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NDDs/Stroke > Cog. Deficits following Stroke > Flashcards

Cog. Deficits following Stroke Flashcards

1
Q

Cognition unifies…

A

Multiple domains

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2
Q

Executive Function encompasses…(2)

A

Problem solving

Planning

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3
Q

General deficits that may follow a stroke include…(2)

A

Processing speed

Executive function

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4
Q

Lesniak et al., (2008) found that after one year post stroke, the majority of patients…..while….

A

Had attention deficits

Deficits in memory/language likely to be resolved

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5
Q

Unilateral spatial neglect is a ______ deficit

A

Perceptual

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6
Q

Which lobe is affected with spatial neglect?

A

Parietal (responsible for orientation)

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7
Q

A person will not be able to respond to one side of their own body, that same side of someone else or that side of a plate.

What is this referring to? ^

A

Unilateral spatial neglect

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8
Q

Dyspraxia is reduced ability to…

A

Co-ordinate/perform/plan out actions

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9
Q

Apraxia relates to…

A

Problems organising speech

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10
Q

If a patient has apraxia, they can produce speech, but…

A

Sentence organisation is affected

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11
Q

Aphasia is

A

impaired ability to produce or understand speech

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12
Q

Broca’s Aphasia

A

Can comprehend

Cannot produce fluent speech

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13
Q

Wernicke’s Aphasia

A

Can produce speech

Cannot understand

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14
Q

Global Aphasia

A

Cannot produce speech or understand it

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15
Q

Diffuse neuronal dysfunction relates to

A

General cognitive deficits e.g. EF/attentional problems

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16
Q

Diffuse dysfunction seems to be associated with…

A

White matter disease (accumulation of infarcts)

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17
Q

3 general assessments for cognitive function?

A
  1. MMSE
  2. Montreal Cognitive Assessment
  3. Neuropsychological test
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18
Q

What is the reference for the MMSE?

A

Folstein et al., 1975

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19
Q

What is the MMSE?

A

A brief screening tool, providing quantitiative assessment

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20
Q

The MMSE is scored out of

A

30

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21
Q

The MMSE examines functions such as …(3)

A

Orientation
Registration
Attention

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22
Q

MMSE

How might ‘orientation’ be measured?

A

“What day/time is it?”

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23
Q

MMSE

How might registration be measured?

A

“Name 3 objects”

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24
Q

3 positives of the MMSE?

A
  1. Quick n Easy
  2. Does not require training
  3. Easy to interpret
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25
3 drawbacks of the MMSE?
1. Lacks sensitivty 2. Lacks EF evaluation 3. Confounds
26
3 things MMSE might be confounded by?
Age Level of education Sociocultural background
27
How could the MMSE be improved?
Addition of other tests
28
The Montreal Cognitive Assessment is used to test...
High level functions
29
How can the MMSE be distinguished from the Montreal Cognitive Assessment?
Includes measures of EF and Visuospatial awareness
30
Montreal Cognitive Assessment Give an example of the 'abstraction' category?
"How is the satsuma related to the banana?" --> encourages categorisation
31
3 benefits of the Montreal Cognitive Assessment?
1. More sensitive 2. Multiple languages 3. Freely accessible
32
1 drawback of the Montreal Cognitive Assessment?
1. Relatively new: reliability/validity not thoroughly tested
33
Cumming, Marshall + Lazar (2013) said this test is the 'gold standard' for detecting cognitive abnormalities.
Neuropsychological test
34
The neuropsychological test refers to...
A battery of tests, resting a whole range of cognitive functions
35
3 examples of tests given in the Neuropsycholgoical test?
1. V-S memory tests 2. Verbal learning tests 3. Weschler adult intelligence scale
36
Positive of the Neuropsychological test?
Can precisely see the area of cognition the patient is struggling with
37
Drawback of the Neuropsychological test?
Very time consuming --> frustration?
38
3 ways in which NEGLECT can be assessed?
1. Line Bisection 2. Clock Drawing 3. Behavioural Inattention Test
39
Reference for the Behavioural Inattention Test?
Wilson et al., 1987
40
The Behavioural Inattention Test is used to assess what?
Neglect
41
What is involved in the line bisection test?
Patients presented with lines, asked to create a cross
42
If a patient has neglect, what will be observed in the line bisection test?
May ignore one side of page Deviate from centre of line
43
Drawback of the line bisection test?
Lacks sensitivty
44
The clock drawing test can either be scored _____ or ______
Qualitatively | Quantitatively
45
How could the line bisection test/clock drawing test be improved?
Addition of other tests to improve sensitivity/avoid confounds
46
2 benefits of the Clock Drawing Test + the Line Bisection test?
1. Easy to administer/cheap | 2. Provides good picture of CI when used in conjunction
47
The Behavioural Inattention Test (Wilson et al., 1987) can be broken down into two subtypes:
1. Conventional Section | 2. Behavioural Section
48
Wilson et al., (1987) The Behavioural Sectin is good because it....
Is relevant to daily life: combines testing with infant rehabilitation
49
With Dyspraxia, diagnosis is based upon....
Differential diagnosis of what it is NOT
50
Dyspraxia It is important to rule out...
Muscle weakness/other movement disorders
51
Aphasia is diagnosed by...
Presence or absence of aspects of speech
52
Cumming, Marshall + Lazar (2013) Cognitive impairment is associated with (3)
1. Higher mortality 2. Higher healthcare costs 3. Greater institutionalisation
53
Cumming, Marshall + Lazar (2013) Approaches to rehabilitation may be .... or ...
Compensatory Restorative
54
Cumming, Marshall + Lazar (2013) What are compensatory treatments?
Adapting external environment to altered cognition
55
Cumming, Marshall + Lazar (2013) What are restorative treatments?
Direct restoration of function: based on neural plasticity
56
Cumming, Marshall + Lazar (2013) Strongest evidence for restorative strategy effectiveness comes from...
Treatment of FOCAL deficits, e.g. aphasia/neglect
57
3 REMEDIAL treatments for Neglect?
1. Visual scanning 2. Computer-scanning 3. Virtual reality therapy
58
1 example of virtual reality therapy for neglect?
Video games
59
Cumming, Marshall + Lazar (2013) Compensatory treatment for Neglect?
Prism adaptation
60
Cumming, Marshall + Lazar (2013) What is Prism adaptation?
Glasses that create an optical shift of visual field
61
Shiraishi et al., (2008) Study on Prism glasses for neglect
- 8 weeks trial in patients 1-7 years post-stroke | - Improved eye movements/improved CoG
62
4 COMPENSATORY treatments for Neglect?
Limb Acitvation Prisms Adaptation Sensory Feedback Eye Patching
63
(Compensatory treatment - Neglect) What are sensory feedback strategies?
Doing things on neglected side
64
Dyspraxia What is strategy training?
Carrying out simple task multiple times
65
Dyspraxia Why might strategy training tactics be effective?
Likened to working a muscle: improvements over time
66
Dyspraxia What is Proprioceptive stimulation?
- Task completed on functional side | - Quickly switch over side
67
Dyspraxia Unfourtunately, positive prognosis...
May involve dependency on close relationships
68
Aphasia Patients may find it easier to communicate through .....
Music
69
Speech and Language Therapy might be recommended to treat...
Aphasia
70
5 methods of treating Aphasia?
``` S+L therapy Group therapy Communication partners Constrain-induced therapy rTMS ```
71
Aphasia patients may be asked not to point, and to speak instead. This is an exmaple of
Constrain-induced therapy
72
Cumming, Marshall + Lazar, 2013 What alternative method for treating Aphasia was identified in the review?
rTMS --> picture naming/expressive language/auditory comprehension
73
Cumming, Marshall + Lazar (2013) 4 methods for treating GENERALISED COGNITIVE IMPAIRMENT, as identified by their review?
1. Controlling hypertension 2. Pharmacological agents 3. Increasing physical acitvity 4. Music
74
Evidence for the Hypertensive approach to Cognitive Impairment is...
Mixed
75
Tzourio et al., (2003) found that lowering BP may reduce risk of cog. decline, due to...
Preventing advance of additional infarcts
76
Meyer et al., (1986) | Converse to Tzourio et al., (2003), it was found that treating Hypertension...
Worsened cognition when reduced below upper normal limits
77
Cumming, Marshall + Lazar (2013) What pharmacological agents could be used to treat general cognitive decline?
Antidepressants
78
Cumming, Marshall + Lazar (2013) Increasing Physical Activity was found to produce...
General benefits in PROCESSING SPEED and ATTENTION
79
Cumming, Marshall + Lazar (2013) Physical activity was seen to improve attention/executive control/processing speed. This is positive as...
These central processes set the foundation for other aspects of cognition
80
Quaner et al., (2009) --> 8 week exercise program -->
Improved IP speed on reaction time task, compared to control
81
Cumming, Marshall + Lazar (2013) Quaner et al., (2009) Improvements in information processing speed were seen after....
An 8 week exercise program
82
Cumming, Marshall + Lazar (2013) Overall, what was concluded to contribute best to post-stroke improvements?
- Increased physical activity - Mental challenges - Sensory stimulation - Social interaction
83
Sun, Tan + Yu (2014) 4 risk factors contrubting to greater post-stroke impairment?
1. Disease 2. Age 3. Education level 4. Vascular risk factors
84
Sun, Tan + Yu (2014) Which age group was idenitfied as being most at-risk for PSCI?
> 65
85
Sun, Tan + Yu (2014) How does education level influence PSCI? (3)
1. Influences EXPRESSION 2. Associated with better performance 3. May increase tolerance
86
Sun, Tan + Yu (2014) How might disease influence PSCI?
Overlap with cerebrovascular disease or dementia --> greater impairment
87
What percentage of stroke patients are affected by Neglect?
23%
88
Aphasia may either be (3)
Broca's Wernicke's Global
89
Cumming, Marshall + Lazar (2013) Diffuse neuronal dysfunction produces a more....
Uniform profile of mental slowing (e.g. EF deficits, attentional problems)
90
Ozdemeir et al., (2001) found the MMSE
Was a significant predictor of functional improvement overall, but not its subsections
91
Ozdemeir et al., (2001) --> orientation, registration, attention etc cannot
Predict functional outcome individually
92
Ozdemeir et al., (2001) --> | What was the relationship between MMSE baseline score and motor FIM improvement
Positive correlation
93
Ozdemeir et al., (2001) --> What were their recommendations?
Cognitive status of post-stroke patients should be carefully monitored to predict functional outcome
94
Ozdemeir et al., (2001) --> Critical evaluation of this study?
Not representative of general population (low proportion of female subjects)
95
Ozdemeir et al., (2001) --> MMSE can predict functional improvement and _______
Ambulation
96
Barker-Collo & Feigin (2006) --> what was the most important determinant of functional outcome?
Cognitive factors
97
Robertson et al., (1997)
Sustained attention is predictive of functional status 2 years post-stroke
98
Joniken et al., (2015)
83% of sample showed impairment in at least one cognitive domain
99
Wernicke's Aphasia What is preserved?
Articulation of speech sounds
100
Carota et al., 2002 Why might Wernicke's Aphasia lead to emotional outbursts?
- Patient often unaware of their condition | - May assume people are speaking in a deliberately incomprehensible manner
101
Two of the most prominent focal deficits are...
Aphasia | Unilateral Spatial Neglect
102
Naeser et al., 2005
rTMS can improve language abilities in picture naming (aphasia)
103
2 studies to rememebr for rTMS and aphasia
Naeser et al., 2005 | Barwood et al., 2011
104
Barwood et al., 2011 rTMS
Expressive language and auditory comprehension improvements after TMS
105
rTMS What is the mechanism for how TMS works for aphasia?
modulates and inhibits overactivity in right hemisphere language sites
106
Study to remember on Prism glasses for Neglect?
Shiraishi et al., 2008
107
Key references to remember 13
``` Joniken et al. 2015 Barker-Collo & Feigin, 2006 Robertson et al., 1997 Lesniak et al., 2008 Folstein et al., 1975 Wilson et al., 1987 Shiraishi et al., 2009 Naeser et al., 2005 Barwood et al., 2011 Tzourio et al., 2003 Meyer et al., 1986 Quaney et al., 2009 Sarkamo et al., 2008 ```
108
What is unilateral spatial neglect?
Failure to attend to the side contralateral to the damaged brain region
109
What were the 3 readings for this topic?
Sun, Tan & Yu (2014) Cumming, Marshall & Lazar (2013) Ozdemir et al., (2001)
110
Sarkamo et al., 2008
Daily self-selected music listening for 2 months --> improvements in verbal memory and focused attention in neuropsychologial assessment

NDDs/Stroke (9 decks)

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