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- Gerafi, Joel
(författare)
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Long-term functional outcome after ischemic stroke: Prognostic value of early identification of neglect and aphasia
- 2017
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Early symptoms of neglect and aphasia are often observed after ischemic stroke and have been associated with unfavorable short-term functional outcomes within one year post-stroke. However, there is a lack of studies with inclusion of both neglect and aphasia as potential predictors that have studied long-term functional outcomes exceeding one year after stroke. In the current licentiate thesis, a consecutive cohort of 375 stroke patients was assessed early after stroke by a basic screening for the occurrence of visuospatial inattention (VSI) using the Star Cancellation Test (SCT) and for language impairment (LI) using the language item from the Scandinavian Stroke Scale (SSS). Neurological deficits were also investigated. At the 7 year follow-up, functional outcomes i.e. disability and levels of participation in instrumental activities of daily living were measured by the modified Rankin Scale (mRS) and the Frenchay Activities Index (FAI). In study I, 235 stroke survivors without a recurrent stroke were included at the follow-up. The aim was to examine if a basic screening of VSI and LI at the early stage post-stroke could provide prognostic information about functional outcomes 7 years post-stroke. Multiple regression analyses identified VSI and neurological deficits (the SSS score without the language item) as the significant independent predictors of unfavorable outcomes in mRS and FAI. The early screening of LI did not provide any further prognostic information beyond the information provided by VSI and neurological deficits. In study II, 105 individuals with left and 77 with right hemisphere stroke without a recurrent stroke were included at the 7 year follow-up. The aim was the same as for study I but in this study the possible prognostic information about long-term functional outcomes provided by neglect and aphasia was investigated separately for left and right hemispheric group. It was found that the presence of VSI following a left hemisphere stroke was as frequent as after a right hemisphere stroke. For the left hemisphere group the multiple regression identified VSI and neurological deficits as the independent predictors of unfavorable outcomes in mRS, and for the outcome in FAI, VSI and LI were the independent predictors. Interestingly, for this group with a left hemisphere stroke, VSI was identified as the strongest significant independent predictor of the unfavorable outcomes. Language impairments (LI) were significantly related with unfavorable long-term outcomes but only in combination with symptoms of VSI. Individuals with such combination of symptoms were those with the most unfavorable outcomes. For the right hemispheric group, the multiple regression identified VSI and neurological deficits as the independent predictors of unfavorable outcome in mRS, and for the outcome in FAI, neurological deficits and age were the independent predictors. Study I and II emphasize the importance of identifying early symptoms of VSI not only after right hemisphere stroke but also after left hemisphere stroke and particularly for individuals with severe symptoms of LI. Identification of these individuals is important since a combination of attention and language deficits seems to be rather common for patients with severe aphasia at the acute phase and indicates an increased risk of unfavorable outcomes.
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- Gerafi, Joel, et al.
(författare)
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Neglect and aphasia in the acute phase as predictors of functional outcome 7 years after ischemic stroke
- 2017
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Ingår i: European Journal of Neurology. - : Wiley. - 1351-5101 .- 1468-1331. ; 24:11, s. 1407-1415
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Tidskriftsartikel (refereegranskat)abstract
- © 2017 EAN Background and purpose: Visuospatial inattention (VSI) and language impairment (LI) are often present early after stroke and associations with an unfavorable short-term functional outcome have been reported. The purpose of this study was to investigate whether a screening of VSI and LI as indicators of cortical symptoms early after stroke could predict long-term functional outcomes. Methods: A consecutive cohort of 375 patients with ischemic stroke was assessed for the occurrence of VSI at a median of 7 days after admission (interquartile range, 1–5 days) using the Star Cancellation Test and for LI (within the first 7 days) with the language item in the Scandinavian Stroke Scale. Seven years later, functional outcomes were assessed by the modified Rankin scale and Frenchay Activities Index in 235 survivors without recurrent stroke. Relationships between baseline predictors and functional outcome at 7 years were analyzed with bivariate correlations and multiple categorical regressions with optimal scaling. Results: The regression model significantly explained variance in the modified Rankin scale (R 2 = 0.435, P < 0.001) and identified VSI (P = 0.001) and neurological deficits (P < 0.001; Scandinavian Stroke Scale score without the language item) as the significant independent predictors. The model for Frenchay Activities Index was also significant (R 2 = 0.269, P < 0.001) with VSI (P = 0.035) and neurological deficits (P < 0.001) as significant independent predictors. Conclusions: Visuospatial inattention at acute stroke has an independent impact on long-term functional outcomes. Early recognition may enable targeted rehabilitative interventions.
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- Gerafi, Joel, et al.
(författare)
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The presence and prediction of lateralized inattention 7 years post-stroke
- 2020
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Ingår i: Acta Neurologica Scandinavica. - : Hindawi Limited. - 0001-6314 .- 1600-0404. ; 141:5, s. 423-430
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Tidskriftsartikel (refereegranskat)abstract
- Objective Lateralized inattention is a typical sign of neglect and related to poor functional outcome. Knowledge of the long-term course of this phenomenon is limited. The purpose of this study was to investigate presence and predictors for signs of lateralized inattention 7 years after stroke. Methods From a cohort of acute ischemic stroke patients, aged 18-69 years (n = 297), a consecutive series of 188 survivors without recurrent stroke at follow-up 7 years later were included. Within the first week after stroke onset, stroke severity was assessed according to the Scandinavian Stroke Scale. Target omissions, asymmetry of omissions, and perceptual speed according to Star- and Letter Cancellation Tests were also assessed. Presence of lateralized inattention at the 7-year follow-up was investigated with the Star- and Letter Cancellation Tests and with the neglect item in the National Institutes of Health Stroke Scale. Results At the follow-up, 22 (11.7%) participants had lateralized inattention and the multivariable regression showed that independent significant baseline predictors were total omissions in target cancellations (P < .001) and inferior baseline performance on visual processing speed (P = .008). Conclusion About one of ten individuals exhibited signs of lateralized inattention 7 years after stroke. Baseline performance in perceptual processing speed and target omissions independently predicted presence of late signs of lateralized inattention. This is the first time processing speed is recognized as a significant predictor of lateralized inattention several years after the stroke incidence, indicating that the longitudinal course of processing speed following stroke is a critical subject for future research.
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- Gerafi, Joel
(författare)
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Visuospatial inattention and processing speed : Predictors of long-term outcome and patterns of change after ischemic stroke
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Impairments of visuospatial attention, language, and processing speed (PS) are common early after stroke and have been associated with unfavorable short-term functional outcomes but little is known about this relationship in the long-term. This thesis investigates 1) the potential importance of visuospatial inattention (VSI) and language impairments (LI) as predictors of functional outcomes 7 years after an ischemic stroke (studies I-II) and 2) presence of lateralized inattention 7 years after stroke and potential predictors of this phenomenon (study III). Study IV gives a detailed description of the long-term course of PS across 3 months and 7 years after an ischemic stroke. A cohort of 375 consecutive stroke patients was assessed early after stroke for the occurrence (studies I–II and IV) and severity (studies III-IV) of VSI using the Star Cancellation Test (SCT, studies I-IV) and Letter Cancellation Test (LCT, studies III-IV). Language impairments were investigated (studies I-II) by the language item from the Scandinavian Stroke Scale (SSS). At the 7-year follow-up, functional outcomes were measured by the modified Rankin Scale (mRS), the Frenchay Activities Index (FAI) (studies I-II and IV), and the recovery item of Stroke Impact Scale (SIS) (study IV). Patients with a recurrent stroke during the follow-up period were excluded (all studies). The presence of lateralized inattention at the 7-year follow-up (study III) was assessed with the SCT, the LCT, and the neglect item from the NIH Stroke Scale (NIHSS). The long-term course of PS (study IV) was measured by a mirrored copy of the SCT with a time limit of 30 seconds, follow-up assessments of SCT, LCT, and NIHSS were also included in this study. In study I, 235 stroke survivors were included at the follow-up and VSI and stroke severity (SSS) were identified as the significant independent predictors of unfavorable outcomes in mRS and FAI. The early screening of LI did not provide independent prognostic information beyond the information provided by VSI and stroke severity. In study II, 105 individuals with left hemispheric stroke were included at the 7-year follow-up. It was found that the presence of VSI was rather common observed in about one of five patients. VSI was the most important independent predictor of unfavorable outcomes in mRS and FAI. Individuals with both VSI and LI had increased risk of poor outcome compared to those with signs of one of these symptoms. In study III, 188 stroke survivors were included at the 7-year follow-up and about one of ten had signs of lateralized inattention. Independent baseline predictors for these long-term signs were total omissions in target cancellations and inferior performance on visual processing speed. In study IV, 148 subjects were included at follow-up and impaired PS was observed in about one of three individuals at baseline with significant improvement in scores at 3 months followed by a clear decline at 7 years. It was also found that slow PS was related with inferior functional outcome at the 7-year follow-up, also after adjusting for age. Age was related with scores in PS but did not explain the scores of PS for those with lowest speed. Conclusions: Studies I-II emphasize the importance of identifying early symptoms of VSI not only after right hemispheric stroke but also after left hemispheric stroke and particularly for individuals with severe symptoms of LI. A combination of attention and language deficits at the acute phase seems to be rather common among patients with left hemispheric stroke and indicates an increased risk of unfavorable outcomes. Studies III-IV are the first studies to recognize PS as a significant predictor of long-term lateralized inattention and to describe changes in speed across two follow-ups up to 7 years in a stroke cohort. The results from these two studies emphasize the importance of further long-term studies of PS after stroke.
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