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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
Q

3 drawbacks of the MMSE?

A
  1. Lacks sensitivty
  2. Lacks EF evaluation
  3. Confounds
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26
Q

3 things MMSE might be confounded by?

A

Age
Level of education
Sociocultural background

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27
Q

How could the MMSE be improved?

A

Addition of other tests

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28
Q

The Montreal Cognitive Assessment is used to test…

A

High level functions

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29
Q

How can the MMSE be distinguished from the Montreal Cognitive Assessment?

A

Includes measures of EF and Visuospatial awareness

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30
Q

Montreal Cognitive Assessment

Give an example of the ‘abstraction’ category?

A

“How is the satsuma related to the banana?” –> encourages categorisation

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31
Q

3 benefits of the Montreal Cognitive Assessment?

A
  1. More sensitive
  2. Multiple languages
  3. Freely accessible
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32
Q

1 drawback of the Montreal Cognitive Assessment?

A
  1. Relatively new: reliability/validity not thoroughly tested
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33
Q

Cumming, Marshall + Lazar (2013) said this test is the ‘gold standard’ for detecting cognitive abnormalities.

A

Neuropsychological test

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34
Q

The neuropsychological test refers to…

A

A battery of tests, resting a whole range of cognitive functions

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35
Q

3 examples of tests given in the Neuropsycholgoical test?

A
  1. V-S memory tests
  2. Verbal learning tests
  3. Weschler adult intelligence scale
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36
Q

Positive of the Neuropsychological test?

A

Can precisely see the area of cognition the patient is struggling with

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37
Q

Drawback of the Neuropsychological test?

A

Very time consuming –> frustration?

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38
Q

3 ways in which NEGLECT can be assessed?

A
  1. Line Bisection
  2. Clock Drawing
  3. Behavioural Inattention Test
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39
Q

Reference for the Behavioural Inattention Test?

A

Wilson et al., 1987

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40
Q

The Behavioural Inattention Test is used to assess what?

A

Neglect

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41
Q

What is involved in the line bisection test?

A

Patients presented with lines, asked to create a cross

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42
Q

If a patient has neglect, what will be observed in the line bisection test?

A

May ignore one side of page

Deviate from centre of line

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43
Q

Drawback of the line bisection test?

A

Lacks sensitivty

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44
Q

The clock drawing test can either be scored _____ or ______

A

Qualitatively

Quantitatively

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45
Q

How could the line bisection test/clock drawing test be improved?

A

Addition of other tests to improve sensitivity/avoid confounds

46
Q

2 benefits of the Clock Drawing Test + the Line Bisection test?

A
  1. Easy to administer/cheap

2. Provides good picture of CI when used in conjunction

47
Q

The Behavioural Inattention Test (Wilson et al., 1987) can be broken down into two subtypes:

A
  1. Conventional Section

2. Behavioural Section

48
Q

Wilson et al., (1987)

The Behavioural Sectin is good because it….

A

Is relevant to daily life: combines testing with infant rehabilitation

49
Q

With Dyspraxia, diagnosis is based upon….

A

Differential diagnosis of what it is NOT

50
Q

Dyspraxia

It is important to rule out…

A

Muscle weakness/other movement disorders

51
Q

Aphasia is diagnosed by…

A

Presence or absence of aspects of speech

52
Q

Cumming, Marshall + Lazar (2013)

Cognitive impairment is associated with (3)

A
  1. Higher mortality
  2. Higher healthcare costs
  3. Greater institutionalisation
53
Q

Cumming, Marshall + Lazar (2013)

Approaches to rehabilitation may be …. or …

A

Compensatory

Restorative

54
Q

Cumming, Marshall + Lazar (2013)

What are compensatory treatments?

A

Adapting external environment to altered cognition

55
Q

Cumming, Marshall + Lazar (2013)

What are restorative treatments?

A

Direct restoration of function: based on neural plasticity

56
Q

Cumming, Marshall + Lazar (2013)

Strongest evidence for restorative strategy effectiveness comes from…

A

Treatment of FOCAL deficits, e.g. aphasia/neglect

57
Q

3 REMEDIAL treatments for Neglect?

A
  1. Visual scanning
  2. Computer-scanning
  3. Virtual reality therapy
58
Q

1 example of virtual reality therapy for neglect?

A

Video games

59
Q

Cumming, Marshall + Lazar (2013)

Compensatory treatment for Neglect?

A

Prism adaptation

60
Q

Cumming, Marshall + Lazar (2013)

What is Prism adaptation?

A

Glasses that create an optical shift of visual field

61
Q

Shiraishi et al., (2008)

Study on Prism glasses for neglect

A
  • 8 weeks trial in patients 1-7 years post-stroke

- Improved eye movements/improved CoG

62
Q

4 COMPENSATORY treatments for Neglect?

A

Limb Acitvation
Prisms Adaptation
Sensory Feedback
Eye Patching

63
Q

(Compensatory treatment - Neglect)

What are sensory feedback strategies?

A

Doing things on neglected side

64
Q

Dyspraxia

What is strategy training?

A

Carrying out simple task multiple times

65
Q

Dyspraxia

Why might strategy training tactics be effective?

A

Likened to working a muscle: improvements over time

66
Q

Dyspraxia

What is Proprioceptive stimulation?

A
  • Task completed on functional side

- Quickly switch over side

67
Q

Dyspraxia

Unfourtunately, positive prognosis…

A

May involve dependency on close relationships

68
Q

Aphasia

Patients may find it easier to communicate through …..

A

Music

69
Q

Speech and Language Therapy might be recommended to treat…

A

Aphasia

70
Q

5 methods of treating Aphasia?

A 
S+L therapy 
Group therapy 
Communication partners
Constrain-induced therapy
rTMS
71
Q

Aphasia patients may be asked not to point, and to speak instead. This is an exmaple of

A

Constrain-induced therapy

72
Q

Cumming, Marshall + Lazar, 2013

What alternative method for treating Aphasia was identified in the review?

A

rTMS –> picture naming/expressive language/auditory comprehension

73
Q

Cumming, Marshall + Lazar (2013)

4 methods for treating GENERALISED COGNITIVE IMPAIRMENT, as identified by their review?

A
  1. Controlling hypertension
  2. Pharmacological agents
  3. Increasing physical acitvity
  4. Music
74
Q

Evidence for the Hypertensive approach to Cognitive Impairment is…

A

Mixed

75
Q

Tzourio et al., (2003) found that lowering BP may reduce risk of cog. decline, due to…

A

Preventing advance of additional infarcts

76
Q

Meyer et al., (1986)

Converse to Tzourio et al., (2003), it was found that treating Hypertension…

A

Worsened cognition when reduced below upper normal limits

77
Q

Cumming, Marshall + Lazar (2013)

What pharmacological agents could be used to treat general cognitive decline?

A

Antidepressants

78
Q

Cumming, Marshall + Lazar (2013)

Increasing Physical Activity was found to produce…

A

General benefits in PROCESSING SPEED and ATTENTION

79
Q

Cumming, Marshall + Lazar (2013)

Physical activity was seen to improve attention/executive control/processing speed. This is positive as…

A

These central processes set the foundation for other aspects of cognition

80
Q

Quaner et al., (2009)

–> 8 week exercise program –>

A

Improved IP speed on reaction time task, compared to control

81
Q

Cumming, Marshall + Lazar (2013)

Quaner et al., (2009)

Improvements in information processing speed were seen after….

A

An 8 week exercise program

82
Q

Cumming, Marshall + Lazar (2013)

Overall, what was concluded to contribute best to post-stroke improvements?

A
  • Increased physical activity
  • Mental challenges
  • Sensory stimulation
  • Social interaction
83
Q

Sun, Tan + Yu (2014)

4 risk factors contrubting to greater post-stroke impairment?

A
  1. Disease
  2. Age
  3. Education level
  4. Vascular risk factors
84
Q

Sun, Tan + Yu (2014)

Which age group was idenitfied as being most at-risk for PSCI?

A

> 65

85
Q

Sun, Tan + Yu (2014)

How does education level influence PSCI? (3)

A
  1. Influences EXPRESSION
  2. Associated with better performance
  3. May increase tolerance
86
Q

Sun, Tan + Yu (2014)

How might disease influence PSCI?

A

Overlap with cerebrovascular disease or dementia –> greater impairment

87
Q

What percentage of stroke patients are affected by Neglect?

A

23%

88
Q

Aphasia may either be (3)

A

Broca’s
Wernicke’s
Global

89
Q

Cumming, Marshall + Lazar (2013)

Diffuse neuronal dysfunction produces a more….

A

Uniform profile of mental slowing (e.g. EF deficits, attentional problems)

90
Q

Ozdemeir et al., (2001) found the MMSE

A

Was a significant predictor of functional improvement overall, but not its subsections

91
Q

Ozdemeir et al., (2001) –> orientation, registration, attention etc cannot

A

Predict functional outcome individually

92
Q

Ozdemeir et al., (2001) –>

What was the relationship between MMSE baseline score and motor FIM improvement

A

Positive correlation

93
Q

Ozdemeir et al., (2001) –>

What were their recommendations?

A

Cognitive status of post-stroke patients should be carefully monitored to predict functional outcome

94
Q

Ozdemeir et al., (2001) –>

Critical evaluation of this study?

A

Not representative of general population (low proportion of female subjects)

95
Q

Ozdemeir et al., (2001) –>

MMSE can predict functional improvement and _______

A

Ambulation

96
Q

Barker-Collo & Feigin (2006) –> what was the most important determinant of functional outcome?

A

Cognitive factors

97
Q

Robertson et al., (1997)

A

Sustained attention is predictive of functional status 2 years post-stroke

98
Q

Joniken et al., (2015)

A

83% of sample showed impairment in at least one cognitive domain

99
Q

Wernicke’s Aphasia

What is preserved?

A

Articulation of speech sounds

100
Q

Carota et al., 2002

Why might Wernicke’s Aphasia lead to emotional outbursts?

A
  • Patient often unaware of their condition

- May assume people are speaking in a deliberately incomprehensible manner

101
Q

Two of the most prominent focal deficits are…

A

Aphasia

Unilateral Spatial Neglect

102
Q

Naeser et al., 2005

A

rTMS can improve language abilities in picture naming (aphasia)

103
Q

2 studies to rememebr for rTMS and aphasia

A

Naeser et al., 2005

Barwood et al., 2011

104
Q

Barwood et al., 2011

rTMS

A

Expressive language and auditory comprehension improvements after TMS

105
Q

rTMS

What is the mechanism for how TMS works for aphasia?

A

modulates and inhibits overactivity in right hemisphere language sites

106
Q

Study to remember on Prism glasses for Neglect?

A

Shiraishi et al., 2008

107
Q

Key references to remember

13

A 
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
Q

What is unilateral spatial neglect?

A

Failure to attend to the side contralateral to the damaged brain region

109
Q

What were the 3 readings for this topic?

A

Sun, Tan & Yu (2014)

Cumming, Marshall & Lazar (2013)

Ozdemir et al., (2001)

110
Q

Sarkamo et al., 2008

A

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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