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Cutting a long story short: Reaction times in acute stroke are associated with longer term cognitive outcomes

      Abstract

      Background

      The viability and usefulness of cognitive assessment in acute stroke have been questioned, with practical challenges arising from the focal nature of neurological deficits as well as heterogeneity in arousal state. We aimed to test whether acute measures of attention correlate with attentional function at 3 months post-stroke.

      Methods

      Patients with confirmed stroke completed 2 computerised cognitive tasks (CogState) within 2 weeks of stroke. The tasks were a simple reaction time task (Detection) and a choice reaction time task (Identification) that required a button press to visual stimuli (playing cards). Each task took approximately 4 min. The Montreal Cognitive Assessment (MoCA) and an extended neuropsychological battery were administered at 3 months post-stroke.

      Results

      Thirty-three patients (mean age 75.5 years, SD 11.9) participated in this preliminary study. Correlations indicated that both Detection speed (r=0.73, p<0.001) and Identification speed (r=0.61, p=0.007) at baseline were associated with attentional function at 3 months, as measured by established neuropsychological tests (Trails-A, Digit span, Digit symbol). In addition, Detection speed at baseline was correlated with total 3-month MoCA score (r=0.54, p=0.012).

      Conclusion

      Simple and brief computerised assessment of attentional function in acute stroke is possible and is related to longer term attentional and cognitive performance.

      Keywords

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      References

        • Jin Y.P.
        • Di Legge S.
        • Ostbye T.
        • Feightner J.W.
        • Hachinski V.
        The reciprocal risks of stroke and cognitive impairment in an elderly population.
        Alzheimers Dement. 2006; 2: 171-178
        • Pendlebury S.T.
        • Rothwell P.M.
        Prevalence, incidence, and factors associated with pre-stroke and post-stroke dementia: a systematic review and meta-analysis.
        Lancet Neurol. 2009 Nov; 8: 1006-1018
        • Feigin V.L.
        • Barker-Collo S.
        • Parag V.
        • Senior H.
        • Lawes C.M.
        • Ratnasabapathy Y.
        • et al.
        Auckland Stroke Outcomes Study. Part 1: gender, stroke types, ethnicity, and functional outcomes 5 years poststroke.
        Neurology. 2010; 75: 1597-1607
        • McNab F.
        • Klingberg T.
        Prefrontal cortex and basal ganglia control access to working memory.
        Nat Neurosci. 2008; 11: 103-107
        • Patel M.D.
        • Coshall C.
        • Rudd A.G.
        • Wolfe C.D.
        Cognitive impairment after stroke: clinical determinants and its associations with long-term stroke outcomes.
        J Am Geriatr Soc. 2002; 50: 700-706
        • Pasquini M.
        • Leys D.
        • Rousseaux M.
        • Pasquier F.
        • Henon H.
        Influence of cognitive impairment on the institutionalisation rate 3 years after a stroke.
        J Neurol Neurosurg Psychiatry. 2007; 78: 56-59
        • Heruti R.J.
        • Lusky A.
        • Dankner R.
        • Ring H.
        • Dolgopiat M.
        • Barell V.
        • et al.
        Rehabilitation outcome of elderly patients after a first stroke: effect of cognitive status at admission on the functional outcome.
        Arch Phys Med Rehabil. 2002; 83: 742-749
        • Barker-Collo S.
        • Feigin V.L.
        • Parag V.
        • Lawes C.M.
        • Senior H.
        Auckland Stroke Outcomes Study. Part 2: cognition and functional outcomes 5 years poststroke.
        Neurology. 2010; 75: 1608-1616
        • Barker-Collo S.L.
        • Feigin V.L.
        • Lawes C.M.
        • Parag V.
        • Senior H.
        • Rodgers A.
        Reducing attention deficits after stroke using attention process training: a randomized controlled trial.
        Stroke. 2009; 40: 3293-3298
        • van Zandvoort M.J.
        • Kessels R.P.
        • Nys G.M.
        • de Haan E.H.
        • Kappelle L.J.
        Early neuropsychological evaluation in patients with ischaemic stroke provides valid information.
        Clin Neurol Neurosurg. 2005; 107: 385-392
        • Dong Y.
        • Sharma V.K.
        • Chan B.P.
        • Venketasubramanian N.
        • Teoh H.L.
        • Seet R.C.
        • et al.
        The Montreal Cognitive Assessment (MoCA) is superior to the Mini-Mental State Examination (MMSE) for the detection of vascular cognitive impairment after acute stroke.
        J Neurol Sci. 2010; 299: 15-18
        • Godefroy O.
        • Fickl A.
        • Roussel M.
        • Auribault C.
        • Bugnicourt J.M.
        • Lamy C.
        • et al.
        Is the Montreal Cognitive Assessment Superior to the Mini-Mental State Examination to detect poststroke cognitive impairment?: a study with neuropsychological evaluation.
        Stroke. 2011; 42 (2011 June 1): 1712-1716
        • Nys G.M.
        • van Zandvoort M.J.
        • de Kort P.L.
        • van der Worp H.B.
        • Jansen B.P.
        • Algra A.
        • et al.
        The prognostic value of domain-specific cognitive abilities in acute first-ever stroke.
        Neurology. 2005; 64: 821-827
        • Nys G.M.
        • van Zandvoort M.J.
        • van der Worp H.B.
        • de Haan E.H.
        • de Kort P.L.
        • Jansen B.P.
        • et al.
        Early cognitive impairment predicts long-term depressive symptoms and quality of life after stroke.
        J Neurol Sci. 2006; 247: 149-156
        • Ballard C.
        • Stephens S.
        • Kenny R.
        • Kalaria R.
        • Tovee M.
        • O'Brien J.
        Profile of neuropsychological deficits in older stroke survivors without dementia.
        Dement Geriatr Cogn Disord. 2003; 16: 52-56
        • Quaney B.M.
        • Boyd L.A.
        • McDowd J.M.
        • Zahner L.H.
        • He J.
        • Mayo M.S.
        • et al.
        Aerobic exercise improves cognition and motor function poststroke.
        Neurorehabil Neural Repair. 2009 Nov; 23: 879-885
        • Collie A.
        • Maruff P.
        • Makdissi M.
        • McCrory P.
        • McStephen M.
        • Darby D.
        CogSport: reliability and correlation with conventional cognitive tests used in postconcussion medical evaluations.
        Clin J Sport Med. 2003; 13: 28-32
        • Falleti M.G.
        • Maruff P.
        • Collie A.
        • Darby D.G.
        Practice effects associated with the repeated assessment of cognitive function using the CogState battery at 10-minute, one week and one month test-retest intervals.
        J Clin Exp Neuropsychol Off J Int Neuropsychol Soc. 2006; 28: 1095-1112
        • Silbert B.S.
        • Maruff P.
        • Evered L.A.
        • Scott D.A.
        • Kalpokas M.
        • Martin K.J.
        • et al.
        Detection of cognitive decline after coronary surgery: a comparison of computerized and conventional tests.
        Br J Anaesth. 2004; 92: 814-820
        • Brott T.
        • Adams H.P.
        • Olinger C.P.
        • Marler J.R.
        • Barson W.G.
        • Biller J.
        • et al.
        Measurements of acute cerebral infarction: a clinical examination scale.
        Stroke. 1989; 20: 864-870
        • Bamford J.
        • Sandercock P.
        • Dennis M.
        • Burn J.
        • Warlow C.
        A prospective study of acute cerebrovascular disease in the community: the Oxfordshire Community Stroke Project—1981–86. 2. Incidence, case fatality rates and overall outcome at one year of cerebral infarction, primary intracerebral and subarachnoid haemorrhage.
        J Neurol Neurosurg Psychiatry. 1990 Jan; 53: 16-22
        • Nasreddine Z.S.
        • Phillips N.A.
        • Bedirian V.
        • Charbonneau S.
        • Whitehead V.
        • Collin I.
        • et al.
        The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment.
        J Am Geriatr Soc. 2005; 53: 695-699
        • Hachinski V.
        • Iadecola C.
        • Petersen R.C.
        • Breteler M.M.
        • Nyenhuis D.L.
        • Black S.E.
        • et al.
        National Institute of Neurological Disorders and Stroke-Canadian Stroke Network vascular cognitive impairment harmonization standards.
        Stroke. 2006; 37: 2220-2241
        • Middleton L.E.
        • Yaffe K.
        Promising strategies for the prevention of dementia.
        Arch Neurol. 2009; 66: 1210-1215
        • Fredrickson J.
        • Maruff P.
        • Woodward M.
        • Moore L.
        • Fredrickson A.
        • Sach J.
        • et al.
        Evaluation of the usability of a brief computerized cognitive screening test in older people for epidemiological studies.
        Neuroepidemiology. 2010; 34: 65-75