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PSY345 > Lecture 8 Cognitive Deficits Following a Stroke > Flashcards

Lecture 8 Cognitive Deficits Following a Stroke Flashcards

1
Q

What are the cognitive domains affected following stroke?

A

Attention (focus attention, selective attention etc.)
Memory (visual, auditory, semantic etc.)
Executive Function (processing speed, planning etc.)
Perception/Praxis (unilateral neglect, agnosia, dyspraxia etc.)
Language (aphasia, transcortical etc.)

  • ALL DEPENDS ON WHERE IN THE BRAIN IS AFFECTED
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2
Q

What causes prosopagnosia?

A

(The inability to recognise faces)

Due to damage in the fusiform gyrus, which is located at the bottom of the temporal lobe through to the occipital lobe

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3
Q

What are the different methods of general assessment for cognitive impairments following stroke?

A

Mini Mental State Examination (Folstein et al., 1975)
Montreal Cognitive Assessment
Neuropsychological Test

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4
Q

Outline the MMSE

A

Orientation - asked about time and date
Registration - naming objects in the picture, told what objects are
Attention and Calculation - given mental arithmetic & spelling
Recall - recall objects from registration task
Language - asked to draw objects, name objects, can they follow instructions?

Score out of 30, the higher the score, the better their cognitive function

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5
Q

What are the strengths of the MMSE?

A

Easy to complete and interpret
Quick and inexpensive
Doesn’t require training
Used widely

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6
Q

What are the limitations of the MMSE?

A

Lacks sensitivity
Lacks evaluation of executive function
Confounded by age, level of education, and sociocultural background

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7
Q

What are the improvements for the MMSE?

A

Add more tests to improve the sensitivity and avoid confounds of age and education level

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8
Q

Outline the MCA

A

Visuo-spatial/Executive Function - draw a clock/cube and see if they can copy
Naming - name pictures and objects
Memory - given a list of words to recall
Attention - given a list of letters e.g. every time they hear ‘A’ have to tap
Abstraction - distinguish between differences & similarities of two objects
Language - repeat sentences, give three words that begin with ‘_’
Orientation - ask about date and time

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9
Q

What are the strengths of MCA?

A

More sensitive that the MMSE

Availability of alternate MoCA e.g. multiple languages, freely accessible

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10
Q

What are the limitations of MCA?

A

Relatively new

Reliability and validity not thoroughly tested

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11
Q

What are the Neuropsychological Tests?

A

A big collection of tests including:
- Visuospatial memory tests, Verbal learning test, Wechsler Memory Scale, Delis-Kaplan Executive Function System, Phonemic/Category Fluency, Wechsler Adult Intelligence Scale, Number/Letter Sequencing, Boston Naming Test

Very time consuming and tiring for patient

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12
Q

What is unilateral spatial neglect?

A

A failure to respond to a stimulus contralateral to the side of the stroke - a sensory issue
The parietal lobe is affected, and cannot process the information
Sometimes confused as a visual problem but it is not to do with vision

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13
Q

What is often used to assess USN?

A

A line bisection test

Patients have to cross lines on a page and if they miss one side or part of it, it indicated USN

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14
Q

What are the strengths and limitations of a line bisection test?

A

Strengths: simple, inexpensive, doesn’t require training

Limitations: lack of sensitivity

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15
Q

What is a second method of assessing USN?

A

Clock drawing task

Asked to draw a clock with hands and numbers

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16
Q

What are the strengths of the clock drawing task?

A

Easy, inexpensive, provides a better picture, demonstrated reliability

17
Q

What are the limitations of the clock drawing task?

A

Confounded by age, education and perhaps motor coordination

18
Q

What are improvements for the clock drawing task?

A

Addition of other tests to improve sensitivity

19
Q

What is a third method of assessing USN?

A

The Behavioural Inattention Test (Wilson et al., 1987)
Has a conventional section (BITC): including tasks like line bisection and letter cancellation
And also a behavioural section (BITB): including tasks like phone dialling, map navigation and coin sorting

20
Q

What are the strengths and limitations of the BIT?

A

Strengths: comprehensive, ecologically valid

Limitations: time consuming and expensive

21
Q

What are some remedial treatments for USN?

A

Aim to restore function

  • Visual Scanning: prompted to look at neglected side
  • Computer-based Scanning: can administer at home
  • Virtual Reality Therapy: relatively new so little evidence
22
Q

What are some compensatory therapies for USN?

A

Compensate for the deficit

  • Prism Adaptations: specific kind of glasses that force them to attend to the neglected side
  • Limb Activation Strategies: attending to neglected side
  • Sensory Feedback Strategies: auditory, visual etc.
  • Eye Patching & Hemispatial Glasses: stops them from being over reliant
23
Q

What is dyspraxia/apraxia?

A

Dyspraxia = problems with motor coordination
Apraxia = problems with organising speech
A perceptual problem, reduced ability to plan and coordinate specific movements - NOT to do with paralysis
The frontal lobe and sometimes the parietal lobe is affected

24
Q

What is the frontal lobe involved with?

A

Motor cortex, judgement, inhibition, personality, emotions, language production

25
Q

What is the parietal lobe involved with?

A

Sensory processing and orientation

26
Q

How do you assess dyspraxia/apraxia?

A

A process of elimination to make sure it is NOT: a comprehension deficit, muscle weakness, sensory impairment etc.

27
Q

What are the different therapies used for dyspraxia/apraxia?

A

Strategy Training: repetition of tasks and practice
Sensory Stimulation: stimulation of the nerve cells
Proprioceptive Based Training (PBT): based on performing concurrent movements with both the unaffected and affected arm, with the aim of motor recovery

28
Q

What is aphasia?

A

The loss of the ability to communicate orally, through signs or in writing (Broca’s) or the inability to understand such communication (Wernicke’s)
Impairment of language as a result of focal brain damage

29
Q

Which therapies are used for aphasia?

A

Speech and Language Therapy
Group Therapy - forced to communicate in a group
Training conversation/communication partners - helps with confidence if others know how to communicate with them
Computer-based therapy - hearing words read out and repeat
Constrain-induced therapy - stop them using objects and gestures to communicate and prevent over reliance

30
Q

What is the six-item screener (SIS)?

A

A brief cognitive function test derived from the MMSE and designed for either in person or telephone administration

31
Q

How many ischaemic stroke survivors show cognitive impairment?

A

30% of ischaemic stroke survivors show a cognitive impairment, which was determined by an MMSE score lower than 27
BUT this statistic varies across countries, races and diagnostic criteria

32
Q

How does age affect post-stroke cognitive impairment risk?

A

Suggested that the prevalence of cognitive decline after stroke increases after 65 years old

33
Q

What are cerebral micro bleeds (CMBs)?

A

Haemorrhages smaller than 5mm, reported to be related to cognitive deficits, and are found in 35% of patients who survived ischaemic strokes, and 60% of those who survived a haemorrhagic stroke

34
Q

What is an example of drugs used in an attempt to improve cognitive impairments?

A

Cholinesterase inhibitors

35
Q

What are the future directions for improving cognitive impairments?

A

Hoped that different techniques that have been shown to promote neural plasticity (e.g. exercise, brain stimulation and pharmacological agents) can be applied to improve the cognitive function of stroke survivors

36
Q

What is the view of the weighting of cognitive problems in stroke?

A

Stroke-related cognitive problems are weighted more towards attention-executive dysfunction than memory dysfunction

37
Q

What has been found to be associated with dementia and cognitive decline post-stroke?

A

Over the 4 years following stroke, higher load of white matter hypertensities is strongly associated with dementia and cognitive decline

38
Q

How can imaging techniques be used to screen for cognitive impairments?

A

Those such as DTI can identify subtle abnormalities in axonal function that may be a marker for generalised cognitive impairment

39
Q

How can TMS be used in cognitive impairments?

A

There is evidence that low frequency repetitive TMS (rTMS) can improve the language abilities in patients with chronic non-fluent aphasia

PSY345 (10 decks)

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