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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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- Pedersen, Annie, 1981, et al.
(författare)
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Fibrinogen concentrations predict long-term cognitive outcome in young ischemic stroke patients
- 2018
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Ingår i: Research and Practice in Thrombosis and Haemostasis. - : Elsevier BV. - 2475-0379. ; 2:2, s. 339-346
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Tidskriftsartikel (refereegranskat)abstract
- Background: Cognitive impairment is frequent after stroke, and young patients may live with this consequence for a long time. Predictors of cognitive outcomes after stroke represent a current gap of knowledge. Objectives: To investigate levels of three hemostatic biomarkers as predictors of long-term cognitive function after stroke. Methods: This longitudinal study included consecutively recruited patients with ischemic stroke at 18-69 years (n = 268). Blood was collected 3 months after index stroke and analyzed for plasma concentrations of fibrinogen, von Willebrand factor (VWF) and tissue-type plasminogen activator (t-PA) antigen. Cognitive function 7 years after index stroke was assessed by the Barrow Neurological Institute Screen for Higher Cerebral Functions (BNIS). Participants with stroke <50 years of age were also examined by the Trail Making Test A and B (n = 41). Associations between biomarker concentrations and cognitive scales were assessed in the whole group and in participants with stroke <50 years of age. Results: The hemostatic biomarkers fibrinogen, VWF and t-PA, were all correlated to total BNIS score, but these associations did not withstand adjustment for confounding factors in the whole group. However, in patients <50 years, we found an independent association between fibrinogen concentrations and total BNIS score (beta(std) = -.27, 95% confidence interval [CI], -0.47 to -0.07) and to performance on the Trail Making Test A (beta(std) = 31, 95% CI, 0.03-0.58). No such association was seen for the Trail Making Test B. Conclusion: High convalescent fibrinogen concentrations were associated with worse long-term cognitive outcomes in ischemic stroke <50 years of age. We propose further investigations of fibrinogen in relation to cognitive function in stroke in the young.
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- Samuelsson, Hans, 1955, et al.
(författare)
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Cognitive function is an important determinant of employment amongst young ischaemic stroke survivors with good physical recovery
- 2021
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Ingår i: European Journal of Neurology. - : Wiley. - 1351-5101 .- 1468-1331. ; 28:11, s. 3692-3701
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose This cross-sectional cohort study aims at investigating young ischaemic stroke survivors with good physical recovery 7 years post-stroke in order to analyze the relation between late cognitive ability and employment. Methods Consecutive ischaemic stroke survivors participating in the Sahlgrenska Academy Study on Ischemic Stroke, <55 years of age at stroke onset, and with no or minimal persisting neurological deficits corresponding to a score <= 2 on the National Institutes of Health Stroke Scale at long-term follow-up 7 years post-stroke were included. At this follow-up, the participants were assessed with respect to general cognitive function, processing speed, executive functions, cardiovascular risk factors, self-reported employment, cognitive difficulties, fatigue, depressive symptoms, anxiety and physical function. Results Seven years post-stroke 112/142 (79%) had part-time or full-time work and 30/142 (21%) had full-time disability pension or sick leave. Compared to those with full-time disability pension or sick leave, participants with current employment demonstrated significantly better performance with respect to general cognitive function and processing speed, and significantly lower self-ratings for cognitive difficulties, physical limitations, fatigue and depressed mood. Multivariable logistic regression selected self-rated memory (odds ratio [OR] 2.61, 95% confidence interval [CI] 1.61-4.21), processing speed (OR 3.50, 95% CI 1.67-7.33) and self-rated communication skills (OR 3.46, 95% CI 1.75-6.85) as most important correlates (area under the curve 0.83-0.87) of having current employment. Conclusion This study indicates that cognitive dysfunction is an important contributor to long-term work disability amongst young stroke survivors with good physical recovery.
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- Viken, Jo Inge, 1976, et al.
(författare)
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Change across time in visuospatial search in patients with right hemisphere stroke
- 2007
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Ingår i: 9th Nordic Meeting in Neuropsychology. August 19-22, Göteborg, Sweden.
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Konferensbidrag (refereegranskat)abstract
- Patients with a right hemisphere stroke often exhibit symptoms of aberrant visuospatial exploration such as visual inattention and disorganized search. These disturbances are complex and constitute several lateralized and non-lateralized impairments. Although individual symptoms of impaired visuospatial search have been examined in several studies, little is known about the change in these symptoms across time and about the relationships between the different symptoms. The participants in the current study were selected from a series of 411 patients included in the Sahlgrenska Academy Study on Ischemic Stroke (SAHLSIS) at Göteborg University. All patients with an acute ischemic stroke admitted to the stroke unit at the Sahlgrenska Univeristy hospital and with an age below 70 years were investigated during a period of 5 year. From these were a consecutive series of patients with a right hemisphere stroke selected for examination of impaired visuospatial search. The patients were tested at the post-acute stage (< 7 days after onset) and at a follow-up session (approximately 90 days after onset). Conventional cancellation tests and visual search tasks were used to assess the following components of impaired search: 1) lateralized inattention (omissions distributed asymmetrically across the test sheet), 2) non-lateralized inattention (omissions distributed equally across the test sheet), 3) ipsilesional bias in the start of visual search (a bias toward the right side of the test sheet when marking the first target), 4) slow processing speed on timed visual cancellation tasks. The results are described and discussed as follows: 1) the occurrence of the different symptoms at the post-acute stage, 2) the pattern of change in the symptoms between post-acute stage and follow-up, 3) the relationships between the acute symptoms and between the changes in the symptoms.
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| 9. |
- Viken, Jo Inge, 1976, et al.
(författare)
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Ipsilesional bias and processing speed are important predictors of functional dependency in the neglect phenomenon after a right hemisphere stroke.
- 2014
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Ingår i: The Clinical neuropsychologist. - : Informa UK Limited. - 1744-4144 .- 1385-4046. ; 28:6, s. 974-93
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Tidskriftsartikel (refereegranskat)abstract
- Visuospatial neglect (VSN) predicts unfavorable functional outcome in stroke patients. This study examined the relative importance of different core symptoms of VSN as predictors of functional dependency. A consecutive series of 105 right hemisphere stroke patients were tested early after stroke on three basic symptoms of VSN (omissions, asymmetry of omissions and ipsilesional bias of attention) and on two symptoms related to VSN (processing speed and repetitive target detections in visual search). Neurological deficits were also assessed. Functional outcome was measured 3 months and 2 years after stroke with the modified Rankin Scale. Univariate analyses revealed significant relationships with functional outcome for both core and related symptoms of VSN and for neurological deficits. Area under the curve statistics and stepwise logistic regressions showed that the most important predictors assessed early after stroke were presence of ipsilesional bias for dependency at 3 months and visual processing speed for dependency at 2 years after stroke. These results show that valuable prognostic information regarding dependency after right hemisphere stroke can be obtained by assessing fundamental sub-components of VSN early after stroke. The development of standardized clinical methods for investigation of sub-components, such as a right capture of attention and processing speed, is essential.
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| 10. |
- Viken, Jo Inge, 1976
(författare)
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The importance of lateralized and nonlateralized sub-symptoms of visuospatial neglect as predictors of functional outcome after stroke
- 2011
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- DEGREE OF LICENTIATE IN PSYCHOLOGY Abstract Viken, J. I. (2011). The importance of lateralized and nonlateralized sub-symptoms of visuospatial neglect as predictors of functional dependency after stroke. Department of Psychology, and the Stroke Research Group at the Department of Neuroscience and Physiology, at the Sahlgrenska Academy at Gothenburg University. Visuospatial neglect (VSN) is a disorder which is commonly observed in the acute phase after stroke, especiaIly following right hemisphere damages. Patients who have VSN exhibit impaired awareness and responses to visual stimuli located towards the side opposite the brain lesion ( contralesional side). Previous studies have shown that the presence of VSN is a predictor of functional dependency following stroke. The present paper investigated how different sub-symptoms of VSN are related to functional outcome. The sub-symptoms of VSN were assessed using standard paper and pencil tests of cancellation and visual search, neurological deficits were examined with the Scandinavian Stroke Scale and functional -dependency was measured with the modified Rankin Scale. Scores of~3 at a three months (Study I and II) and at a two years (Study II) follow-up were c1assified as functional dependency. Patients in the current studies were sub-samples from the prospective Sahlgrenska Academy Study on Ischemic Stroke (SAHLSIS). Study I inc1uded 375 consecutive stroke patients who were divided into three groups having either lateralized-, nonlateralized-, or no visual inattention. The study examined the course of lateralized and nonlateralized symptoms of inattention across time in relation to functional outcome and neurological symptoms. Compared to the other two groups, participants with lateralized inattention exhibited significantly more severe neurological symptoms, functional dependency and persisting visual inattention, both post-acutely and after three months. Stepwise logistic regressions revealed that post-acute lateralized inattention was an important and independent predictor of functional dependency following right hemisphere damage, but not af ter left hemisphere damage. In Study n a consecutive series of 104 patients with right hemisphere stroke were incIuded. The relative importance of sub-symptoms of VSN as predictors of functional dependency was investigated. Three sub-symptoms of visuospatial neglect (the total number of omissions, asymmetry of omissions and right capture of attention in orientation) and two symptoms related to VSN (visual processing speed and repetitive identification of previously detected targets) were analyzed. The univariate analyses showed that right capture of attention in orientation, asymmetry of omissions and increased processing speed all had strong and significant associations with functional dependency at three months and at two years after stroke. Moreover, stepwise logistic regressions identified right capture of attention as the only significant predictor of dependency at three months whilst increased processing speed was the only significant predictor of dependency at two years. Condusions: When predicting functional outcome following VSN the sub-symptoms of increased processing speed and asymmetry in the orientation of attention are more important than the omissions per se. The development of standardized test methods for these subsymptoms is an important dinical issue since they provide valuable prognostic information over and above the dassification of presence or absence of visuospatial neglect. Keywords: Functional outcome, neglect, recovery, stroke, visual attention, visual search. ISSN 1101-718X ISRN GU/PSYK/A VH-241-SE
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