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Neuropsychological Outcome and its Predictors Across the First Year after Ischaemic Stroke

Published online by Cambridge University Press:  30 August 2016

Suzanne Barker-Collo ,
Rita Krishnamurthi ,
Valery Feigin ,
Amy Jones ,
Alice Theadom ,
P. Alan Barber ,
Nicola Starkey ,
Kathryn McPherson ,
Elaine Rush  and
Derrick Bennett
Suzanne Barker-Collo
Affiliation:
School of Psychology, University of Auckland, Private Bag 92019, Auckland, New Zealand
Rita Krishnamurthi
Affiliation:
National Institute for Stroke and Applied Neurosciences, AUT University, Auckland, New Zealand
Valery Feigin
Affiliation:
National Institute for Stroke and Applied Neurosciences, AUT University, Auckland, New Zealand
Amy Jones
Affiliation:
National Institute for Stroke and Applied Neurosciences, AUT University, Auckland, New Zealand
Alice Theadom
Affiliation:
National Institute for Stroke and Applied Neurosciences, AUT University, Auckland, New Zealand
P. Alan Barber
Affiliation:
Department of Neurology, Auckland City Hospital, Centre for Brain Research, University of Auckland, Auckland, New Zealand
Nicola Starkey
Affiliation:
Department of Psychology, Waikato University, Hamilton, New Zealand Health Research Council of New Zealand, Auckland, New Zealand
Kathryn McPherson
Affiliation:
Health Research Council of New Zealand, Auckland, New Zealand
Elaine Rush
Affiliation:
Centre for Physical Activity and Nutrition, Faculty of Health and Environmental Sciences, AUT University, Auckland, New Zealand
Derrick Bennett
Affiliation:
Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
Corresponding
E-mail address:
s.barker-collo@auckland.ac.nz
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Abstract

Background: Neuropsychological deficits occur in over half of the stroke survivors and are associated with the reduced functioning and a decline in quality of life. However, the trajectory of recovery and predictors of neuropsychological outcomes over the first year post stroke are poorly understood.

Method: Neuropsychological performance, assessed using the CNS-Vital signs, was examined at 1 month, 6 months and 12 months after ischaemic stroke (IS) in a sample drawn from a population-based study (N = 198).

Results: While mean scores across neuropsychological domains at each time-point fell in the average range, one in five individuals produced very low-range scores for verbal memory, attention and psychomotor speed. Significant improvements were seen for executive functioning, psychomotor speed and cognitive flexibility within 6 months post stroke, but no gains were noted from 6 to 12 months. Stroke-related neurological deficits and depression at baseline significantly contributed to the prediction of neuropsychological function at 12 month follow-up.

Conclusions: In a significant minority of IS survivors, focal deficits are evident in psychomotor speed, verbal memory, executive functions and attention. Significant improvements in these domains were only evident in the first 6 months post stroke. Initial stroke-related neurological deficits and concurrent depression may be the best predictors of later cognitive functioning.

Keywords

ischaemic stroke neuropsychology mood recovery longitudinal
Type
Themed articles on Stroke
Information
Brain Impairment , Volume 17 , Issue 2: Themed issue on Stroke , September 2016 , pp. 111 - 122
Copyright
Copyright © Australasian Society for the Study of Brain Impairment 2016 

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References

Aho, K., Harmsen, P., Hatano, S., Marquardsen, J., Smirnov, V.E., & Strasser, T. (1980). Cerebrovascular disease in the community: Results of a WHO collaborative study. Bulletin of the World Health Organisation, 58, 113–130.Google ScholarPubMed
Barker-Collo, S., Feigin, V., Parag, V., Lawes, C., & Senior, H. (2010). Auckland stroke outcomes study. Part 2: Cognition and functional outcomes 5-years post-stroke. Neurology, 75(18), 1608–1616.CrossRefGoogle Scholar
Barker-Collo, S.L., Feigin, V.L., Lawes, C.M.M., Parag, V., Senior, H., & Rodgers, A. (2009). Reducing attention deficits after stroke using attention process training. A randomised controlled trial. Stroke, 40(10), 3293–3298.CrossRefGoogle Scholar
Barker-Collo, S., Starkey, N., Lawes, C., Feigin, V., Senior, H., & Parag, V. (2012). Neuropsychological profiles of 5-year ischemic stroke survivors by Oxfordshire stroke classification and hemisphere of lesion. Stroke, 43(1), 50–55.CrossRefGoogle Scholar
Bjelland, I., Dahl, A., Haug, T., & Neckelmann, D. (2002). The validity of the hospital anxiety and depression scale. An updated literature review. Journal of Psychosomatic Research, 52(2), 69–77.CrossRefGoogle ScholarPubMed
Brott, T., Adams, H.P. Jr, Olinger, C.P., Marler, J.R., Barsan, W.G., Biller, J., . . .Hertzberg, V. (1989). Measurements of acute cerebral infarction—A clinical examination scale. Stroke, 20, 864–870.CrossRefGoogle ScholarPubMed
Cumming, T.B., Blomstrand, C., Bernhardt, J., & Linden, T. (2010). The NIH stroke scale can establish cognitive function after stroke. Cardiovascular Diseases, 30(1), 7–14.Google ScholarPubMed
de Haan, E., Nys, G.M., & Van Zandvoort, M.J. (2006). Cognitive function following stroke and vascular cognitive impairment. Current Opinion in Neurology, 19(6), 559–564.CrossRefGoogle ScholarPubMed
Desmond, D., Moroney, J.T., Paik, M., Sano, J., Mohr, S., & Aboumatar, C. (2000). Frequency and clinical determinants of dementia after ischemic stroke. Neurology, 54(5), 1124–1131.CrossRefGoogle ScholarPubMed
Desmond, D., Moroney, J.T., Sano, M., & Stern, Y. (2002). Incidence of dementia after ischemic stroke: Results of a longitudinal study. Stroke, 33(9), 2254–2260.CrossRefGoogle ScholarPubMed
Dewey, H.M., Thrift, A.G., Mihalopoulos, C., Carter, R., Macdonell, R.A.L., McNeil, J.J., & Donnan, G.A. (2003). Lifetime cost of stroke subtypes in Australia: Findings from the North East Melbourne Stroke Incidence Study (NEMESIS). Stroke, 34(12), 2502–2507.CrossRefGoogle Scholar
Douiri, A., Rudd, A.G., & Wolfe, C.D. (2013). Prevalence of poststroke cognitive impairment: South London stroke register 1995–2010. Stroke, 44(1), 138–145.CrossRefGoogle ScholarPubMed
Duncan, P.W., Lai, S.M., & Keighley, J. (2000). Defining post-stroke recovery: Implications for design and interpretation of drug trials. Neuropharmacology, 39(5), 835–841.CrossRefGoogle ScholarPubMed
Elliot, R. (1998). The neuropsychological profile of unipolar depression. Trends in Cognitive Sciences, 2(11), 447–454.CrossRefGoogle Scholar
Frankel, M.R., Morgenstern, L.B., Kwiatkowski, T., Lu, M., Tilley, B.C., Broderick, J.P., . . .Brott, T. (2000). Predicting prognosis after stroke: A placebo group analysis from the National Institute of Neurological Disorders and Stroke rt-PA stroke trial. Neurology, 55(7), 952–959.CrossRefGoogle ScholarPubMed
Gottesman, R.F., & Hillis, A.E. (2010). Predictors and assessment of cognitive dysfunction resulting from ischaemic stroke. Lancet Neurology, 9(9), 895–905.CrossRefGoogle ScholarPubMed
Granger, C., Dewis, L., Peters, N., Sherwood, C., & Barrett, J. (1979). Stroke rehabilitation: Analysis of repeated Barthel Index measures. Archives of Physical Medicine and Rehabilitation, 60, 14–17.Google ScholarPubMed
Gualtieri, C., & Johnson, L. (2006). Reliability and validity of a computerized neurocognitive test barrey, CNS vital signs. Archives of Clinical Neuropsychology, 21(7), 623–643.CrossRefGoogle Scholar
Gualtieri, C., Johnson, L., & Benedict, K. (2004). Psychometric and clinical properties of a new, computerized neurocognitive assessment battery. Paper presented at the American Neuropsychiatric Association Annual Meeting, Bal Harbor, Florida.Google Scholar
Gustavsson, A., Svensson, M., & Jacobi, F. (2011). Cost of disorders of the brain in Europe 2010. European Neurophamacology, 21, 718–779.CrossRefGoogle ScholarPubMed
Hochstenbach, J.B., Anderson, P.G., van Limbeek, J., & Mulder, T.T. (2001). Is there a relation between neuropsychologic variables and quality of life after stroke?. Archives of Physical Medicine & Rehabilitation, 82(10), 1360–1366.CrossRefGoogle Scholar
Hochstenbach, J., den Otter, R., & Mulder, T. (2003). Cognitive recovery after stroke: A 2-year follow-up. Archives of Physical Medicine and Rehabilitation, 84(10), 1499–1504.CrossRefGoogle ScholarPubMed
Hsieh, Y.W., Wang, C.H., Wu, S.C., Chen, P.C., Sheu, C.F., & Hsieh, C.L. (2007). Establishing the minimal clinically important difference of the Barthel Index in stroke patients. Neurorehabiitation and Neural Repair, 21(3), 233–238.CrossRefGoogle ScholarPubMed
Hsueh, I.-P., Lin, J.-H., Jeng, J.-S., & Hsieh, C.-L. (2002). Comparison of the psychometric characteristics of the functional independence measure, 5 item Barthel Index, and 10 item Barthel Index in patients with stroke. Journal of Neurology, Neurosurgery, and Psychiatry, 73(2), 188–190.CrossRefGoogle ScholarPubMed
Huybrechts, K.F., & Caro, J.J. (2007). The Barthel Index and modified Rankin Scale as prognostic tools for long-term outcomes after stroke: A qualitative review of the literature. Current Medical Research and Opinion, 23(7), 1627–1636.CrossRefGoogle ScholarPubMed
Hyndman, D., & Ashburn, A. (2003). People with stroke living in the community: Attention deficits, balance, ADL ability and falls. Disability & Rehabilitation, 25(15), 817–822.CrossRefGoogle ScholarPubMed
Krishnamurthi, R., Jones, A., Barber, P.A., Barker-Collo, S., McPherson, K., Bennett, D., . . .ARCOS IV Programme Group (2014). Methodology of a population-based stroke and TIA incidence and outcomes study: The Auckland Regional Community Stroke Study (ARCOS IV) 2011-2012. International Journal of Stroke, 9(1), 140–147.CrossRefGoogle ScholarPubMed
Kwakkel, G., Veerbeek, J.M., van Wegen, E.E., Nijland, R., Harmeling-van der Wel, B.C., & Dippel, D.W. (2010). Predictive value of the NIHSS for ADL outcome after ischemic hemispheric stroke: Does timing of early assessment matter?. Journal of Neurological Science, 294(1–2), 57–61.CrossRefGoogle ScholarPubMed
Lezak, M.D. (1995). Neuropsychological assessment (3rd ed.). New York, NY: Oxford University Press.Google ScholarPubMed
Lloyd-Jones, D., Adams, R.J., & Brown, T.M. (2010). AHA heart disease and stroke statistics—2010 update: A report from the American Heart Association. Circulation, 121, e46–e215.Google Scholar
McDowd, J., Filion, D.L., Pohl, P.S., Richards, L.G., & Stiers, W. (2003). Attentional abilities and functional outcomes following stroke. Journals of Gerontology Series B – Psychological Sciences & Social Sciences, 58(1), 45–53.CrossRefGoogle ScholarPubMed
Muir, K.W., Weir, C.J., Murray, G.D., Povey, C., & Lees, K.R. (1996). Comparison of neurological scales and scoring systems for acute stroke prognosis. Stroke, 27(10), 1817–1820.CrossRefGoogle ScholarPubMed
Mukherjee, D., & Patil, C.G. (2011). Epidemiology and the global burden of stroke. World Neurosurgery, 76(6), S85–S90.CrossRefGoogle ScholarPubMed
Nys, G. (2005). The Neuropsychology of acute stroke: Characterisation and prognostic implications. PhD thesis, Department of Psychology, Utrecht University, Utrecht, Holland.Google Scholar
Nys, G., van Zandvoort, M.J., de Kort, H., Jansen, B., de Haan, E., & Kappelle, J.L. (2007). Cognitive disorders in acute stroke: Prevalence and clinical determinants. Cerebrovascular Diseases, 23(5–6), 408–416.CrossRefGoogle ScholarPubMed
Planton, M., Peiffer, S., Albucher, J.F., Barbeau, E.J., Tardy, J., Pastor, J., . . .Pariente, J.. (2012). Neuropsychological outcome after a first symptomatic ischaemic stroke with good recovery. European Journal of Neurology, 19(2), 212–219.CrossRefGoogle Scholar
Robertson, I.H., Ridgeway, V., Greenfield, E., & Parr, A. (1997). Motor recovery after stroke depends on intact sustained attention: A 2-year follow-up study. Neuropsychology, 11(2), 290–295.CrossRefGoogle ScholarPubMed
Schaapsmeerders, P., Maaijwee, N., van Dijk, E.J., Rutten-Jacobs, L., Arntz, R.M., Schoonderwaldt, H.C., . . .de Leeuw, F.-E. (2013). Long-term cognitive impairment after first-ever ischemic stroke in young adults. Stroke, 44(6), 1621–1628.CrossRefGoogle ScholarPubMed
Scott, W. G., & Scott, H. (1994). Ischaemic stroke in: An economic study. Medical Journal, 107(989), 443–446.Google Scholar
Stapleton, T., Ashburn, A., & Stack, E. (2001). A pilot study of attention deficits, balance control and falls in the subacute stage following stroke. Clinical Rehabilitation, 15(4), 437–444.CrossRefGoogle ScholarPubMed
Sun, J.H., Tan, L., & Yu, J.T. (2014). Post-stroke cognitive impairment: Epidemiology, mechanisms and management. Annals of Translational Medicine, 2(8), 80–96.Google ScholarPubMed
Veiela, H.O.F. (1997). A preliminary profile of neuropsychological deficits associated with major depression. Journal of Clinical and Experimental Neuropsychology, 19(4), 587–603.CrossRefGoogle Scholar
Wolfe, C.D.A., Taub, N.A., Woodrow, E.J., & Burney, P.G.J. (1991). Assessment of scales of disability and handicap for stroke patients. Stroke, 22(10), 1242–1244.CrossRefGoogle ScholarPubMed
Zigmond, A., & Snaith, R. (1983). The hospital anxiety and depression scale. . Acta Psychiatrica Scandinavica, 67(6), 361–370.CrossRefGoogle ScholarPubMed

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