Abstract T P415: Assessment Of Cognitive Symptoms In Sub-acute Stroke With An iPad Test-battery

Introduction and hypothesis: Research into the time-course of cognitive symptoms in stroke as well as planning of rehabilitation is dependent on reliable and sensitive cognitive testing. Usually, it is not possible to have all patients seen by a neuropsychologist. Moreover, a battery for stroke patients poses special challenges as symptoms like aphasia, hemineglect and hemiplegia may exclude many patients from performing a number of traditionally employed test methods. Finally, the battery has to be performed in a short timespan because many patients are easily fatigued. Method: We developed a battery comprising tests for anosognosia, aphasia, neglect, depression, episodic memory, attention span, working memory, mental speed, manual motor speed, and executive function (response inhibition). We present data from sub-acute stroke patients and age-matched controls. Both groups were tested twice with a 3 month interval in order to: 1) assess the proportion of patients able to perform the different tests; 2) determine the typical time needed to do the testing; 3) demonstrate the sensitivity to cognitive symptoms in sub-acute stroke Results: 51 stroke patients 43 healthy controls were included. 49 patients (96%) were able to do at least one test and 41 (80%) were able to do all tests. Mean duration for the testing of sub-acute stroke patients was 39 minutes (range 30-60 minutes). Mean Age 67 years (patients 65 and controls 69, range 33-90). Mean verbal fluency correct in 1st session: patients 29.2 and Controls 45.3; Mean difference 16.03, 95%CI (10.1-22.0) p 〈0.001. Mean change in patients from 1st to 2nd Session: 6.2, 95%CI(1.2-11.2) p=0.017. Mental speed by coding: patients 29.3 and controls 45.7; mean difference 16.4, 95% CI(10.3-22.4) p〈0.001. Similar analysis of memory, attention span, and executive function showed significant differences between control and patient groups as well as in patients from 1st to 2nd session. Conclusion: Our cognitive test-battery for iPad can be used with most stroke patients in the sub-acute phase. It can be performed in a relatively short time span. It is sensitive to cognitive reduction after stroke and remission of symptoms.

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STROKE OUTCOMES IN NON-DIABETIC, DENOVO DIABETIC AND DIABETIC INDIAN PATIENTS MEASURED BY MODIFIED RANKIN SCALE: AN OBSERVATIONAL STUDY

International Journal of Pharmacy and Pharmaceutical Sciences ◽

10.22159/ijpps.2017v9i8.18378 ◽

2017 ◽

Vol 9 (8) ◽

pp. 94

Author(s):

Syed Junaid Ahmed ◽

Abdur Rahman Mohd Masood ◽

Safiya Sumana ◽

Khadeer Ahmed Ghori ◽

Javed Akhtar Ansari ◽

...

Keyword(s):

Blood Glucose ◽

Observational Study ◽

Hospital Admission ◽

Acute Stroke ◽

Mean Difference ◽

Modified Rankin Scale ◽

Stroke Patients ◽

Glucose Levels ◽

Blood Glucose Levels ◽

The Mean

Objective: Hyperglycemia is a known risk factor which adversely impacts the outcomes in stroke patients compared to patients with normal blood glucose levels. Patients suffering from an acute stroke who are previously nonhyperglycemic may show elevated blood glucose levels. The present study was designed to measure the outcomes in denovo diabetic and diabetic stroke patients compared to nondiabetics.Methods: A prospective observational study over a period of 6 mo, in which 103 patients were divided into three cohorts based on their blood glucose levels (nondiabetic, denovo diabetic and diabetics). The modified Rankin scale (mRS) score was calculated at in-hospital admission and discharge in these three cohorts. The initial and final scores were correlated and mean differences with respect to outcomes between all the three cohorts was calculated.Results: The mean mRS at the time of hospital admission in diabetics and nondiabetics was 3.6±0.81 and 3.3±0.78 which decreased to 2.8±0.95 and 2.9±0.83 respectively at the time of discharge. The mean mRS score in denovo diabetic stroke patients during in-hospital admission was 4±0.81 which was calculated as 3.7±0.85 at the time of discharge. The mean difference in mRS score in diabetics vs non-diabetics was found to be 0.73±0.8 (p =<0.001). The mean difference in mRS score of denovo diabetics vs non-diabetics and denovo diabetics vs diabetics was 0.30±0.63 and 0.38±0.61 respectively (p = 0.1).Conclusion: Results of these observational study in Indian patients, highlights the need for controlling hyperglycemia in stroke patients to improve outcomes and to prevent mortality arising out of acute stroke attacks.

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The effects of acute dopamine reuptake inhibition on cognitive function during passive hyperthermia

Applied Physiology Nutrition and Metabolism ◽

10.1139/apnm-2020-0869 ◽

2020 ◽

Author(s):

Phillip J. Wallace ◽

Ricardo S Martins ◽

Jake S Scott ◽

Scott W Steele ◽

Matthew Greenway ◽

...

Keyword(s):

Heat Stress ◽

Executive Function ◽

Cognitive Function ◽

Thermal Strain ◽

Maze Learning ◽

Test Battery ◽

Cognitive Test ◽

Set Shifting ◽

Heart Rates ◽

The Impact

Dopamine activity can modulate physical performance in the heat, but less is known about its effects on cognition during thermal stress. Twelves males completed a randomized, double-blinded protocol consisting of oral ingestion of 20 mg of methylphenidate (MPH) or placebo (lactose pill) during passive heating using a water-perfused suit (water temperature ~49°C). To identify the impact of peripheral versus central thermal strain, a cognitive test battery was completed at four different thermal states: baseline (BASE; 37.2±0.6˚C core, 32.9±0.7˚C skin), neutral core-hot skin (NC-HS; 37.2±0.3˚C, 37.4±0.3˚C), hyperthermic core-hot skin (HC-HS; 38.7±0.4˚C, 38.7±0.2˚C), and hyperthermic core-cooled skin (HC-CS; 38.5±0.4˚C, 35.1±0.8˚C). The cognitive test battery consisted of the 2-back task (i.e. working memory), set-shifting (i.e. executive function), Groton Maze Learning Task (i.e. executive function) and detection task (i.e. psychomotor processing). MPH led to significantly higher heart rates (~5-15 b·min-1) at BASE, NC-HS, and HC-HS (all p<0.05). There were no significant differences in the number of errors made on each task (all p<0.05). Participants were significantly faster (p<0.05) on the set-shifting task in the HC-HS timepoint, irrespective of drug condition (p>0.05). In summary, we demonstrated that 20 mg of MPH did not significantly alter cognitive function during either normothermia or moderate hyperthermia. Novelty: ● 20 mg of MPH did not significantly alter cognitive function during passive heat stress ● MPH led to significant higher heart rates (~5-15 bmin-1) in thermoneutral and during passive heat stress ● Future studies are needed to determine the mechanisms of why MPH improves physical but not cognitive performance during heat stress

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Abstract 2395: Respiratory Muscle Weakness in Acute Stroke Patients

Stroke ◽

10.1161/str.43.suppl_1.a2395 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Ross Pollock ◽

Ged Rafferty ◽

John Moxham ◽

Lalit Kalra

Keyword(s):

Systematic Review ◽

Muscle Strength ◽

Acute Stroke ◽

Muscle Weakness ◽

Respiratory Muscle ◽

Mean Difference ◽

Respiratory Muscle Strength ◽

Inclusion Criteria ◽

Stroke Patients ◽

Respiratory Muscle Weakness

Background: Increased frequency of chest infections in acute stroke patients may be the result of respiratory muscle weakness contributing to a weak cough and poor airway clearance. We undertook a systematic review of studies comparing respiratory muscle strength in acute stroke patients with age-matched controls. Method: A systematic review of literature was performed using the electronic databases Medline, EMBASE, ISI web of knowledge and the Scopus. The key words searched were stroke or cerebrovascular accident in combination with cough, inspiratory, expiratory or respiratory and strength or weakness. Studies were included if they compared stroke patients with age matched controls and measured maximum inspiratory or expiratory mouth pressure (PImax and PEmax) for inspiratory and expiratory muscle strength respectively. Results: The initial search identified 136 articles, 14 of which remained after screening for pre-defined inclusion criteria and removal of duplicates. Eleven were excluded after reviewing abstracts (5 did not assess muscle strength, 5 did not include healthy control group, 1 absolute values could not be obtained). A further study was identified from the reference lists of screened articles. The 4 studies that met inclusion criteria included 121 subjects. Mean PImax ranged from 75-99 cmH 2 O in controls and 37-74 cmH 2 O in stroke patients. (mean difference 41 cmH 2 O, 95% CI 54 to 29 cm H 2 O; P<0.0001). Mean PEmax ranged from 52-89 cm H 2 O in stroke patients and was also reduced compared with age matched controls (mean difference 55 cmH 2 O, 95% CI 61 to 48 cmH 2 O; P<0.0001). ( Fig 1 ). Conclusion: Individual studies and pooled data suggest that respiratory muscle strength is impaired in acute stroke patients. However, these studies are limited by small samples and design heterogeneity. Larger studies are needed to assess the relationship of respiratory muscle weakness with chest infections and clinical outcomes in the acute phase.

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Prognostic Significance of Hyponatremia in Acute Stroke: A Systematic Review and Meta-Analysis

Cerebrovascular Diseases ◽

10.1159/000510751 ◽

2020 ◽

Vol 49 (5) ◽

pp. 531-539

Author(s):

Shogo Shima ◽

Yasunari Niimi ◽

Yosuke Moteki ◽

Osamu Takahashi ◽

Shinsuke Sato ◽

...

Keyword(s):

Systematic Review ◽

Hospital Mortality ◽

Hospital Stay ◽

Acute Stroke ◽

Meta Analysis ◽

Length Of Hospital Stay ◽

Mean Difference ◽

Cochrane Library ◽

Inclusion Criteria ◽

Stroke Patients

Objective: Hyponatremia is a common electrolyte disorder in patients with stroke, which leads to various fatal complications. We performed a systematic review and meta-analysis to investigate the outcomes of acute stroke patients with hyponatremia. Methods: We searched MEDLINE, EMBASE, and the Cochrane Library databases for relevant literature in English published up to March 2020. Two review authors independently screened and selected the studies by assessing the eligibility and validity based on the inclusion criteria. Mortality at 90 days was set as the primary end point, and in-hospital mortality and length of hospital stay were set as the secondary end points. We conducted the data synthesis and analyzed the outcomes by calculating the odds ratio (OR) and mean difference. Results: Of 835 studies, 15 studies met the inclusion criteria (n = 10,745). The prevalence rate of stroke patients with hyponatremia was 7.0–59.2%. They had significantly higher 90-day mortality (OR, 1.73; 95% confidence interval (CI), 1.24–2.42) and longer length of hospital stay (mean difference, 10.68 days; 95% CI, 7.14–14.22) than patients without hyponatremia. Patients with hyponatremia had a higher tendency of in-hospital mortality than those without hyponatremia (OR, 1.61; 95% CI, 0.97–2.69). Conclusions: The development of hyponatremia in the clinical course of stroke is associated with higher short-term mortality and a longer hospital stay. Although the causal relationship is unclear, hyponatremia could be a significant predictor of poor outcomes after stroke.

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Unemployment in multiple sclerosis (MS): utility of the MS Functional Composite and cognitive testing

Multiple Sclerosis Journal ◽

10.1177/1352458513488235 ◽

2013 ◽

Vol 20 (1) ◽

pp. 112-115 ◽

Cited By ~ 38

Author(s):

Lauren Strober ◽

Nancy Chiaravalloti ◽

Nancy Moore ◽

John DeLuca

Keyword(s):

Multiple Sclerosis ◽

Logistic Regression ◽

Employment Status ◽

Test Battery ◽

Cognitive Testing ◽

Cognitive Test ◽

Information Processing Speed ◽

Significant Group ◽

Functional Composite ◽

Serial Addition

Unemployment is a significant concern among individuals with multiple sclerosis (MS). Determinations regarding ability to work are highly dependent on measurement tools used by neurologists and allied professionals. However, little is known of the usefulness of these tools when determining issues pertaining to employment status. The purpose of the present investigation was to examine the utility of the Multiple Sclerosis Functional Composite (MSFC) and a brief cognitive test battery when examining employment status in MS. Seventy-seven individuals with MS completed the MSFC and a brief cognitive test battery. On the MSFC, unemployed individuals demonstrated worse upper extremity functioning. There was no difference on the Paced Auditory Serial Addition Task (PASAT), the sole cognitive measure of the MSFC. On cognitive testing, unemployed individuals performed worse on measures of memory, information processing speed, and executive functioning. Through logistic regression analysis, the Symbol Digit Modalities Test (SDMT) was found to be the sole predictor of employment status among the significant disease, MSFC and cognitive variables. Consistent with previous findings, logistic regression found the SDMT to be a significant predictor of employment status. Given the lack of significant group differences on the PASAT, continued consideration of replacing the PASAT with the SDMT in the MSFC appears warranted.

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Cognitive test battery for evaluating elderly Chinese Americans

International Psychogeriatrics ◽

10.1017/s1041610218001060 ◽

2018 ◽

Vol 31 (04) ◽

pp. 505-511 ◽

Cited By ~ 2

Author(s):

Clara Li ◽

Judith Neugroschl ◽

Carolyn W. Zhu ◽

Mari Umpierre ◽

Jane Martin ◽

...

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Executive Function ◽

Statistical Significance ◽

Chinese Americans ◽

Consensus Conference ◽

Test Battery ◽

Cognitive Domain ◽

Cognitive Test ◽

Elderly Chinese

ABSTRACTObjectives:This study aimed to determine the diagnostic utility of a Chinese test battery for evaluating cognitive loss in elderly Chinese Americans.Methods:Data from a pilot study at the Mount Sinai Alzheimer’s Disease Research Center was examined. All participants were > 65 years old, primarily Chinese speaking, with adequate sensorimotor capacity to complete cognitive tests. A research diagnosis of normal mild cognitive impairment (MCI) or Alzheimer’s disease (AD) was assigned to each participant in consensus conference. Composite scores were created to summarize test performance on overall cognition, memory, attention executive function, and language. Multivariable logistic regression models were used to assess the sensitivity of each cognitive domain for discriminating three diagnostic categories. Adjustment was made for demographic variables (i. e., age, gender, education, primary language, and years living in the USA).Results:The sample included 67 normal, 37 MCI, and 12 AD participants. Performance in overall cognition, memory, and attention executive function was significantly worse in AD than in MCI, and performance in MCI was worse than in normal controls. Language performance followed a similar pattern, but differences did not achieve statistical significance among the three diagnostic groups.Conclusions:This study highlights the need for cognitive assessment in elderly Chinese immigrants.

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The role of nursing in the rehabilitation of acute stroke patients: Toward a unified theoretical perspective

Pflege ◽

10.1024/1012-5302.12.1.21 ◽

1999 ◽

Vol 12 (1) ◽

pp. 21-27

Author(s):

Marit Kirkevold

Keyword(s):

Acute Stroke ◽

Theoretical Perspective ◽

Stroke Patients ◽

Role Of Nursing ◽

Rolle Der Pflegenden

Eine Übersicht der bestehenden Literatur weist auf Unsicherheiten bezüglich der spezifischen Rolle der Pflegenden in der Rehabilitation von Hirnschlagpatientinnen und -patienten hin. Es existieren zwei unterschiedliche Begrifflichkeiten für die Rolle der Pflegenden, keine davon bezieht sich auf spezifische Rehabilitationsziele oder Patientenergebnisse. Ein anfänglicher theoretischer Beitrag der Rolle der Pflege in der Genesung vom Hirnschlag wird als Struktur unterbreitet, um die therapeutischen Aspekte der Pflege im Koordinieren, Erhalten und Üben zu vereinen. Bestehende Literatur untermauert diesen Beitrag. Weitere Forschung ist jedoch notwendig, um den spezifischen Inhalt und Fokus der Pflege in der Genesung bei Hirnschlag zu entwickeln.

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Kognitive Defizite bei Schizophren Erkrankten

Zeitschrift für Klinische Psychologie und Psychotherapie ◽

10.1026/1616-3443/a000288 ◽

2015 ◽

Vol 44 (2) ◽

pp. 106-120 ◽

Cited By ~ 2

Author(s):

Almut Carolus ◽

Petia Popova ◽

Brigitte Rockstroh

Keyword(s):

Test Battery ◽

Cognitive Test ◽

Kognitive Defizite ◽

Kognitive Funktionen

Zusammenfassung. Theoretischer Hintergrund: Kognitive Funktionseinschränkungen sind zentrales Merkmal schizophrener Erkrankungen und werden entsprechend im Behandlungskonzept berücksichtigt. Kognitive Remediationsprogramme gelten als wirksam, Effektstärken als moderat. Trainingsvarianten werden zur Effektoptimierung erprobt. Fragestellung: Ist gezieltes Funktionstraining in neuroplastizitäts-orientiertem Lernkontext effektiver als breitgefächertes Behandlungsprogramm und werden Effekte durch das Erkrankungsstadium moduliert? Methode: Bei 59 chronisch und 31 ersthospitalisierten schizophren Erkrankten wurden kognitive Defizite über Testleistungen der MATRICS Consensus Cognitive Test Battery gegenüber 25 gesunder Kontrollpersonen erfasst. Testleistungen vor, nach 4-wöchiger Interventionsphase mit zwei spezifischen Trainings oder Standardbehandlung und 3-monatiger Katamnese prüften den Einfluss von Interventionstypus und Erkrankungsstadium auf Leistungsverbesserung. Ergebnisse: Sowohl chronische wie erstmals behandelte Patienten aller Behandlungsgruppen verbesserten sich signifikant über die Messzeitpunkte, obwohl Defizite relativ zu Kontrollen fortbestanden. Schlussfolgerungen: Spezifisches Training verbessert kognitive Funktionen nicht über Zeit/Remissionseffekte hinaus.

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