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Frequency of cognitive impairment in chronic stroke patients.
Source publication
Background
Following stroke, clinicians are challenged to detect and untangle symptoms of cognitive dysfunction and mood disorders. Additionally, they need to evaluate the informative value of self-reports to identify patients in need of further attendance.
Aims
To examine the association between neuropsychological measures, symptoms of depression...
Context in source publication
Context 1
... was some variation in the number of patients who completed individual tests since some patients indicated increasing fatigue, discontinued assessment, or had motor deficits (Table 3). Of the 105 patients assessed, 58% revealed cognitive impairment (Fig. 1) reaching from isolated impairment in 1 domain (29%) to impairment in all 6 domains (2%). Cognitive deficits for the domain of executive functioning occurred significantly more frequently in older patients (χ 2 = 8.89, p = 0.003). Only individuals in the age group ≥65 years showed impairment for the MMSE and the verbal memory domain. ...
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Cognitive dysfunction, and comorbidities such as mood disorder and fibromyalgia, are common in systemic lupus erythematosus (SLE). This study aims to explore the associations between fibromyalgia, mood disorders, cognitive symptoms and cognitive dysfunction in SLE patients, and their impact on quality of life.
Methods
We tested cognitio...
Citations
... Over the past few decades, the advancement in the eld of neuroimaging has spurred the increased interest of neuroscientists regarding cortical reorganization and brain plasticity following stroke. They have drifted their focus towards the compensatory mechanisms following brain damage specically on the two broad mechanisms; surviving regions of the hemisphere that incurred the injury versus (1), (2). homologous regions of the intact contra-lesional hemisphere The present review was conducted to specify the therapeutic effects of tDCS extensive efforts were devoted to retrieve the literature regarding effect of tDCS on various cognitive domains in the stroke survivors ...
Background: Identification of involved networks in a patient-specic context along with the deeper understanding of interconnected neuronal
network may yield better outcomes when applied with conventional rehabilitation. Principles of the neural plasticity and motor and cognitive
learning through cortical reorganization lead the extensive use of (tDCS) in management of Stroke.
Aim- To ascertain the synergistic effect of
(tDCS) on cognitive manifestations in stroke.
Methodology
Data Identification: identification of the english language literature search using Pubmed, Pedro, Medline, google scholar, Researchgate,
Cocharne, and bibliographic review of textbooks & articles.
Data Extraction: Articles were extracted based on the explicit methodological criteria. Databases were searched for the search terms: tDCS,
Stroke, cognitive impairments, memory.
Results-The review gathered the literature regarding use of “modern” tDCS protocols in treatment of Cognitive impairments in stroke. The most of
studies found strong evidence in alleviation of symptoms with improvement in cognitive performance of patients in Stroke lasting up to several
weeks, when applied appropriately.
Conclusion- tDCS is effective at modulating neural activity, However Refinement is required to expand the effectiveness of tDCS with their exact physiological mechanisms behind.
... Stroke on the other hand is characterized by an unexpected event, which potentiates high levels of stress that can cause physical, cognitive, social, and psychological deficits (Caprio and Sorond 2019). This type of brain injury is one of the main causes of death worldwide, and in case of survival can lead to deficits in different functions, namely, cognitive, sensory, language, motor (e.g., hemiparesis, hemiplegia, ataxia), and emotional functions (Nakling et al. 2017;Pavan et al. 2015;Silva 2010). Stroke can be classified based on its nature: haemorrhagic and/or ischemic stroke (Doria and Forgacs 2019;Kogan et al. 2020) and according to data from the National Statistics Institute of Portugal (INE), ischemic stroke is more fatal, having its highest incidence in ages over 70 years. ...
The acquired brain injuries (ABI) have consequences that affect the patients’ autonomy, particularly regarding activities of daily living (ADL). To reduce the impact that these changes will have on the patient’s life, it is important to develop diversified tasks with which individuals can train and improve their impaired abilities and strengthen those that are preserved. Therefore, this study aimed to validate a virtual ATM (Automated Teller Machine) task to be used to train patients with cognitive impairments. The sample consisted of 34 participants with ABI and 66 healthy controls. These participants performed the task either virtually or with a real ATM. Beyond revealing that the type of environment did not influence task performance, the results showed a relationship between the results of cognitive screening measures and the time to complete the task, in which participants with the lowest results had worse performance in the task. Also, the virtual ATM was more sensitive in discriminating the clinical group than the real task.
... A stroke occurs when blood flow to the brain is disrupted, causing brain cells to die suddenly (Farkas et al., 2007;Owolabi et al., 2015). People with a stroke experience physical, cognitive, and psychological deficits that limit their ability to accomplish daily living activities and negatively affect their quality of life (de Bekker et al., 2022;Gagnon et al., 2022;Gil-Salcedo et al., 2022;Nakling et al., 2017;Tsalta-Mladenov & Andonova, 2022) More than half of people with a stroke become chronically disabled, and stroke is the world's third-leading cause of disability, with an estimated global cost of 721 billion dollars (Donkor, 2018;Feigin et al., 2022). Globally, in 2019 stroke accounted for 5.7% of total disability adjusted life years (DALYs), which refers to the sum of years of life lost because of premature death and years of life adjusted for the average severity of any mental or physical impairment brought on by an illness or an accident (Rushby & Hanson, 2001). ...
The aim of this study is to evaluate the acceptance and attitudes toward assistive technology (AT) for people with stroke from their caregivers' perspectives in Jordan. Also, this study further validates the Unified Theory of Acceptance and Use of Technology (UTAUT) questionnaire. This is a cross-sectional study that includes a three-sections survey: the first section contains demographic data, the second section includes the Unified Theory of Acceptance and Use of Technology (UTAUT) questionnaire, and the third section consists of two optional open-ended questions. Among 123 caregivers of people with stroke over 18 years of age who participated in this study, 23% were male. The findings indicate a moderate to high acceptance of using AT for stroke survivors, confirm the validity and reliability of the UTAUT questionnaire, and clarify novel issues regarding AT based on the caregivers' perspectives.
... Ghana (72.8%), Korea (62.6%), and Norway (52.1%) [3,32,33]. ...
Background
Little is known about the characteristics and determinants of post-stroke cognitive impairment in residents of low- and middle-income countries. The objective of this study was to determine the frequencies, patterns, and risk factors for cognitive impairment in a cross-sectional study of consecutive stroke patients cared for at Uganda’s Mulago Hospital, located in sub-Saharan Africa.
Methods
131 patients were enrolled a minimum of 3-months after hospital admission for stroke. A questionnaire, clinical examination findings, and laboratory test results were used to collect demographic information and data on vascular risk factors and clinical characteristics. Independent predictor variables associated with cognitive impairment were ascertained. Stroke impairments, disability, and handicap were assessed using the National Institute of Health Stroke Scale (NIHSS), Barthel Index (BI), and modified Rankin scale (mRS), respectively. The Montreal Cognitive Assessment (MoCA) was used to assess participants’ cognitive function. Stepwise multiple logistic regression was used to identify variables independently associated with cognitive impairment.
Results
The overall mean MoCA score was 11.7-points (range 0.0–28.0-points) for 128 patients with available data of whom 66.4% were categorized as cognitively impaired (MoCA < 19-points). Increasing age (OR 1.04, 95% CI 1.00-1.07; p = 0.026), low level of education (OR 3.23, 95% CI 1.25–8.33; p = 0.016), functional handicap (mRS 3–5; OR 1.84, 95% CI 1.28–2.63; p < 0.001) and high LDL cholesterol (OR 2.74, 95% CI 1.14–6.56; p = 0.024) were independently associated with cognitive impairment.
Conclusions
Our findings highlight the high burden and need for awareness of cognitive impairment in post stroke populations in the sub-Saharan region and serve to emphasize the importance of detailed cognitive assessment as part of routine clinical evaluation of patients who have had a stroke.
... Post-stroke cognitive impairment (PSCI) is defined as the development of a new cognitive deficit within the first 3 months after stroke that persists for at least 6 months and is not related to conditions other than stroke [6]. Several cognitive domains, including memory [4,7], language [4,8,9], visuospatial [5,8,9], and executive abilities [5,8,9], can be affected by stroke and are the most common deficits observed in patients in the first few months after stroke when assessed with standardized measures. Furthermore, it has been reported that advanced age [10] and severe stroke [11] may act as further risk factors for PSCI and cognitive decline after stroke. ...
... Since patients with impaired cognition at acute stroke units are more likely to report cognitive problems after 3 months, this study suggests that items reported on Riksstroke can adequately represent the most common cognitive difficulties that affect patients after stroke. Indeed, the most reported cognitive problem 3 months after stroke was memory in this study, and this result is in line with previous studies [4,7,18]. These findings may be limited by the lack of an objective measure that could prove the presence of actual cognitive deficits, as self-reports may be hindered by patients' lack of insight or underestimation of their problems [33]. ...
Objective:
Cognitive deficits are commonly observed after stroke and have been associated with the cognitive decline and development of dementia in later stages. This study aimed to investigate whether cognition screened at acute stroke units could explain subjective cognitive complaints 3 months after stroke and evaluate how the severity of stroke and age could influence this association.
Methods:
In this register-based longitudinal study, data were retrieved from three Swedish registers between November 2014 and June 2019. Information on subjective cognitive complaints (SCC) was collected from the Riksstroke 3-month follow-up form, which were used to analyze the primary outcomes. Cognitive function screened using the Montreal Cognitive Assessment (MoCA) at acute stroke units was expressed as the primary independent variable.
Results:
Of the 1977 patients included in the study, 58% were males, the median age was 73 years, and 63% had a minor stroke. A total of 60% of patients had impaired cognition at acute stroke units (MoCA score, <26), of whom 40.3% reported at least 1 cognitive problem after 3 months. In adjusted binary regression analysis models, patients with normal cognitive function had lower odds for SCCs. This pattern was observed regardless of age and in patients with a minor stroke.
Conclusions:
Intact cognition early after stroke was related to decreased odds of subjective cognitive complaints at the 3-month follow-up. This study highlights the importance of both early cognitive screening after stroke and subjective cognitive complaints, which have been shown to be associated with cognitive decline. Furthermore, we suggest the importance of discussing cognitive function with patients during regular follow-up in primary care, usually 3 months after stroke.
... Ghana (72.8%), Korea (62.6%), and Norway (52.1%) (3,30,31). A metaanalysis of 65 observational studies, published in 2019, reported sparse data on cognitive impairment in sub-Saharan Africa, but found overall prevalence among African people aged 5-years or older at 30-40% (32). ...
Background
Little is known about the characteristics and determinants of post-stroke cognitive impairments in low- and middle-income countries. The objective of this study was to determine the frequencies, patterns, and risk factors for cognitive impairment in a cross-sectional study of consecutive stroke patients cared for at Uganda’s Mulago Hospital, located in sub-Saharan Africa.
Methods
From August 2019 to July 2020, patients were enrolled a minimum of 3-months post-stroke hospital admission. We collected data on their demographics, vascular risk factors and clinical factors using a questionnaire, clinical examination findings, and test results. Independent predictor variables associated with cognitive impairment were ascertained. Stroke impairments, disability, and handicap were assessed using the National Institute of Health Stroke Scale (NIHSS), Barthel Index (BI), and modified Rankin scale (mRS), respectively. The Montreal Cognitive Assessment (MoCA) was used to assess participants’ cognitive function. Stepwise multiple logistic regression was used to identify variables independently associated with cognitive impairment.
Results
The overall mean MoCA score was 11.7-points (range 0.0–28.0-points) for 128 patients with available data of whom 66.4% were categorized as cognitively impaired (MoCA < 19-points). Increasing age (OR 1.04, 95% CI 1.00-1.07; p = 0.026), low level of education (OR 3.23, 95% CI 1.25–8.33; p = 0.016), functional handicap (mRS 3–5; OR 1.84, 95% CI 1.28–2.63; p < 0.001) and high LDL cholesterol (OR 2.74, 95% CI 1.14–6.56; p = 0.024) were independently associated with cognitive impairment.
Discussion
Further longitudinal, prospective studies are required to confirm these findings and identify strategies for reducing the risk of post-stroke cognitive impairment in this population.
... In the literature, a few studies suggest an association between self-reported and objective cognitive dysfunction (44,45); however, most often, there is a limited relationship between these outcomes (50)(51)(52)(53). Additionally, there may be a psychosocial component that mediates self-reported CF (43,(54)(55)(56)(57)(58). Thus, there is an unmet need to evaluate the relationship between subjective and objective CF in APS patient populations, which often have a high prevalence of depression compared to the general population (33,34). ...
Objective:
This study assessed patient-reported outcomes (PROs) in individuals with persistently positive antiphospholipid antibodies (aPL) to better understand how living with aPL may affect their quality of life.
Methods:
Patients completed Patient-Reported Outcomes Measurement Information System Physical Function (PF) and Cognitive Function (CF) Short Forms as well as the pain intensity (PI) rating (scale of 1-10). Patients were characterized for demographics, clinical manifestations of antiphospholipid syndrome (APS), cardiovascular risk factors, laboratory test results, and medication usage. Multivariate modeling was done via linear regression.
Results:
Of 139 patients, 89 had primary APS, 21 had secondary APS, and 29 had persistent aPL without meeting clinical criteria for APS. The average T scores (±SD) for PF and CF were 45.4 ± 9.2 and 48.6 ± 11.6, respectively; the average for PI was 3.0 ± 2.6. Approximately half of the patients (47%) endorsed at least mild impairment in PF (T score < 45). Mean PF, CF, and PI did not differ between diagnostic groups. Individuals who endorsed more impairment on one measure also tended to endorse more impairment on another (Pearson r = 0.43-0.59). In the multivariate models, age, smoking, pain medications, and serotonergic medications were associated with impairment in at least one PRO domain. The Damage Index for APS was significantly correlated with both PF and CF.
Conclusion:
Individuals living with APS endorsed more impairment in PF (and potentially CF) than expected for the general population. The relationship between certain medications and PROs warrants further study, as does the longitudinal trajectory of these and other PROs.
... In the chronic phase, cognitive impairment can be observed, and, if a progressive cognitive deterioration is present (usually after six months from the accident), a variant of vascular dementia called post-stroke dementia might be diagnosed [5]. Neuropsychological assessments conducted in this phase show deficits in attention, mental processing speed, executive functioning, and visual perception [6][7][8]. However, neuropsychological profiles that occur in vascular dementia are heterogeneous and depend on the number, side, and location(s) of the lesion(s). ...
Post-stroke, in addition to sensorimotor signs and symptoms, could lead to cognitive deficits. Theories of embodiment stress the role of sensorimotor system and multisensory integration in sustaining high-order cognitive domains. Despite conventional post-stroke cognitive rehabilitation being effective, innovative technologies could overcome some limitations of standard interventions and exploit bodily information during cognitive rehabilitation. This systematic review aims to investigate whether ‘multisensory technologies’ compared to usual care treatment can be a viable alternative for cognitive rehabilitation. By applying PRISMA guidelines, we extracted data and assessed the bias of 10 studies that met the required criteria. We found that multisensory technologies were at least comparable to standard treatment but particularly effective for attention, spatial cognition, global cognition, and memory. Multisensory technologies consisted principally of virtual reality alone or combined with a motion tracking system. Multisensory technologies without motion tracking were more effective than standard procedures, whereas those with motion tracking showed balanced results for the two treatments. Limitations of the included studies regarded the population (e.g., no study on acute stroke), assessment (e.g., lack of multimodal/multisensory pre-post evaluation), and methodology (e.g., sample size, blinding bias). Recent advancements in technological development and metaverse open new opportunities to design embodied rehabilitative programs.
... Current findings also suggest that cognitive impairment is a significant predictor of depression symptomology. This is in line with previous research, which suggests that deficits in attention, memory, processing speed, and executive functioning, are commonly experienced by stroke survivors and are also associated with symptoms of depression (Broomfield et al., 2011;Nakling et al., 2017;Nys et al., 2006). This finding may thus reflect stroke-induced damage to the frontal subcortical circuits, which are responsible for both executive skills and emotional regulation (Alexopoulos et al., 1997;Flaster et al., 2013). ...
We investigated the relationships between cognitive change following stroke, awareness of cognitive impairments, and mood to further understanding of change processes influencing psychological outcomes post-stroke in line with the "Y-shaped" process model. Patients (n = 143; Mage = 73 years, SD = 13.73; 74 males) were assessed at 3-weeks (T1) and 6-months (T2) post-stroke and had completed the Oxford Cognitive Screen (T1 and T2), the Cognitive Failures Questionnaire (CFQ; T2), and the Hospital Anxiety and Depression Scale (HADS; T2). An ANCOVA controlling for disability relating to activities of daily living (ADL) revealed that awareness of cognitive impairment was significantly lower in participants with moderate-severe cognitive impairment. Regression analysis indicated that greater awareness of cognitive impairment and reduced independence in ADL were associated with greater emotional distress at T2. Cognitive improvement was associated with lower emotional distressat T2. Contrary to the awareness hypothesis, moderation analyses suggest that this effect was largest for those most cognitively impaired at T1. Findings emphasize the importance of monitoring stroke patients' capacity to be self-aware when assessing and formulating long-term post-stroke distress and have potential implications for improving long-term emotional status in those most cognitively impaired post-stroke, e.g., through psychoeducation, cognitive rehabilitation, and emotional support.
... We hypothesized that CBCI through Pablo System could lead to better levels of functional independence, anxiety, depression and disability (understanding and communication, self care, getting along with people, life care activities at home and in work culture, participation in society) post-therapy in comparison to CCI through the paper-pencil method. Emerging facts proved that cognitive impairment is highly recognizing as a concerning factor for long term disability in post-stroke patients [17]. As it was mentioned in the introduction that extent of deficits in cognitive functions can have bad impact on physical performance. ...
Objective: The main purpose of this study was to investigate the effectiveness of computer based cognitive intervention (CBCI) on the functional independence level, anxiety and depression level and disability levels in post stroke patients in comparison with conventional cognitive intervention (CCI). Methods: This study includes sample of 80 acute (up to 6 months) post stroke patients. No recurrent stroke patients were included. Cognitive impairment with MMSE score>10, age between 18 to 65 years, were selected as inclusion criteria. Both groups (N=40 in each group) were trained in session of 30 minutes per day, 5 days a week, for 4 weeks. One group named as Group A performing the computer based cognitive intervention and the other group performing conventional cognitive intervention named as Group B. The main outcome Measures-The relative levels of functional independence, anxiety and depression and disability were measured before and after intervention (after 4 weeks) using the Barthel Index (BI),Hospital Anxiety and Depression Scale (HADS), World Health Organization Disability Assessment Scale 2.0 (WHODAS 2.0). Findings: After 4 weeks of intervention both the groups showed significant improvement in levels of functional independence, anxiety and depression and disability. The group A showed better therapeutic effects in a time-dependent manner in comparison to the group B on levels of anxiety and depression and disability but there was no significant difference observed in the levels of functional independence. Conclusion: These findings suggest that computer based cognitive intervention may have effects on the improvements of levels of functional independence, anxiety and depression and disability in comparison with conventional cognitive intervention in stroke.
