Abstract
Memory dysfunction is one of the main cognitive impairments caused by stroke, especially associative memory. Therefore, cognitive training, such as face-name mnemonic strategy training, could be an important intervention for this group of patients. The goal of this study was to evaluate the behavioral effects of face-name mnemonic strategy training, along with the neural substrate behind these effects, in the left frontoparietal lobe stroke patients. Volunteers underwent 2 sessions of functional magnetic resonance imaging (fMRI) during face-name association task: one prior and the other after the cognitive training. The fMRI followed a block design task with three active conditions: trained face-name pairs, untrained face-name pairs, and a couple of repeated face-name pairs. Prior to each fMRI session, volunteers underwent neuropsychological assessment. Training resulted in better performance on delayed memory scores of HVLT-R, and on recognition on a generalization strategy task, as well as better performance in the fMRI task. Also, trained face-name pairs presented higher activation after training in default-mode network regions, such as the posterior cingulate cortex, precuneus, and angular gyrus, as well as in lateral occipital and temporal regions. Similarly, untrained face-name pairs also showed a nonspecific training effect in the right superior parietal cortex, right supramarginal gyrus, anterior intraparietal sulcus, and lateral occipital cortex. A correlation between brain activation and task performance was also found in the angular gyrus, superior parietal cortex, anterior intraparietal sulcus, and lateral occipital cortex. In conclusion, these results suggest that face-name mnemonic strategy training has the potential to improve memory performance and to foster brain activation changes, by the recruitment of contralesional areas from default-mode, frontoparietal, and dorsal attention networks as a possible compensation mechanism.
Highlights
The presence of cognitive deficits after stroke has been demonstrated in, at least, one-third of survivors and can continue for many years generating significant impact in their quality of life and higher mortality [1,2,3]
Previous studies in patients with amnestic mild cognitive impairment, a neurodegenerative condition, using face-name mnemonic strategy training (MST), showed significant behavior improvement associated with recruitment of widespread cerebral networks including the frontoparietal, inferior parietal cortex, temporal and fusiform gyri, angular gyrus, posterior cingulate cortex, and precuneus using functional magnetic resonance imaging [11, 12]
There were no significant differences on self-reports of memory functioning (MMQ, Spontaneous Strategy Implementation Inquiry (SSII)) except for Brief FaceName Questionnaire (BFNQ) strategy for faces (w = 1 500, FDR-corrected p = 0 007, and rrb = −0 955), BFNQ improvement and strategy use for name were borderline significant after FDR correction, and strategy use had the same effect size, as the BFNQ strategy for faces
Summary
The presence of cognitive deficits after stroke has been demonstrated in, at least, one-third of survivors and can continue for many years generating significant impact in their quality of life and higher mortality [1,2,3]. The face-name mnemonic strategy applied by these previous studies is a specific cognitive method that facilitates the organization and association of new information (i.e., a proper name to its respective face), thereby enhancing depth processing and encoding [14]. It is considered an ecologically valid approach in cognitive rehabilitation and has been associated with the declarative or explicit memory system [11,12,13]
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