Cognitive, behavioral and brain lesional factors in the neurorehabilitation of stroke patients: prognostic and clinical outcomes
Abstract
Stroke is the second most common cause of death worldwide and the main cause of adult disability in Western Countries, with 40% of stroke survivors reporting problems in activities of daily living. functional and clinical outcomes of the rehabilitative process may vary as a function of a number of variables, and predicting the degree of recovery after stroke, although essential, can be challenging, such that patients with similar baseline impairments might show different recovery trajectories.
In the present study, we explored this issue in a sample of 48 stroke patients (right hemisphere damage) admitted to the IRCCS Santa Lucia Foundation, a neurorehabilitation hospital located in Rome, Italy. Specifically, we focused on cognitive, neuropsychiatric and brain lesion measures to predict clinical outcome.
Results revealed that age, baseline neuro-functional, neurocognitive and neuropsychiatric data, along with sparing of temporal pole and inferior frontal regions, mediate post-stroke recovery. Such results could provide further hints in considering the clinical variables involved in functional recovery and return to work in stroke patients.
References
- 1) Benjamin EJ, Blaha MJ, Chiuve SE, Cushman M, Das SR, Deo R, Ferranti SD de, Floyd J, Fornage M, Gillespie C, Isasi CR, Jiménez MC, Jordan LC, Judd SE, Lackland D, Lichtman JH, Lisabeth L, Liu S, Longenecker CT, Mackey RH, Matsushita K, Mozaffarian D, Mussolino ME, Nasir K, Neumar RW, Palaniappan L, Pandey DK, Thiagarajan RR, Reeves MJ, Ritchey M, Rodriguez CJ, Roth GA, Rosamond WD, Sasson C, Towfighi A, Tsao CW, Turner MB, Virani SS, Voeks JH, Willey JZ, Wilkins JT, Wu JH, Alger HM, Wong SS, Muntner P (2017) Heart Disease and Stroke Statistics—2017 Update: A Report From the American Heart Association. Circulation 135, e146. DOI: https://doi.org/10.1161/CIR.0000000000000485
- 2) Gresham GE, Granger C V., Linn RT, Kulas MA (1999) Status of Functional Outcomes for Stroke Survivors. Phys. Med. Rehabil. Clin. N. Am. 10, 957-966. DOI: https://doi.org/10.1016/S1047-9651(18)30173-6
- 3) Albert SJ, Kesselring J (2011) Neurorehabilitation of stroke. J. Neurol. 2011 2595 259, 817-832. DOI: https://doi.org/10.1007/s00415-011-6247-y
- 4) Prabhakaran S, Zarahn E, Riley C, Speizer A, Chong JY, Lazar RM, Marshall RS, Krakauer JW (2008) Inter-individual Variability in the Capacity for Motor Recovery After Ischemic Stroke. Neurorehabil Neural Repair 22, 64-71. DOI: https://doi.org/10.1177/1545968307305302
- 5) Meldrum D, Pittock S, Hardiman O, Ni Dhuill C, O'Regan M (2004) Recovery of the upper limb post ischaemic stroke and the predictive value of the Orpington Prognostic Score. Clin. Rehabil. 18, 694-702. 5) Feys H, De Weerdt W, Nuyens G, van de Winckel A, Selz B, Kiekens C (2000) Predicting motor recovery of the upper limb after stroke rehabilitation: value of a clinical examination. Physiother. Res. Int. 5, 1-18. DOI: https://doi.org/10.1191/0269215504cr753oa
- 7) Folstein MF, Folstein SE, McHugh PR (1975) "Mini-mental state" A practical method for grading the cognitive state of patients for the clinician. J. Psychiatr. Res. 12, 189-98. DOI: https://doi.org/10.1016/0022-3956(75)90026-6
- 8) Hamilton M (1960) A rating scale for depression. 23. DOI: https://doi.org/10.1037/t04100-000
- 9) Hamilton MC, Schutte NS, Malouff JM (1959) Hamilton anxiety scale (HAMA). Sourceb. Adult Assess. Appl. Clin. Psychol. 154-157. DOI: https://doi.org/10.1037/t02824-000
- 10) Carlesimo GA, Caltagirone C, Gainotti G, Fadda L, Gallassi R, Lorusso S, Marfia G, Marra C, Nocentini U, Parnetti L (1996) The Mental Deterioration Battery: normative data, diagnostic reliability and qualitative analyses of cognitive impairment. The Group for the Standardization of the Mental Deterioration Battery. Eur: Neurol. 36, 378-384. DOI: https://doi.org/10.1159/000117297
- 11) Stroop JR (1935) Studies of interference in serial verbal reactions. J. Exp. Psychol. 18, 643-662. DOI: https://doi.org/10.1037/h0054651
- 12) Shah S, Vanclay F, Cooper B (1989) Improving the sensitivity of the Barthel Index for stroke rehabilitation. J. Clin. Epidemiol. 42, 703-709. DOI: https://doi.org/10.1016/0895-4356(89)90065-6
- 13) Brett M, Leff AP, Rorden C, Ashburner J (2001) Spatial Normalization of Brain Images with Focal Lesions Using Cost Function Masking. Neuroimage 14, 486-500. DOI: https://doi.org/10.1006/nimg.2001.0845
- 14) MU, RE S, PC V, J DK, GJ L (2005) Optimizing cutoff scores for the Barthel index and the modified Rankin scale for defining outcome in acute stroke trials. Stroke 36, 1984-1987. DOI: https://doi.org/10.1161/01.STR.0000177872.87960.61
- 15) Karnat O, Himmelbach M, Rorden C (2002) The subcortical anatomy of human spatial neglect: putamen, caudate nucleus and pulvinar. Brain 125, 350-360. DOI: https://doi.org/10.1093/brain/awf032
- 16) Picelli A, Filippetti M, Del Piccolo L, Schena F, Chelazzi L, Della Libera C, Donadelli M, Donisi V, Fabene PF, Fochi S, Fonte C, Gandolfi M, Gomez-Lira M, Locatelli E, Malerba G, Mariotto S, Milanese C, Patuzzo C, Romanelli MG, Sbarbati A, Tamburin S, Venturelli M, Zamparo P, Carcereri de Prati A, Butturini E, Varalta V, Smania N (2021) Rehabilitation and Biomarkers of Stroke Recovery: Study Protocol for a Randomized Controlled Trial. Front. Neurol. 11, 1800. DOI: https://doi.org/10.3389/fneur.2020.618200
- 17) Stinear C, Byblow W (2014) Predicting and accelerating motor recovery after stroke. Curr. Opin. Neurol. 27, 624-630. DOI: https://doi.org/10.1097/WCO.0000000000000153
- 18) Vázquez-Guimaraens M, Caamaño-Ponte JL, Seone-Pillado T, Cudeiro J (2021) Factors Related to Greater Functional Recovery after Suffering a Stroke. Brain Sci. 2021, Vol. 11, Page 802 11, 802. 19) Knoflach M, Matosevic B, Rücker M, Furtner M, Mair A, Wille G, Zangerle A, Werner P, Ferrari J, Schmidauer C, Seyfang L, Kiechl S, Willeit J, Collaborators F the ASUR (2012) Functional recovery after ischemic stroke—A matter of age. Neurology 78, 279-285. 20) Mijajlovic MD, Pavlovié A, Brainin M, Heiss W-D, Quinn TJ, IhleHansen HB, Hermann DM, Assayag E Ben, Richard E, Thiel A, Kliper E, Shin Y-1, Kim Y-H, Choi S, Jung S, Lee Y-B, Sinanovic O, Levine DA, Schlesinger 1, Mead G, Milosevic V, Leys D, Hagberg G, Ursin MH, Teuschl Y, Prokopenko S, Mozheyko E, Bezdenezhnykh A, Matz K, Aleksié V, Muresanu D, Korczyn AD, Bornstein NM (2017) Post-stroke dementia - a comprehensive review. BMC Med. 15.
- 21) StrokeAssociation (2017) A New Era for Stroke. https://www.stroke.org.uk/sites/defaultlfileslanefs_report_web.pdf. 22) Park J, Lee G, Lee S, Jung S (2016) The Impact of Acute Phase Domain-Specific Cognitive Function on Post-stroke Functional Recovery. Ann. Rehabil. Med. 40, 214-222. DOI: https://doi.org/10.5535/arm.2016.40.2.214
- 23) Malouin F, Belleville S, Richards C, Desrosiers J, Doyon J (2004) Working memory and mental practice outcomes after stroke. Arch. Phys. Med. Rehabil. 85, 177-183. DOI: https://doi.org/10.1016/S0003-9993(03)00771-8
- 24) Roth M (1955) The Natural History of Mental Disorder in Old Age. J. Ment. Sci. 101, 281-301. DOI: https://doi.org/10.1192/bjp.101.423.281
- 25) Bartoli F, Brita C Di, Crocamo C, Clerici M, Carrà G (2018) Early Post-stroke Depression and Mortality: Meta-Analysis and MetaRegression. Front. Psychiatry 9, 530. DOI: https://doi.org/10.3389/fpsyt.2018.00530
- 26) Eriksson M, Glader E, Norrving B, Asplund K (2015) Poststroke suicide attempts and completed suicides: a socioeconomic and nationwide perspective. Neurology 84, 1732-1738. DOI: https://doi.org/10.1212/WNL.0000000000001514
- 27) Tu J, Wang L, Wen H, Xu Y, Wang P (2018) The association of different types of cerebral infarction with post-stroke depression and cognitive impairment. Medicine (Baltimore). 97. DOI: https://doi.org/10.1097/MD.0000000000010919
- 28) Kim ES, Kim JW, Kang HJ, Bae KY, Kim SW, Kim JT, Park MS, Cho KH, Kim JM (2018) Longitudinal impact of depression on quality of life in stroke patients. Psychiatry Investig. 15, 141-146. 29) Khedr EM, Abdelrahman AA, Desoky T, Zaki AF, Gamea A Poststroke depression: frequency, risk factors, and impact on quality of life among 103 stroke patients-hospital-based study. DOI: https://doi.org/10.30773/pi.2017.10.11
- 30) Argyriadis A, Fylaktou C, Bellou-Mylona P, Gourni M, Asimakopoulou E, Sapountzi-Krepia D (2020) Post stroke depression and its effects on functional rehabilitation of patients: socio-cultural disability communities. Heal. Res. J. 6, 3-20. DOI: https://doi.org/10.12681/healthresj.22512
- 31) Paolucci S, Di Vita A, Massicci R, Traballesi M, Bureca I, Matano A, losa M, Guariglia C (2012) Impact of participation on rehabilitation results: a multivariate study. Eur J Phys Rehabil Med. 48, 455-66. 32) Chemerinski E, Robinson R, Kosier J (2001) Improved recovery in activities of daily living associated with remission of poststroke depression. Stroke 32, 113-117. DOI: https://doi.org/10.1161/01.STR.32.1.113
- 33) Nickel A, Thomalla G (2017) Post-Stroke Depression: Impact of Lesion Location and Methodological Limitations—A Topical Review. Front. Neurol. 8. DOI: https://doi.org/10.3389/fneur.2017.00498
- 34) Kalaria RN, Akinyemi R, Ihara M (2016) Stroke injury, cognitive impairment and vascular dementia. Biochim. Biophys. Acta - Mol. Basis Dis. 1862, 915-925. DOI: https://doi.org/10.1016/j.bbadis.2016.01.015
- 35) Carter AR, Astafiev S V., Lang CE, Connor LT, Rengachary J, Strube MJ, Pope DLW, Shulman GL, Corbetta M (2010) Resting interhemispheric functional magnetic resonance imaging connectivity predicts performance after stroke. Ann. Neurol. 67, 365-375. DOI: https://doi.org/10.1002/ana.21905
- 36) Carter AR, Shulman GL, Corbetta M (2012) Why use a connectivitybased approach to study stroke and recovery of function? Neuroimage 62, 2271-2280. DOI: https://doi.org/10.1016/j.neuroimage.2012.02.070
- 37) Mohajerani MH, Aminoltejari K, Murphy TH (2011) Targeted ministrokes produce changes in interhemispheric sensory signal processing that are indicative of disinhibition within minutes. Proc. Natl. Acad. Sci. U.S. A. 108. DOI: https://doi.org/10.1073/pnas.1101914108
- 38) Grefkes C, Fink GR (2011) Reorganization of cerebral networks after stroke: new insights from neuroimaging with connectivity approaches. Brain 134, 1264. DOI: https://doi.org/10.1093/brain/awr033
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