Abstract P359: Secondary Thalamic Atrophy Related to Brain Infarction is Associated With Post-Stroke Cognitive Impairment

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Jieli Geng ◽  
Kie Honjo ◽  
Fuqiang Gao ◽  
Joel Ramirez ◽  
Melissa Holmes ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Cognitive Functions ◽  
Infarct Volume ◽  
Brain Infarction ◽  
Brain Mri ◽  
Brain Regions ◽  
Vascular Lesion ◽  
Cognitive Testing ◽  
Post Stroke ◽  
Brain Infarcts

Background: The thalamus is globally connected to many brain regions. Previous work highlights thalamic contributions to multiple cognitive functions, but few studies have measured thalamic volume changes or explored correlates of such changes with post-stroke cognition. Hence this study investigates possible associations of thalamic volumes with post-stroke cognitive functions. Methods: Participants with brain infarcts (6-42 months) underwent volumetric brain MRI and cognitive testing, including the Montreal Cognitive Assessment (MoCA). Focal Brain infarcts and thalami were traced manually. If the patient had bilateral infarcts, the side of the primary infarct volume defined the hemisphere involved. Brain parcellation and volumetrics used our comprehensive semi-automatic brain region and vascular lesion extraction pipeline (Ramirez, Neuroimage, 2011). MRI in 24 age and gender-matched healthy people provided normal comparative thalamic volumes. Thalamic atrophy was defined by percent thalamic volume loss in the stroke hemisphere compared to the other side. Spearman correlation assessed relationships between thalamic and infarct volumes and MoCA scores. Logistic regression analysis assessed whether thalamic atrophy correlated with MoCA score. Results: Thalami volumes ipsilateral to the infarct in stroke patients (n=55) were smaller than left (4.4 ± 1.4 vs. 5.4 ± 0.8 cc, p = 0.012) and right (4.4 ± 1.4 vs. 5.3 ± 0.7 cc, p = 0.024) thalamic volumes in the controls. Thalamic volumes were inversely correlated with ipsilateral infarct volumes (r = -0.384, p = 0.004). After controlling for head-size and brain atrophy, infarct volume independently correlated with ipsilateral thalamic volume s (β= -0.068, P=0.026), and only frontal infarcts (β = 2.300, p = 0.021) independently contributed to > 15% ipsilateral thalamic atrophy. Left thalamic atrophy of > 10% correlated significantly with poorer MoCA performance (β = 3.139, p = 0.023), after controlling for demographics and infarct volumes. Conclusions: Our results suggest that remote effects of infarction on ipsilateral thalamic volume, presumably related to disrupted thalamic-cortical interconnectivity, is associated with a commonly used metric of post-stroke cognitive impairment.

Post Stroke Rehabilitation Using Computer-based Cognitive Intervention (CBCI): A Systematic Review

2020 ◽  
Vol 16 (2) ◽  
pp. 93-102
Author(s):  
Sudhi Kulshrestha ◽  
Manju Agrawal ◽  
Ajai K. Singh ◽  
Dinkar Kulshreshtha
Keyword(s):  
Cognitive Impairment ◽  
Cognitive Functions ◽  
Cognitive Intervention ◽  
Cochrane Library ◽  
Stroke Patients ◽  
Future Studies ◽  
Computer Based Training ◽  
Post Stroke ◽  
Significant Difference ◽  
Computer Based

Background: Cognitive impairment as a consequence of stroke is a major cause affecting the patient’s functional independence, activity participation, daily living skills, and occupation. Almost 75% of post-stroke patients are diagnosed with significant cognitive impairment, which includes problems with attention, orientation, memory, language, and perception. Along with effective pharmaceutical cures, cognitive intervention as a part of rehabilitation approaches that may prevent, delay, or treat cognitive impairment is becoming increasingly important. Many studies have reported improvement in cognitive functions of post-stroke patients after using computer-based cognitive intervention (CBCI). CBCI can be an effective add-on to available rehabilitation programs. Objective: This article provides reviews related to relevant literature and, represents a structure to specify the efficacy of CBCI for the rehabilitation of post-stroke patients for future research. Methods: We searched many search engines namely MEDLINE, Web of Science, clinical key and The Cochrane Library, for studies investigating the effect of cognitive intervention based on a computer program for post-stroke patients. The results of selected studies were summarized. Total 19 publications from January 2007 to January 2019 are included in this review. The search terms entered were a combination of these search areas that defined (1) the population as adults who had suffered a stroke and cognitive dysfunction, (2) intervention search term included cognitive abilities, cognitive training, and computer-based training; computer-based cognitive intervention for rehabilitation. Results: The results after computer-based training showed improvement in various cognitive functions such as; memory, attention and executive functions of post-stroke patients. However, a significant difference between the study groups has not been observed in all the studies. Most studies analyzed in this research project indicated that such interventions might contribute to the improvement of cognitive function, especially attention concentration and memory. Of the 19 kinds of research that discussed CBCI outcomes 18 found significant improvements for one or more cognitive functions. When the effect size for CBCI was reported, effects were large in comparison to other traditional cognitive interventions of post-stroke patients. Conclusion: Studies related to cognitive functions strongly support CBCI except few have reported a significant difference. The review of all the studies suggests that CBCI may help to change the functional aspect of post-stroke patients by improving their cognitive functions. In this field, it is a challenge to conduct well designed and sufficiently powered studies due to low budgets availability, the limited number of available patients, heterogeneity of the population, and ethical considerations. Future studies should examine all the challenges, limitations, and valuable insights into the study and emphasize the need for a carefully designed computer-based cognitive intervention program for the future. Future studies should target to compare CBCI with active and passive control conditions and include a larger sample size.

Comparison of changes in cognitive functions of post-stroke patients with the computer-based cognitive intervention (PABLO system) and conventional cognitive intervention (Paper-Pencil method)

2021 ◽  
Vol 17 ◽  
Author(s):  
Sudhi Kulshrestha ◽  
Manju Agrawal ◽  
Ajai K Singh ◽  
Akash Ved
Keyword(s):  
Cognitive Impairment ◽  
Cognitive Functions ◽  
Research Work ◽  
Cognitive Intervention ◽  
Stroke Patients ◽  
Post Stroke ◽  
Group A ◽  
Computer Based ◽  
Attention Memory ◽  
Group B

Background: Cognitive functions are mental series of activities that allow us to carry out any activity. The most important cognitive functions are orientation, attention, memory, executive functions, language, and visuospatial skills. Cognitive impairment is a prevalent consequence of stroke. Prognosis of stroke recovery can be estimated through the severity of cognitive impairment. The objective of this research work was to compare the changes in cognitive functions of post-stroke patients with the computer-based cognitive intervention (CBCI) using PABLO system and conventional cognitive intervention (CCI) using paper-pencil method. Methods: Total 80 stroke patients with cognitive impairment were selected and divided into two groups. The Group A received intervention through PABLO System (CBCI) and the Group B received the cognitive intervention through Paper Pencil method (CCI). Pre and post-assessment of cognitive functions like verbal fluency, language, orientation and attention, memory, visuospatial and mini mental state examination for both the groups were done by Addenbrooke Cognitive Examination-Revised (ACE-R) scale. Result: After the intervention of 4 weeks, patients of both groups showed improvement in cognitive functions. However, the group A scored higher in comparison to group B. Conclusion: Data suggest that both the interventions will bring the changes in cognitive functions post-stroke patients but CBCI may be much more effective in improving cognitive functions of stroke patients.

scholarly journals Executive, language and fluency dysfunction are markers of localised TDP-43 cerebral pathology in non-demented ALS

2019 ◽  
Vol 91 (2) ◽  
pp. 149-157 ◽  
Author(s):  
Jenna M Gregory ◽  
Karina McDade ◽  
Thomas H Bak ◽  
Suvankar Pal ◽  
Siddharthan Chandran ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Executive Functions ◽  
Cognitive Deficits ◽  
Regional Distribution ◽  
Brain Regions ◽  
Cognitive Testing ◽  
Functional Deficits ◽  
Language Functions ◽  
Cerebral Pathology ◽  
Lateral Sclerosis

ObjectiveApproximately 35% of patients with amyotrophic lateral sclerosis (ALS) exhibit mild cognitive deficits in executive functions, language and fluency, without dementia. The precise pathology of these extramotor symptoms has remained unknown. This study aimed to determine the pathological correlate of cognitive impairment in patients with non-demented ALS.MethodsIn-depth neuropathological analysis of 27 patients with non-demented ALS who had undergone cognitive testing (Edinburgh Cognitive and Behaviour ALS Screen (ECAS)) during life. Analysis involved assessing 43 kDa Tar-DNA binding protein (TDP-43) accumulation in brain regions specifically involved in executive functions, language functions and verbal fluency to ascertain whether functional deficits would relate to a specific regional distribution of pathology.ResultsAll patients with cognitive impairment had TDP-43 pathology in extramotor brain regions (positive predictive value of 100%). The ECAS also predicted TDP-43 pathology with 100% specificity in brain regions associated with executive, language and fluency domains. We also detected a subgroup with no cognitive dysfunction, despite having substantial TDP-43 pathology, so called mismatch cases.ConclusionsCognitive impairment as detected by the ECAS is a valid predictor of TDP-43 pathology in non-demented ALS. The profile of mild cognitive deficits specifically predicts regional cerebral involvement. These findings highlight the utility of the ECAS in accurately assessing the pathological burden of disease.

scholarly journals Vascular Sema3E-Plexin-D1 Signaling Reactivation Promotes Post-stroke Recovery through VEGF Downregulation in Mice

2021 ◽  
Author(s):  
Ri Yu ◽  
Nam-Suk Kim ◽  
Yan Li ◽  
Jin-Young Jeong ◽  
Sang-Joon Park ◽  
...  
Keyword(s):  
Functional Recovery ◽  
Knockout Mice ◽  
Vascular Remodeling ◽  
Infarct Volume ◽  
Brain Infarction ◽  
Adult Brain ◽  
Stroke Recovery ◽  
Neurological Deficits ◽  
Post Stroke ◽  
Vegf Signaling

AbstractPost-stroke vascular remodeling, including angiogenesis, facilitates functional recovery. Proper vascular repair is important for efficient post-stroke recovery; however, the underlying mechanisms coordinating the diverse signaling pathways involved in vascular remodeling remain largely unknown. Recently, axon guidance molecules were revealed as key players in injured vessel remodeling. One such molecule, Semaphorin 3E (Sema3E), and its receptor, Plexin-D1, control vascular development by regulating vascular endothelial growth factor (VEGF) signaling. In this study, using a mouse model of transient brain infarction, we aimed to investigate whether Sema3E-Plexin-D1 signaling was involved in cerebrovascular remodeling after ischemic injury. We found that ischemic damage rapidly induced Sema3e expression in the neurons of peri-infarct regions, followed by Plexin-D1 upregulation in remodeling vessels. Interestingly, Plexin-D1 reemergence was concurrent with brain vessels entering an active angiogenic process. In line with this, Plxnd1 ablation worsened neurological deficits, infarct volume, neuronal survival rate, and blood flow recovery. Furthermore, reduced and abnormal vascular morphogenesis was caused by aberrantly increased VEGF signaling. In Plxnd1 knockout mice, we observed significant extravasation of intravenously administered tracers in the brain parenchyma, junctional protein downregulation, and mislocalization in regenerating vessels. This suggested that the absence of Sema3E-Plexin-D1 signaling is associated with blood–brain barrier (BBB) impairment. Finally, the abnormal behavioral performance, aberrant vascular phenotype, and BBB breakdown defects in Plxnd1 knockout mice were restored following the inhibition of VEGF signaling during vascular remodeling. These findings demonstrate that Sema3E-Plexin-D1 signaling can promote functional recovery by downregulating VEGF signaling in the injured adult brain.

scholarly journals Cognitive impairment and dementia

2018 ◽  
pp. 10-15
Author(s):  
V. A. Parfenov ◽  
S. V. Verbitskaya
Keyword(s):  
Cognitive Impairment ◽  
Brain Damage ◽  
Cognitive Functions ◽  
Stroke Prevention ◽  
Stroke Patients ◽  
Acquired Disability ◽  
Post Stroke ◽  
Treatment And Prevention ◽  
Meta Analyses

Cognitive impairment (CI) is one of the causes of acquired disability in post-stroke patients. The article presents an analysis of the prevalence, pathogenesis, manifestations, diagnosis, treatment and prevention of post-stroke CI. It is noted that CI can be caused not only by focal vascular brain damage, but also by the presence of concomitant vascular and degenerative lesions in stroke patients. The authors present the results of their own study of CI in 350 patients after stroke within 5 years. The treatment and prevention of CI progression are based on stroke prevention, non-pharmaceutical and pharmaceutical methods for improving cognitive functions. The article discusses data on the use of Cerebrolysin in post-stroke patients, the results of the two latter meta-analyses of Cerebrolysin use.

Enriched environment alleviates post-stroke cognitive impairment through enhancing α7-nAChR expression in rats

2020 ◽  
Vol 78 (10) ◽  
pp. 603-610
Author(s):  
Mei YUAN ◽  
Xin-Xin ZHANG ◽  
Xiao-Cui FU ◽  
Xia BI
Keyword(s):  
Cognitive Impairment ◽  
Cognitive Function ◽  
Infarct Volume ◽  
Long Term Potentiation ◽  
Enriched Environment ◽  
Morris Water Maze Test ◽  
Control Group ◽  
Α7 Nicotinic Acetylcholine Receptor ◽  
Post Stroke ◽  
Α7 Nachr

ABSTRACT Background: Enriched environment (EE) is a simple and effective intervention to improve cognitive function in post-stroke cognitive impairment (PSCI), partly due to the rebalancing of the cholinergic signaling pathway in the hippocampus. α7-nicotinic acetylcholine receptor (α7-nAChR) is a cholinergic receptor whose activation inhibits inflammation and promotes the recovery of neurological function in PSCI patients. However, it is still unclear whether EE can regulate α7-nAChR and activate the cholinergic anti-inflammatory pathway (CAP) in PSCI. Objective: To investigate the effects of EE on cognitive impairment, and the role of α7-nAChR in PSCI. Methods: A PSCI rat model was induced by middle cerebral artery occlusion and reperfusion (MCAO/R) and were reared in standard environment (SE) or EE for 28d, control group with sham surgery. Cognitive function was determined by Morris water maze test. The long-term potentiation (LTP) was assessed by Electrophysiology. Histopathological methods were used to determine infarct volume, α7-nAChR expression and the cytokines and cholinergic proteins expression. Results: Compared with SE group, rats in EE group had better cognitive function, higher expression of α7-nAChR positive neurons in hippocampal CA1 region. In addition, EE attenuated unfavorable changes induced by MCAO/R in cytokines and cholinergic proteins, and also enhanced LTP promoted by nicotine and attenuated by α-BGT; but showed no significantly difference in infarct volume. Conclusions: EE markedly improves cognitive impairment and enhances neuroplasticity in PSCI rats, which may be closely related to enhancement of α7-nAChR expression.

scholarly journals Strategic infarct location for post-stroke cognitive impairment: A multivariate lesion-symptom mapping study

2017 ◽  
Vol 38 (8) ◽  
pp. 1299-1311 ◽  
Author(s):  
Lei Zhao ◽  
J Matthijs Biesbroek ◽  
Lin Shi ◽  
Wenyan Liu ◽  
Hugo J Kuijf ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Basal Ganglia ◽  
Brain Regions ◽  
Angular Gyrus ◽  
Support Vector ◽  
Subcortical Structures ◽  
Cognitive Domains ◽  
Post Stroke ◽  
Lesion Symptom Mapping ◽  
Basal Ganglia Structures

Lesion location is an important determinant for post-stroke cognitive impairment. Although several ‘strategic’ brain regions have previously been identified, a comprehensive map of strategic brain regions for post-stroke cognitive impairment is lacking due to limitations in sample size and methodology. We aimed to determine strategic brain regions for post-stroke cognitive impairment by applying multivariate lesion-symptom mapping in a large cohort of 410 acute ischemic stroke patients. Montreal Cognitive Assessment at three to six months after stroke was used to assess global cognitive functioning and cognitive domains (memory, language, attention, executive and visuospatial function). The relation between infarct location and cognition was assessed in multivariate analyses at the voxel-level and the level of regions of interest using support vector regression. These two assumption-free analyses consistently identified the left angular gyrus, left basal ganglia structures and the white matter around the left basal ganglia as strategic structures for global cognitive impairment after stroke. A strategic network involving several overlapping and domain-specific cortical and subcortical structures was identified for each of the cognitive domains. Future studies should aim to develop even more comprehensive infarct location-based models for post-stroke cognitive impairment through multicenter studies including thousands of patients.

scholarly journals Experience with citicoline in patients with post-stroke cognitive impairment

2020 ◽  
Vol 12 (4) ◽  
pp. 43-48
Author(s):  
A. N. Bogolepova ◽  
S. G. Burd ◽  
A. V. Lebedeva ◽  
E. A. Kovalenko
Keyword(s):  
Cognitive Impairment ◽  
Cognitive Functions ◽  
Time Course ◽  
Depressive Disorders ◽  
Recovery Period ◽  
Depression Scale ◽  
Oral Solution ◽  
Cognitive Status ◽  
Post Stroke ◽  
Number Of Patients

Objective: to investigate the efficacy and safety of citicoline (Ceresil® Canon) in patients with post-stroke cognitive impairment.Patients and methods. Examinations were made in 33 patients aged 45 years and older who had experienced primary ischemic hemispheric stroke with complaints of a decline in memory or other cognitive functions. The cognitive status was assessed using the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA). The presence of anxiety-depressive spectrum disorders was determined on the Hospital Anxiety and Depression Scale. All the patients received citicoline (Ceresil® Canon) oral solution at a dose of 1000 mg/day for 3 months.Results and discussion. Citicoline administration showed a statistically significant reduction in the severity of cognitive impairment (p<0.001). The time course of positive changes in the cognitive status of patients was reflected by an increase in the median score on the MMSE from 26 [25; 27.5] to 28 [26.5; 29] and on MoCA from 23 [21; 25] to 25 [22; 26]. There was a decline in the number of patients with anxiety-depressive disorders. No adverse events or side effects were found in the patients.Conclusion. The findings suggest that citicoline (Ceresil® Canon) produced as an oral solution is well tolerated and improves cognitive functions and affective sphere in patients in the recovery period of ischemic stroke.

scholarly journals Slower EEG alpha generation, synchronization and “flow”—possible biomarkers of cognitive impairment and neuropathology of minor stroke

PeerJ ◽  
2017 ◽  
Vol 5 ◽  
pp. e3839 ◽  
Author(s):  
Jelena Petrovic ◽  
Vuk Milosevic ◽  
Miroslava Zivkovic ◽  
Dragan Stojanov ◽  
Olga Milojkovic ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Frontal Cortex ◽  
Cognitive Functions ◽  
Alpha Activity ◽  
Electrode Placement ◽  
Minor Stroke ◽  
Stroke Patients ◽  
Post Stroke ◽  
Alpha Frequency ◽  
Eeg Alpha

Background We investigated EEG rhythms, particularly alpha activity, and their relationship to post-stroke neuropathology and cognitive functions in the subacute and chronic stages of minor strokes. Methods We included 10 patients with right middle cerebral artery (MCA) ischemic strokes and 11 healthy controls. All the assessments of stroke patients were done both in the subacute and chronic stages. Neurological impairment was measured using the National Institute of Health Stroke Scale (NIHSS), whereas cognitive functions were assessed using the Montreal Cognitive Assessment (MoCA) and MoCA memory index (MoCA-MIS). The EEG was recorded using a 19 channel EEG system with standard EEG electrode placement. In particular, we analyzed the EEGs derived from the four lateral frontal (F3, F7, F4, F8), and corresponding lateral posterior (P3, P4, T5, T6) electrodes. Quantitative EEG analysis included: the group FFT spectra, the weighted average of alpha frequency (αAVG), the group probability density distributions of all conventional EEG frequency band relative amplitudes (EEG microstructure), the inter- and intra-hemispheric coherences, and the topographic distribution of alpha carrier frequency phase potentials (PPs). Statistical analysis was done using a Kruskal–Wallis ANOVA with a post-hoc Mann–Whitney U two-tailed test, and Spearman’s correlation. Results We demonstrated transient cognitive impairment alongside a slower alpha frequency (αAVG) in the subacute right MCA stroke patients vs. the controls. This slower alpha frequency showed no amplitude change, but was highly synchronized intra-hemispherically, overlying the ipsi-lesional hemisphere, and inter-hemispherically, overlying the frontal cortex. In addition, the disturbances in EEG alpha activity in subacute stroke patients were expressed as a decrease in alpha PPs over the frontal cortex and an altered “alpha flow”, indicating the sustained augmentation of inter-hemispheric interactions. Although the stroke induced slower alpha was a transient phenomenon, the increased alpha intra-hemispheric synchronization, overlying the ipsi-lesional hemisphere, the increased alpha F3–F4 inter-hemispheric synchronization, the delayed alpha waves, and the newly established inter-hemispheric “alpha flow” within the frontal cortex, remained as a permanent consequence of the minor stroke. This newly established frontal inter-hemispheric “alpha flow” represented a permanent consequence of the “hidden” stroke neuropathology, despite the fact that cognitive impairment has been returned to the control values. All the detected permanent changes at the EEG level with no cognitive impairment after a minor stroke could be a way for the brain to compensate for the lesion and restore the lost function. Discussion Our study indicates slower EEG alpha generation, synchronization and “flow” as potential biomarkers of cognitive impairment onset and/or compensatory post-stroke re-organizational processes.

scholarly journals Explore the correlation between cerebral vessel characteristics with cognitive impairment among elder individuals: a community study from China

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Wei-Wen Wu ◽  
Yang Wang ◽  
Jun Xu ◽  
Li-Xia Lu ◽  
Lin Chen ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Carotid Artery ◽  
Cognitive Functions ◽  
Linear Regression Analysis ◽  
Brain Mri ◽  
Brain Magnetic Resonance Imaging ◽  
Full Blood Count ◽  
Cerebral Vessel ◽  
Significant Difference ◽  
Cerebral Vascular

Abstract Background Brain Magnetic Resonance Imaging (MRI) examination of cerebral small vessel disease (CSVD) may help screen vascular cognitive impairment. A recently estimated CSVD score system was suggested to capture the overall CSVD burden. The study aimed to detect the association between systemic evaluation score of cerebral vascular imaging parameters with cognitive functions. Methods This was a cross-sectional study in community settings. From October 2017 to September 2018, elder (≧60) residents were recruited through on-site visit in 6 communities from Shanghai, China. The participants underwent brain MRI, carotid ultrasound, laboratory tests of blood and urine samples. Cognitive function was evaluated using Mini-Mental State Examination (MMSE). MRI score of CSVD was calculated according to the 2012 standard for the evaluation of statistical changes in imaging. Results Total 171 subjects completed survey and examinations. There were 55 participants diagnosed with cognitive impairment, with a total percentage of 32.2%. Participants with and without cognitive impairment showed significant differences in age, BMI and education level. Cognitive impaired participant had more disease history/comorbidity of hypertension and chronic renal insufficiency, higher level of creatinine, as well as lower level of full blood count (FBC) and alanine aminotransferase (ALT). A significant difference was detected in CSVD score between participants with and without cognitive impairment. Results of linear regression analysis showed significant negative correlations between MMSE score and both left and right carotid artery peak systolic velocity (PSV), however the CSVD score was only borderline (P = 0.0566) positively correlated with MMSE. Multivariate linear correlation analysis including all collected risk factor data showed that left carotid artery PSV score was among the independent negative correlated factors of MMSE. Multivariate binary logistic analysis showed that age, education and history of hypertension were the only statistically associated factors of cognitive impairment. Conclusions The current study identified high prevalence of cognitive impairment in a Chinese community. In addition, correlations between cerebral vascular disease imaging status and cognitive functions were confirmed although the sample size limited the possibility of screening cognitive impairment with imaging technique.

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