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Tsiakiri A, Christidi F, Tsiptsios D, Vlotinou P, Kitmeridou S, Bebeletsi P, Kokkotis C, Serdari A, Tsamakis K, Aggelousis N, Vadikolias K. Processing Speed and Attentional Shift/Mental Flexibility in Patients with Stroke: A Comprehensive Review on the Trail Making Test in Stroke Studies. Neurol Int 2024; 16:210-225. [PMID: 38392955 PMCID: PMC10893544 DOI: 10.3390/neurolint16010014] [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: 12/30/2023] [Revised: 01/17/2024] [Accepted: 01/19/2024] [Indexed: 02/25/2024] Open
Abstract
The Trail Making Test (TMT) is one of the most commonly administered tests in clinical and research neuropsychological settings. The two parts of the test (part A (TMT-A) and part B (TMT-B)) enable the evaluation of visuoperceptual tracking and processing speed (TMT-A), as well as divided attention, set-shifting and cognitive flexibility (TMT-B). The main cognitive processes that are assessed using TMT, i.e., processing speed, divided attention, and cognitive flexibility, are often affected in patients with stroke. Considering the wide use of TMT in research and clinical settings since its introduction in neuropsychological practice, the purpose of our review was to provide a comprehensive overview of the use of TMT in stroke patients. We present the most representative studies assessing processing speed and attentional shift/mental flexibility in stroke settings using TMT and applying scoring methods relying on conventional TMT scores (e.g., time-to-complete part A and part B), as well as derived measures (e.g., TMT-(B-A) difference score, TMT-(B/A) ratio score, errors in part A and part B). We summarize the cognitive processes commonly associated with TMT performance in stroke patients (e.g., executive functions), lesion characteristics and neuroanatomical underpinning of TMT performance post-stroke, the association between TMT performance and patients' instrumental activities of daily living, motor difficulties, speech difficulties, and mood statue, as well as their driving ability. We also highlight how TMT can serve as an objective marker of post-stroke cognitive recovery following the implementation of interventions. Our comprehensive review underscores that the TMT stands as an invaluable asset in the stroke assessment toolkit, contributing nuanced insights into diverse cognitive, functional, and emotional dimensions. As research progresses, continued exploration of the TMT potential across these domains is encouraged, fostering a deeper comprehension of post-stroke dynamics and enhancing patient-centered care across hospitals, rehabilitation centers, research institutions, and community health settings. Its integration into both research and clinical practice reaffirms TMT status as an indispensable instrument in stroke-related evaluations, enabling holistic insights that extend beyond traditional neurological assessments.
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Affiliation(s)
- Anna Tsiakiri
- Neurology Department, School of Medicine, Democritus University of Thrace, 681 00 Alexandroupolis, Greece; (A.T.); (F.C.); (P.V.); (S.K.); (P.B.); (K.V.)
| | - Foteini Christidi
- Neurology Department, School of Medicine, Democritus University of Thrace, 681 00 Alexandroupolis, Greece; (A.T.); (F.C.); (P.V.); (S.K.); (P.B.); (K.V.)
| | - Dimitrios Tsiptsios
- Neurology Department, School of Medicine, Democritus University of Thrace, 681 00 Alexandroupolis, Greece; (A.T.); (F.C.); (P.V.); (S.K.); (P.B.); (K.V.)
| | - Pinelopi Vlotinou
- Neurology Department, School of Medicine, Democritus University of Thrace, 681 00 Alexandroupolis, Greece; (A.T.); (F.C.); (P.V.); (S.K.); (P.B.); (K.V.)
| | - Sofia Kitmeridou
- Neurology Department, School of Medicine, Democritus University of Thrace, 681 00 Alexandroupolis, Greece; (A.T.); (F.C.); (P.V.); (S.K.); (P.B.); (K.V.)
| | - Paschalina Bebeletsi
- Neurology Department, School of Medicine, Democritus University of Thrace, 681 00 Alexandroupolis, Greece; (A.T.); (F.C.); (P.V.); (S.K.); (P.B.); (K.V.)
| | - Christos Kokkotis
- Department of Physical Education and Sport Science, Democritus University of Thrace, 691 00 Komotini, Greece; (C.K.); (N.A.)
| | - Aspasia Serdari
- Department of Child and Adolescent Psychiatry, School of Medicine, Democritus University of Thrace, 681 00 Alexandroupolis, Greece;
| | - Konstantinos Tsamakis
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, London SE5 8AB, UK;
| | - Nikolaos Aggelousis
- Department of Physical Education and Sport Science, Democritus University of Thrace, 691 00 Komotini, Greece; (C.K.); (N.A.)
| | - Konstantinos Vadikolias
- Neurology Department, School of Medicine, Democritus University of Thrace, 681 00 Alexandroupolis, Greece; (A.T.); (F.C.); (P.V.); (S.K.); (P.B.); (K.V.)
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Capobianco L, Faija C, Husain Z, Wells A. Metacognitive beliefs and their relationship with anxiety and depression in physical illnesses: A systematic review. PLoS One 2020; 15:e0238457. [PMID: 32911486 PMCID: PMC7500039 DOI: 10.1371/journal.pone.0238457] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 08/17/2020] [Indexed: 02/06/2023] Open
Abstract
Anxiety and depression are common among patients with chronic physical illnesses
and have a significant impact on morbidity, quality of life, and health service
utilisation. Psychological treatment of anxiety and depression has small to
moderate efficacy in this group and is not commonly based on a model of causal
mechanisms. A novel approach to understanding and improving mental health
outcomes in physical illnesses is needed. One approach may be to explore the
role of metacognitive beliefs which are reliably associated with anxiety and
depression in individuals with mental health difficulties. The current
systematic review aimed to evaluate the contribution of metacognitive beliefs to
anxiety and depression across physical illnesses. Systematic searches were
conducted on Web of Science, PsychINFO, MEDLINE, Embase, and CINAHL of studies
published between 1997 and January 2019. 13 eligible studies were identified
that in sum comprised 2851 participants. Metacognitive beliefs were found to
have reliable, moderate, positive and significant associations with anxiety and
depression symptoms across a range of physical illnesses. There appeared to be
commonality and some specificity in the relationships. Negative metacognitive
beliefs concerned with uncontrollability and danger of worry were associated
with both anxiety and depression across all physical illnesses assessed, whilst
more specific associations emerged for individual medical conditions where
positive beliefs about worry, cognitive confidence and cognitive
self-consciousness were unique correlates. Negative metacognitive beliefs of
uncontrollability and danger significantly and positively predicted symptoms of
anxiety and depression after controlling for factors including age, gender,
disease factors and cognition (illness perceptions and intolerance of
uncertainty). The results suggest that the metacognitive model of psychological
disorder is applicable to psychological symptoms of anxiety and depression
across a range of chronic medical conditions, implying that metacognitive
therapy might be helpful in improving outcomes in multiple morbidities that
involve poor mental and medical health.
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Affiliation(s)
- Lora Capobianco
- Research and Innovation, Greater Manchester Mental Health NHS Foundation
Trust, Manchester, United Kingdom
- * E-mail:
| | - Cintia Faija
- Division of Nursing, Midwifery & Social Work, Faculty of Biology,
Medicine and Health, Manchester Academic Health Science Centre, The University
of Manchester, Manchester, United Kingdom
| | - Zara Husain
- Research and Innovation, Greater Manchester Mental Health NHS Foundation
Trust, Manchester, United Kingdom
| | - Adrian Wells
- Research and Innovation, Greater Manchester Mental Health NHS Foundation
Trust, Manchester, United Kingdom
- Faculty of Biology, Medicine and Health, School of Psychological
Sciences, Manchester Academic Health Science Centre, The University of
Manchester, Manchester, United Kingdom
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Knapp P, Dunn-Roberts A, Sahib N, Cook L, Astin F, Kontou E, Thomas SA. Frequency of anxiety after stroke: An updated systematic review and meta-analysis of observational studies. Int J Stroke 2020; 15:244-255. [PMID: 31980004 DOI: 10.1177/1747493019896958] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Anxiety is a common and distressing problem after stroke. AIMS To undertake an updated systematic review and meta-analysis of observational studies of anxiety after stroke and integrate the findings with those reported previously. SUMMARY OF REVIEW Multiple databases were searched in May 2018 and 53 new studies were included following dual independent sifting and data extraction. These were combined with 44 previous studies to form a combined data set of 97 studies, comprising 22,262 participants. Studies using interview methods were of higher quality. Rates of anxiety by interview were 18.7% (95% confidence interval 12.5, 24.9%) and 24.2% (95% confidence interval 21.5, 26.9%) by rating scale. Rates of anxiety did not lower meaningfully up to 24 months after stroke. Eight different anxiety subtypes were also reported. CONCLUSIONS This review confirms that anxiety occurs in around one in four patients (by rating scale) and one in five patients (by interview). More research on anxiety subtypes is needed for an informed understanding of its effects and the development of interventions.
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Affiliation(s)
- Peter Knapp
- Department of Health Sciences, University of York, York, UK
| | | | - Nimah Sahib
- Hull York Medical School, Kingston upon Hull, UK
| | - Liz Cook
- Department of Health Sciences, University of York, York, UK
| | | | - Eirini Kontou
- Medical School Queens Medical Centre, University of Nottingham, Nottingham, UK
| | - Shirley A Thomas
- Medical School Queens Medical Centre, University of Nottingham, Nottingham, UK
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Lenzo V, Sardella A, Martino G, Quattropani MC. A Systematic Review of Metacognitive Beliefs in Chronic Medical Conditions. Front Psychol 2020; 10:2875. [PMID: 31998178 PMCID: PMC6965316 DOI: 10.3389/fpsyg.2019.02875] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 12/04/2019] [Indexed: 12/19/2022] Open
Abstract
Background: Psychological functioning plays an important role in medical conditions and impacts patients' quality of life. Previously, many studies have highlighted the association of metacognition to both the development and maintenance of emotional disorders. Recently, several researchers pointed out the relevant role of dysfunctional metacognitive beliefs in the context of chronic diseases. Hence, dysfunctional metacognitive beliefs could be directly related to anxiety and depression, regardless of the medical condition's expression. The aim of this systematic review was to summarize the available evidence regarding the association of metacognition with anxiety, depression, and perceived quality of life, in the context of medical conditions, according to Wells' theory. Methods: A systematic review based on electronic bibliographic databases (PsycINFO, PubMed, Scopus, Web of Science, and Web of Knowledge) of scientific literature was carried out. Studies involving patients evaluated in clinical settings were included in the analysis. Results: Our findings indicated that metacognition appears to be related to anxiety, depression, and quality of life in patients with medical chronic conditions. Therefore, dysfunctional metacognitive beliefs might be a relevant factor associated with the process of adapting to illness. Conclusions: The additional evaluation of metacognitive factors in the context of several medical chronic conditions appears valuable. Due to the rising interest in the study of metacognition, suggestions for future research have also been provided.
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Affiliation(s)
- Vittorio Lenzo
- Department of Human, Social and Health Sciences, University of Cassino and South Latium, Cassino, Italy
| | - Alberto Sardella
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Gabriella Martino
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Maria C Quattropani
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
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Backhouse EV, McHutchison CA, Cvoro V, Shenkin SD, Wardlaw JM. Cognitive ability, education and socioeconomic status in childhood and risk of post-stroke depression in later life: A systematic review and meta-analysis. PLoS One 2018; 13:e0200525. [PMID: 30011299 PMCID: PMC6047794 DOI: 10.1371/journal.pone.0200525] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 06/28/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Depression after stroke is common and is associated with poorer recovery. Risk factors such as gender, age and stroke severity are established, but it is unclear whether factors from earlier in life might also contribute. METHODS We searched MEDLINE, PsycINFO, EMBASE and meta-analysed all available evidence on childhood (premorbid) IQ, socioeconomic status (SES), education and stroke in adulthood. We included all studies reporting data on >50 patients, calculating overall odds ratios (OR), mean difference, correlation, 95% confidence intervals (CI) and 95% predictive intervals (PI) using random effects methods. We quality assessed all studies, performed sensitivity analyses, assessed heterogeneity and publication bias. RESULTS We identified 33 studies including 2,664 participants with post-stroke depression and 5,460 without (314 participants not classified). Low education (< = 8 years) was associated with post-stroke depression in studies which defined depression as score of mild and above on a depression rating scale (OR 1.47 95% CI 1.10-1.97, p<0.01) but not in studies where depression was defined as severe depressive symptoms or a clinical diagnosis of major depression (OR 1.04 95% CI 0.90-1.31, p = 0.60). Low education was not associated with an increased risk for post-stroke depression in studies that adjusted for age and sex (OR 0.86 95% CI 0.50-1.48 p = 0.58). Those with post-stroke depression had fewer years of education than those without post-stroke depression (MD 0.68 95% CI 0.05-1.31 p = 0.04). Few studies adjusted for vascular risk factors or stroke severity. Heterogeneity between studies was moderate and was partly explained by severity of depression. In the one study identified premorbid IQ did not differ between those with post-stroke depression (mean IQ 10.1.8 SD 9.8) vs those without (mean IQ 104 SD 10.1). There were no studies that examined childhood socioeconomic status and risk of post-stroke depression. CONCLUSIONS Having less education is associated with an increased risk of post-stroke depressive symptoms but with large confidence intervals and heterogeneity. Future studies should explore the relationship between early and late life risk factors to improve risk identification and to target prevention and treatment strategies.
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Affiliation(s)
- Ellen V. Backhouse
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Caroline A. McHutchison
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, United Kingdom
| | - Vera Cvoro
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, United Kingdom
- Scottish Imaging Network, A Platform for Scientific Excellence (SINAPSE), Scotland, United Kingdom
| | - Susan D. Shenkin
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, United Kingdom
- Scottish Imaging Network, A Platform for Scientific Excellence (SINAPSE), Scotland, United Kingdom
- Geriatric Medicine, Department of Clinical and Surgical Sciences, The University of Edinburgh, Edinburgh, United Kingdom
| | - Joanna M. Wardlaw
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, United Kingdom
- Scottish Imaging Network, A Platform for Scientific Excellence (SINAPSE), Scotland, United Kingdom
- UK Dementia Research Institute at The University of Edinburgh, Edinburgh Medical School, Edinburgh, United Kingdom
- * E-mail:
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Fishman KN, Ashbaugh AR, Lanctôt KL, Cayley ML, Herrmann N, Murray BJ, Sicard M, Lien K, Sahlas DJ, Swartz RH. The Role of Apathy and Depression on Verbal Learning and Memory Performance After Stroke. Arch Clin Neuropsychol 2018; 34:327-336. [DOI: 10.1093/arclin/acy044] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 04/09/2018] [Accepted: 04/30/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Keera N Fishman
- School of Psychology, Faculty of Social Sciences, University of Ottawa, Jean Jacques Lussier, VNR, Ottawa, Ontario, K1N 6N5, Canada
- Department of Medicine (Psychiatry), Sunnybrook Health Sciences Centre, Bayview Avenue, Room FG21, Toronto, Ontario, M4N 3M5, Canada
| | - Andrea R Ashbaugh
- School of Psychology, Faculty of Social Sciences, University of Ottawa, Jean Jacques Lussier, VNR, Ottawa, Ontario, K1N 6N5, Canada
| | - Krista L Lanctôt
- Department of Medicine (Psychiatry), Sunnybrook Health Sciences Centre, Bayview Avenue, Room FG21, Toronto, Ontario, M4N 3M5, Canada
| | - Megan L Cayley
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada
| | - Nathan Herrmann
- Department of Medicine (Psychiatry), Sunnybrook Health Sciences Centre, Room FG19, Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada
| | - Brian J Murray
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada
| | - Michelle Sicard
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, Toronto, Ontario, M4N 3M5, Canada
| | - Karen Lien
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, Toronto, Ontario, M4N 3M5, Canada
| | - Demetrios J Sahlas
- Department of Medicine (Neurology), McMaster University, Hamilton, Ontario, Canada
| | - Richard H Swartz
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada
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