Critical issue on the extinction and inattention subtest of NIHSS scale: an analysis on post-acute stroke patients attending inpatient rehabilitation

Objectives This study aims to evaluate the diagnostic performance of NIHSS extinction and inattention item, compared to the results of the Oxford Cognitive Screen (OCS) heart subtest. Additionally, the possible role of the NIHSS visual field subtest on the NIHSS extinction and inattention subtest performance is explored and discussed. Methods We analysed scores on NIHSS extinction and inattention subtest, NIHSS visual field subtest, and OCS heart subtest on a sample of 118 post-stroke patients. Results Compared to OCS heart subtest, the results on NIHSS extinction and inattention subtest showed an accuracy of 72.9% and a moderate agreement level (Cohen’s kappa = 0.404). Furthermore, a decrease in NIHSS accuracy detecting neglect (61.1%) was observed in patients with pathological scores in NIHSS visual field item. Conclusions Extreme caution is recommended for the diagnostic performance of extinction and inattention item of NIHSS. Signs of neglect may not be detected by NIHSS, and may be confused with visual field impairment. Trial registration This study refers to an observational study protocol submitted to ClinicalTrials.gov with identifier: NCT03968627. The name of the registry is “Development of a National Protocol for Stroke Rehabilitation in a Multicenter Italian Institution” and the date of the registration is the 30th May 2019.

Post-stroke executive function impairments in relation to white matter damage due to stroke lesions versus leukoaraiosis

BACKGROUND There is a high prevalence of executive function impairments among stroke survivors. However, the underlying aetiology remains unclear. In particular, we address whether focal, stroke-specific white matter damage or diffuse comorbid white matter damage (leukoaraiosis) is more associated with executive function impairments. METHODS This project is a retrospective analysis of data collected within the Oxford Cognitive Screening programme. Patients were recruited in the acute stage of stroke if they had a confirmed diagnosis of stroke, were at least 18 years of age, were able to remain alert for 20 minutes, and were able to provide informed consent. Patients in the present analysis completed follow up neuropsychological assessment at six-months with the Oxford Cognitive Screen-Plus to assess executive function. Stroke lesions were manually delineated on acute clinical brain scans allowing us to quantify focal stroke-specific white matter damage using the HCP-842 tractography atlas. Leukoaraiosis was visually rated on clinical scans using the Age-Related White Matter Changes scale. RESULTS This study included data from 90 stroke patients (mean age = 73.76 years; 47.78% female). Multiple linear regression analyses showed that the presence of leukoaraiosis predicted poorer executive functioning six-months after stroke (B = -0.33, p = .031, 95% CI [-0.64 -0.03]). However, post-stroke executive functioning was not predicted by stroke-specific damage to white matter tracts. CONCLUSIONS Overall, these results provide novel insight into the neural substrates underlying post-stroke executive dysfunction and highlight the prognostic utility of using routine clinical CT scans to assess leukoaraiosis.

MSC 2021 Virtual E-Abstract

1. Extended Hours Thrombolysis Guided By DWI-FLAIR Mismatch.2. Carotid Artery Stenting For Radiation Induced Late Carotid Stenosis: A Case Report.3. Cerebral Venous Sinus Thrombosis In Male Gender: A Case Series.4. Effects Of Malaysian Movement Control Order (MCO) 1.0 Following Covid-19 Pandemic On Acute Stroke Service In Seberang Jaya Hospital.5. A Rare Pontine Infarct With Abducens Nerve Palsy, Hyperacusis And Contralateral Hemianaesthesia Mimicking Gasperini Syndrome.6. A Case Report On A Rare Syndrome: Gerstmann Tetrad In A Stroke Patient.7. Oxford Cognitive Screen Malay Version: Validation Of Stroke-Specific Cognitive Screening Test Pilot Study.

Perceptions of Canadian Armed Forces Health Services health care professionals on cognitive assessment processes

Lay Summary Canadian Armed Forces (CAF) Service Members (SMs) experience mild traumatic brain injuries (mTBI), which can affect cognitive functioning. Adequate cognitive functioning is needed to perform military duties safely and function in all aspects of life. A standardized process that includes cognitive screen/assessment within a mTBI rehabilitation strategy is not widely used within Canadian Forces Health Services (CFHS). A qualitative thematic analysis nested within an implementation science approach was used to explore the experiences of 17 CFHS health care professionals who perform cognitive screens/assessments. Perceived facilitators, barriers, and recommendations for improving cog-nitive assessment practices for injured CAF-SMs were identified within 5 themes. Development and implementation of cognitive screen/assessment policies and protocols will enable CFHS to best assess and treat cognitive dysfunction among CAF-SMs.