Cognitive Function In Stroke Patients Research Articles

Effects of Combined Interventions with Aerobic Physical Exercise and Cognitive Training on Cognitive Function in Stroke Patients: A Systematic Review.

(1) Background: Stroke is a major cause of permanent disability in multiple functions, including the cognitive domain. Since both cognitive training and aerobic physical exercise may exert positive effects on cognition after stroke, one may expect synergistic benefits when combining both interventions. (2) Methods: We carried out a systematic search of studies testing, in adult stroke patients, whether structured aerobic exercise combined with cognitive training led to higher cognitive benefits than either of these interventions when applied singly, or than interventions not including aerobic exercise or cognitive training. (3) Results: Five fair-quality randomized controlled trials fulfilled the search criteria. Exercise intensity was moderate-vigorous and cognitive training was mainly computer-based. The studies were heterogeneous regarding the cognitive tests used, and for this reason, a meta-analysis was not performed. Only three studies included follow-up assessment. The combined intervention was associated with pre-post improvement in at least one cognitive test in all the studies, and with higher positive effects compared to other conditions (although statistical significance was not always reached) in four studies. (4) Conclusions: Further trials including a long-term follow-up and comprehensive neuropsychological testing should be undertaken to determine whether combined aerobic exercise and cognitive training leads to additive cognitive benefits after stroke.

The Effect of Brain Game on Cognitive Function in Stroke Patients

The decline in cognitive function has been a disorder frequently experienced by stroke patients. The present studyaimed to determine the effect of android-based brain games on cognitive function in stroke patients. Brain games inthis study are designed using an exploratory approach to various cognitive function domains that are damaged. Thequasi experiment using two groups pretest and posttest design involved 15 individuals for each group recruited froma hospital in West Java through purposive sampling with a sample calculation formula using a paired numericalanalytical research formula. The intervention group received an android-based brain games three times a week forone month, the control group received placebo intervention (mentioning colors of different words) three times aweek for one month. The FACT-Cog Version 3 questionnaire utilized as the measuring instrument. Measurementswere taken every week after the intervention for one month. The results indicated that there was a signifcant changein cognitive function scores before and after the intervention in the intervention group (p = 0.000). Meanwhile,in the control group there is no signifcant change (p = 0.164). Moreover, the results of cognitive function scoreanalysis after intervention between the intervention and control group exhibit a signifcant difference (p = 0.000).The brain game intervention has a signifcant effect on cognitive function after the third treatment in the frst week(p <0.05). Also, the results exhibit the potential effect of brain games on the cognitive function level of strokepatients. Some of the things that make the intervention in this study effective in improving cognitive functionare that the respondents included in this study are only those who have a score greater than or equal to 46, whichmay be different when applied to patients with lower scores. In addition, the intervention was carried out onrespondents who had experienced a stroke for the frst time and may be different if applied to people who have hadseveral strokes. Therefore, it is important to expand the criteria for respondents in further research. Furthermore,this can be used as an option of the nursing intervention to manage cognitive problems among stroke patients.

Abstract 46: An Innovative Approach to the Bedside Nursing Swallow Screening Tool: Can Be Used as a Trigger for an Inpatient Cognitive Evaluation to Improve Timeliness of Post-Discharge Cognitive Therapy Referrals

Background: According to the American Heart Association, a formal assessment of cognitive dysfunction caused by stroke is a level I recommendation. However, cognitive evaluation is often missed or overlooked in the inpatient setting. When and who performs the assessment is not well-defined. Stroke nurses can corroborate with clinicians in completing the Montreal Cognitive Assessment (MoCA) 8.1, a validated tool for assessing cognitive function in stroke patients. Purpose: The purpose of this study was to evaluate the process of using the bedside nursing swallow screen (NSS) as a trigger for an inpatient cognitive evaluation by the Speech Therapist (ST). This study was also used to determine if post-discharge cognitive therapy referrals were placed based on the MoCA scores. Methods: All STs completed the required MoCA certification. The new process was implemented in October 2019. Data were analyzed from October 2019 through March 2020. NSS was performed on newly admitted stroke patients. If failed, an ST consult was ordered for a dysphagia evaluation. However, if passed, a cognitive evaluation consult was triggered by the RN. MoCA was completed within 24 hours. The total possible score is 30; a score of 26 or above is considered normal. A MoCA score of 25 or less, prompted a post-discharge cognitive therapy referral. Results: 229 patients were assessed, all of whom had an NSS completed. 120 (52.4%) passed the NSS, of which 85 (71%) completed a MoCA evaluation. 42 (49.4%) scored 25 or less, of which 35 (83.3%) were referred for a post-discharge cognitive therapy. 7 (17%) had no referral, of which 4 (57%) were discharged home to self-care; 2 (29%) discharged to other healthcare facility; and 1 (14%) left against medical advice. Conclusions: Repurposing the NSS as a standardized tool to trigger an inpatient MoCA evaluation was innovative, practical and efficient. Timely post-discharge cognitive therapy referrals were also evident on MoCA scores of 25 or less.

Gangguan Tidur pada Pasien Stroke Fase Akut

Stroke is a condition when a person has a sudden neurological deficit caused by a disruption in the blood vessels of the brain. About 21-77% of stroke patients have sleep disorders that occur after a stroke. The sleep cycle is regulated by the brain and strokes can cause sleep disturbances due to abnormalities that can occur in the brain structures that regulate sleep. Post Stroke Sleep Disoder (PSSD) is the most common symptom after stroke. Sleep disorders after stroke include Sleep Disordered Breathing (SDB), insomnia, circadian rhythm sleep disturbance, hypersomnia, parasomnia and sleep-related movement disorders. Sleep has many benefits, one of which is the restoration of physical and mental functions, the consolidation of memory and improving the learning ability of a person both motorically and sensitively. Other studies have also shown a correlation between electrographic sleep time and cognitive function of stroke patients during recovery. Another experimental study also indicated that sleep disorders can increase the expression of neurocans, which are genes that inhibit nerve growth. Sleep disorders in stroke patients can reduce the efficiency and effectiveness of stroke rehabilitation

The Effects of Self-Efficacy on Cognitive Function in Patients with Acute Stroke: Verification of the Medicating Effect of Family Support

Background: Post–stroke cognitive impairment (PSCI) is a common consequence of stroke. Many factors that affect cognitive function are known, but the effects of self-efficacy and family support have not been identified. Objectives: This study was a descriptive correlation investigation to determine the mediating effects of family support on the relationship between self-efficacy and cognitive function in stroke patients. Methods: This descriptive cross-sectional study recruited 339 adult patients with acute stroke. Data were collected using structured questionnaires between January and June 2020 and analyzed by multiple regression analysis using SPSS 25.0. The mediating effect of resilience on the relationship between emotional labor and job satisfaction was analyzed using multiple regression analysis according to Baron and Kenny’s procedure. Results: In this study, self-efficacy in patients with acute stroke showed a positive relationship with cognitive function (r=.467, p<.05) and family support (r=.341, p<.001), and family support and cognitive function also showed a positive relationship (r=.356, p<.05). In addition, family support was shown to have a partial mediating effect on the relationship between self-efficacy and cognitive function in patients with acute stroke (β=.26, p<.001). Conclusions: To improve the cognitive function of acute stroke patients, their self-efficacy and family support must be evaluated, and interventions are necessary to enhance self-efficacy and improve family support.

Effect of BCI-Controlled Pedaling Training System With Multiple Modalities of Feedback on Motor and Cognitive Function Rehabilitation of Early Subacute Stroke Patients.

Brain-computer interfaces (BCIs) are currently integrated into traditional rehabilitation interventions after stroke. Although BCIs bring many benefits to the rehabilitation process, their effects are limited since many patients cannot concentrate during training. Despite this outcome post-stroke motor-attention dual-task training using BCIs has remained mostly unexplored. This study was a randomized placebo-controlled blinded-endpoint clinical trial to investigate the effects of a BCI-controlled pedaling training system (BCI-PT) on the motor and cognitive function of stroke patients during rehabilitation. A total of 30 early subacute ischemic stroke patients with hemiplegia and cognitive impairment were randomly assigned to the BCI-PT or traditional pedaling training. We used single-channel Fp1 to collect electroencephalography data and analyze the attention index. The BCI-PT system timely provided visual, auditory, and somatosensory feedback to enhance the patient's participation to pedaling based on the real-time attention index. After 24 training sessions, the attention index of the experimental group was significantly higher than that of the control group. The lower limbs motor function (FMA-L) increased by an average of 4.5 points in the BCI-PT group and 2.1 points in the control group (P = 0.022) after treatments. The difference was still significant after adjusting for the baseline indicators ( β = 2.41 , 95%CI: 0.48-4.34, P = 0.024). We found that BCI-PT significantly improved the patient's lower limb motor function by increasing the patient's participation. (clinicaltrials.gov: NCT04612426).

Use of a Brain–Computer Interface + Exoskeleton Technology in Complex Multimodal Stimulation in the Rehabilitation of Stroke Patients

Introduction. Studies of the potentials of brain–computer neural interface technology with an arm exoskeleton (BCNI) in training to motor imagery in the recovery of higher mental functions in patients constitute an interesting task. The effectiveness of multimodal stimulation including diverse information channels needs to be assessed, as this approach should promote stimulation of neuroplasticity and improvement to interhemisphere interactions. Objectives. To study the influences of multimodal stimulation using BCNI technologies on the restoration of cognitive functions in stroke patients. Materials and methods. A total of 44 stroke patients were studied and treated at periods of two months to two years after onset. Patients were divided into two groups with comparable main parameters: a study group (22 patients) and a reference group (22 patients). Patients of the study group underwent a program of complex multimodal stimulation including procedures using BCNI technologies, cognitive training, use of a stabilometric platform with biological feedback for the support reaction, and vibrotherapy. Patients of the reference group received only BCNI. Results. After treatment, statistically significant improvements in therapeutic results were obtained in the form of improvements in memory, attention, and visuospatial skills in patients of the study group as compared with those of the reference group. Conclusions. Questions of cognitive training using BCNI technologies are currently a relatively new direction in neurorehabilitation; the promising results obtained here provide evidence of the potential of this direction.

Effects of mirror neuron system-based training on rehabilitation of stroke patients.

ObjectiveTo investigate the clinical effects of the mirror neuron system (MNS)‐based training on upper extremity motor function and cognitive function in stroke patients.MethodsSixty stroke patients (time from stroke onset 3–9 months) with upper extremity paresis (Brunnstrom stage II–IV) and cognitive impairment (MoCA score ≥ 15) were enrolled in this study. Patients were randomly allocated into MNS treatment group (N = 30) and control group (N = 30). Both groups underwent regular training for upper extremity motor function and cognitive function, and the MNS group was trained with a therapeutic apparatus named mirror neuron system training (MNST) including different levels of action observation training (AOT). Training lasted 20 min/day, 5 days/week for 8 weeks. MoCA, reaction time, and Wisconsin Card Sorting Test (WCST) were assessed at baseline and 8 weeks after training. Furthermore, Fugl‐Meyer assessment (FMA) and Modified Barthel index (MBI) were adopted to evaluated upper extremity motor function and daily life ability.ResultsAfter 8 consecutive weeks’ training, both groups showed significant improvements on the upper extremity motor function, cognitive function, and daily life ability score after training (p < .05). The MNS group showed significantly improved upper extremity motor function and cognitive function (p < .05) compared with control group.ConclusionsCombining MNS‐based and conventional training can improve upper extremity motor function and cognitive function in stroke patients.

Effect of transcranial direct-current stimulation on cognitive function in stroke patients: A systematic review and meta-analysis.

Transcranial direct-current stimulation (tDCS) is a noninvasive approach that can alter brain excitability. Several studies have shown the effectiveness of tDCS in improving language and movement function in stroke patients. However, the effect of tDCS on cognitive function after stroke remains uncertain. We searched Medline, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), the China National Knowledge Infrastructure, the China Science and Technology Journal Database, and the Wanfang Data Knowledge Service Platform from inception to April 2, 2019. Two reviewers independently screened the studies, extracted the data, and evaluated the quality of the included studies using the Cochrane Collaboration Risk of Bias Tool. All statistical analyses were performed in RevMan 5.3, and the mean difference (MD) or standard mean difference (SMD) were used as the pooled statistics. Fifteen studies involving 820 participants were included. When compared with passive tDCS, anodal tDCS was associated with improved general cognitive performance as examined by the Minimum Mental State Examination or Montreal Cognitive Assessment (SMD = 1.31, 95% CI 0.91-1.71, P < 0.00001), attention performance (SMD = 0.66, 95% CI 0.11-1.20, P = 0.02). There was no significant difference in memory performance (SMD = 0.41, 95% CI -0.67-1.50, P = 0.46). tDCS is likely to be effective for patients with cognitive impairment after stroke. The evidence for different effects based on population characteristics and stimulation methods was limited, but a real effect cannot be ruled out. More high-quality research in this field is required to determine the potential benefits of tDCS in the treatment of cognitive deficits after stroke and to establish the optimal treatment program.

A DTI study of cognitive function post stroke

Event Abstract Back to Event A DTI study of cognitive function post stroke Minjae Cho1, 2*, Yoonhye Na1, 2, Yumi Hwang2 and Sung-bom Pyun3 1 Department of Biomedical Sciences, College of Medicine, Korea University, Republic of Korea 2 Brain Science Research Center, Korea Advanced Institute of Science & Technology, Republic of Korea 3 Department of Rehabilitation Medicine, College of Medicine, Korea University, Republic of Korea In Korea, more than 100,000 patients experience stroke every year, and one of the common complications among stroke patients is cognitive impairment. The computerized neurocognitive function test (CNT) is composed of cognitive and perceptual functional areas in a computerized cognitive function evaluation tool mainly used for patients with cognitive dysfunction. In this study, correlation were analyzed between CNT score and the index value of fractional anisotropy (FA) from diffusion tensor imaging (DTI). 55 stroke patients were included in the analysis. Subjects were administered the CNT and had DTI in the Department of Rehabilitation Medicine. DTI was acquired on a 3.0 T Prisma magnetic resonance imaging device. With regard to the neuroimaging data analysis, the following measures were calculated based on the DTI data: fiber number from the FA in the corpus callosum (CC), arcuate fasciculus (AF) and inferior longitudinal fasciculus (ILF). Cognitive functions were measured based on CNT performance, consisting of memory, attention, and higher cognitive function tests. Results of Pearson’s correlation analysis revealed that the FA values of CC, AF and ILF had a positive association with the verbal learning score of the CNT. Especially left AF had a high correlation with verbal learning. In addition, AF and ILF values showed significant correlations with digit span and visual span scores. Together, these results suggest that the FA values of CC, AF and ILF are closely related to the cognitive function of stroke patients. Acknowledgements This work was supported by the National Research Foundation of Korea(NRF) grant funded by the Korean government(MSIT)(No. 2019R1A2C2003020). Keywords: neuroanatomical factors, DTI (diffusion tensor imaging), Stroke, Cognitive Function, CNT Conference: Academy of Aphasia 57th Annual Meeting, Macau, Macao, SAR China, 27 Oct - 29 Oct, 2019. Presentation Type: Poster presentation Topic: Not eligible for student award Citation: Cho M, Na Y, Hwang Y and Pyun S (2019). A DTI study of cognitive function post stroke. Front. Hum. Neurosci. Conference Abstract: Academy of Aphasia 57th Annual Meeting. doi: 10.3389/conf.fnhum.2019.01.00114 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 06 May 2019; Published Online: 09 Oct 2019. * Correspondence: Mx. Minjae Cho, Department of Biomedical Sciences, College of Medicine, Korea University, Seoul, Republic of Korea, mjop878@gmail.com Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Minjae Cho Yoonhye Na Yumi Hwang Sung-bom Pyun Google Minjae Cho Yoonhye Na Yumi Hwang Sung-bom Pyun Google Scholar Minjae Cho Yoonhye Na Yumi Hwang Sung-bom Pyun PubMed Minjae Cho Yoonhye Na Yumi Hwang Sung-bom Pyun Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

Effect of transcranial direct current stimulation on cognitive function in stroke patients

BackgroundCognitive impairment after stroke is common and can cause disability with major impacts on quality of life and independence. Transcranial direct current stimulation may represent a promising tool for reconstitution of cognitive functions in stroke patients.ObjectivesThis study aimed to investigate the effect of transcranial direct current stimulation on cognitive functions in stroke patients.Patients and methodsForty male stroke patients were included. Patients were divided randomly into two equal groups (A and B). Group A received transcranial direct current stimulation (tDCS) in combination with selected cognitive training program by RehaCom. Group B received sham transcranial direct current stimulation in combination with the same cognitive training program.Cognitive evaluation and functional independence measure (FIM) were done for all patients before and after treatment.ResultsThere was a significant improvement in the scores of attention and concentration, figural memory, logical reasoning, reaction behavior, and FIM post treatment in both groups; the improvement was significantly higher in group A compared to group B.ConclusiontDCS is a safe and effective neuro-rehabilitation modality that improves post stroke cognitive dysfunctions. Moreover, tDCS has a positive impact on performance of daily activities.

Research on changes in cognitive function, β-amyloid peptide and neurotrophic factor in stroke patients.

To investigate the changes as well as the related mechanism in cognitive function and levels of serum β-amyloid peptide (Aβ) and brain-derived neurotrophic factor (BDNF) in stroke patients. A total of 30 patients with acute stroke treated in our hospital from June 2015 to September 2016 were selected as stroke group, while 30 volunteers during the same period were enrolled as control group. Changes in cognitive function of patients were evaluated using the Montreal Cognitive Assessment (MoCA) and mini-mental state examination (MMSE) before and after the treatment. At the same time, the concentrations of serum Aβ1-40 and BDNF were detected, and their correlations with the MMSE score were analyzed. Finally, levels of serum cyclic adenosine monophosphate (cAMP) and phosphorylated-cAMP-response element binding protein (p-CREB), and the phosphorylation level of Tau protein were detected by Western blotting. MoCA and MMSE scores of patients in stroke group were significantly lower than those in control group (p < 0.01), and the scores were significantly higher in stroke patients after treatment than those before treatment (p < 0.01). Compared with those in control group, the serum Aβ1-40 concentration in patients in stroke group was significantly increased (p < 0.01), but the BDNF level was significantly decreased (p < 0.01). Compared with those before treatment, the serum Aβ1-40 concentration in patients was significantly decreased after treatment (p < 0.01), but the BDNF concentration was significantly increased (p < 0.01). Correlation analysis showed that the MMSE score was negatively correlated with the concentration of Aβ1-40 (r2 = 0.764, p < 0.01), but positively related to the level of BDNF (r2 = 0.827, p < 0.01). Compared with those in control group, the content of serum cAMP and p-CREB in stroke patients was significantly decreased (p < 0.01), but the expression of p-Tau was statistically increased (p < 0.01). The cognitive function in stroke patients is impaired, with the rising content of serum Aβ1-40 and reduction of BDNF, the mechanism of which is related to the decrease of cAMP and p-CREB and the increase of p-Tau. This provides a theoretical basis for searching the new therapeutic targets and new drugs for stroke.

A longitudinal study of computerized cognitive training in stroke patients – effects on cognitive function and white matter

ABSTRACTBackground Computerized cognitive training is suggested to enhance attention and working memory functioning following stroke, but effects on brain and behavior are not sufficiently studied and longitudinal studies assessing brain and behavior relationships are scarce.Objective The study objectives were to investigate relations between neuropsychological performance post-stroke and white matter microstructure measures derived from diffusion tensor imaging (DTI), including changes after 6 weeks of working memory training.Methods In this experimental training study, 26 stroke patients underwent DTI and neuropsychological tests at 3 time points – before and after a passive phase of 6 weeks, and again after 6 weeks of working memory training (Cogmed QM). Fractional anisotropy (FA) was extracted from stroke-free brain areas to assess the white matter microstructure. Twenty-two participants completed the majority of training (≥18/25 sessions) and were entered into longitudinal analyses.Results Significant correlations between FA and baseline cognitive functions were observed (r = 0.58, p = 0.004), however, no evidence was found of generally improved cognitive functions following training or of changes in white matter microstructure.Conclusions While white matter microstructure related to baseline cognitive function in stroke patients, the study revealed no effect on cognitive functions or microstructural changes in white matter in relation to computerized working memory training.

Effects of virtual reality-based training with BTs-Nirvana on functional recovery in stroke patients: preliminary considerations

ABSTRACTAim of the study: Cognitive impairment occurs frequently in post-stroke patients. This study aimed to determine the effects of a virtual reality training (VRT) with BTs-Nirvana (BTsN) on the recovery of cognitive functions in stroke patients, using the Interactive-Semi-Immersive Program (I-SIP).Materials and methods: We enrolled 12 subjects (randomly divided into two groups: experimental group (EG); and control group (CG)), who attended the Laboratory of Robotic and Cognitive Rehabilitation of IRCCS Neurolesi of Messina from January to June 2016. The EG underwent a VRT with BTsN, whereas CG received a standard cognitive treatment. Both the groups underwent the same conventional physiotherapy program. Each treatment session lasted 45 minutes and was repeated three times a week for 8 weeks. All the patients were evaluated by a specific clinical-psychometric battery before (T0), immediately (T1), and one month (T2) after the end of the training.Results: At T1, the EG presented a greater improvement in the trunk control test (p = 0.03), the Montreal Cognitive Assessment (p = 0.01), the selective attention assessment scores (p = 0.01), the verbal memory (p = 0.03), and the visuospatial and constructive abilities (p = 0.01), as compared to CG. Moreover, such amelioration persisted at T2 only in the EG.Conclusions: According to these preliminary data, VRT with I-SIP can be considered a useful complementary treatment to potentiate functional recovery, with regard to attention, visual-spatial deficits, and motor function in patients affected by stroke.

Differences in ability of balance according to cognitive function of stroke patients

Differences in ability of balance according to cognitive function of stroke patients

S184 Effect of different frequencies of repetitive transcranial magnetic stimulation on cognitive function in stroke

Objective To evaluate the effect of different frequencies of repetitive transcranial magnetic stimulation( rTMS) on cognitive function in stroke patients. Methods The study was conducted on 30 right handed stroke patients with right sided hemiparesis and history of stroke from 6 to 20 months. They were divided into two equal groups; group I receiving 10 Hz frequency of rTMS and group II receiving 5 Hz in 10 sessions. Each session included 6 trains and 7 min duration. They were evaluated by Addenbrooke Cognitive Examination Revised Test (ACER) and transcranial doppler (TCD) for blood flow velocity (BFV) in affected middle cerebral artery pre and post- treatment with rTMS. Results There was a significant differences in blood flow velocity in the affected side (left MCA) in both groups ( p 0.05 ) with improvement of (20.02%, 11.41%) respectively. There was also a significant differences in total ACER Test in both groups ( p 0.05 ) with improvement of (33.5%, 25%) respectively. A significant positive correlation ( p 0.05 ) between improvement percentage of blood flow and improvement percentage of total ACER Test in both groups was found. Discussion This study showed significant increase in the BFV in the MCA and the total ACER score after applying high frequencies of rTMS, supported by many authors. Conclusions High frequency rTMS plays a major role in improving the cognitive impairment in stroke patients. Significance Repetitive transcranial magnetic stimulation should be considered a future cornerstone in neurorehabilitation and therapy.

Relationship between Grooming Performance and Motor and Cognitive Functions in Stroke Patients with Receiver Operating Characteristic Analysis

This study aimed to elucidate the relationship between grooming performance of stroke patients and various motor and cognitive functions and to examine the cognitive and physical functional standards required for grooming independence. We retrospectively analyzed the data of 96 hospitalized patients with first stroke in a rehabilitation hospital ward. Logistic regression analysis and receiver operating characteristic curves were used to investigate the related cognitive and motor functions with grooming performance and to calculate the cutoff values for independence and supervision levels in grooming. For analysis between the independent and supervision-dependent groups, the only item with an area under the curve (AUC) of .9 or higher was the Berg Balance Scale, and the calculated cutoff value was 41/40 (sensitivity, 83.6%; specificity, 87.8%). For analysis between the independent-supervision and dependent groups, the items with an AUC of .9 or higher were the Simple Test for Evaluating Hand Function (STEF) on the nonaffected side, Vitality Index (VI), and FIM® cognition. The cutoff values were 68/67 for the STEF (sensitivity, 100%; specificity, 72.2%), 9/8 points for the VI (sensitivity, 92.3%; specificity, 88.9%), and 23/22 points for FIM® cognition (sensitivity, 91.0%; specificity, 88.9%). Our results suggest that upper-extremity functions on the nonaffected side, motivation, and cognitive functions are particularly important to achieve the supervision level and that balance is important to reach the independence level. The effective improvement of grooming performance is possible by performing therapeutic or compensatory intervention on functions that have not achieved these cutoff values.

THE RELATIONSHIP OF HYPERTENSION, DIABETES AND OTHER VASCULAR RISK FACTORS WITH POSTSTROKE COGNITIVE FUNCTION: THE STROKOG (STROKE AND COGNITION) CONSORTIUM

While hypertension, diabetes, atrial fibrillation (AF), smoking and past stroke are associated with increased risk of dementia, it is not known whether they contribute to cognitive impairment in patients with recent stroke. This study examines the relationship between vascular risk factors and cognitive function in stroke patients from a combined sample of international cohorts. Eleven studies from the STROKOG consortium provided individual participant data (IPD). Demographic data were harmonised and for each participant, using appropriate normative data from individuals without stroke, z-scores for 5 domains (attention, memory, language, visuospatial and executive function) were calculated from neuropsychological tests completed 3–6 months after index stroke/TIA. Linear mixed effects models in a one-stage IPD meta-analysis were used to examine the association between each cognitive domain z-score and risk factor, adjusting for sex, age and education. Among 2,981 stroke/TIA participants from 9 countries (61% male, mean age 66 years, 94% ischaemic stroke, 4% TIA and 2% haemorrhagic stroke), the mean z-scores in all domains were nearly 1 SD below normal. 70% had a history of hypertension, 30% diabetes, 14% AF, 14% past stroke*and 47% were ex- or current smokers. Diabetes and a history of past stroke were strongly related to poorer cognition in all domains, with global cognition scores (the average of 5 domains) being 0.44 SD less (95%CI: -0.56, -0.31; p-value <0.001) in participants with diabetes and 0.37 SD less (-0.53, -0.22; <0.001) in those with past stroke. Hypertension was associated with poorer cognition in all domains except for memory, with a 0.19 SD ([-0.32, -0.07]; 0.002) lower global cognition score. Smoking contributed negatively to memory and visuospatial domains (-0.14 SD [-0.25,-0.03]; 0.016), (-0.22 SD [-0.35, -0.09]; 0.001), but not the other domains. The relationships between AF and domain scores were not significant (Table 1). Diabetes and history of past stroke are both associated with poorer cognitive performance in stroke patients. Hypertension and smoking are also associated with poorer cognitive function although the effects are smaller and not in all domains. *History of past stroke indicates having one or more strokes prior to the index event.

Effect of motor imagery therapy on cognitive function of patients with stroke

Objective To explore the rehabilitation effect of motor imagery therapy on cognitive function of stroke patients. Methods A total of 99 stroke patients with mild to moderate cognitive dysfunction were randomly divided into 3 groups: control group (N = 33), cognitive training group (N = 33) and motor imagery training group (N = 33). All patients received conventional rehabilitation training. Before and after 8-week training, all subjects were assessed with Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA). At the same time, event-related potential (ERP) was examined to detect P300 latency and amplitude. Results ompared with before training, MMSE ( P = 0.000) and MoCA ( P = 0.000) scores were significantly increased, P300 latency was shortened ( P = 0.000) and P300 amplitude was increased ( P = 0.000) in 3 groups after 8 - week training. There were significant differences among 3 groups on MMSE ( P = 0.030) and MoCA ( P = 0.013) scores, P300 latency ( P = 0.004) and P300 amplitude ( P = 0.009) before and after training. Among them, cognitive training group and motor imagery training group had significantly higher MMSE ( P = 0.019, 0.021) and MoCA ( P = 0.003, 0.031) scores, shorter P300 latency ( P = 0.020, 0.003) and higher P300 amplitude ( P = 0.003, 0.002) than control group. Conclusions Motor imagery training can not only improve motor function of stroke patients, but also improve their cognitive function. DOI: 10.3969/j.issn.1672-6731.2017.06.005

OSAS-Related Cognitive Impairment after First-Ever Stroke: Study Design and Methodology

Introduction: Obstructive Sleep Apnea Syndrome (OSAS) is considered an emerging risk factor for cerebrovascular disease. Both the two conditions could share the same neurocognitive impairment, which, in the early phase of OSAS, are reversible and mediated by the excessive daytime sleepiness. Treatment with continuous positive air pressure (CPAP) device could improve the neurocognitive functions, and therefore, it could be considered as a valid treatment option in stroke patients affected by OSAS and neurocognitive impairment. Materials and Methods: Patients affected by unilateral ischemic stroke will be subdivided into two groups, according to the presence or absence of OSAS. All participants will be evaluated by using a specific neuropsychological battery exploring attention, memory, praxic abilities and executive functions. Patients presented with a moderate to severe OSAS will be treated with CPAP and followed for at least 1 year. Results: The data analysis requires a sample size of 550 to provide adequate power of the study. The outcome variable is the score of specific neuropsychological and quality of life tests at baseline, after 6 months and at 1 year follow-up. Discussion and Conclusion: This study design presents three specific analysis limitations. First, several other sleep disorders can produce drowsiness beyond OSAS. Second, the neurocognitive impairment in stroke patients is difficult to assess. Third, OSAS patients are often intolerant to diagnostic tests requiring an excessive length. However, the findings coming from the protocol may have important implications about the effect of sleep disorders on cognitive function in stroke patients. Moreover, the easy employed procedures could be translated into clinical practice to improve the quality of life of patients affected by both OSAS and stroke.