychiatric Inventory Questionnaire, and sections of the Resident Assessment Instrument for Long-Term Care Facilities. The list was filled out in a structured interview with a qualified nurse assistant who knew the resident well. RESULTS We included 274 residents (mean age 76.6, 58.4% female). The stroke that caused NH-dependency was in 81.3% ischemic, and in 49.8% right-sided. Median time post-stroke was 47 months; 90.9% of the residents were severely dependent in basic activities of daily living and 58% were in pain. Nearly half of the residents showed moderate (24.4%) or severe (23%) cognitive impairment. Irritability (52.9%), depressive symptoms (52.6%) and apathy (34.3%) occurred as the most frequent neuropsychiatric symptoms; 27.7% had a poor ability to express themselves and 30.3% had a low social engagement. We found more severe cognitive impairment, agitation/aggression and poor expression in left-sided strokes, more nighttime behavioral disturbances and delusions in right-sided strokes, and lower social engagement in residents with the largest time-interval post-stroke. CONCLUSION This study among institutionalized stroke patients in Dutch NHs revealed very high prevalence of impairments on all domains of functioning, above the well-known severe disabilities in basic activities of daily living. The monitoring and management of both pain and neuropsychiatric symptoms should be key elements in an integrated care and treatment program.
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Affiliation(s)
- Suzanne van Almenkerk
- Department of General Practice and Elderly Care Medicine and EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, Amsterdam, The Netherlands.
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