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  • Print publication year: 2007
  • Online publication date: October 2009

1 - Evaluation of cognitive and behavioral disorders in the stroke unit

Summary

Introduction

The general aim of a clinical neuropsychological examination is to assess language, memory, attention, adaptive behavior, motivation, and emotion impairments that result from a brain dysfunction. This behavioral and cognitive evaluation can be performed during the first hours following cerebral damage either in a classical bedside approach or by means of standardized tests and may thus help establish a precise diagnostic. In the hyperacute or acute phase of stroke, neuropsychological intervention may also be necessary to establish communication with the patient (e.g. in the case of aphasia) or to set up adequate strategies to be used by healthcare providers (e.g. in the case of spatial neglect). In this context, the patient is most often tested while lying in bed and in the presence of other patients in the same room. Due to this context, as well as other disturbing factors, the evaluation of cognitive–behavioral deficits in the stroke unit is generally difficult, of relatively short duration, and must thus be repeated in order to correctly track the clinical evolution and to advise when the symptoms become more stable. Moreover, effective rehabilitation of cognitive deficits often relies on modular neuropsychological models (e.g. Pilgrim and Humphreys, 1994), which are often incompatible with clinical fluctuations and global dysfunction such as confusional states, frequently found in the acute phase. So, actual neuropsychological rehabilitation does not rely on acute evaluation.

In this chapter, we will first emphasize the difficulties in undertaking systematic neurocognitive evaluations in the stroke unit.

REFERENCES
Aichner, F., Adelwohrer, C. and Haring, H. P. (2002). Rehabilitation approaches to stroke. J. Neural Transm. Suppl., 59–73.
Aldrich, M. S., Alessi, A. G., Beck, R. W. and Gilman, S. (1987). Cortical blindness: etiology, diagnosis, and prognosis. Ann. Neurol., 21, 149–58.
Argenta, P. A. and Morgan, M. A. (1998). Cortical blindness and Anton syndrome in a patient with obstetric hemorrhage. Obstet. Gynecol., 91, 810–12.
Auchus, A. P., Chen, C. P., Sodagar, S. N., Thong, M. and Sng, E. C. (2002). Single stroke dementia: insights from 12 cases in Singapore. J. Neurol. Sci., 203/204, 85–9.
Azouvi, P., Samuel, C., Louis-Dreyfus, A., et al. (2002). Sensitivity of clinical and behavioural tests of spatial neglect after right hemisphere stroke. J. Neurol. Neurosurg. Psychiatry, 73, 160–6.
Basso, A. (1992). Prognostic factors in aphasia. Aphasiology, 6, 337–48.
Bisiach, E. and Luzzatti, C. (1978). Unilateral neglect of representational space. Cortex, 14, 129–33.
Blanke, O., Landis, T., Mermoud, C., Spinelli, L. and Safran, A. B. (2003). Direction-selective motion blindness after unilateral posterior brain damage. Eur. J. Neurosci., 18, 709–22.
Bogousslavsky, J. (2003). William Feinberg lecture 2002: emotions, mood, and behavior after stroke. Stroke, 34, 1046–50.
Bowen, A., Lincoln, N. B. and Dewey, M. E. (2002). Spatial neglect: is rehabilitation effective?Stroke, 33, 2728–9.
Brown, A. W., Bjelke, B. and Fuxe, K. (2004). Motor response to amphetamine treatment, task-specific training, and limited motor experience in a postacute animal stroke model. Exp. Neurol., 190, 102–8.
Burns, M. S. (2004). Clinical management of agnosia. Top Stroke Rehabil., 11, 1–9.
Caeiro, L., Ferro, J. M., Albuquerque, R. and Figueira, M. L. (2004). Delirium in the first days of acute stroke. J. Neurol., 251, 171–8.
Cals, N., Devuyst, G., Afsar, N., Karapanayiotides, T. and Bogousslavsky, J. (2002). Pure superficial posterior cerebral artery territory infarction in the Lausanne Stroke Registry. J. Neurol., 249, 855–61.
Cappa, S. F., Perani, D., Grassi, F., et al. (1997). A PET follow-up study of recovery after stroke in acute aphasics. Brain Lang., 56, 55–67.
Carota, A., Rossetti, A. O., Karapanayiotides, T. and Bogousslavsky, J. (2001). Catastrophic reaction in acute stroke: a reflex behavior in aphasic patients. Neurology, 57, 1902–5.
Cohen, L., Dehaene, S., Naccache, L., et al. (2000). The visual word form area: spatial and temporal characterization of an initial stage of reading in normal subjects and posterior split-brain patients. Brain, 123, 291–307.
Crisostomo, E. A., Duncan, P. W., Propst, M., Dawson, D. V. and Davis, J. N. (1988). Evidence that amphetamine with physical therapy promotes recovery of motor function in stroke patients. Ann. Neurol., 23, 94–7.
Croquelois, A. and Bogousslavsky, J. (2004). Cognitive deficits in hyperacute stroke. Stroke, 35, 25.
Croquelois, A., Wintermark, M., Reichhart, M., Meuli, R. and Bogousslavsky, J. (2003). Aphasia in hyperacute stroke: language follows brain penumbra dynamics. Ann. Neurol., 54, 321–9.
Renzi, E., Gentilini, M. and Barbieri, C. (1989). Auditory neglect. J. Neurol. Neurosurg. Psychiatry, 52, 613–17.
Déjerine, J. (1892). Contribution à l'étude anatomo-pathologique et clinique des différentes variétés de cécité verbale. Mémoires de la Société de Biologie, 4, 61–90.
Engelter, S., Gostynski, M., Papa, S., et al. (2004). Prevalence and severity of aphasia due to first ischemic stroke: a prospective population based study. European Stroke Conference. Mannheim-Heidelberg.
Ferro, J. M. (2001). Hyperacute cognitive stroke syndromes. J. Neurol., 248, 841–9.
Ghika, J., Bogousslavsky, J. and Regli, F. (1995). “Hyperneglect,” a sequential hemispheric stroke syndrome. J. Neurol. Sci., 132, 233–8.
Ghika-Schmid, F., Melle, G., Guex, P. and Bogousslavsky, J. (1999). Subjective experience and behavior in acute stroke: the Lausanne Emotion in Acute Stroke Study. Neurology, 52, 22–8.
Gil, R. (1996). Abrégé de Neuropsychologie, Paris: Masson.
Godefroy, O., Dubois, C., Debachy, B., Leclerc, M. and Kreisler, A. (2002). Vascular aphasias: main characteristics of patients hospitalized in acute stroke units. Stroke, 33, 702–5.
Grossman, M., Galetta, S. and D'Esposito, M. (1997). Object recognition difficulty in visual apperceptive agnosia. Brain Cogn., 33, 306–42.
Grotta, J. and Bratina, P. (1995). Subjective experiences of 24 patients dramatically recovering from stroke. Stroke, 26, 1285–8.
Grüsser, O.-J. and Landis, T. (1991). Lost letters: pure alexia. In Cronly-Dillon, J. R., ed., Visual Agnosias and Other Disturbances of Visual Perception and Cognition. Vol 12. London: Macmillan Press, pp. 333–56.
Hacke, W., Kaste, M., Skyhoj Olsen, T., Orgogozo, J. M. and Bogousslavsky, J. (2000). European Stroke Initiative (EUSI) recommendations for stroke management. The European Stroke Initiative Writing Committee. Eur. J. Neurol., 7, 607–23.
Halligan, P., Wilson, B. and Cockburn, J. (1990). A short screening test for visual neglect in stroke patients. Int. Disabil. Stud., 12, 95–9.
Halligan, P. W., Cockburn, J. and Wilson, B. A. (1991). The behavioural assessment of visual neglect. Neuropsychol. Rehab., 1, 5–32.
Heinsius, T., Bogousslavsky, J. and Melle, G. (1998). Large infarcts in the middle cerebral artery territory: etiology and outcome patterns. Neurology, 50, 341–50.
Hillis, A. E., Wityk, R. J., Barker, P. B., Ulatowski, J. A. and Jacobs, M. A. (2003). Change in perfusion in acute nondominant hemisphere stroke may be better estimated by tests of hemispatial neglect than by the National Institutes of Health Stroke Scale. Stroke, 34, 2392–6.
Hillis, A. E., Newhart, M., Heidler, J., et al. (2005). Anatomy of spatial attention: insights from perfusion imaging and hemispatial neglect in acute stroke. J. Neurosci., 25, 3161–7.
Husain, M. and Rorden, C. (2003). Non-spatially lateralized mechanisms in hemispatial neglect. Nat. Rev. Neurosci., 4, 26–36.
Kalra, L., Perez, I., Gupta, S. and Wittink, M. (1997). The influence of visual neglect on stroke rehabilitation. Stroke, 28, 1386–91.
Kerkhoff, G. (2001). Spatial hemineglect in humans. Prog. Neurobiol., 63, 1–27.
Kertesz, A. (1988). What do we learn from recovery from aphasia?Adv. Neurol., 47, 277–92.
Landis, T., Graves, R., Benson, D. F. and Hebben, N. (1982). Visual recognition through kinaesthetic mediation. Psychol. Med., 12, 515–31.
Meijer, R., Ihnenfeldt, D. S., Limbeek, J., Vermeulen, M. and Haan, R. J. (2003). Prognostic factors in the subacute phase after stroke for the future residence after six months to one year, a systematic review of the literature. Clin. Rehabil., 17, 512–20.
Merino, J. G. and Heilman, K. M. (2003). Editorial comment: Measurement of cognitive deficits in acute stroke. Stroke, 34, 2396–8.
Mesulam, M. M. (1999). Spatial attention and neglect: parietal, frontal and cingulate contributions to the mental representation and attentional targeting of salient extrapersonal events. Philos. Trans. R. Soc. Lond. B. Biol. Sci., 354, 1325–46.
Miozzo, M. and Caramazza, A. (1998). Varieties of pure alexia: the case of failure to access graphemic representations. Cogn. Neuropsych., 15.
Motomura, N., Sawada, T., Inoue, N., Asaba, H. and Sakai, T. (1988). Neuropsychological and neuropsychiatric findings in right hemisphere damaged patients. Jpn. J. Psychiatry Neurol., 42, 747–52.
Ortigue, S., Viaud-Delmon, I., Michel, C. M., et al. (2003). Pure imagery hemineglect of far space. Neurology, 60, 2000–2.
Paolucci, S., Antonucci, G., Gialloreti, L. E., et al. (1996). Predicting stroke inpatient rehabilitation outcome: the prominent role of neuropsychological disorders. Eur. Neurol., 36, 385–90.
Parton, A., Malhotra, P. and Husain, M. (2004). Hemispatial neglect. J. Neurol. Neurosurg. Psychiatry, 75, 13–21.
Pashek, G. V. and Holland, A. L. (1988). Evolution of aphasia in the first year post-onset. Cortex, 24, 411–23.
Pedersen, P. M., Jorgensen, H. S., Nakayama, H., Raaschou, H. O. and Olsen, T. S. (1995). Aphasia in acute stroke: incidence, determinants, and recovery. Ann. Neurol., 38, 659–66.
Pegna, A. J., Khateb, A., Lazeyras, F. and Seghier, M. L. (2005). Discriminating emotional faces without primary visual cortices involves the right amygdala. Nat. Neurosci., 8, 24–5.
Pierce, S. R. and Buxbaum, L. J. (2002). Treatments of unilateral neglect: a review. Arch. Phys. Med. Rehabil., 83, 256–68.
Pilgrim, E. and Humphreys, G. W. (1994). Rehabilitation of a case of ideomotor apraxia. In Riddoch, M. J. and Humphreys, G. W., eds., Cognitive Neuropsychology and Cognitive Rehabilitation. Hove, Hillsdale: Lawrence Erlbaum Associates, pp. 271–85.
Pohjasvaara, T., Erkinjuntti, T., Ylikoski, R., et al. (1998). Clinical determinants of poststroke dementia. Stroke, 29, 75–81.
Rentschler, I., Treutwein, B. and Landis, T. (1994). Dissociation of local and global processing in visual agnosia. Vision Res., 34, 963–71.
Robertson, I. H. and Halligan, P. W. (1998). Spatial Neglect: A Clinical Handbook for Diagnosis and Treatment, East Sussex, UK: Psychology Press.
Stone, S. P., Wilson, B., Wroot, A., et al. (1991). The assessment of visuo-spatial neglect after acute stroke. J. Neurol. Neurosurg. Psychiatry, 54, 345–50.
Trapl, M., Eckhardt, R., Bosak, P. and Brainin, M. (2004). Early recognition of speech and speech-associated disorders after acute stroke. Wien. Med. Wochenschr., 154, 571–6.
Vuilleumier, P. (2004). Anosognosia: the neurology of beliefs and uncertainties. Cortex, 40, 9–17.
Wade, D. T., Hewer, R. L., David, R. M. and Enderby, P. M. (1986). Aphasia after stroke: natural history and associated deficits. J. Neurol. Neurosurg. Psychiatry, 49, 11–16.
Warrington, E. K. and Shallice, T. (1980). Word-form dyslexia. Brain, 103, 99–11.