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Laskowitz DT, Troy J, Poehlein E, Bennett ER, Shpall EJ, Wingard JR, Freed B, Belagaje SR, Khanna A, Jones W, Volpi JJ, Marrotte E, Kurtzberg J. A Randomized, Placebo-Controlled, Phase II Trial of Intravenous Allogeneic Non-HLA Matched, Unrelated Donor, Cord Blood Infusion for Ischemic Stroke. Stem Cells Transl Med 2024; 13:125-136. [PMID: 38071749 PMCID: PMC10872695 DOI: 10.1093/stcltm/szad080] [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: 05/30/2023] [Accepted: 08/13/2023] [Indexed: 02/18/2024] Open
Abstract
Stroke remains a leading cause of death and disability in the US, and time-limited reperfusion strategies remain the only approved treatment options. To address this unmet clinical need, we conducted a phase II randomized clinical trial to determine whether intravenous infusion of banked, non-HLA matched unrelated donor umbilical cord blood (UCB) improved functional outcome after stroke. Participants were randomized 2:1 to UCB or placebo within strata of National Institutes of Health Stroke Scale Score (NIHSS) and study center. Study product was infused 3-10 days following index stroke. The primary endpoint was change in modified Rankin Scale (mRS) from baseline to day 90. Key secondary outcomes included functional independence, NIHSS, the Barthel Index, and assessment of adverse events. The trial was terminated early due to slow accrual and logistical concerns associated with the COVID-19 pandemic, and a total of 73 of a planned 100 participants were included in primary analyses. The median (range) of the change in mRS was 1 point (-2, 3) in UCB and 1 point (-1,4) in Placebo (P = 0.72). A shift analysis comparing the mRS at day 90 utilizing proportional odds modeling showed a common odds ratio of 0.9 (95% CI: 0.4, 2.3) after adjustment for baseline NIHSS and randomization strata. The distribution of adverse events was similar between arms. Although this study did not suggest any safety concerns related to UCB in ischemic stroke, we did not show a clinical benefit in the reduced sample size evaluated.
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Affiliation(s)
- Daniel T Laskowitz
- Department of Neurology, Duke University School of Medicine, Durham, NC, USA
| | - Jesse Troy
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Emily Poehlein
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Ellen R Bennett
- Department of Neurology, Duke University School of Medicine, Durham, NC, USA
| | | | - John R Wingard
- LifeSouth Cord Blood Bank, University of Florida, Gainesville, FL, USA
| | - Brian Freed
- ClinImmune Labs, University of Colorado Cord Blood Bank, Aurora, CO, USA
| | - Samir R Belagaje
- Departments of Neurology and Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Anna Khanna
- Department of Neurology, University of Florida, Gainesville, FL, USA
| | - William Jones
- Department of Neurology, University of Colorado, Aurora, CO, USA
| | - John J Volpi
- Department of Neurology, Houston Methodist, Houston, TX, USA
| | - Eric Marrotte
- Department of Neurology, Wake Forest University Baptist Medical Center, Winston-Salem, NC, USA
| | - Joanne Kurtzberg
- Marcus Center for Cellular Cures, Duke University School of Medicine, Durham, NC, USA
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2
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Johnson T, Ridgeway G, Luchmee D, Jacob J, Kantak S. Bimanual coordination during reach-to-grasp actions is sensitive to task goal with distinctions between left- and right-hemispheric stroke. Exp Brain Res 2022; 240:2359-2373. [PMID: 35869986 PMCID: PMC10077867 DOI: 10.1007/s00221-022-06419-2] [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: 10/19/2021] [Accepted: 07/06/2022] [Indexed: 11/30/2022]
Abstract
The perceptual feature of a task such as how a task goal is perceived influences performance and coordination of bimanual actions in neurotypical adults. To assess how bimanual task goal modifies paretic and non-paretic arm performance and bimanual coordination in individuals with stroke affecting left and right hemispheres, 30 participants with hemispheric stroke (15 right-hemisphere damage-RHD); 15 left-hemisphere damage-LHD) and 10 age-matched controls performed reach-to-grasp and pick-up actions under bimanual common-goal (i.e., two physically coupled dowels), bimanual independent-goal (two physically uncoupled dowels), and unimanual conditions. Reach-to-grasp time and peak grasp aperture indexed motor performance, while time lags between peak reach velocities, peak grasp apertures, and peak pick-up velocities of the two hands characterized reach, grasp, and pick-up coordination, respectively. Compared to unimanual actions, bimanual actions significantly slowed non-paretic arm speed to match paretic arm speed, thus affording no benefit to paretic arm performance. Detriments in non-paretic arm performance during bimanual actions was more pronounced in the RHD group. Under common-goal conditions, movements were faster with smaller peak grasp apertures compared to independent-goal conditions for all groups. Compared to controls, individuals with stroke demonstrated poor grasp and pick-up coordination. Of the patient groups, patients with LHD showed more pronounced deficits in grasp coordination between hands. Finally, grasp coordination deficits related to paretic arm motor deficits (upper extremity Fugl-Meyer score) for LHD group, and to Trail-Making Test performance for RHD group. Findings suggest that task goal and distinct clinical deficits influence bimanual performance and coordination in patients with left- and right-hemispheric stroke.
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Affiliation(s)
- Tessa Johnson
- Neuroplasticity and Motor Behavior Laboratory, Moss Rehabilitation Research Institute, Elkins Park, PA, 19027, USA
- Department of Health and Rehabilitation Sciences, Temple University, Philadelphia, PA, USA
| | - Gordon Ridgeway
- College of Medicine, Drexel University, Philadelphia, PA, USA
| | - Dustin Luchmee
- Neuroplasticity and Motor Behavior Laboratory, Moss Rehabilitation Research Institute, Elkins Park, PA, 19027, USA
| | - Joshua Jacob
- Neuroplasticity and Motor Behavior Laboratory, Moss Rehabilitation Research Institute, Elkins Park, PA, 19027, USA
| | - Shailesh Kantak
- Neuroplasticity and Motor Behavior Laboratory, Moss Rehabilitation Research Institute, Elkins Park, PA, 19027, USA.
- Department of Physical Therapy, Arcadia University, Glenside, PA, USA.
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3
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Aravind G, Bashir K, Cameron JI, Howe JA, Jaglal SB, Bayley MT, Teasell RW, Moineddin R, Zee J, Wodchis WP, Tee A, Hunter S, Salbach NM. Community-based exercise programs incorporating healthcare-community partnerships to improve function post-stroke: feasibility of a 2-group randomized controlled trial. Pilot Feasibility Stud 2022; 8:88. [PMID: 35459194 PMCID: PMC9028093 DOI: 10.1186/s40814-022-01037-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 03/17/2022] [Indexed: 11/10/2022] Open
Abstract
Background Despite the potential for community-based exercise programs supported through healthcare-community partnerships (CBEP-HCPs) to improve function post-stroke, insufficient trial evidence limits widespread program implementation and funding. We evaluated the feasibility and acceptability of a CBEP-HCP compared to a waitlist control group to improve everyday function among people post-stroke. Methods We conducted a 3-site, pilot randomized trial with blinded follow-up evaluations at 3, 6, and 10 months. Community-dwelling adults able to walk 10 m were stratified by site and gait speed and randomized (1:1) to a CBEP-HCP or waitlist control group. The CBEP-HCP involved a 1-h, group exercise class, with repetitive and progressive practice of functional balance and mobility tasks, twice a week for 12 weeks. We offered the exercise program to the waitlist group at 10 months. We interviewed 13 participants and 9 caregivers post-intervention and triangulated quantitative and qualitative results. Study outcomes included feasibility of recruitment, interventions, retention, and data collection, and potential effect on everyday function. Results Thirty-three people with stroke were randomized to the intervention (n = 16) or waitlist group (n = 17). We recruited 1–2 participants/month at each site. Participants preferred being recruited by a familiar healthcare professional. Participants described a 10- or 12-month wait in the control group as too long. The exercise program was implemented per protocol across sites. Five participants (31%) in the intervention group attended fewer than 50% of classes for health reasons. In the intervention and waitlist group, retention was 88% and 82%, respectively, and attendance at 10-month evaluations was 63% and 71%, respectively. Participants described inclement weather, availability of transportation, and long commutes as barriers to attending exercise classes and evaluations. Among participants in the CBEP-HCP who attended ≥ 50% of classes, quantitative and qualitative results suggested an immediate effect of the intervention on balance, balance self-efficacy, lower limb strength, everyday function, and overall health. Conclusion The CBEP-HCP appears feasible and potentially beneficial. Findings will inform protocol revisions to optimize recruitment, and program and evaluation attendance in a future trial. Trial registration ClinicalTrials.gov, NCT03122626. Registered April 21, 2017 — retrospectively registered.
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Affiliation(s)
- Gayatri Aravind
- Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada
| | - Kainat Bashir
- Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada
| | - Jill I Cameron
- Department of Occupational Science and Occupational Therapy, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada
| | - Jo-Anne Howe
- Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada.,Toronto Rehabilitation Institute, University Health Network, University of Toronto, 550 University Avenue, Toronto, ON, M5G 2A2, Canada
| | - Susan B Jaglal
- Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada.,The KITE Research Institute, University Health Network, 550 University Avenue, Toronto, ON, M5G 2A2, Canada
| | - Mark T Bayley
- Toronto Rehabilitation Institute, University Health Network, University of Toronto, 550 University Avenue, Toronto, ON, M5G 2A2, Canada.,The KITE Research Institute, University Health Network, 550 University Avenue, Toronto, ON, M5G 2A2, Canada.,Department of Medicine, University of Toronto, C. David Naylor Building, 6 Queen's Park Crescent West, Third Floor, London, ON, M5S 3H2, Canada
| | - Robert W Teasell
- Schulich School of Medicine and Dentistry, Western University, St Joseph's Health Care London - Parkwood Institute, 550 Wellington Rd, London, ON, N6C 0A7, Canada
| | - Rahim Moineddin
- Department of Family and Community Medicine, University of Toronto, 160‑500 University Avenue, Toronto, ON, M5G 1V7, Canada
| | - Joanne Zee
- Toronto General Hospital, University Health Network, 585 University Avenue, Toronto, ON, M5G 2N2, Canada
| | - Walter P Wodchis
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th Floor, Toronto, ON, M5T 3M6, Canada
| | - Alda Tee
- Central East Stroke Network, Royal Victoria Regional Health Centre, 201 Georgian Drive, Barrie, ON, L4M6M2, Canada
| | - Susan Hunter
- School of Physical Therapy, Western University, 1151 Richmond Street, London, ON, N6A 3K7, Canada
| | - Nancy M Salbach
- Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada. .,The KITE Research Institute, University Health Network, 550 University Avenue, Toronto, ON, M5G 2A2, Canada.
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Virtual Reality-Based Cognitive-Motor Rehabilitation in Older Adults with Mild Cognitive Impairment: A Randomized Controlled Study on Motivation and Cognitive Function. Healthcare (Basel) 2020; 8:healthcare8030335. [PMID: 32932997 PMCID: PMC7551774 DOI: 10.3390/healthcare8030335] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/08/2020] [Accepted: 09/10/2020] [Indexed: 12/03/2022] Open
Abstract
The purpose of this study was to investigate the effects of virtual reality-based cognitive–motor rehabilitation (VRCMR) on the rehabilitation motivation and cognitive function in older adults. This study enrolled 40 older adults with mild cognitive impairment (MCI), living in the community. The subjects were randomly assigned to a VRCMR group (n = 20) or a conventional cognitive rehabilitation (CCR) group (n = 20). The VRCMR group underwent VRCMR using MOTOcog, a computer recognition program, whereas the CCR group underwent conventional cognitive rehabilitation, which included puzzles, wood blocks, card play, stick construction activity, and maze activity. Both interventions were performed 30 min per day, 5 days/week, for 6 weeks. This study performed a cognitive assessment using the Montreal Cognitive Assessment (MoCA) scale, Trail Making Test A and B (TMT-A/B), and Digit Span Test forward and backward (DST-forward/backward). In addition, a 0-to-10 numeric rating self-report scale was used to assess interest and motivation during the rehabilitation training. After the intervention, the VRCMR group showed a significantly greater improvement in the MoCA (p = 0.045), TMT-A (p = 0.039), TMT-B (p = 0.040), and DST-forward (p = 0.011) scores compared to the CCR group, but not in the DST-backward score (p = 0.424). In addition, subjects in the experimental group had significantly higher interest (p = 0.03) and motivation (p = 0.03) than those in the control group. Cohen’s d effect size was 0.4, 0.3, 0.35, 0.4, and 0.5 for the MoCA, TMT-A, TMT-B, DST-forward, and DST-backward tests, respectively. This study demonstrates that VRCMR enhances motivation for rehabilitation and cognitive function in older adults with MCI better than CCR.
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5
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Zheng Z, Lang M, Wang W, Xiao F, Guo S, Li J. False Recognition of Emotionally Categorized Pictures in Young and Older Adults. Front Psychol 2019; 10:1477. [PMID: 31316434 PMCID: PMC6610321 DOI: 10.3389/fpsyg.2019.01477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 06/11/2019] [Indexed: 11/13/2022] Open
Abstract
Normal aging is associated with the shift in motivational priorities from knowledge acquisition to emotion regulation. Current evidence indicates an age-related increase in preferences for positive over negative stimuli in true memory. In the present study, using the categorized pictures paradigm, we investigated whether older adults would exhibit a greater increase in false memory for positive versus negative lures, compared with young adults. We also examined the association of executive functioning with the preferences for positive over negative pictures in false recognition memory. A total of 27 young and 26 older adults studied emotional pictures from various categories during encoding and subsequently completed an old/new recognition test. In addition, all participants completed the executive functioning tests. The results revealed that both older and young adults showed higher rates of false recognition for positive pictures compared with negative pictures; no significant group by valence interaction was observed. Trail making scores were negatively correlated with positive processing preferences in false recognition rates in older but not young adults. These findings suggest that false recognition memory exhibits preferences toward positively valenced stimuli in both young and older adults. Cognitive control processes are necessary for older adults to distort memory in emotionally gratifying ways.
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Affiliation(s)
- Zhiwei Zheng
- Center on Aging Psychology, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Minjia Lang
- Center on Aging Psychology, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Wei Wang
- Center on Aging Psychology, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Fengqiu Xiao
- China National Children's Center, Beijing, China
| | - Shuhan Guo
- Center on Aging Psychology, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Juan Li
- Center on Aging Psychology, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.,Magnetic Resonance Imaging Research Center, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,State Key Laboratory of Brain and Cognitive Science, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
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6
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Kurihara J, Lee B, Hara D, Noguchi N, Yamazaki T. Increased center of pressure trajectory of the finger during precision grip task in stroke patients. Exp Brain Res 2018; 237:327-333. [PMID: 30406395 DOI: 10.1007/s00221-018-5425-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 11/01/2018] [Indexed: 11/28/2022]
Abstract
The aim of this study was to assess the spatial stability of stroke patients while holding a freely movable object. Twenty-two acute stroke patients with mild hand impairment performed a grip and lift task using the thumb and index finger. The displacement of the center of pressure (COP) trajectory, the grip force (GF) and several clinical parameters were monitored. Although the GF was not different between paretic and nonparetic hands, the COP trajectory of the paretic index finger was increased. Moreover, the COP trajectories of the thumb and index finger in hemorrhagic patients were longer than those in ischemic patients. These discrepancies between kinetic parameters suggest that different aspects of grip force control may be considered in patients with mild stroke.
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Affiliation(s)
- Junichi Kurihara
- Division of Rehabilitation Service, Geriatrics Research Institute and Hospital, 3-26-8, Otomachi, Maebashi, Gunma, 371-0847, Japan
| | - Bumsuk Lee
- Gunma University Graduate School of Health Sciences, 3-39-22, Showa, Maebashi, Gunma, 371-8514, Japan.
| | - Daichi Hara
- Department of Rehabilitation, Maebashi Red Cross Hospital, 3-21-26, Asahi, Maebashi, Gunma, 371-0014, Japan
| | - Naoto Noguchi
- Gunma University Graduate School of Health Sciences, 3-39-22, Showa, Maebashi, Gunma, 371-8514, Japan
| | - Tsuneo Yamazaki
- Gunma University Graduate School of Health Sciences, 3-39-22, Showa, Maebashi, Gunma, 371-8514, Japan
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7
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Teuschl Y, Ihle-Hansen H, Matz K, Dachenhausen A, Ratajczak P, Tuomilehto J, Ursin MH, Hagberg G, Thommessen B, Øksengård AR, Brainin M. Multidomain intervention for the prevention of cognitive decline after stroke - a pooled patient-level data analysis. Eur J Neurol 2018; 25:1182-1188. [PMID: 29782693 PMCID: PMC6099341 DOI: 10.1111/ene.13684] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 05/03/2018] [Indexed: 12/16/2022]
Abstract
Background and purpose The aim of this pooled patient‐level data analysis was to test if multidomain interventions, addressing several modifiable vascular risk factors simultaneously, are more effective than usual post‐stroke care for the prevention of cognitive decline after stroke. Methods This pooled patient‐level data analysis included two randomized controlled trials using a multidomain approach to target vascular risk factors in stroke patients and cognition as primary outcome. Changes from baseline to 12 months in the trail making test (TMT)‐A, TMT‐B and 10‐words test were analysed using stepwise backward linear mixed models with study as random factor. Two analyses were based on the intention‐to‐treat (ITT) principle using different imputation approaches and one was based on complete cases. Results Data from 322 patients (157 assigned to multidomain intervention and 165 to standard care) were analysed. Differences between randomization groups for TMT‐A scores were found in one ITT model (P = 0.014) and approached significance in the second ITT model (P = 0.087) and for complete cases (P = 0.091). No significant intervention effects were found for any of the other cognitive variables. Conclusion We found indications that multidomain interventions compared with standard care can improve the scores in TMT‐A at 1 year after stroke but not those for TMT‐B or the 10‐words test. These results have to be interpreted with caution due to the small number of patients.
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Affiliation(s)
- Y Teuschl
- Department for Clinical Neurosciences and Preventive Medicine, Danube University Krems, Krems, Austria
| | - H Ihle-Hansen
- Department of Medicine, Vestre Viken Hospital Trust, Baerum Hospital, Drammen, Norway
| | - K Matz
- Department for Clinical Neurosciences and Preventive Medicine, Danube University Krems, Krems, Austria.,Karl Landsteiner University of Health Sciences, Krems, Austria.,Department of Neurology, University Hospital Tulln, Tulln, Austria
| | - A Dachenhausen
- Department for Clinical Neurosciences and Preventive Medicine, Danube University Krems, Krems, Austria
| | - P Ratajczak
- Department for Clinical Neurosciences and Preventive Medicine, Danube University Krems, Krems, Austria
| | - J Tuomilehto
- Department for Clinical Neurosciences and Preventive Medicine, Danube University Krems, Krems, Austria.,Dasman Diabetes Center, Dasman, Kuwait
| | - M H Ursin
- Department of Medicine, Vestre Viken Hospital Trust, Baerum Hospital, Drammen, Norway
| | - G Hagberg
- Department of Medicine, Vestre Viken Hospital Trust, Baerum Hospital, Drammen, Norway
| | - B Thommessen
- Department of Neurology, Akershus University Hospital, Oslo, Norway
| | - A R Øksengård
- Department of Medicine, Vestre Viken Hospital Trust, Baerum Hospital, Drammen, Norway
| | - M Brainin
- Department for Clinical Neurosciences and Preventive Medicine, Danube University Krems, Krems, Austria
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8
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Varjačić A, Mantini D, Levenstein J, Slavkova ED, Demeyere N, Gillebert CR. The role of left insula in executive set-switching: Lesion evidence from an acute stroke cohort. Cortex 2017; 107:92-101. [PMID: 29248158 PMCID: PMC6181803 DOI: 10.1016/j.cortex.2017.11.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 07/18/2017] [Accepted: 11/13/2017] [Indexed: 12/18/2022]
Abstract
Impairments in executive functions are common in stroke survivors, both in the acute and in the chronic phase. However, little is known about the underlying lesion neuroanatomy of these deficits. This study aimed to elucidate the pattern of brain damage underlying executive dysfunction in a large and acute stroke cohort. Executive set-switching deficits were evaluated by a shape-based analogue of the Trail Making Test (from the Oxford Cognitive Screen) in a consecutive sample of 144 stroke patients (age: 70 ± 15 years, examination: 5 ± 4 days post-stroke; brain imaging: 1.7 ± 2.9 days post-stroke). A voxelwise lesion-symptom mapping analysis was performed by combining executive set-switching accuracy scores with manually delineated lesions on computerized tomography or magnetic resonance imaging scans. The analysis showed that lesions within the left insular cortex and adjacent white matter predicted poorer executive set-switching. Further analyses confirmed that the lesion effect in the left insula survived correction for the low-level visuospatial and motor component processes of executive set-switching. In conclusion, the study provides lesion-based evidence for the role of the left insular cortex in flexible switching of attention. The findings are consistent with emergent models of insular function postulating the role of this region in regulatory aspects of goal-directed behaviour.
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Affiliation(s)
- Andreja Varjačić
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom.
| | - Dante Mantini
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom; Department of Brain and Cognition, University of Leuven, Leuven, Belgium; Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland.
| | - Jacob Levenstein
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom.
| | - Elitsa D Slavkova
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom.
| | - Nele Demeyere
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom.
| | - Céline R Gillebert
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom; Department of Brain and Cognition, University of Leuven, Leuven, Belgium.
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9
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MacPherson SE, Cox SR, Dickie DA, Karama S, Starr JM, Evans AC, Bastin ME, Wardlaw JM, Deary IJ. Processing speed and the relationship between Trail Making Test-B performance, cortical thinning and white matter microstructure in older adults. Cortex 2017; 95:92-103. [PMID: 28865241 PMCID: PMC5637162 DOI: 10.1016/j.cortex.2017.07.021] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 01/14/2017] [Accepted: 08/01/2017] [Indexed: 11/21/2022]
Abstract
Part B of the Trail Making Test (TMT-B) is widely used as a quick and easy to administer measure of executive dysfunction. The current study investigated the relationships between TMT-B performance, brain volumes, cortical thickness and white matter water diffusion characteristics in a large sample of older participants, before and after controlling for processing speed. Four hundred and eleven healthy, community-dwelling older adults who were all born in 1936 were assessed on TMT-B, 5 tests of processing speed, and provided contemporaneous structural and diffusion MRI data. Significant relationships were found between slower TMT-B completion times and thinner cortex in the frontal, temporal and inferior parietal regions as well as the Sylvian fissure/insula. Slower TMT-B completion time was also significantly associated with poorer white matter microstructure of the left anterior thalamic radiation, and the right uncinate fasciculus. The majority of these associations were markedly attenuated when additionally controlling for processing speed. These data suggest that individual differences in processing speed contribute to the associations between TMT-B completion time and the grey and white matter structure of older adults.
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Affiliation(s)
- Sarah E MacPherson
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, UK; Department of Psychology, University of Edinburgh, UK.
| | - Simon R Cox
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, UK; Department of Psychology, University of Edinburgh, UK; Scottish Imaging Network, a Platform for Scientific Excellence (SINAPSE) Collaboration, Edinburgh, UK
| | - David A Dickie
- Scottish Imaging Network, a Platform for Scientific Excellence (SINAPSE) Collaboration, Edinburgh, UK; Department of Neuroimaging Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, UK
| | - Sherif Karama
- Department of Neurology and Neurosurgery, McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal, QC, Canada; Department of Psychiatry, Douglas Mental Health University Institute, McGill University, Verdun, QC, Canada
| | - John M Starr
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, UK; Alzheimer Scotland Dementia Research Centre, The University of Edinburgh, Edinburgh, UK
| | - Alan C Evans
- Department of Neurology and Neurosurgery, McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Mark E Bastin
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, UK; Scottish Imaging Network, a Platform for Scientific Excellence (SINAPSE) Collaboration, Edinburgh, UK; Department of Neuroimaging Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, UK
| | - Joanna M Wardlaw
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, UK; Scottish Imaging Network, a Platform for Scientific Excellence (SINAPSE) Collaboration, Edinburgh, UK; Department of Neuroimaging Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, UK
| | - Ian J Deary
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, UK; Department of Psychology, University of Edinburgh, UK
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10
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Linder SM, Rosenfeldt AB, Rasanow M, Alberts JL. Forced Aerobic Exercise Enhances Motor Recovery After Stroke: A Case Report. Am J Occup Ther 2015; 69:6904210010p1-8. [PMID: 26114455 DOI: 10.5014/ajot.2015.015636] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Previously, we demonstrated that forced aerobic exercise (FE) increases the pattern of neural activation in Parkinson's disease. We sought to evaluate whether FE, when coupled with repetitive task practice, could promote motor recovery poststroke. METHOD A 46-yr-old man with ischemic stroke exhibited chronic residual upper-extremity deficits, scoring 35/66 on the Fugl-Meyer Assessment (FMA) at baseline. He completed 24 training sessions comprising 45 min of FE on a motorized stationary bicycle followed by 45 min of upper-extremity repetitive task practice. RESULTS From baseline to end of treatment, the FMA score improved by 20 points, perceived level of recovery on the Stroke Impact Scale increased by 20 percentage points, and cardiovascular function measured by peak oxygen uptake improved 30%. These improvements persisted 4 wk after the intervention ceased. CONCLUSION FE may be a safe and feasible rehabilitation approach to augment recovery of motor and nonmotor function while improving aerobic fitness in people with chronic stroke.
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Affiliation(s)
- Susan M Linder
- Susan M. Linder, PT, DPT, NCS, is Research Scientist, Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH;
| | - Anson B Rosenfeldt
- Anson B. Rosenfeldt, PT, DPT, MBA, is Senior Physical Therapist, Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH
| | - Matthew Rasanow
- Matthew Rasanow is Research Assistant, Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH
| | - Jay L Alberts
- Jay L. Alberts, PhD, is Staff, Department of Biomedical Engineering, Cleveland Clinic, and Investigator, Cleveland FES Center, L. Stokes Cleveland VA Medical Center, Cleveland, OH
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11
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Errors on the Trail Making Test Are Associated with Right Hemispheric Frontal Lobe Damage in Stroke Patients. Behav Neurol 2015; 2015:309235. [PMID: 26074673 PMCID: PMC4444530 DOI: 10.1155/2015/309235] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 03/20/2015] [Accepted: 04/15/2015] [Indexed: 12/01/2022] Open
Abstract
Measures of performance on the Trail Making Test (TMT) are among the most popular neuropsychological assessment techniques. Completion time on TMT-A is considered to provide a measure of processing speed, whereas completion time on TMT-B is considered to constitute a behavioral measure of the ability to shift between cognitive sets (cognitive flexibility), commonly attributed to the frontal lobes. However, empirical evidence linking performance on the TMT-B to localized frontal lesions is mostly lacking. Here, we examined the association of frontal lesions following stroke with TMT-B performance measures (i.e., completion time and completion accuracy measures) using voxel-based lesion-behavior mapping, with a focus on right hemispheric frontal lobe lesions. Our results suggest that the number of errors, but not completion time on the TMT-B, is associated with right hemispheric frontal lesions. This finding contradicts common clinical practice—the use of completion time on the TMT-B to measure cognitive flexibility, and it underscores the need for additional research on the association between cognitive flexibility and the frontal lobes. Further work in a larger sample, including left frontal lobe damage and with more power to detect effects of right posterior brain injury, is necessary to determine whether our observation is specific for right frontal lesions.
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12
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Song Y, Blackwell T, Yaffe K, Ancoli-Israel S, Redline S, Stone KL. Relationships between sleep stages and changes in cognitive function in older men: the MrOS Sleep Study. Sleep 2015; 38:411-21. [PMID: 25325465 PMCID: PMC4335525 DOI: 10.5665/sleep.4500] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 08/07/2014] [Indexed: 12/12/2022] Open
Abstract
STUDY OBJECTIVE To investigate the associations between sleep stage distributions and subsequent decline in cognitive function in older men over time. DESIGN A population-based prospective substudy of the Osteoporotic Fractures in Men Study. SETTINGS Six sites in the United States. PARTICIPANTS Community-dwelling men aged 67 y or older (n = 2,601), who were free of probable dementia at sleep visit. Follow-up averaged 3.4 y. MEASUREMENT AND RESULTS Sleep stages were identified by in-home polysomnography at the initial sleep visit (2003-2005). Cognitive outcomes were assessed with the Trail Making Test Part B and Modified Mini-Mental State Examination (3MS) at sleep visit and two follow-up visits. After adjusting for multiple confounders compared with men in the lowest quartile of percent of sleep time spent in Stage N1, those in the highest quartile had a twofold increase in cognitive decline for both cognitive tests (adjusted annualized percent change/y: Trail Making Test Part B Q1 = 1.06, Q4 = 2.45, P = 0.01; 3MS Q1 = -0.27, Q4 = -0.48, P = 0.03). In addition, compared with men in the highest quartile, men in the lowest quartile of percent of sleep time in Stage R revealed more cognitive decline on the 3MS (adjusted annualized percent change/y: Q1 = -0.49, Q4 = -0.22, P = 0.003). These findings were consistent even after further adjustment of total sleep time and sleep disordered breathing. No significant relationships between other sleep stages (N2, N3) and cognitive change were found. CONCLUSION Increased time in Stage N1 and less time in Stage R are associated with worsening cognitive performance in older men over time.
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Affiliation(s)
- Yeonsu Song
- VA Greater Los Angeles Healthcare System, Geriatric Research, Education, and Clinical Center, Los Angeles, CA
| | - Terri Blackwell
- San Francisco Coordinating Centers and California Pacific Medical Center Research Institute, San Francisco, CA
| | - Kristine Yaffe
- Department of Psychiatry, Neurology, and Epidemiology, School of Medicine, University of California, San Francisco, CA
| | - Sonia Ancoli-Israel
- Department of Psychiatry, School of Medicine, University of California, San Diego, CA
| | - Susan Redline
- Department of Medicine, Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Katie L. Stone
- San Francisco Coordinating Centers and California Pacific Medical Center Research Institute, San Francisco, CA
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13
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Conti J, Sterr A, Brucki SMD, Conforto AB. Diversity of approaches in assessment of executive functions in stroke: limited evidence? eNeurologicalSci 2015; 1:12-20. [PMID: 26623442 PMCID: PMC4662603 DOI: 10.1016/j.ensci.2015.08.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Stroke is a leading cause of disability worldwide. Cognitive functions and, in particular, executive function, are commonly affected after stroke, leading to impairments in performance of daily activities, decrease in social participation and in quality of life. Appropriate assessment and understanding of executive dysfunction are important, firstly to develop better rehabilitation strategies for executive functions per se and secondly to consider executive function abilities on rehabilitation strategies in general. The purpose of this review was to identify the most widely used assessment tools of executive dysfunction for patients with stroke, and their psychometric properties. We systematically reviewed manuscripts published in English in databases from 1999 to 2015. We identified 35 publications. The most frequently used instruments were the Stroop, Digit Span and Trail making tests. Psychometric properties were described for the Executive Function Performance Test, Executive Clock Drawing Task, Chinese Frontal Assessment Battery and Virtual Action Planning — Supermarket, and two subtests of the Cambridge Cognitive Examination — Revised. There is a paucity of tools to reliably measure executive dysfunction after stroke, despite the fact that executive dysfunction is frequent. Identification of the best tools for executive dysfunction assessment is necessary to address important gaps in research and in clinical practice.
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Affiliation(s)
- Juliana Conti
- Neurostimulation Laboratory, Neurology Clinical Division. Hospital das Clínicas/Sao Paulo University
| | - Annette Sterr
- School of Psychology, University of Surrey, Guildford, UK and Visiting Professor, Neurostimulation Laboratory
| | | | - Adriana B Conforto
- Neurostimulation Laboratory, Neurology Clinical Division. Hospital das Clínicas/Sao Paulo University ; Hospital Israelita Albert Einstein, São Paulo, Brazil
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