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Relander K, Hietanen M, Ijäs P, Nuotio K, Vikatmaa P, Koskinen SM, Ala-Kauhaluoma M, Paajanen TI, Virkkala J, Lindsberg PJ, Soinne L. Long-term cognitive and neurovascular changes after carotid endarterectomy. J Neurol Sci 2024; 459:122981. [PMID: 38569375 DOI: 10.1016/j.jns.2024.122981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 03/26/2024] [Accepted: 03/26/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Carotid endarterectomy (CEA) has been associated with both cognitive decline and improvement, but the underlying neurovascular mechanisms are unclear. The aim of this study was to investigate the relationship between neurovascular indices and cognitive changes after CEA. METHODS We studied 55 patients with severe (≥70%) symptomatic or asymptomatic carotid stenosis before and six months after CEA. A wide array of neuropsychological tests was arranged in eight cognitive domains and cognitive functions specific to hemisphere ipsilateral to operation. Differences in cognitive performance between patients and 38 matching healthy controls were studied with linear mixed models. Neurovascular functioning and microembolic signals were assessed with transcranial Doppler ultrasound of the middle cerebral artery. Associations between neurovascular indices and cognitive change were assessed with linear regression analyses. RESULTS On group level, the CEA patients improved more than controls in working memory, whereas no cognitive deterioration was detected. Also on individual level, improvement was most frequently observed in working memory. Worse preoperative cerebrovascular reactivity was related with improvement in cognitive functions of the ipsilateral hemisphere. Low preoperative pulsatility index was associated with improvement in executive functioning and ipsilateral cognitive functions. Poorer preoperative blood flow velocity associated with improvement in complex attention. Microembolic signals were rare. CONCLUSION The present findings suggest that CEA may have beneficial long-term effects on cognition. These effects may specifically involve patients with impaired preoperative circulatory adaptive mechanisms.
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Affiliation(s)
- Kristiina Relander
- Neuropsychology, HUS Neurocenter, University of Helsinki and Helsinki University Hospital, Finland.
| | - Marja Hietanen
- Neuropsychology, HUS Neurocenter, University of Helsinki and Helsinki University Hospital, Finland
| | - Petra Ijäs
- Neurology, HUS Neurocenter, University of Helsinki and Helsinki University Hospital, Finland
| | - Krista Nuotio
- Neurology, HUS Neurocenter, University of Helsinki and Helsinki University Hospital, Finland
| | - Pirkka Vikatmaa
- Vascular Surgery, HUS Abdominal center, University of Helsinki and Helsinki University Hospital, Finland
| | - Suvi M Koskinen
- Radiology, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, Finland
| | - Marianne Ala-Kauhaluoma
- Ophthalmology, HUS Head and Neck Center, University of Helsinki and Helsinki University Hospital, Finland
| | - Teemu I Paajanen
- Finnish Institute of Occupational Health, Work Ability and Working Careers Unit, Helsinki, Finland
| | - Jussi Virkkala
- Clinical Neurophysiology and Clinical Neurosciences, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, Finland
| | - Perttu J Lindsberg
- Neurology, HUS Neurocenter, University of Helsinki and Helsinki University Hospital, Finland
| | - Lauri Soinne
- Neurology, HUS Neurocenter, University of Helsinki and Helsinki University Hospital, Finland
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Mäki K, Nybo T, Hietanen M, Huovinen A, Marinkovic I, Isokuortti H, Melkas S. Stressful life events are associated with self-reported fatigue and depressive symptoms in patients with mild traumatic brain injury. J Rehabil Med 2024; 56:jrm13438. [PMID: 38436399 PMCID: PMC10926572 DOI: 10.2340/jrm.v56.13438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 01/30/2024] [Indexed: 03/05/2024] Open
Abstract
OBJECTIVE To examine the associations between recent stressful life events and self-reported fatigue and depressive symptoms in patients with mild traumatic brain injury. DESIGN Observational cohort study. PARTICIPANTS Patients (aged 18-68 years) with mild traumatic brain injury (n = 99) or lower extremity orthopaedic injury (n = 34). METHODS Data on stressful life events and self-reported symptoms were collected 3 months post-injury. Stressful life events in the last 12 months were assessed as part of a structured interview using a checklist of 11 common life events, self-reported fatigue with Barrow Neurological Institute Fatigue Scale, and depressive symptoms with Beck Depression Inventory - Fast Screen. RESULTS Median number of stressful life events was 1 (range 0-7) in the mild traumatic brain injury group and 1.5 (range 0-6) in the orthopaedic injury group. The groups did not differ significantly in terms of fatigue or depressive symptoms. In the mild traumatic brain injury group, the total number of recent stressful life events correlated significantly with self-reported fatigue (rs = 0.270, p = 0.007) and depressive symptoms (rs = 0.271, p = 0.007). CONCLUSION Stressful life events are associated with self-reported fatigue and depressive symptoms in patients with mild traumatic brain injury. Clinicians should consider stressful life events when managing patients who experience these symptoms, as this may help identifying potential targets for intervention.
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Affiliation(s)
- Kaisa Mäki
- Neuropsychology, Helsinki University and Helsinki University Hospital, Helsinki, Finland.
| | - Taina Nybo
- Neuropsychology, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Marja Hietanen
- Neuropsychology, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Antti Huovinen
- Neurology, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Ivan Marinkovic
- Neurology, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Harri Isokuortti
- Neurology, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Susanna Melkas
- Neurology, Helsinki University and Helsinki University Hospital, Helsinki, Finland
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3
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Uimonen J, Villarreal S, Laari S, Arola A, Ijäs P, Salmi J, Hietanen M. Virtual reality tasks with eye tracking for mild spatial neglect assessment: a pilot study with acute stroke patients. Front Psychol 2024; 15:1319944. [PMID: 38348259 PMCID: PMC10860750 DOI: 10.3389/fpsyg.2024.1319944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 01/03/2024] [Indexed: 02/15/2024] Open
Abstract
Objective Increasing evidence shows that traditional neuropsychological tests are insensitive for detecting mild unilateral spatial neglect (USN), lack ecological validity, and are unable to clarify USN in all different spatial domains. Here we present a new, fully immersive virtual reality (VR) task battery with integrated eye tracking for mild visual USN and extinction assessment in the acute state of stroke to overthrow these limitations. Methods We included 11 right-sided stroke patients and 10 healthy controls aged 18-75 years. Three VR tasks named the Extinction, the Storage and the Shoot the target tasks were developed to assess USN. Furthermore, neuropsychological assessment examining various parts of cognitive functioning was conducted to measure general abilities. We compared VR and neuropsychological task performance in stroke patients - those with (USN+, n = 5) and without USN (USN-, n = 6) - to healthy controls (n = 10) and tentatively reported the usability of VR system in the acute state of stroke. Results Patients had mostly mild neurological and USN symptoms. Nonetheless, we found several differences between the USN+ and healthy control groups in VR task performance. Compared to controls, USN+ patients showed visual extinction and asymmetry in gaze behavior and detection times in distinct spatial locations. Extinction was most evident in the extrapersonal space and delayed detection times on the extreme left and on the left upper parts. Also, USN+ patients needed more time to complete TMT A compared with USN- patients and TMT B compared with controls. VR system usability and acceptance were rated high; no relevant adverse effects occurred. Conclusion New VR technology with eye tracking enables ecologically valid and objective assessment methods with various exact measures for mild USN and thus could potentially improve future clinical assessments.
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Affiliation(s)
- Jenni Uimonen
- Department of Neuropsychology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Sanna Villarreal
- Department of Neuropsychology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Siiri Laari
- Department of Neuropsychology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Anne Arola
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Petra Ijäs
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Juha Salmi
- Department of Neuroscience and Biomedical Engineering, Aalto University, Espoo, Finland
| | - Marja Hietanen
- Department of Neuropsychology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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4
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Haraldsen IH, Hatlestad-Hall C, Marra C, Renvall H, Maestú F, Acosta-Hernández J, Alfonsin S, Andersson V, Anand A, Ayllón V, Babic A, Belhadi A, Birck C, Bruña R, Caraglia N, Carrarini C, Christensen E, Cicchetti A, Daugbjerg S, Di Bidino R, Diaz-Ponce A, Drews A, Giuffrè GM, Georges J, Gil-Gregorio P, Gove D, Govers TM, Hallock H, Hietanen M, Holmen L, Hotta J, Kaski S, Khadka R, Kinnunen AS, Koivisto AM, Kulashekhar S, Larsen D, Liljeström M, Lind PG, Marcos Dolado A, Marshall S, Merz S, Miraglia F, Montonen J, Mäntynen V, Øksengård AR, Olazarán J, Paajanen T, Peña JM, Peña L, Peniche DL, Perez AS, Radwan M, Ramírez-Toraño F, Rodríguez-Pedrero A, Saarinen T, Salas-Carrillo M, Salmelin R, Sousa S, Suyuthi A, Toft M, Toharia P, Tveitstøl T, Tveter M, Upreti R, Vermeulen RJ, Vecchio F, Yazidi A, Rossini PM. Intelligent digital tools for screening of brain connectivity and dementia risk estimation in people affected by mild cognitive impairment: the AI-Mind clinical study protocol. Front Neurorobot 2024; 17:1289406. [PMID: 38250599 PMCID: PMC10796757 DOI: 10.3389/fnbot.2023.1289406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 12/12/2023] [Indexed: 01/23/2024] Open
Abstract
More than 10 million Europeans show signs of mild cognitive impairment (MCI), a transitional stage between normal brain aging and dementia stage memory disorder. The path MCI takes can be divergent; while some maintain stability or even revert to cognitive norms, alarmingly, up to half of the cases progress to dementia within 5 years. Current diagnostic practice lacks the necessary screening tools to identify those at risk of progression. The European patient experience often involves a long journey from the initial signs of MCI to the eventual diagnosis of dementia. The trajectory is far from ideal. Here, we introduce the AI-Mind project, a pioneering initiative with an innovative approach to early risk assessment through the implementation of advanced artificial intelligence (AI) on multimodal data. The cutting-edge AI-based tools developed in the project aim not only to accelerate the diagnostic process but also to deliver highly accurate predictions regarding an individual's risk of developing dementia when prevention and intervention may still be possible. AI-Mind is a European Research and Innovation Action (RIA H2020-SC1-BHC-06-2020, No. 964220) financed between 2021 and 2026. First, the AI-Mind Connector identifies dysfunctional brain networks based on high-density magneto- and electroencephalography (M/EEG) recordings. Second, the AI-Mind Predictor predicts dementia risk using data from the Connector, enriched with computerized cognitive tests, genetic and protein biomarkers, as well as sociodemographic and clinical variables. AI-Mind is integrated within a network of major European initiatives, including The Virtual Brain, The Virtual Epileptic Patient, and EBRAINS AISBL service for sensitive data, HealthDataCloud, where big patient data are generated for advancing digital and virtual twin technology development. AI-Mind's innovation lies not only in its early prediction of dementia risk, but it also enables a virtual laboratory scenario for hypothesis-driven personalized intervention research. This article introduces the background of the AI-Mind project and its clinical study protocol, setting the stage for future scientific contributions.
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Affiliation(s)
| | | | - Camillo Marra
- Memory Clinic, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Department of Neuroscience, Catholic University of the Sacred Heart, Rome, Italy
| | - Hanna Renvall
- Department of Neuroscience and Biomedical Engineering, Aalto University, Helsinki, Finland
- BioMag Laboratory, HUS Medical Imaging Centre, Helsinki University Hospital, Helsinki University and Aalto University School of Science, Helsinki, Finland
| | - Fernando Maestú
- Centre for Cognitive and Computational Neuroscience, Universidad Complutense de Madrid, Madrid, Spain
- Department of Experimental Psychology, Cognitive Psychology and Speech and Language Therapy, Universidad Complutense de Madrid, Pozuelo de Alarcón, Spain
- Institute of Sanitary Investigation (IdISSC), San Carlos University Hospital, Madrid, Spain
| | | | - Soraya Alfonsin
- Centre for Cognitive and Computational Neuroscience, Universidad Complutense de Madrid, Madrid, Spain
- Department of Experimental Psychology, Cognitive Psychology and Speech and Language Therapy, Universidad Complutense de Madrid, Pozuelo de Alarcón, Spain
| | | | - Abhilash Anand
- Performance and Assurance Solutions, Digital Solutions, DNV, Oslo, Norway
| | | | - Aleksandar Babic
- Healthcare Programme, Group Research and Development, DNV, Oslo, Norway
| | - Asma Belhadi
- Department of Computer Science, OsloMet—Oslo Metropolitan University, Oslo, Norway
- NordSTAR—Nordic Center for Sustainable and Trustworthy AI Research, Oslo, Norway
| | | | - Ricardo Bruña
- Centre for Cognitive and Computational Neuroscience, Universidad Complutense de Madrid, Madrid, Spain
- Institute of Sanitary Investigation (IdISSC), San Carlos University Hospital, Madrid, Spain
- Department of Radiology, Universidad Complutense de Madrid, Madrid, Spain
| | - Naike Caraglia
- Memory Clinic, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Claudia Carrarini
- Department of Neuroscience and Neurorehabilitation, IRCCS San Raffaele, Rome, Italy
| | | | - Americo Cicchetti
- The Graduate School of Health Economics and Management (ALTEMS), Catholic University of the Sacred Heart, Rome, Italy
| | - Signe Daugbjerg
- The Graduate School of Health Economics and Management (ALTEMS), Catholic University of the Sacred Heart, Rome, Italy
| | - Rossella Di Bidino
- The Graduate School of Health Economics and Management (ALTEMS), Catholic University of the Sacred Heart, Rome, Italy
| | | | - Ainar Drews
- IT Department, University of Oslo, Oslo, Norway
| | - Guido Maria Giuffrè
- Memory Clinic, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Department of Neuroscience, Catholic University of the Sacred Heart, Rome, Italy
| | | | - Pedro Gil-Gregorio
- Department of Geriatric Medicine, Hospital Universitario Clínico San Carlos, Madrid, Spain
- Department of Geriatrics, Fundación para la Investigación Biomédica del Hospital Clínico San Carlos, Madrid, Spain
| | | | - Tim M. Govers
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, Netherlands
| | - Harry Hallock
- Healthcare Programme, Group Research and Development, DNV, Oslo, Norway
| | - Marja Hietanen
- Division of Neuropsychology, HUS Neurocenter, Helsinki University Hospital and Helsinki University, Helsinki, Finland
| | - Lone Holmen
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Jaakko Hotta
- Department of Neurology, Helsinki University Hospital and Clinical Neurosciences, Neurology, University of Helsinki, Helsinki, Finland
| | - Samuel Kaski
- Department of Computer Science, Helsinki Institute of Information Technology, Aalto University, Helsinki, Finland
- Department of Computer Science, University of Manchester, Manchester, United Kingdom
| | - Rabindra Khadka
- Department of Computer Science, OsloMet—Oslo Metropolitan University, Oslo, Norway
- NordSTAR—Nordic Center for Sustainable and Trustworthy AI Research, Oslo, Norway
| | - Antti S. Kinnunen
- BioMag Laboratory, HUS Medical Imaging Centre, Helsinki University Hospital, Helsinki University and Aalto University School of Science, Helsinki, Finland
| | - Anne M. Koivisto
- Department of Neurology, Helsinki University Hospital and Clinical Neurosciences, Neurology, University of Helsinki, Helsinki, Finland
- Department of Neurosciences, University of Helsinki, Helsinki, Finland
- Neurocenter, Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Shrikanth Kulashekhar
- BioMag Laboratory, HUS Medical Imaging Centre, Helsinki University Hospital, Helsinki University and Aalto University School of Science, Helsinki, Finland
| | - Denis Larsen
- Department of Computer Science, OsloMet—Oslo Metropolitan University, Oslo, Norway
- NordSTAR—Nordic Center for Sustainable and Trustworthy AI Research, Oslo, Norway
| | - Mia Liljeström
- Department of Neuroscience and Biomedical Engineering, Aalto University, Helsinki, Finland
- BioMag Laboratory, HUS Medical Imaging Centre, Helsinki University Hospital, Helsinki University and Aalto University School of Science, Helsinki, Finland
| | - Pedro G. Lind
- Department of Computer Science, OsloMet—Oslo Metropolitan University, Oslo, Norway
- NordSTAR—Nordic Center for Sustainable and Trustworthy AI Research, Oslo, Norway
| | - Alberto Marcos Dolado
- Institute of Sanitary Investigation (IdISSC), San Carlos University Hospital, Madrid, Spain
- Neurology Department, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Serena Marshall
- Healthcare Programme, Group Research and Development, DNV, Oslo, Norway
| | - Susanne Merz
- Department of Neuroscience and Biomedical Engineering, Aalto University, Helsinki, Finland
| | - Francesca Miraglia
- Department of Neuroscience and Neurorehabilitation, IRCCS San Raffaele, Rome, Italy
| | - Juha Montonen
- BioMag Laboratory, HUS Medical Imaging Centre, Helsinki University Hospital, Helsinki University and Aalto University School of Science, Helsinki, Finland
| | - Ville Mäntynen
- BioMag Laboratory, HUS Medical Imaging Centre, Helsinki University Hospital, Helsinki University and Aalto University School of Science, Helsinki, Finland
| | | | - Javier Olazarán
- Neurology Service, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Teemu Paajanen
- Finnish Institute of Occupational Health, Helsinki, Finland
| | | | | | | | - Ana S. Perez
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Mohamed Radwan
- Department of Computer Science, OsloMet—Oslo Metropolitan University, Oslo, Norway
- NordSTAR—Nordic Center for Sustainable and Trustworthy AI Research, Oslo, Norway
| | - Federico Ramírez-Toraño
- Centre for Cognitive and Computational Neuroscience, Universidad Complutense de Madrid, Madrid, Spain
- Department of Experimental Psychology, Cognitive Psychology and Speech and Language Therapy, Universidad Complutense de Madrid, Pozuelo de Alarcón, Spain
| | - Andrea Rodríguez-Pedrero
- Centre for Cognitive and Computational Neuroscience, Universidad Complutense de Madrid, Madrid, Spain
- Department of Experimental Psychology, Cognitive Psychology and Speech and Language Therapy, Universidad Complutense de Madrid, Pozuelo de Alarcón, Spain
| | - Timo Saarinen
- BioMag Laboratory, HUS Medical Imaging Centre, Helsinki University Hospital, Helsinki University and Aalto University School of Science, Helsinki, Finland
| | - Mario Salas-Carrillo
- Institute of Sanitary Investigation (IdISSC), San Carlos University Hospital, Madrid, Spain
- Memory Unit, Department of Geriatrics, Hospital Clínico San Carlos, Madrid, Spain
| | - Riitta Salmelin
- Department of Neuroscience and Biomedical Engineering, Aalto University, Helsinki, Finland
| | - Sonia Sousa
- School of Digital Technologies, Tallinn University, Tallinn, Estonia
| | - Abdillah Suyuthi
- Performance and Assurance Solutions, Digital Solutions, DNV, Oslo, Norway
| | - Mathias Toft
- Department of Neurology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Pablo Toharia
- Center for Computational Simulation, Universidad Politécnica de Madrid, Madrid, Spain
| | | | - Mats Tveter
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Ramesh Upreti
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Robin J. Vermeulen
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, Netherlands
| | - Fabrizio Vecchio
- Department of Neuroscience and Neurorehabilitation, IRCCS San Raffaele, Rome, Italy
- Department of Theoretical and Applied Sciences, eCampus University, Como, Italy
| | - Anis Yazidi
- Department of Computer Science, OsloMet—Oslo Metropolitan University, Oslo, Norway
- NordSTAR—Nordic Center for Sustainable and Trustworthy AI Research, Oslo, Norway
| | - Paolo Maria Rossini
- Department of Neuroscience and Neurorehabilitation, IRCCS San Raffaele, Rome, Italy
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Vuori O, Kallio EL, Wikström A, Jokinen H, Hietanen M. Web-based psychoeducational interventions for managing cognitive impairment-a systematic review. Front Neurol 2023; 14:1249995. [PMID: 37780726 PMCID: PMC10535106 DOI: 10.3389/fneur.2023.1249995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 08/29/2023] [Indexed: 10/03/2023] Open
Abstract
Objective Web-based rehabilitation, a branch of telerehabilitation, is carried out over the internet, unrestricted by time or place. Even though web-based interventions have been reported as feasible and effective in cases of mood disorders, for example, such evidence on the effectiveness of web-based cognitive rehabilitation remains unclear. This systematic review summarizes current knowledge on web-based psychoeducational programs aiming to manage cognitive deficits in patients with diseases that affect cognition. Methods Using the Ovid database and the Web of Science, we systematically searched the Cochrane Database of Systematic Reviews, Medline, and PsycINFO to identify eligible studies. The review protocol (CRD42021257315) was pre-registered with the PROSPERO International Prospective Register of Systematic Reviews. The search was performed 10/13/2022. Two reviewers independently screened titles, abstracts, and full-texts, and extracted data for the selected studies. Two independent reviewers assessed the methodological quality. Results The search retrieved 6,487 articles. Four studies with different patient groups (stroke, traumatic brain injury, brain tumor, and cancer) met the inclusion criteria of this systematic review. The studies examined systematic cognition-focused psychoeducational rehabilitation programs in which the patient worked independently. Three studies found positive effects on subjective cognitive functions, executive functions, and self-reported memory. No effects were found on objective cognitive functions. However, the studies had methodological weaknesses (non-randomized designs, small sample sizes, vaguely described interventions). Overall, adherence and patient satisfaction were good/excellent. Conclusion Web-based cognitive intervention programs are a new approach to rehabilitation and patient education. The evidence, although scarce, shows that web-based interventions are feasible and support subjective cognitive functioning. However, the literature to date is extremely limited and the quality of the studies is weak. More research with high-quality study designs is needed. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=257315, identifier: CRD42021257315.
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Affiliation(s)
- Outi Vuori
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Division of Neuropsychology, HUS Neurocenter, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Eeva-Liisa Kallio
- Division of Neuropsychology, HUS Neurocenter, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Annamaria Wikström
- Division of Neuropsychology, HUS Neurocenter, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Hanna Jokinen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Division of Neuropsychology, HUS Neurocenter, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Marja Hietanen
- Division of Neuropsychology, HUS Neurocenter, Helsinki University and Helsinki University Hospital, Helsinki, Finland
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Backström M, Salo H, Kärki J, Aalto K, Rebane K, Levälampi T, Grönlund MM, Kröger L, Pohjankoski H, Hietanen M, Korkatti K, Kuusalo L, Rantalaiho V, Huhtakangas J, Relas H, Pääkkö T, Löyttyniemi E, Sokka-Isler T, Vähäsalo P. The feasibility of existing JADAS10 cut-off values in clinical practice: a study of data from The Finnish Rheumatology Quality Register. Pediatr Rheumatol Online J 2023; 21:35. [PMID: 37060076 PMCID: PMC10105448 DOI: 10.1186/s12969-023-00814-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 03/31/2023] [Indexed: 04/16/2023] Open
Abstract
BACKGROUND The ten-joint juvenile arthritis disease activity score (JADAS10) is designed to measure the level of disease activity in non-systemic juvenile idiopathic arthritis by providing a single numeric score. The clinical JADAS10 (cJADAS10) is a modification of the JADAS10 that excludes erythrocyte sedimentation rate (ESR). Three different sets of JADAS10/cJADAS10 cut-offs for disease activity states have been published, i.e., the Backström, Consolaro, and Trincianti cut-offs. The objective of this study was to investigate the performance of existing JADAS10 cut-offs in real-life settings using patient data from The Finnish Rheumatology Quality Register (FinRheuma). METHODS Data were collected from the FinRheuma register. The proportion of patients with an active joint count (AJC) above zero when classified as being in clinically inactive disease (CID) or low disease activity (LDA) groups according to existing JADAS10/cJADAS10 cut-off levels were analyzed. RESULTS A significantly larger proportion of the patients classified as being in CID had an AJC > 0 when using the JADAS10/cJADAS10 cut-offs by Trincianti et al. compared to those for the other cut-offs. In the LDA group, a significantly larger proportion of the polyarticular patients (35%/29%) had an AJC of two when Trincianti JADAS10/cJADAS10 cut-offs were used compared with when Backström (11%/10%) and Consolaro (7%/3%) JADAS10/cJADAS10 cut-offs were used. CONCLUSIONS We found the cut-offs proposed by Consolaro et al. to be the most feasible, since these cut-off levels for CID do not result in the misclassification of active disease as remission, and the proportion of patients with AJC > 1 in the LDA group is lowest using these cut-offs.
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Affiliation(s)
- M Backström
- Department of Paediatrics, The Wellbeing Services County of Ostrobothnia, Vaasa, Finland.
- PEDEGO Research Unit, University of Oulu, Oulu, Finland.
- Vaasa Central Hospital, U2, Hietalahdenkatu 2-4, 65130, Vaasa, Finland.
| | - H Salo
- Knowledge Brokers Department, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - J Kärki
- Department of Children and Adolescents, Kanta-Häme Central Hospital, Hämeenlinna, Finland
- The Finnish Institute for Welfare and Health, The Finnish Rheumatology Quality Register, Helsinki, Finland
| | - K Aalto
- New Children's Hospital, Pediatric Research Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - K Rebane
- New Children's Hospital, Pediatric Research Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - T Levälampi
- New Children's Hospital, Pediatric Research Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - M-M Grönlund
- Department of Paediatrics, Turku University Hospital, Turku, Finland
| | - L Kröger
- Department of Children and Adolescents, Kuopio University Hospital, Kuopio, Finland
| | - H Pohjankoski
- Department of Children and Adolescents, Päijät-Häme Central Hospital, Lahti, Finland
| | - M Hietanen
- Department of Children and Adolescents, Päijät-Häme Central Hospital, Lahti, Finland
| | - K Korkatti
- Department of Paediatrics, Central Ostrobothnia Central Hospital, Kokkola, Finland
| | - L Kuusalo
- Centre for Rheumatology and Clinical Immunology, Division of Medicine, University of Turku and Turku University Hospital, Turku, Finland
| | - V Rantalaiho
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Centre for Rheumatic Diseases, Tampere University Hospital, Tampere, Finland
- Centre for Rheumatic Diseases, Kanta-Häme Central Hospital, Hämeenlinna, Finland
| | - J Huhtakangas
- Division of Rheumatology, Kuopio University Hospital, Kuopio, Finland
| | - H Relas
- Department of Rheumatology, Inflammation Center, Helsinki University Hospital, and University of Helsinki, Helsinki, Finland
| | - T Pääkkö
- Department of Internal Medicine, Oulu University Hospital, Oulu, Finland
| | - E Löyttyniemi
- Department of Biostatistics, University of Turku, Turku, Finland
| | - T Sokka-Isler
- University of Eastern Finland, Kuopio and Central Finland Central Hospital, Jyväskylä, Finland
| | - P Vähäsalo
- PEDEGO Research Unit, University of Oulu, Oulu, Finland
- Department of Paediatrics, Oulu University Hospital, Oulu, Finland
- Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
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Liesto S, Sipilä R, Hietanen M, Kalso E. Cognitive function is well preserved in a cohort of breast cancer survivors: Roles of cognitive reserve, resilience, and general health. Breast 2022; 65:157-163. [PMID: 35994867 PMCID: PMC9418976 DOI: 10.1016/j.breast.2022.07.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 07/05/2022] [Accepted: 07/19/2022] [Indexed: 11/23/2022] Open
Abstract
Many patients return to cognitively demanding work after breast cancer treatments. This makes treatment-related cognitive decline an important research topic. Psychological resilience, cognitive reserve and better perceived general health may work as protective factors against cognitive decline. The aim of this study was to analyse whether these factors are associated with cognitive function among such women. Data from 384 breast cancer survivors who underwent neuropsychological examination at follow-up 4–9 years after surgery were used. The neurocognitive domain variable Learning and Memory was computed from Wechsler Memory Scale-III subtests Learning and Delayed Recall. Another variable, Attention, Processing speed and Executive function, was computed from semantic and verbal fluency tests, Trail Making Test A and B, and Wechsler Adult Intelligence Test-IV subtest Coding. Psychological resilience was measured with Resilience Scale-14, and perceived general health with RAND-36 subitem General Health. Results showed that levels of cognitive performance and general health were statistically higher than population average. Resilience and general health in separate models were associated with Attention, Processing speed and Executive function (β = 0.14, p = 0.01; β = 0.13, p = 0.03, respectively). When added simultaneously in the same model, resilience was significant (β = 0.13, p = 0.04), but general health was not. These associations were nonsignificant after controlling for confounding factors. Learning and Memory was not associated with resilience or general health. Future research should focus on longitudinal studies identifying patients at a high risk of developing cognitive decline after breast cancer treatments and on preventive and therapeutic approaches. 401 women were neuropsychologically examined 4–9 years after breast cancer surgery. Their cognitive performance was on average well preserved. Psychological Resilience associated with better cognitive performance in one domain. The association between General Health and cognition was less prominent. High education level might protect against cognitive decline after breast cancer.
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Backström M, Vuorimaa H, Tarkiainen M, Löyttyniemi E, Kröger L, Aalto K, Rebane K, Markula-Patjas K, Malin M, Sard S, Keskitalo P, Korkatti K, Grönlund MM, Möttönen M, Pohjankoski H, Hietanen M, Kärki J, Vähäsalo P. POS0335 IMPROVED PAIN COPING SCALE FOR CHILDREN AND THEIR CAREGIVERS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundPain can be a problem in a subgroup of juvenile idiopathic arthritis (JIA) patients even though in clinical remission. This can at least partly be due to their pain coping strategy of catastrophizing [1]. In a chronic disease such as JIA, the quality of coping with pain is crucial. The importance of coping with pain is well recognized in children [2]. The understanding of the parental role in supporting the child in pain is growing [3]; yet measuring the precise mechanism of parental pain coping is less studied. Thus, it seems important to measure also parental coping quality.ObjectivesThe aim of this study was to develop a pain coping scale (PCSpar) for assessing the parents’ coping strategies to their child´s pain and a shorter improved PCSped for children feasible for use in clinical practice.MethodsThe original pain coping questionnaire (PCQ) [4] has been validated in Finnish [5] resulting in a 38-item, eight-factor structured PCQ. The items in the new version of PCQ were reduced into twenty by an interdisciplinary team (mPCQped). A corresponding scale was created for parental use (mPCQpar). Consecutive patients aged 8-16 years, visiting pediatric rheumatology outpatient clinic, reporting musculoskeletal pain during the last week before visit or longer, were recruited to participate in this study. Both the patient and the caregiver rated the child’s pain VAS from 0 to 100, completed the mPCQped /the mPCQpar and Children´s Depression Inventory (CDI) [6]/the Beck´s depression Inventory (BDI) [7] as appropriate. The selection process of pain questionnaire items was performed with factor analyses. The construct validity, the associations of the mPCQ factors, CDI, BDI and pain VAS, were tested by Spearman´s correlation coefficient.ResultsThe study was conducted in all five tertiary and four secondary hospitals evenly distributed throughout Finland. Of the 153 families invited to the study, 130 attended. The average (SD) age of the attending patients was 13.0 (2.3) years. Of the patients, 91 (70%) were girls. Several steps in the exploratory factor analyses preceded the final factor analyses mPCQped and mPCQpar results. The four factors retained in the new improved Pain Coping Scale for children (iPCSped) were named positive cognitive distraction, catastrophizing (CATped), seeking social support (SSSped) and behavioral distraction. The factors in the improved Pain Coping Scale for caregivers (iPCSpar) were positive self-statement, catastrophizing (CATpar), seeking social support and distraction. In both iPCSped and iPCSpar there are a total of 15 items, 2-5 items/factor. The factor´s Cronbach´s alpha reliability coefficients were satisfactory, and the goodness-of-fit statistics were good. The CATpar correlated to BDI Rs= 0.33, p<0.05 and parent’s assessment of the child’s pain Rs= 0.23, p<0.05 in caregivers. The CATped correlated to CDI Rs= 0.49, p<0.05 and SSSped Rs= 0.26, p=0.05 but not to patient pain VAS Rs= 0.08, p>0.05.ConclusionIn this study, we created a shorter pain coping scale for children (iPCSped) and a novel scale for caregivers (iPCSpar). Both showed good validity and reliability.References[1]Lomholt JJ et al. Pediatric Rheumatology 2013;11:21-28.[2]Gaultney, AC et al. Children 2017;4:11.[3]Caes L et al. Front. Psychol 12:680546. doi: 10.3389/fpsyg.2021.680546[4]Reid GJ et al. Pain 1998;76:83-96.[5]Marttinen MK et al. Eur J Pain 2018;22:1016-1025.[6]Kovacs M et al. Psychopharmacil Bull 1985;21:995-8.[7]Beck AT et al. Arch Gen Psychiatry 1961;4:561–71.Disclosure of InterestsNone declared
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Abstract
OBJECTIVE To examine perceived injustice and its associations with self-reported symptoms and return to work at 3 months after injury in a prospectively recruited sample of patients with mild traumatic brain injury (mTBI). DESIGN Observational study. SETTING TBI outpatient unit. PARTICIPANTS Adult patients aged 18 to 68 years with mTBI (n = 100) or orthopedic injury ([OI]; n = 34). MAIN MEASURES The Injustice Experience Questionnaire (IEQ) and its associations with the Rivermead Post Concussion Questionnaire (RPQ), Beck Depression Inventory-Second Edition (BDI-II), PTSD Checklist-Civilian Version (PCL-C), and Pain Visual Analog Scale (PVAS). Information on injury-related characteristics, compensation seeking and litigation, and return-to-work status was also collected. RESULTS Median IEQ total score was 3 (range, 0-23) in the mTBI group and 2.5 (range, 0-25) in the OI group. In the mTBI group, IEQ was significantly correlated with RPQ (rs = 0.638, P < .01), BDI-II (rs = 0.612, P < .01), PCL-C (rs = 0.679, P < .01), and PVAS (rs = 0.232, P < .05). The association between IEQ and PCL-C (rs =0.797, P < .01) and BDI-II (rs = 0.395, P < .05) was also found in the OI group. In both groups, patients who were still on sick leave at 3 months after injury tended to report higher perceived injustice (IEQ total score) than patients who had returned to work or studies. However, this difference did not reach statistical significance. CONCLUSIONS Perceived injustice is associated with self-reported symptoms in patients with mTBI. Our results suggest that perceived injustice could be a relevant construct to consider in clinical management of patients with mTBI. Also, perceived injustice could be a potential target for psychological interventions promoting recovery after mTBI.
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Affiliation(s)
- Kaisa Mäki
- Neuropsychology (Ms Mäki and Drs Nybo and Hietanen) and Neurology (Drs Huovinen, Marinkovic, Isokuortti, and Melkas), University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Taina Nybo
- Neuropsychology (Ms Mäki and Drs Nybo and Hietanen) and Neurology (Drs Huovinen, Marinkovic, Isokuortti, and Melkas), University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Marja Hietanen
- Neuropsychology (Ms Mäki and Drs Nybo and Hietanen) and Neurology (Drs Huovinen, Marinkovic, Isokuortti, and Melkas), University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Antti Huovinen
- Neuropsychology (Ms Mäki and Drs Nybo and Hietanen) and Neurology (Drs Huovinen, Marinkovic, Isokuortti, and Melkas), University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ivan Marinkovic
- Neuropsychology (Ms Mäki and Drs Nybo and Hietanen) and Neurology (Drs Huovinen, Marinkovic, Isokuortti, and Melkas), University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Harri Isokuortti
- Neuropsychology (Ms Mäki and Drs Nybo and Hietanen) and Neurology (Drs Huovinen, Marinkovic, Isokuortti, and Melkas), University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Susanna Melkas
- Neuropsychology (Ms Mäki and Drs Nybo and Hietanen) and Neurology (Drs Huovinen, Marinkovic, Isokuortti, and Melkas), University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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10
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Relander K, Hietanen M, Rämö J, Vento A, Tikkala I, Roine RO, Lindsberg PJ, Soinne L. Differential Cognitive Functioning and Benefit From Surgery in Patients Undergoing Coronary Artery Bypass Grafting and Carotid Endarterectomy. Front Neurol 2022; 13:824486. [PMID: 35350398 PMCID: PMC8957972 DOI: 10.3389/fneur.2022.824486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 01/24/2022] [Indexed: 11/13/2022] Open
Abstract
Background Stenosing atherosclerosis in both coronary and carotid arteries can adversely affect cognition. Also their surgical treatments, coronary artery bypass grafting (CABG) and carotid endarterectomy (CEA), are associated with cognitive changes, but the mechanisms of cognitive decline or improvement may not be the same. This study was designed to compare the cognitive profile and outcome in patients undergoing surgical treatment for coronary or carotid disease. Methods A total of 100 CABG patients and 44 CEA patients were recruited in two previously reported studies. They were subjected to a comprehensive neuropsychological examination prior to surgery and in the acute (3-8 days) and stable (3 months) phase after operation. A group of 17 matched healthy controls were assessed with similar intervals. We used linear mixed models to compare cognitive trajectories within six functional domains between the CABG, CEA and control groups. Postoperative cognitive dysfunction (POCD) and improvement (POCI) were determined with the reliable change index method in comparison with healthy controls. Results Before surgery, the CEA patients performed worse than CABG patients or healthy controls in the domains of executive functioning and processing speed. The CABG patients exhibited postoperative cognitive dysfunction more often than the CEA patients in most cognitive domains in the acute phase but had regained their performance in the stable phase. The CEA patients showed more marked postoperative improvement in executive functioning than the CABG group in the acute phase, but the difference did not reach significance in the stable phase. Conclusion Our findings suggest that anterior cerebral dysfunction in CEA patients impairs preoperative cognition more severely than global brain dysfunction in CABG patients. However, CEA may have more beneficial effects on cognition than CABG, specifically in executive functions mainly operated by the prefrontal lobes. In addition, the results underline that POCD is a heterogeneous condition and dependent on type of revascularization surgery.
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Affiliation(s)
- Kristiina Relander
- Division of Neuropsychology, Neurocenter, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Marja Hietanen
- Division of Neuropsychology, Neurocenter, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Juhani Rämö
- Division of Cardiac Surgery, Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Antti Vento
- Division of Cardiac Surgery, Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Irene Tikkala
- Division of Neuropsychology, Neurocenter, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Risto O Roine
- University of Turku and Turku University Hospital, Turku, Finland
| | - Perttu J Lindsberg
- Department of Neurology, Neurocenter, Helsinki University Hospital and Clinical Neurosciences, University of Helsinki, Helsinki, Finland
| | - Lauri Soinne
- Department of Neurology, Neurocenter, Helsinki University Hospital and Clinical Neurosciences, University of Helsinki, Helsinki, Finland
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11
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Villarreal S, Linnavuo M, Sepponen R, Vuori O, Bonato M, Jokinen H, Hietanen M. Computer-Based Assessment: Dual-Task Outperforms Large-Screen Cancellation Task in Detecting Contralesional Omissions. Front Psychol 2022; 12:790438. [PMID: 35069375 PMCID: PMC8777372 DOI: 10.3389/fpsyg.2021.790438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 12/09/2021] [Indexed: 11/18/2022] Open
Abstract
Objective: Traditionally, asymmetric spatial processing (i.e., hemispatial neglect) has been assessed with paper-and-pencil tasks, but growing evidence indicates that computer-based methods are a more sensitive assessment modality. It is not known, however, whether simply converting well-established paper-and-pencil methods into a digital format is the best option. The aim of the present study was to compare sensitivity in detecting contralesional omissions of two different computer-based methods: a "digitally converted" cancellation task was compared with a computer-based Visual and Auditory dual-tasking approach, which has already proved to be very sensitive. Methods: Participants included 40 patients with chronic unilateral stroke in either the right hemisphere (RH patients, N = 20) or the left hemisphere (LH patients, N = 20) and 20 age-matched healthy controls. The cancellation task was implemented on a very large format (173 cm × 277 cm) or in a smaller (A4) paper-and-pencil version. The computer-based dual-tasks were implemented on a 15'' monitor and required the detection of unilateral and bilateral briefly presented lateralized targets. Results: Neither version of the cancellation task was able to show spatial bias in RH patients. In contrast, in the Visual dual-task RH patients missed significantly more left-sided targets than controls in both unilateral and bilateral trials. They also missed significantly more left-sided than right-sided targets only in the bilateral trials of the Auditory dual-task. Conclusion: The dual-task setting outperforms the cancellation task approach even when the latter is implemented on a (large) screen. Attentionally demanding methods are useful for revealing mild forms of contralesional visuospatial deficits.
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Affiliation(s)
- Sanna Villarreal
- Division of Neuropsychology, HUH Neurocenter, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Matti Linnavuo
- Department of Electrical Engineering and Automation, Aalto University, Espoo, Finland
| | - Raimo Sepponen
- Department of Electrical Engineering and Automation, Aalto University, Espoo, Finland
| | - Outi Vuori
- Division of Neuropsychology, HUH Neurocenter, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Mario Bonato
- Department of General Psychology, University of Padova, Padua, Italy
| | - Hanna Jokinen
- Division of Neuropsychology, HUH Neurocenter, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Marja Hietanen
- Division of Neuropsychology, HUH Neurocenter, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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12
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Relander K, Mäki K, Soinne L, García-García J, Hietanen M. Active lifestyle as a reflection of cognitive reserve: The Modified Cognitive Reserve Scale. Nordic Psychology 2021. [DOI: 10.1080/19012276.2021.1902846] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Kristiina Relander
- Clinical Neurosciences, Neuropsychology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Kaisa Mäki
- Clinical Neurosciences, Neuropsychology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Lauri Soinne
- Clinical Neurosciences, Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Juan García-García
- Health Research Center, Psychology Department, University of Almería, Spain
| | - Marja Hietanen
- Clinical Neurosciences, Neuropsychology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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13
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Relander K, Hietanen M, Nuotio K, Ijäs P, Tikkala I, Saimanen E, Lindsberg PJ, Soinne L. Cognitive Dysfunction and Mortality After Carotid Endarterectomy. Front Neurol 2021; 11:593719. [PMID: 33519678 PMCID: PMC7840953 DOI: 10.3389/fneur.2020.593719] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 12/02/2020] [Indexed: 12/02/2022] Open
Abstract
Background: Carotid endarterectomy (CEA) has been associated with both postoperative cognitive dysfunction (POCD) and improvement (POCI). However, the prognostic significance of postoperative cognitive changes related to CEA is largely unknown. The aim of this study was to examine the associations between postoperative cognitive changes after CEA and long-term survival. Methods: We studied 43 patients 1 day before CEA as well as 4 days and 3 months after surgery with an extensive neuropsychological test array, and followed them for up to 14 years. POCD and POCI relative to baseline were determined with the reliable change index derived from 17 healthy controls. Associations between POCD/POCI and mortality within the patient group were studied with Cox regression analyses adjusted for confounders. Results: POCD in any functional domain was evident in 28% of patients 4 days after surgery and in 33% of patients 3 months after surgery. POCI was shown in 23% of patients at 4 days and in 44% of patients at 3 months. POCD at 3 months was associated with higher long-term mortality (hazard ratio 5.0, 95% CI 1.8–13.9, p = 0.002) compared with patients with no cognitive decline. Conclusions: Our findings suggest that POCD in a stable phase, 3 months after CEA predicts premature death. Evaluation of postoperative cognitive changes is essential, and POCD in a stable phase after CEA should prompt scrutiny of underlying factors and better adherence to therapies to prevent recurrences and to promote early intervention in imminent deterioration.
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Affiliation(s)
- Kristiina Relander
- Neuropsychology, Neurocenter, Helsinki University Hospital, Helsinki, Finland.,Clinical Neurosciences, Clinicum, University of Helsinki, Helsinki, Finland
| | - Marja Hietanen
- Neuropsychology, Neurocenter, Helsinki University Hospital, Helsinki, Finland.,Clinical Neurosciences, Clinicum, University of Helsinki, Helsinki, Finland
| | - Krista Nuotio
- Clinical Neurosciences, Clinicum, University of Helsinki, Helsinki, Finland.,Neurology, Neurocenter, Helsinki University Hospital, Helsinki, Finland
| | - Petra Ijäs
- Clinical Neurosciences, Clinicum, University of Helsinki, Helsinki, Finland.,Neurology, Neurocenter, Helsinki University Hospital, Helsinki, Finland
| | - Irene Tikkala
- Neuropsychology, Neurocenter, Helsinki University Hospital, Helsinki, Finland.,Clinical Neurosciences, Clinicum, University of Helsinki, Helsinki, Finland
| | - Eija Saimanen
- Department of Surgery, South Karelia Central Hospital, Lappeenranta, Finland
| | - Perttu J Lindsberg
- Clinical Neurosciences, Clinicum, University of Helsinki, Helsinki, Finland.,Neurology, Neurocenter, Helsinki University Hospital, Helsinki, Finland
| | - Lauri Soinne
- Clinical Neurosciences, Clinicum, University of Helsinki, Helsinki, Finland.,Neurology, Neurocenter, Helsinki University Hospital, Helsinki, Finland
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14
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Relander K, Hietanen M, Rantanen K, Rämö J, Vento A, Saastamoinen KP, Roine RO, Soinne L. Postoperative cognitive change after cardiac surgery predicts long-term cognitive outcome. Brain Behav 2020; 10:e01750. [PMID: 32681544 PMCID: PMC7507551 DOI: 10.1002/brb3.1750] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 06/17/2020] [Accepted: 06/19/2020] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Postoperative cognitive dysfunction (POCD) is a common consequence of coronary artery bypass grafting. However, domain-specific associations between postoperative changes and long-term performance are poorly known. The aim of this study was to investigate whether domain-specific cognitive changes after cardiac surgery predict long-term cognitive outcome. MATERIALS AND METHODS We assessed 100 patients (86 men, mean age 60) before coronary artery bypass grafting, with re-examinations after one week, three months, and a mean of 6.7 years. The extensive neuropsychological test battery was organized into seven functional cognitive domains. Cognitive decline and improvement were defined with the reliable change index derived from 17 matching healthy controls. Analyses were adjusted for baseline cognitive performance, age, gender, education and cardiovascular risks factors. RESULTS On group level, one week after surgery 71% patients showed cognitive decline and 9% improvement in any functional domain, as compared to preoperative results. Three months postsurgery, decline was observed in 47% and improvement in 25% of patients. Executive functioning was the most sensitive domain to both decline and improvement. Postoperative dysfunction predicted long-term cognitive deterioration six years after operation, particularly in the domain of executive functioning. CONCLUSIONS POCD after coronary artery bypass grafting is an essential risk factor for long-term deterioration and an indication for neuropsychological follow-up. Assessment of change in executive functioning after coronary artery bypass grafting may help to identify patients at risk for unfavorable long-term outcome.
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Affiliation(s)
- Kristiina Relander
- Clinical Neurosciences, Neuropsychology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Marja Hietanen
- Clinical Neurosciences, Neuropsychology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Kirsi Rantanen
- Clinical Neurosciences, Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Juhani Rämö
- Department of Cardiac Surgery, Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Antti Vento
- Department of Cardiac Surgery, Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Kari-Pekka Saastamoinen
- Clinical Neurosciences, Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Risto O Roine
- University of Turku and Turku University Hospital, Turku, Finland
| | - Lauri Soinne
- Clinical Neurosciences, Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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15
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Liesto S, Sipilä R, Aho T, Harno H, Hietanen M, Kalso E. Psychological resilience associates with pain experience in women treated for breast cancer. Scand J Pain 2020; 20:545-553. [PMID: 32335540 DOI: 10.1515/sjpain-2019-0137] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 03/21/2020] [Indexed: 11/15/2022]
Abstract
Background and aims Psychological resilience refers to successful adaptation or a positive outcome in the context of significant life adversity, such as chronic pain. On the other hand, anxiety closely associates with pain. The aim of this study was to explore how anxiety and psychological resilience together associate with persistent and experimental pain. Methods In a cross-sectional design, we studied 160 patients who had previously been treated for breast cancer and who now reported at least moderate pain (NRS ≥ 4) in any area of the body. Psychological resilience was measured on the Resilience Scale-14, anxiety on the Hospital Anxiety and Depression Scale, and intensity and interference of persistent pain by means of the Brief Pain Inventory. The cold pressor test was conducted to assess sensitivity to experimental cold pain. Results The results showed that resilience associated with pain interference in persistent pain, and that anxiety moderated this effect. Higher psychological resilience was associated with lower pain interference and this association was stronger in patients with low anxiety than among patients with high anxiety. These effects were visible with regard to persistent pain but not in experimental cold pain. Conclusions These results indicate that chronic pain and experimental pain as well as pain severity and pain interference are psychologically different phenomena. Psychological resilience protects against pain interference but effectively only in patients with low anxiety. It is necessary also to consider protective factors in addition to vulnerability factors in cases of persistent pain. Implications Resilience has been considered a potential target for intervention in chronic pain. However, high levels of anxiety might diminish the protective effect of psychological resilience in clinical settings. Therefore, it is important to treat anxiety in addition to resilience enhancing interventions. Patients with low psychological distress might be more suitable for resilience enhancing interventions than patients with high anxiety.
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Affiliation(s)
- Sanna Liesto
- Division of Pain Medicine, Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Clinical Neurosciences, Neuropsychology, University of Helsinki and Neurocenter, Helsinki University Hospital, Helsinki, Finland
| | - Reetta Sipilä
- Division of Pain Medicine, Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tommi Aho
- Division of Pain Medicine, Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Hanna Harno
- Division of Pain Medicine, Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Clinical Neurosciences, Neurology, University of Helsinki and Neurocenter, Helsinki University Hospital, Helsinki, Finland
| | - Marja Hietanen
- Clinical Neurosciences, Neuropsychology, University of Helsinki and Neurocenter, Helsinki University Hospital, Helsinki, Finland
| | - Eija Kalso
- Division of Pain Medicine, Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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16
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Kallio EL, Hietanen M, Kautiainen H, Pitkälä KH. Neuropsychological outcome of cognitive training in mild to moderate dementia: A randomized controlled trial. Neuropsychol Rehabil 2020; 31:935-953. [PMID: 32295483 DOI: 10.1080/09602011.2020.1749674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Effectiveness of a 12-week cognitive training (CT) programme for community-dwelling patients with dementia was evaluated on various cognitive functions (attention, memory, executive functions and reasoning) and psychological well-being (PWB). A single-blind randomized controlled trial was conducted in adult day care centres in Helsinki, Finland. Participants (N = 147) were older individuals with mild to moderate dementia living at home and attending day care (mean age 83 years, 72% female, 63% at mild stage of dementia). The intervention group (n = 76) received systematic CT for 45 min twice a week while the control group (n = 71) attended day care as usual. The cognitive and psychological outcomes were measured at baseline, and followed up at 3 and 9 months. No differences between the two groups in changes of any of the cognitive functions, or PWB over time were found. We observed a positive trend at 3 months in the change for PWB favouring the intervention group, but no significant interaction effect was found (p = .079; d = -0.31). Thus, systematic CT appears to have no effect on neuropsychological outcomes of cognitive functioning and PWB in older adults who already have dementia.
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Affiliation(s)
- Eeva-Liisa Kallio
- Department of General Practice and Primary Health Care, University of Helsinki, and Unit of Primary Health Care, Helsinki University Hospital, Helsinki, Finland.,Clinical Neurosciences, Neuropsychology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Marja Hietanen
- Clinical Neurosciences, Neuropsychology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Hannu Kautiainen
- Department of General Practice and Primary Health Care, University of Helsinki, and Unit of Primary Health Care, Helsinki University Hospital, Helsinki, Finland
| | - Kaisu H Pitkälä
- Department of General Practice and Primary Health Care, University of Helsinki, and Unit of Primary Health Care, Helsinki University Hospital, Helsinki, Finland
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Kaltiainen H, Liljeström M, Helle L, Salo A, Hietanen M, Renvall H, Forss N. Mild Traumatic Brain Injury Affects Cognitive Processing and Modifies Oscillatory Brain Activity during Attentional Tasks. J Neurotrauma 2019; 36:2222-2232. [PMID: 30896274 PMCID: PMC6653790 DOI: 10.1089/neu.2018.6306] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Despite the high prevalence of mild traumatic brain injury (mTBI), current diagnostic tools to objectively assess cognitive complaints after mTBI continue to be inadequate. Our aim was to identify neuronal correlates for cognitive difficulties in mTBI patients by evaluating the possible alterations in oscillatory brain activity during a behavioral task known to be sensitive to cognitive impairment after mTBI. We compared oscillatory brain activity during rest and cognitive tasks (Paced Auditory Serial Addition Test [PASAT] and a vigilance test [VT]) with magnetoencephalography between 25 mTBI patients and 20 healthy controls. Whereas VT induced no significant differences compared with resting state in either group, patients exhibited stronger attenuation of 8- to 14-Hz oscillatory activity during PASAT than healthy controls in the left parietotemporal cortex (p ≤ 0.05). Further, significant task-related modulation in the left superior frontal gyrus and right prefrontal cortex was detected only in patients. The ∼10-Hz (alpha) peak frequency declined in frontal, temporal, and parietal regions during PASAT compared with rest (p < 0.016) in patients, whereas in controls it remained the same or showed a tendency to increase. In patients, the ∼10-Hz peak amplitude was negatively correlated with behavioral performance in the Trail Making Test. The observed alterations in the cortical oscillatory activity during cognitive load may provide measurable neurophysiological correlates of cognitive difficulties in mTBI patients, even at the individual level.
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Affiliation(s)
- Hanna Kaltiainen
- 1 Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Espoo, Finland.,2 Aalto Neuroimaging, MEG Core, Aalto University, Espoo, Finland.,3 Lohja District Hospital, Department of Neurology, Lohja, Finland.,5 Clinical Neurosciences, University of Helsinki, and Department of Neurology, Helsinki University Hospital, BioMag Laboratory, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mia Liljeström
- 1 Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Espoo, Finland.,2 Aalto Neuroimaging, MEG Core, Aalto University, Espoo, Finland
| | - Liisa Helle
- 1 Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Espoo, Finland.,2 Aalto Neuroimaging, MEG Core, Aalto University, Espoo, Finland.,4 MEGIN (Elekta Oy), Helsinki, Finland
| | - Anne Salo
- 5 Clinical Neurosciences, University of Helsinki, and Department of Neurology, Helsinki University Hospital, BioMag Laboratory, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Marja Hietanen
- 5 Clinical Neurosciences, University of Helsinki, and Department of Neurology, Helsinki University Hospital, BioMag Laboratory, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Hanna Renvall
- 1 Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Espoo, Finland.,2 Aalto Neuroimaging, MEG Core, Aalto University, Espoo, Finland.,5 Clinical Neurosciences, University of Helsinki, and Department of Neurology, Helsinki University Hospital, BioMag Laboratory, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,6 HUS Medical Imaging Center, BioMag Laboratory, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Nina Forss
- 1 Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Espoo, Finland.,2 Aalto Neuroimaging, MEG Core, Aalto University, Espoo, Finland.,5 Clinical Neurosciences, University of Helsinki, and Department of Neurology, Helsinki University Hospital, BioMag Laboratory, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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18
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Laakso HM, Hietanen M, Melkas S, Sibolt G, Curtze S, Virta M, Ylikoski R, Pohjasvaara T, Kaste M, Erkinjuntti T, Jokinen H. Executive function subdomains are associated with post‐stroke functional outcome and permanent institutionalization. Eur J Neurol 2018; 26:546-552. [DOI: 10.1111/ene.13854] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 11/05/2018] [Indexed: 11/30/2022]
Affiliation(s)
- H. M. Laakso
- Neurology and Neuropsychology University of Helsinki and Helsinki University Hospital HelsinkiFinland
- Department of Psychology and Logopedics Faculty of Medicine University of Helsinki HelsinkiFinland Finland
| | - M. Hietanen
- Neurology and Neuropsychology University of Helsinki and Helsinki University Hospital HelsinkiFinland
| | - S. Melkas
- Neurology and Neuropsychology University of Helsinki and Helsinki University Hospital HelsinkiFinland
| | - G. Sibolt
- Neurology and Neuropsychology University of Helsinki and Helsinki University Hospital HelsinkiFinland
| | - S. Curtze
- Neurology and Neuropsychology University of Helsinki and Helsinki University Hospital HelsinkiFinland
| | - M. Virta
- Department of Psychology and Logopedics Faculty of Medicine University of Helsinki HelsinkiFinland Finland
| | - R. Ylikoski
- Neurology and Neuropsychology University of Helsinki and Helsinki University Hospital HelsinkiFinland
| | - T. Pohjasvaara
- Neurology and Neuropsychology University of Helsinki and Helsinki University Hospital HelsinkiFinland
| | - M. Kaste
- Neurology and Neuropsychology University of Helsinki and Helsinki University Hospital HelsinkiFinland
| | - T. Erkinjuntti
- Neurology and Neuropsychology University of Helsinki and Helsinki University Hospital HelsinkiFinland
| | - H. Jokinen
- Neurology and Neuropsychology University of Helsinki and Helsinki University Hospital HelsinkiFinland
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19
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Kallio EL, Öhman H, Hietanen M, Soini H, Strandberg TE, Kautiainen H, Pitkälä KH. Effects of Cognitive Training on Cognition and Quality of Life of Older Persons with Dementia. J Am Geriatr Soc 2018; 66:664-670. [DOI: 10.1111/jgs.15196] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Eeva-Liisa Kallio
- Department of General Practice and Primary Health Care; University of Helsinki; and Unit of Primary Health Care; Helsinki University Hospital; Helsinki Finland
- Clinical Neurosciences; Neuropsychology; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - Hannareeta Öhman
- Department of General Practice and Primary Health Care; University of Helsinki; and Unit of Primary Health Care; Helsinki University Hospital; Helsinki Finland
- City of Helsinki; Hospital; Rehabilitation; and Care Services; Helsinki Finland
| | - Marja Hietanen
- Clinical Neurosciences; Neuropsychology; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - Helena Soini
- City of Helsinki; Social Services and Health Care Department; Helsinki Finland
| | - Timo E. Strandberg
- University of Helsinki and Helsinki University Hospital; Helsinki Finland
- Center for Life Course Health Research; University of Oulu; Oulu Finland
| | - Hannu Kautiainen
- Department of General Practice and Primary Health Care; University of Helsinki; and Unit of Primary Health Care; Helsinki University Hospital; Helsinki Finland
| | - Kaisu H. Pitkälä
- Department of General Practice and Primary Health Care; University of Helsinki; and Unit of Primary Health Care; Helsinki University Hospital; Helsinki Finland
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20
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Kallio EL, Öhman H, Kautiainen H, Hietanen M, Pitkälä K. Cognitive Training Interventions for Patients with Alzheimer's Disease: A Systematic Review. J Alzheimers Dis 2017; 56:1349-1372. [PMID: 28222505 DOI: 10.3233/jad-160810] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Cognitive training (CT) refers to guided cognitive exercises designed to improve specific cognitive functions, as well as enhance performance in untrained cognitive tasks. Positive effects of CT on cognitive functions in healthy elderly people and persons with mild cognitive impairment have been reported, but data regarding the effects of CT in patients with dementia is unclear. OBJECTIVE We systematically reviewed the current evidence from randomized controlled trials (RCTs) to find out if CT improves or stabilizes cognition and/or everyday functioning in patients with mild and moderate Alzheimer's disease. RESULTS Altogether, 31 RCTs with CT as either the primary intervention or part of a broader cognitive or multi-component intervention were found. A positive effect was reported in 24 trials, mainly on global cognition and training-specific tasks, particularly when more intensive or more specific CT programs were used. Little evidence of improved everyday functioning was found. CONCLUSIONS Despite some positive findings, the inaccurate definitions of CT, inadequate sample sizes, unclear randomization methods, incomplete datasets at follow-up and multiple testing may have inflated the results in many trials. Future high quality RCTs with appropriate classification and specification of cognitive interventions are necessary to confirm CT as an effective treatment option in Alzheimer's disease.
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Affiliation(s)
- Eeva-Liisa Kallio
- Department of General Practice and Primary Health Care, University of Helsinki, and Unit of Primary Health Care, Helsinki University Hospital, Helsinki, Finland
- Clinical Neurosciences, Neuropsychology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Hanna Öhman
- Department of General Practice and Primary Health Care, University of Helsinki, and Unit of Primary Health Care, Helsinki University Hospital, Helsinki, Finland
- Hospital, Rehabilitation, and Care Services, City of Helsinki, Helsinki, Finland
| | - Hannu Kautiainen
- Department of General Practice and Primary Health Care, University of Helsinki, and Unit of Primary Health Care, Helsinki University Hospital, Helsinki, Finland
| | - Marja Hietanen
- Clinical Neurosciences, Neuropsychology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Kaisu Pitkälä
- Department of General Practice and Primary Health Care, University of Helsinki, and Unit of Primary Health Care, Helsinki University Hospital, Helsinki, Finland
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21
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Jokinen H, Melkas S, Ylikoski R, Pohjasvaara T, Kaste M, Erkinjuntti T, Hietanen M. Post-stroke cognitive impairment is common even after successful clinical recovery. Eur J Neurol 2015; 22:1288-94. [DOI: 10.1111/ene.12743] [Citation(s) in RCA: 225] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 04/06/2015] [Indexed: 11/30/2022]
Affiliation(s)
- H. Jokinen
- Clinical Neurosciences, Neurology; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - S. Melkas
- Clinical Neurosciences, Neurology; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - R. Ylikoski
- Clinical Neurosciences, Neurology; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - T. Pohjasvaara
- Clinical Neurosciences, Neurology; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - M. Kaste
- Clinical Neurosciences, Neurology; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - T. Erkinjuntti
- Clinical Neurosciences, Neurology; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - M. Hietanen
- Clinical Neurosciences, Neurology; University of Helsinki and Helsinki University Hospital; Helsinki Finland
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22
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Melkas S, Jokinen H, Hietanen M, Erkinjuntti T. Poststroke cognitive impairment and dementia: prevalence, diagnosis, and treatment. Degener Neurol Neuromuscul Dis 2014; 4:21-27. [PMID: 32669898 PMCID: PMC7337160 DOI: 10.2147/dnnd.s37353] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Accepted: 11/26/2013] [Indexed: 12/21/2022] Open
Abstract
Three aspects of poststroke cognitive impairment and dementia are discussed in this review: prevalence; diagnosis; and treatment. The aim is to increase awareness of poststroke cognitive impairment in order to further stimulate strategies to recognize the condition and to prevent its progression. Approximately two-thirds of all middle-aged and elderly stroke patients develop cognitive impairment, and one in three develops dementia. The standard reference for diagnosis is a detailed neuropsychological examination. Short screening tests have been used for both clinical and research purposes, but their sensitivity is limited and there is no consensus as to which test is the most appropriate. The treatment of poststroke cognitive impairment and dementia is based on effective treatment of vascular risk factors, including lifestyle modification when needed.
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Affiliation(s)
- Susanna Melkas
- Department of Neurology, Helsinki University Central Hospital and Department of Neurological Sciences, University of Helsinki, Helsinki, Finland
| | - Hanna Jokinen
- Department of Neurology, Helsinki University Central Hospital and Department of Neurological Sciences, University of Helsinki, Helsinki, Finland
| | - Marja Hietanen
- Department of Neurology, Helsinki University Central Hospital and Department of Neurological Sciences, University of Helsinki, Helsinki, Finland
| | - Timo Erkinjuntti
- Department of Neurology, Helsinki University Central Hospital and Department of Neurological Sciences, University of Helsinki, Helsinki, Finland
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23
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Ojala-Oksala J, Jokinen H, Kopsi V, Lehtonen K, Luukkonen L, Paukkunen A, Seeck L, Melkas S, Pohjasvaara T, Karhunen P, Hietanen M, Erkinjuntti T, Oksala N. Educational history is an independent predictor of cognitive deficits and long-term survival in postacute patients with mild to moderate ischemic stroke. Stroke 2012; 43:2931-5. [PMID: 22935400 DOI: 10.1161/strokeaha.112.667618] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Poststroke cognitive decline and white matter lesions (WML) are related to poor poststroke survival. Whether cognitive reserve as reflected by educational history associates with cognitive decline, recurrent strokes, and poststroke mortality independent of WML is not known. METHODS A total of 486 consecutive acute mild/moderate ischemic stroke patients subjected to comprehensive neuropsychological assessment (n=409) and magnetic resonance imaging (n=395) 3 months poststroke were included in the study and followed-up for up to 12 years. Odds ratios (OR) for logistic and hazard ratios for Cox regression analyses are reported (OR and hazard ratio≤1 indicates a beneficial effect). RESULTS Long educational history (per tertile) was associated with lower frequency of executive dysfunction in models adjusted for age, sex, marital status, and stroke severity (OR, 0.75; P<0.05) but not when adding WML as a covariate. In contrast, educational history was independently associated with less memory impairment (OR, 0.67; P<0.01), aphasia (OR, 0.69; P<0.05), visuospatial and constructive deficits (OR, 0.70; P<0.05), Mini-Mental State Examination score<25 (OR, 0.53; P<0.0001), and dementia (OR, 0.66; P<0.01). In Cox regression analysis, educational history was not associated with recurrent strokes, but it associated independently with favorable poststroke survival (hazard ratio, 0.86; P<0.05). CONCLUSIONS Long educational history associates with less poststroke cognitive deficits, dementia, and favorable long-term survival independent of age, gender, marital status, stroke severity, and WML in patients with mild/moderate ischemic stroke. This supports the hypothesis that educational history as a proxy indicator of cognitive reserve protects against deficits induced by acute stroke.
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Affiliation(s)
- Johanna Ojala-Oksala
- School of Medicine, University of Tampere and Tampere University Hospital, Department of Surgery, Tampere, Finland
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24
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Särkämö T, Tervaniemi M, Soinila S, Autti T, Silvennoinen HM, Laine M, Hietanen M, Pihko E. Auditory and cognitive deficits associated with acquired amusia after stroke: a magnetoencephalography and neuropsychological follow-up study. PLoS One 2010; 5:e15157. [PMID: 21152040 PMCID: PMC2996293 DOI: 10.1371/journal.pone.0015157] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2010] [Accepted: 10/22/2010] [Indexed: 11/18/2022] Open
Abstract
Acquired amusia is a common disorder after damage to the middle cerebral artery (MCA) territory. However, its neurocognitive mechanisms, especially the relative contribution of perceptual and cognitive factors, are still unclear. We studied cognitive and auditory processing in the amusic brain by performing neuropsychological testing as well as magnetoencephalography (MEG) measurements of frequency and duration discrimination using magnetic mismatch negativity (MMNm) recordings. Fifty-three patients with a left (n = 24) or right (n = 29) hemisphere MCA stroke (MRI verified) were investigated 1 week, 3 months, and 6 months after the stroke. Amusia was evaluated using the Montreal Battery of Evaluation of Amusia (MBEA). We found that amusia caused by right hemisphere damage (RHD), especially to temporal and frontal areas, was more severe than amusia caused by left hemisphere damage (LHD). Furthermore, the severity of amusia was found to correlate with weaker frequency MMNm responses only in amusic RHD patients. Additionally, within the RHD subgroup, the amusic patients who had damage to the auditory cortex (AC) showed worse recovery on the MBEA as well as weaker MMNm responses throughout the 6-month follow-up than the non-amusic patients or the amusic patients without AC damage. Furthermore, the amusic patients both with and without AC damage performed worse than the non-amusic patients on tests of working memory, attention, and cognitive flexibility. These findings suggest domain-general cognitive deficits to be the primary mechanism underlying amusia without AC damage whereas amusia with AC damage is associated with both auditory and cognitive deficits.
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Affiliation(s)
- Teppo Särkämö
- Cognitive Brain Research Unit, Institute of Behavioural Sciences, University of Helsinki, Helsinki, Finland.
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25
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Särkämö T, Pihko E, Laitinen S, Forsblom A, Soinila S, Mikkonen M, Autti T, Silvennoinen HM, Erkkilä J, Laine M, Peretz I, Hietanen M, Tervaniemi M. Music and Speech Listening Enhance the Recovery of Early Sensory Processing after Stroke. J Cogn Neurosci 2010; 22:2716-27. [DOI: 10.1162/jocn.2009.21376] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Abstract
Our surrounding auditory environment has a dramatic influence on the development of basic auditory and cognitive skills, but little is known about how it influences the recovery of these skills after neural damage. Here, we studied the long-term effects of daily music and speech listening on auditory sensory memory after middle cerebral artery (MCA) stroke. In the acute recovery phase, 60 patients who had middle cerebral artery stroke were randomly assigned to a music listening group, an audio book listening group, or a control group. Auditory sensory memory, as indexed by the magnetic MMN (MMNm) response to changes in sound frequency and duration, was measured 1 week (baseline), 3 months, and 6 months after the stroke with whole-head magnetoencephalography recordings. Fifty-four patients completed the study. Results showed that the amplitude of the frequency MMNm increased significantly more in both music and audio book groups than in the control group during the 6-month poststroke period. In contrast, the duration MMNm amplitude increased more in the audio book group than in the other groups. Moreover, changes in the frequency MMNm amplitude correlated significantly with the behavioral improvement of verbal memory and focused attention induced by music listening. These findings demonstrate that merely listening to music and speech after neural damage can induce long-term plastic changes in early sensory processing, which, in turn, may facilitate the recovery of higher cognitive functions. The neural mechanisms potentially underlying this effect are discussed.
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Affiliation(s)
| | | | | | | | | | | | - Taina Autti
- 4Helsinki University Central Hospital, Finland
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26
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Hänninen T, Pulliainen V, Sotaniemi M, Hokkanen L, Salo J, Hietanen M, Pirttilä T, Pöyhönen M, Juva K, Remes A, Erkinjuntti T. [Early detection of cognitive changes in memory diseases: new cut-off scores for the Finnish version of CERAD neuropsychological battery]. Duodecim 2010; 126:2013-2021. [PMID: 21053518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The evaluation of cognitive functions by using CERAD (Consortium to Establish a Registry for Alzheimer's Disease) is recommended as a tool in basic health care for screening of memory diseases. The reliability of this method, adopted in Finland in 1999, has been impaired by the fact that there have been no comprehensive Finnish norms to serve as the basis for the cut-off limits of the test tasks. This article presents the new, revised cut-off values for the CERAD procedure, based on the comparison of Finnish population-based normative data with those of persons having very mild or mild Alzheimer's disease.
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Oksala NKJ, Jokinen H, Melkas S, Oksala A, Pohjasvaara T, Hietanen M, Vataja R, Kaste M, Karhunen PJ, Erkinjuntti T. Cognitive impairment predicts poststroke death in long-term follow-up. J Neurol Neurosurg Psychiatry 2009; 80:1230-5. [PMID: 19620138 DOI: 10.1136/jnnp.2009.174573] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Poststroke global cognitive decline and dementia have been related to poor long-term survival. Whether deficits in specific cognitive domains are associated with long-term survival in patients with ischaemic stroke is not known in detail. METHODS Patients with acute stroke subjected to comprehensive neuropsychological evaluation were included in the study (n = 409) and followed up for up to 12 years. RESULTS In Kaplan-Meier analysis, impairments in following cognitive domains predicted poor poststroke survival (estimated years): executive functions (48.2%) (5.8 vs 10.1 years, p<0.0001), memory (59.9%) (6.8 vs 9.3 years, p = 0.009), language (28.9%) (5.3 vs 8.6 years, p = 0.004) and visuospatial/constructional abilities (55.2%) (5.6 vs 10.1 years, p<0.0001). Low Mini Mental Status Examination (MMSE) <or=25 (30.5%) (4.4 vs 9.3 years, p<0.0001), low education (<6 years) (31.8%) (6.4 vs 8.2 years, p = 0.003) and poor modified Rankin score (39.9%) (3.9 vs 9.7 years, p<0.0001) were also related to poor survival. In Cox regression proportional hazards analyses including age, sex and years of education as covariates, deficits in executive functions (hazard ratio (HR) 1.59, p<0.0001), memory (HR 1.31, p = 0.042), language (HR 1.33, p = 0.036) and visuospatial/constructional abilities (HR 1.82, p<0.0001) were significant predictors of poor poststroke survival. Of these, executive functions (HR 1.33, p = 0.040) as well as visuospatial/constructional abilities (HR 1.53, p = 0.004) remained as significant predictors after addition of MMSE<or=25 and poor modified Rankin score as covariates. Furthermore, cognitive impairment no dementia (CIND) was also an independent predictor of poor poststroke survival (HR 1.63, p = 0.0123). CONCLUSIONS In patients with ischaemic stroke, cognitive impairment, particularly in executive functions, and visuospatial/constructional abilities relate to poor survival.
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Affiliation(s)
- N K J Oksala
- Department of Surgery and Forensic Medicine, Medical School, University of Tampere and Tampere University Hospital, 33014 University of Tampere, Finland.
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Särkämö T, Tervaniemi M, Soinila S, Autti T, Silvennoinen HM, Laine M, Hietanen M. Amusia and Cognitive Deficits after Stroke. Ann N Y Acad Sci 2009; 1169:441-5. [DOI: 10.1111/j.1749-6632.2009.04765.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
PRIMARY OBJECTIVE To analyse time-sharing strategies in patients with cerebral lesions when they performed everyday in-car tasks in real-life highway driving. A case-control study. METHODS AND PROCEDURES Thirteen male patients with brain damage and 11 healthy controls participated. The frequency and duration of glances at the in-car tasks, total time of eyes-off the road during tasks, speed and lateral displacement of the car were recorded. MAIN OUTCOMES AND RESULTS Long glances away from the road and consequent large lateral displacements were characteristic for patients with anterior damage, while the patients with more posterior lesions used frequent short glances at the in-car task. CONCLUSION Two different time-sharing strategies that appeared to be related to different aetiology were found in the patients, indicating different control of the driving task. It is proposed that standardized on-road dual tasks should be used for detecting problems in allocation of attention during driving.
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Affiliation(s)
- Anna-Stina Wikman
- Department of Psychology, University of Helsinki, Helsinki, Finland.
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30
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Särkämö T, Tervaniemi M, Soinila S, Autti T, Silvennoinen HM, Laine M, Hietanen M. Cognitive deficits associated with acquired amusia after stroke: a neuropsychological follow-up study. Neuropsychologia 2009; 47:2642-51. [PMID: 19500606 DOI: 10.1016/j.neuropsychologia.2009.05.015] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2008] [Revised: 05/18/2009] [Accepted: 05/22/2009] [Indexed: 10/20/2022]
Abstract
Recent evidence on amusia suggests that our ability to perceive music might be based on the same neural resources that underlie other higher cognitive functions, such as speech perception and spatial processing. We studied the neural correlates of acquired amusia by performing extensive neuropsychological assessments on 53 stroke patients with a left or right hemisphere middle cerebral artery (MCA) stroke 1 week, 3 months, and 6 months after the stroke. In addition, structural magnetic resonance imaging (MRI) was performed on all patients 1 week and 6 months post-stroke. Based on their performance on a shortened version of the Montreal Battery of Evaluation of Amusia (MBEA), the patients were classified as amusic (n=32) or non-amusic (n=21). MRI results showed that the incidence of auditory cortex and frontal lobe damage was significantly higher in the amusic group than in the non-amusic group, but the two groups did not differ in respect to lesion laterality. Cognitively, amusia was associated with general deficits in working memory and learning, semantic fluency, executive functioning, and visuospatial cognition, as well as hemisphere-specific deficits in verbal comprehension, mental flexibility, and visuospatial attention (unilateral spatial neglect). Moreover, the recovery of music perception ability was related to the recovery of verbal learning, visuospatial perception and attention, and focused attention, especially in amusic patients. Together, these results suggest the ability to perceive music is closely linked to other higher cognitive functions.
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Affiliation(s)
- Teppo Särkämö
- Department of Psychology, University of Helsinki, Helsinki, Finland.
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32
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Teräväinen H, Hietanen M, Huttunen J, Pihl S. MESULERGINE AND LEVODOPA IN PARKINSON'S DISEASE. Acta Neurol Scand 2009. [DOI: 10.1111/j.1600-0404.1984.tb02385.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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33
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34
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Soinne L, Helenius J, Tikkala I, Saimanen E, Salonen O, Hietanen M, Lindsberg PJ, Kaste M, Tatlisumak T. The effect of severe carotid occlusive disease and its surgical treatment on cognitive functions of the brain. Brain Cogn 2008; 69:353-9. [PMID: 18823689 DOI: 10.1016/j.bandc.2008.08.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2008] [Revised: 08/08/2008] [Accepted: 08/14/2008] [Indexed: 11/28/2022]
Abstract
Surgery of a high-grade carotid stenosis is evidence-based stroke prevention. Also cognitive effects are reported after carotid endarterectomy (CEA): both deterioration and improvement, the former attributed to perioperative complications and the latter often to learning effect. By imaging, brain perfusion and diffusion changes were shown in subjects with a high-grade stenosis undergoing CEA. We wanted to find out if the cognition of patients undergoing CEA display postoperative worsening or true improvement in association with findings in serial MR imaging. The patients had a poorer overall cognition than healthy matched controls. The cerebral hemisphere ipsilateral to the stenosis had higher diffusion and more sluggish perfusion leading to perfusion deficits. These asymmetries were abolished by CEA. Postoperatively, the patients showed a trend for cognitive worsening, most often attentional, but over months, the group performance improved similarly to the controls. Still, lower baseline perfusion was associated with a greater cognitive improvement, most clearly in executive functions. Consequently, despite the risk for transient decline, true cognitive benefit by CEA seems possible.
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Affiliation(s)
- Lauri Soinne
- Department of Neurology, Helsinki University Central Hospital, Haartmaninkatu 4, 00029 Helsinki, Finland.
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van Erp TG, Therman S, Pirkola T, Tuulio-Henriksson A, Glahn DC, Bachman P, Huttunen MO, Lönnqvist J, Hietanen M, Kaprio J, Koskenvuo M, Cannon TD. Verbal recall and recognition in twins discordant for schizophrenia. Psychiatry Res 2008; 159:271-80. [PMID: 18442861 PMCID: PMC2519867 DOI: 10.1016/j.psychres.2007.03.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2005] [Revised: 10/31/2006] [Accepted: 03/11/2007] [Indexed: 10/22/2022]
Abstract
The nature, neural underpinnings, and etiology of deficits in verbal declarative memory in patients with schizophrenia remain unclear. To examine the contributions of genes and environment to verbal recall and recognition performance in this disorder, the California Verbal Learning Test was administered to a large population-based Finnish twin sample, which included schizophrenic and schizoaffective patients, their non-ill monozygotic (MZ) and dizygotic (DZ) co-twins, and healthy control twins. Compared with controls, patients and their co-twins showed relatively greater performance deficits on free recall compared with recognition. Intra-pair differences between patients and their non-ill co-twins in hippocampal volume and memory performance were highly positively correlated. These findings are consistent with the view that genetic influences are associated with reduced verbal recall in schizophrenia, but that non-genetic influences further compromise these abnormalities in patients who manifest the full-blown schizophrenia phenotype, with this additional degree of disease-related declarative memory deficit mediated in part by hippocampal pathology.
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Affiliation(s)
| | - Sebastian Therman
- Department of Mental Health and Alcohol Research, National Public Health Institute of Finland, Helsinki, Finland
| | - Tiia Pirkola
- Department of Mental Health and Alcohol Research, National Public Health Institute of Finland, Helsinki, Finland
| | - Annamari Tuulio-Henriksson
- Department of Mental Health and Alcohol Research, National Public Health Institute of Finland, Helsinki, Finland
| | - David C. Glahn
- Department of Psychiatry and Research Imaging Center, UTHSCA, San Antonio, TX, U. S.A
| | - Peter Bachman
- Department of Psychology, UCLA, Los Angeles, CA, U.S.A
| | - Matti O. Huttunen
- Department of Mental Health and Alcohol Research, National Public Health Institute of Finland, Helsinki, Finland
| | - Jouko Lönnqvist
- Department of Mental Health and Alcohol Research, National Public Health Institute of Finland, Helsinki, Finland
| | - Marja Hietanen
- Department of Neurology, University of Helsinki, Helsinki, Finland
| | - Jaakko Kaprio
- Department of Mental Health and Alcohol Research, National Public Health Institute of Finland, Helsinki, Finland, Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Markku Koskenvuo
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Tyrone D. Cannon
- Department of Psychology, UCLA, Los Angeles, CA, U.S.A., Department of Psychiatry and Biobehavioral Sciences, and Human Genetics, UCLA, CA, U.S.A
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Särkämö T, Tervaniemi M, Laitinen S, Forsblom A, Soinila S, Mikkonen M, Autti T, Silvennoinen HM, Erkkilä J, Laine M, Peretz I, Hietanen M. Music listening enhances cognitive recovery and mood after middle cerebral artery stroke. Brain 2008; 131:866-76. [PMID: 18287122 DOI: 10.1093/brain/awn013] [Citation(s) in RCA: 380] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
We know from animal studies that a stimulating and enriched environment can enhance recovery after stroke, but little is known about the effects of an enriched sound environment on recovery from neural damage in humans. In humans, music listening activates a wide-spread bilateral network of brain regions related to attention, semantic processing, memory, motor functions, and emotional processing. Music exposure also enhances emotional and cognitive functioning in healthy subjects and in various clinical patient groups. The potential role of music in neurological rehabilitation, however, has not been systematically investigated. This single-blind, randomized, and controlled trial was designed to determine whether everyday music listening can facilitate the recovery of cognitive functions and mood after stroke. In the acute recovery phase, 60 patients with a left or right hemisphere middle cerebral artery (MCA) stroke were randomly assigned to a music group, a language group, or a control group. During the following two months, the music and language groups listened daily to self-selected music or audio books, respectively, while the control group received no listening material. In addition, all patients received standard medical care and rehabilitation. All patients underwent an extensive neuropsychological assessment, which included a wide range of cognitive tests as well as mood and quality of life questionnaires, one week (baseline), 3 months, and 6 months after the stroke. Fifty-four patients completed the study. Results showed that recovery in the domains of verbal memory and focused attention improved significantly more in the music group than in the language and control groups. The music group also experienced less depressed and confused mood than the control group. These findings demonstrate for the first time that music listening during the early post-stroke stage can enhance cognitive recovery and prevent negative mood. The neural mechanisms potentially underlying these effects are discussed.
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Affiliation(s)
- Teppo Särkämö
- Cognitive Brain Research Unit, Department of Psychology, University of Helsinki, and Helsinki Brain Research Centre, Helsinki, Finland.
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Sarkamo T, Tervaniemi M, Laitinen S, Forsblom A, Soinila S, Mikkonen M, Autti T, Silvennoinen HM, Erkkila J, Laine M, Peretz I, Hietanen M. Music listening enhances cognitive recovery and mood after middle cerebral artery stroke. Brain 2008. [DOI: 10.1093/brain/awn013 10.1212/wnl.0b013e31826c1a8d] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Abstract
Exposure of workers to radiofrequency fields was assessed in two medium-sized antenna towers. Towers had transmitting antennas from different networks, e.g. mobile phone networks, radio and digital TV sub-stations and amateur radio. The levels of radiofrequency fields were measured close to the ladders of the towers. All measured values were below ICNIRP occupational reference levels.
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Affiliation(s)
- T Alanko
- Finnish Institute of Occupational Health, New Technologies and Risks, Topeliuksenkatu 41 a A, FI-00250 Helsinki, Finland
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Jokinen H, Kalska H, Mäntylä R, Pohjasvaara T, Ylikoski R, Hietanen M, Salonen O, Kaste M, Erkinjuntti T. Cognitive profile of subcortical ischaemic vascular disease. J Neurol Neurosurg Psychiatry 2006; 77:28-33. [PMID: 16361588 PMCID: PMC2117424 DOI: 10.1136/jnnp.2005.069120] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Subcortical ischaemic vascular disease (SIVD) is a subtype of vascular cognitive impairment characterised by extensive white matter lesions and multiple lacunar infarcts. Radiologically defined diagnostic criteria for SIVD have been introduced, but only a few studies have presented empirical data on its clinical and cognitive features. The aim of this study is to describe in detail the neuropsychological characteristics of patients with SIVD from a large well defined stroke cohort. METHODS A sample of 323 consecutive patients with ischaemic stroke, aged 55-85 years, was investigated using neuropsychological examination and magnetic resonance imaging (MRI). Patients fulfilling the MRI criteria of SIVD (n = 85) were compared to the other stroke patients (n = 238) and to normal control subjects (n = 38). RESULTS Cognitive performance of the SIVD group was inferior to that of the normal control group throughout all domains. As compared to the other stroke patients, the SIVD group performed significantly worse in tests measuring executive functions and delayed memory recall. Adjusting for depression had no effect on these results. Instead, after controlling for medial temporal lobe atrophy, the differences disappeared for delayed memory but remained significant for executive functions. CONCLUSION Executive deficits are the most prominent cognitive characteristic associated with SIVD. Patients with SIVD also exhibit subtle deficits in delayed memory, which is explained in part by medial temporal lobe atrophy. Cognitive and mood changes seem to be parallel but independent processes related to SIVD. The results support the concept of SIVD as a separate clinical entity.
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Affiliation(s)
- H Jokinen
- Department of Psychology, University of Helsinki, Helsinki, Finland.
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40
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Jokinen H, Kalska H, Mäntylä R, Ylikoski R, Hietanen M, Pohjasvaara T, Kaste M, Erkinjuntti T. White matter hyperintensities as a predictor of neuropsychological deficits post-stroke. J Neurol Neurosurg Psychiatry 2005; 76:1229-33. [PMID: 16107356 PMCID: PMC1739804 DOI: 10.1136/jnnp.2004.055657] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVES Cerebral white matter hyperintensities (WMHs) on magnetic resonance imaging (MRI) are a recognised risk factor for post-stroke dementia. Their specific relations to cognitive impairment are still not well known. The purpose of this study was to explore how the severity and location of WMHs predict neuropsychological test performance in the context of other brain lesions in elderly stroke patients. METHODS In the Helsinki Stroke Aging Memory Study, 323 patients, aged from 55 to 85 years, completed a detailed neuropsychological test battery and MRI 3 months after an ischaemic stroke. The demographic and MRI predictors of cognition were studied with sequential linear regression analyses. RESULTS After age, education and total infarct volume were controlled for, the overall degree of WMHs predicted poor performance in tests of mental speed, executive functions, memory, and visuospatial functions, but not in those of short term memory storage or verbal conceptualisation. However, the contribution of separate white matter regions was relatively low. Only the lesions along the bodies of lateral ventricles were independently associated with speed and executive measures. Additionally, general cortical atrophy clearly predicted a wide range of cognitive deficits while infarct volume had less relevance. Further analyses revealed that executive functions act as a strong mediator between the relationship of WMHs to memory and visuospatial functions. CONCLUSIONS The degree of WMHs is independently related to post-stroke cognitive decline. The most affected cognitive domains seem to be executive functions and speed of mental processing, which may lead to secondary deficits of memory and visuospatial functions.
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Affiliation(s)
- H Jokinen
- Department of Neurology, Helsinki University Central Hospital, P.O. Box 302, FIN-00029 HUS, Helsinki, Finland.
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Jokinen H, Kalska H, Ylikoski R, Hietanen M, Mäntylä R, Pohjasvaara T, Kaste M, Erkinjuntti T. Medial temporal lobe atrophy and memory deficits in elderly stroke patients. Eur J Neurol 2005; 11:825-32. [PMID: 15667413 DOI: 10.1111/j.1468-1331.2004.00870.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Medial temporal lobe atrophy (MTA) and its role in memory deficits have been studied extensively in patients with various dementias and non-degenerative neurologic diseases. In stroke patients MTA is a significant risk factor for dementia. However, its role in memory decline in non-demented stroke patients is not yet known. Our aim was to evaluate the relationship between MTA and cognitive functions in a large cohort of elderly patients, who underwent a comprehensive neuropsychologic examination and magnetic resonance imaging 3 months after an ischemic stroke. The study sample (n = 260) was divided into three groups according to the severity of MTA. After adjusting for age, volume of infarcts and cortical atrophy, we found that patients with moderate to severe MTA performed significantly worse in tests of learning, story recall, visual reproduction, block design and mental speed. In contrast, the groups did not differ in tests of digit span, flexibility, verbal fluency and conceptualization. Our conclusion is that in aged stroke patients, MTA is associated with poor performance in specific cognitive domains. The most vulnerable domains are memory and visuospatial functions, whereas verbal and executive functions seem to be unrelated to MTA.
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Affiliation(s)
- H Jokinen
- Department of Psychology, University of Helsinki, Helsinki, Finland.
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42
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Vataja R, Pohjasvaara T, Mäntylä R, Ylikoski R, Leskelä M, Kalska H, Hietanen M, Juhani Aronen H, Salonen O, Kaste M, Leppävuori A, Erkinjuntti T. Depression-executive dysfunction syndrome in stroke patients. Am J Geriatr Psychiatry 2005; 13:99-107. [PMID: 15703318 DOI: 10.1176/appi.ajgp.13.2.99] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE It has been suggested that executive dysfunction could be the core defect in patients with geriatric or vascular depression, and that this depression-dysexecutive syndrome (DES) might be related to frontal-subcortical circuit dysfunction. The authors tested this hypothesis in 158 poststroke patients, of whom 21 had both depression and executive dysfunction. METHODS In this cross-sectional cohort study, a neurological, psychiatric, and neuropsychological examination was carried out 3 months after ischemic stroke, and brain infarcts, white-matter changes, and brain atrophy were recorded by MRI. RESULTS The 21 patients with DES had significantly more brain infarcts affecting their frontal-subcortical circuit structures than the 137 patients without DES, or the 41 patients with depression but without executive dysfunction. Patients with DES also had more severe depressive symptoms and worse psychosocial functioning, and they coped less well in complex activities of daily living. CONCLUSIONS DES is a valid concept and may define a subgroup of poststroke patients with frontal-subcortical pathology and with distinct prognosis and treatment options.
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Affiliation(s)
- Risto Vataja
- Memory Research Unit, Department of Neurology, Helsinki University Central Hospital, P.O. BOX 300, FIN-00029 HUS, Finland
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Vataja R, Pohjasvaara T, Mäntylä R, Ylikoski R, Leppävuori A, Leskelä M, Kalska H, Hietanen M, Aronen HJ, Salonen O, Kaste M, Erkinjuntti T. MRI correlates of executive dysfunction in patients with ischaemic stroke. Eur J Neurol 2004; 10:625-31. [PMID: 14641506 DOI: 10.1046/j.1468-1331.2003.00676.x] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Executive dysfunction (ED) may lead to problem behaviour and impaired activities of daily living in many neuropsychiatric disorders, but the neuroanatomical correlates of ED are still not well known. Different aspects of executive functions were studied by widely used neuropsychological tests in 214 elderly patients 3 months after ischaemic stroke, and a sum score of eight different measures was counted in each patient. The number and site of brain infarcts as well as severity and location of white matter lesions (WMLs) and brain atrophy on magnetic resonance imaging were recorded and compared between patients with and without ED. ED was present in 73 (34.1%) of the 214 patients. The mean frequency of brain infarcts in the brain and in the left hemisphere was higher in the patients with ED. Lesions affecting the frontal-subcortical circuits (e.g. pallidum, corona radiata or centrum semiovale) were more frequent in patients with ED than in those without. Also, patients with pontine brain infarcts frequently had ED, but this may have been due to more extensive ischaemic changes in these patients in general. Mean number of brain infarcts affecting the pons and posterior centrum semiovale on the left side, moderate to severe medial temporal atrophy, the Fazekas white matter score, the Mini-Mental State Examination score and low education were independent correlates of ED. Brain infarcts and WML affecting the frontal-subcortical circuits or the pons may increase risk for ED in stroke patients.
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Affiliation(s)
- R Vataja
- Memory Research Unit, Department of Clinical Neurosciences, Helsinki University Central Hospital, Helsinki, Finland
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Pohjasvaara T, Ylikoski R, Hietanen M, Kalska H, Erkinjuntti T. [Cognition disorders after cerebrovascular accidents]. Duodecim 2002; 118:593-9. [PMID: 12233003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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Pohjasvaara T, Leskelä M, Vataja R, Kalska H, Ylikoski R, Hietanen M, Leppävuori A, Kaste M, Erkinjuntti T. Post-stroke depression, executive dysfunction and functional outcome. Eur J Neurol 2002; 9:269-75. [PMID: 11985635 DOI: 10.1046/j.1468-1331.2002.00396.x] [Citation(s) in RCA: 124] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The early diagnosis of vascular cognitive impairment has been challenged and executive control function has been suggested to be a rational basis for the diagnosis of vascular dementia. We sought to examine the correlates of executive dysfunction in a well-defined stroke cohort. A group of 256 patients from a consecutive cohort of 486 patients with ischaemic stroke, aged 55-85 years, was subjected to a comprehensive neuropsychological examination 3-4 months after ischaemic stroke and 188 of them in addition to detailed psychiatric examination. Basic and complex activities of daily living (ADLs) (bADLs and cADLs) post-stroke were assessed. The DSM-III-R criteria were used for the diagnosis of the depressive disorders. Altogether 40.6% (n=104) of the patients had executive dysfunction. The patients with executive dysfunction were older, had lower level of education, were more often dependent, did worse in bADLs and cADLs, had more often DSM-III dementia, had worse cognition as measured by Mini Mental State Examination (MMSE) and were more depressed as measured by the BECK depression scale, but not with the more detailed psychiatric evaluation. They had more often stroke in the anterior circulation and less often in the posterior circulation. The independent correlates of executive dysfunction were cADLs (OR 1.1, 95% CI 1.03-1.16), each point of worsening in cognition by MMSE (OR 1.7, 95% CI 1.42-1.97) and stroke in the posterior circulation area (OR 0.4, 95% CI 0.18-0.84). Clinically significant executive dysfunction is frequent after ischaemic stroke and is closely connected with cADLs and to overall cognitive status but could be distinguished from depression by detailed neuropsychological examination. Executive measures may detect patients at risk of dementia and disability post-stroke.
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Affiliation(s)
- T Pohjasvaara
- Memory Research Unit, Department of Clinical Neuroscience, Helsinki University Central Hospital, Finland
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46
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Pohjasvaara T, Ylikoski R, Leskelä M, Kalska H, Hietanen M, Kaste M, Erkinjuntti T. Evaluation of various methods of assessing symptoms of cognitive impairment and dementia. Alzheimer Dis Assoc Disord 2001; 15:184-93. [PMID: 11723369 DOI: 10.1097/00002093-200110000-00004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE The effect of different diagnostic criteria for detecting dementia in both epidemiological and stroke cohort studies has been shown, but comparison between different assessment methods has only seldom been done. We compared both assessment methods and diagnostic criteria for dementia in a large well-defined stroke cohort. SUBJECT AND METHODS A group of 227 of 486 patients aged 55 to 85 years who 3 months after ischemic stroke completed a comprehensive neuropsychological test battery, structured clinical mental status examination of defined cognitive domains with expanded Mini-Mental State Examination. The criteria for dementia were those of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III, DSM-III-R) and the National Institute of Neurological Disorders and Stroke-Associated Internationale pour la Recherche et l'Enseignement en Neurosciences (NINDS-AIREN). RESULTS The main differences between clinical and neuropsychological examinations were seen in memory functions: clinically 24.7% and neuropsychologically 54.2% had impairment in short-term memory and 10.4% versus 5.3% in long-term memory. Accordingly, the prevalence of dementia varied greatly: It was clinically 14.1% by DSM-III, 9.7% by DSM-III-R and 8.4% by NINDS-AIREN criteria. The corresponding frequencies based on neuropsychological evaluation were 27.3%, 4.0% and 25.6%. Between these 3 diagnostic criteria the concordance varied in clinical testing between 59.4%-68.8% (kappa 0.72-0.79) and in neuropsychological testing between 14.5%-81.1% (kappa 0.20-0.86). The concordance between clinical and neuropsychological testing was 56.8% (kappa 0.42) by DSM-III, 31.6% (kappa 0.35) by DSM-III-R and 25.5% (kappa 0.24) by NINDS-AIREN. CONCLUSIONS The frequency of poststroke dementia and cognitive decline varied sharply when different systems of diagnostic classification and methods were used. This may have serious influences on investigation and treatment of patients. We underline the importance of further debate and studies to refine the categories of cognitive impairment used in the setting of CVD.
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Affiliation(s)
- T Pohjasvaara
- Memory Research and Stroke Unit, Department of Clinical Neuroscience, Helsinki University Central Hospital, Helsinki, Finland
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Pekkonen E, Jääskeläinen LP, Erkinjuntti T, Hietanen M, Huotilainen M, Ilmoniemi RJ, Näätänen R. Preserved stimulus deviance detection in Alzheimer's disease. Neuroreport 2001; 12:1649-52. [PMID: 11409733 DOI: 10.1097/00001756-200106130-00027] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Aging attenuates automatic auditory discrimination to duration change, whereas frequency change detection is relatively unimpaired in aging and in Alzheimer's disease (AD). Here we studied with a whole-head magnetometer whether cortical auditory discrimination to duration change as shown by magnetic mismatch negativity (MMNm) response is impaired in AD. Twenty AD patients with mild to moderate cognitive impairment and 18 age-matched healthy subjects were monaurally presented a sequence of frequent standard tones embedded with occasional deviants with shorter duration. MMNm was significantly delayed in the left hemisphere ipsilaterally to the ear stimulated in the patient group, whereas the MMNm amplitudes over both hemispheres were quite similar in both groups. This suggests that although MMNm is delayed in the left hemisphere, the automatic discrimination to duration change in the auditory cortex is not attenuated in the early stages of AD.
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Affiliation(s)
- E Pekkonen
- Department of Neurology, University of Helsinki, and Medical Engineering Centre, Helsinki University Central Hospital, Finland
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48
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Ahveninen J, Jääskeläinen IP, Pekkonen E, Hallberg A, Hietanen M, Näätänen R, Schröger E, Sillanaukee P. Increased distractibility by task-irrelevant sound changes in abstinent alcoholics. Alcohol Clin Exp Res 2000; 24:1850-4. [PMID: 11141044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
BACKGROUND Chronic alcoholism is accompanied by "frontal" neuropsychological deficits that include an inability to maintain focus of attention. This might be associated with pronounced involuntary attention shifting to task-irrelevant stimulus changes and, thereafter, an impaired reorienting to the relevant task. The neural abnormalities that underlie such deficits in alcoholics were explored with event-related potential (ERP) components that disclosed different phases of detection and orienting to stimulus changes. METHODS Twenty consecutive abstinent male alcoholics (DSM-IV) and 20 age-matched male controls (healthy social drinkers) were instructed to discriminate equiprobable 100 and 200 msec tones in a reaction-time task (RT) and to ignore occasional, either slight (7%) or wide (70%), frequency changes (hypothesized to increase RT) during an ERP measurement. RESULTS In the alcoholics, we found pronounced distractibility, evidenced by a RT lag (p < 0.01) caused by deviants, that correlated (Spearman p = 0.5) with a significantly enhanced (p < 0.01) amplitude of mismatch negativity (MMN) to deviants. Significantly increased RT lag for trials subsequent to deviants (slight p < 0.001, wide p < 0.05) in the alcoholics suggested impaired reorienting to the relevant task. The MMN enhancement also predicted poorer hit rates in the alcoholics (Spearman p = 0.6-0.7). Both the MMN enhancement and pronounced distractibility correlated (Spearman p = 0.4) with an early onset of alcoholism. CONCLUSIONS Attentional deficits in the abstinent alcoholics were indicated by the increased distractibility by irrelevant sound changes. The MMN enhancement suggested that this reflects impaired neural inhibition of involuntary attention shifting, being most pronounced in early-onset alcoholics.
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Affiliation(s)
- J Ahveninen
- Cognitive Brain Research Unit, Department of Psychology, University of Helsinki, Finland.
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Ahveninen J, Jaaskelainen IP, Pekkonen E, Hallberg A, Hietanen M, Naatanen R, Schroger E, Sillanaukee P. Increased Distractibility by Task-Irrelevant Sound Changes in Abstinent Alcoholics. Alcohol Clin Exp Res 2000. [DOI: 10.1111/j.1530-0277.2000.tb01989.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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50
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Pohjasvaara T, Mäntylä R, Salonen O, Aronen HJ, Ylikoski R, Hietanen M, Kaste M, Erkinjuntti T. MRI correlates of dementia after first clinical ischemic stroke. J Neurol Sci 2000; 181:111-7. [PMID: 11099720 DOI: 10.1016/s0022-510x(00)00437-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Dementia after first clinical stroke frequently has been found, but the clinical and radiological correlates have not been fully detailed. We examined magnetic resonance imaging (MRI) correlates of dementia in a large well-defined series of patients with first clinical ischemic stroke. METHODS Detailed medical, neurological and neuropsychological examination was conducted 3 months after ischemic stroke for 273 patients with first clinical stroke from a consecutive series of 486 patients aged 55-85 years. MRI of the head categorised infarcts (type, site, side, number, volume), extent of white matter lesions (WMLs) and degree of atrophy. The DSM-III definition for dementia was used. RESULTS Dementia was diagnosed in 79 (28.9%) of the patients with first clinical stroke. Volumes, numbers, distinct sites of infarcts, extent of WMLs and degree of atrophy were different for the demented and nondemented subjects. Logistic regression analysis showed that the correlates of dementia included the combination of infarct features (volume of infarcts in left-sided anterior corona radiata; OR 1.86), extent of WMLs (OR 1. 37), medial temporal lobe atrophy (OR 3.4) and host factors (low education; OR 1.11). The additive effect of having more than one correlate was detected (OR 2.53). CONCLUSIONS Dementia occurring after first clinical stroke is frequent and not solely due to a single stroke, but contain a combination of infarcts features, extent of WMLs, medial temporal lobe atrophy and host factors reflecting more than one underlying pathology.
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Affiliation(s)
- T Pohjasvaara
- Memory Research Unit, Department of Clinical Neurosciences, Helsinki University Central Hospital, P.O. BOX 300, FIN-00029 HYKS, Helsinki, Finland
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