Cognitive Defects following Stroke Flashcards
domains affected
attention - focus attention, sustained attention, selective attention, divided attention
memory - visual, auditory, WM, episodic, semantic, procedural
EF - initiation, processing speed, problem solving, planning
Perception, Praxis - visuo-spatial, visuo-perceptual, unilateral neglect, inattention, dyspraxia/apraxia, agnosia, prosopagnosia (fusiform face area)
Language - aphasia: Brocca’s, Wernicke’s, transcortical motor/sensory or mixed, conductive, global
- overlaps between different domains
assessments for cognitive impairment
- mini mental state examination (MMSE)
- montreal cognitive assessment
- neuropsychological test
mini mental state examination (MMSE)
- orientation test (patient asked about time or date)
- registration (naming objects within a picture)
- attention and calculation (basic arithmetic and spelling tests)
- recall (recall objects from registration tasks)
- language (patients asked to draw or name objects, can they follow and comprehend instructions)
- cognitive deficits (given score out of 30 - 24-30 is quite good) - bigger the score the better
strengths of MMSE
\+ easy to complete \+ used widely \+ quick \+ easy to interpret \+ inexpensive \+ does not require training
limitations of MMSE
- confounded by sociocultural background
- lacks evaluation of EF
- lacks sensitivity (few tasks)
- confounded by age
- confounded by level of education
IMPROVEMENTS
> addition of other tests improve sensitivity and avoid confounds of age and education level
montreal cognitive assessment (MoCA)
Tests visuospatial executive function
- naming (name objects and animals)
- memory (lists of words to recall)
- attention (tap when hearing a letter out of big lists)
- abstraction (identify similarities and diffrences between 2 objects)
- language (asked to repeat sentences, give 3 words beginning with p)
- orientation (patient asked about time or date)
strengths and limitations of Montreal Cognitive Assessment (MoCA)
+ more sensitive than MMSE (tests higher level of cognitive function)
+ availability of alternate MoCA (different languages)
+ freely accessible
- relatively new
- reliability and validity not thoroughly tested
Neuropsychological tests
Large battery of tests
- visuospatial memory tests
- verbal learning tests
- Wechsler memory scale
- Delis-Kaplen EF system
- number and letter sequencing
- Boston naming test
- Wechsler adult intelligence scale (IQ)
- phonemic fluency
limitation - time consuming (especially after stroke - tiredness could cause poor performance)
Aphasia therapy
aim is to get speech and comprehension back
- speech and language therapy (specialist working with individual)
- group therapy (individual forced into group scenario - have to use language)
- training conversation/communication partners (family members trained to understand them to continue communication)
- computer based therapy (often involves seeing pictures, hearing words, copying and getting immediate feedback if they’re producing the right words [can be used in homes])
- constraint-induced therapy (relies on objects or gestures - can become overly reliant - must force them to produce speech)
unilateral spatial neglect
failure to report or respond to stimuli on the opposite side of stroke (contralateral side)
- sensory issue (parietal lobe)
unilateral spatial neglect assessments
- clock drawing task
- line bisection task
- behavioural inattention task
clock drawing task
asked to draw a clock
- all numbers will be written, but half the clock ignored
+ easy to administer
+ can be used with other tasks to gain a more complete picture of cognitive function
+ reliability
- confounded by age and education level
- affected by motor coordination
line bisection task
asked to bisect a number of lines in half, if they deviate from the middle = USN
+ simple
+ inexpensive
+ no training
- lack of sensitivity (cant distinguish between severities)
behavioural inattention tests (BIT)
Wilson et al. (1987) - conventional section (BITC) > line crossing > letter cancellation > star cancellation > shape copying > representational drawing
- behavioural section (BITB) > picture scanning > phone dialling > menu reading > article reading > telling and setting the time > map navigation
behavioural inattention test (BIT) strengths and limitations
+ comprehensive
+ ecologically valid
- time consuming
- expensive (need training)
Remedial treatments for USN
- visual scanning (prompting to look at neglected side)
- computer based scanning (puzzles and games)
+ administered at home +variable - virtual reality therapy
compensatory therapies for USN
compensate for deficits
- prism adaptation (specific types of glasses developed to shift visual field)
- limb activation strategies (on side of neglect can help attenuate)
- sensory feedback strategies (having visual/auditory feedback encouraging attention to neglected side)
- eye patching and hemispatial glasses
dyspraxia/apraxia
motor coordination deficit/problems with organising speech
- perceptual problem (reduced ability to coordinate or perform/plan specific movements
- frontal lobe (motor coordination, judgement, inhibition, personality, emotion)
assessment of dyspraxia/apraxia
based on an elimination method of what its not if it isn't: - comprehension deficit - muscle weakness - sensory impairment - tone of abnormality - other movement disorder
therapy for dyspraxia/apraxia
- strategy training (occupational therapist giving instructions on how to do things)
- sensory stimulation (stimulation of nerve cells - limited evidence)
- proprioceptive stimulation (on functioning side patient does task, then switched to other side - cross communication)
- cueing verbal and physical prompts (prompting them what to do)
aphasia
loss in the ability to communicate, broken down into two areas
- Brocca’s area - frontal lobe - speech formation
- Wernicke’s area - parietal and temporal lobe - comprehension and understanding
- some can express in different forms (poetry, song)
