Cognitive rehabilitation for memory deficits after stroke

Nair, Roshan das; Cogger, Heather; Worthington, Esme; Lincoln, Nadina B.

doi:10.1002/14651858.cd002293.pub3

Cited by 105 publications

(81 citation statements)

References 74 publications

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“…Clinical studies have shown impaired social cognition [59,60], memory deficits [61] and somatosensory deficits [62], which may influence overall functional recovery. Functional recovery is most rapid early after stroke, which is typically considered ≤3 months for humans and ≤1 month for rodents [63].…”

Section: Cells and Significant Increases In Cd4+ T Cells And Cd8+ T mentioning

confidence: 99%

Experimental Stroke Induces Chronic Gut Dysbiosis and Neuroinflammation in Male Mice

Brichacek¹,

Nwafor²,

Benkovic³

et al. 2020

Preprint

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Recent literature implicates gut epithelia mucosa and intestinal microbiota as important players in post-stroke morbidity and mortality. As most studies have focused on the acute effects of stroke on gut dysbiosis, our study objective was to measure chronic, longitudinal changes in the gut microbiota and intestinal pathology following ischemic stroke. We hypothesized that mice with experimental ischemic stroke would exhibit chronic gut dysbiosis and intestinal pathology up to 36 days post-stroke compared to sham controls. Male C57BL/6J mice were subjected to 60 minutes of transient middle cerebral artery occlusion (tMCAO) or sham surgery. To determine the long-term effects of tMCAO on gut dysbiosis, fecal boli were collected pre- and post-tMCAO on days 0, 3, 14, and 28. Bioinformatics analysis demonstrate significant differences in abundance among Firmicutes and Bacteroidetes taxa at the phylum, family, and species levels in tMCAO compared to sham mice that persisted up to one month post-stroke. The most persistent changes in post-stroke microbial abundance were a decrease in bacteria family S24-7 and significant increases in Ruminococcaceae. Overall, these changes resulted in a persistently increased Firmicutes:Bacteroidetes ratio in stroke animals. Intestinal histopathology showed evidence of chronic intestinal inflammation that included marked increases in immune cell infiltration with mild-moderate epithelial hyperplasia and villous blunting. Increased astrocyte and microglial activity were also detected one-month post-stroke. These results demonstrate that acute, post-stroke disruption of the gut-brain-microbiota axis progresses to chronic gut dysbiosis, intestinal inflammation, and chronic neuroinflammation.Clinical PerspectivesThe microbiota-gut-brain axis, recently implicated in several neurological disorders, remains largely unexplored at chronic time points post-tMCAO.Our results demonstrate chronic gut dysbiosis, prolonged behavioral deficits, and persistent cerebral and intestinal inflammation post-tMCAO in male C57BL/6J mice.These results suggest that manipulation of microbiota may help reduce poor outcomes after stroke and lead to improved post-stroke functional recovery.

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Section: Cells and Significant Increases In Cd4+ T Cells And Cd8+ T mentioning

confidence: 99%

Experimental Stroke Induces Chronic Gut Dysbiosis and Neuroinflammation in Male Mice

Brichacek¹,

Nwafor²,

Benkovic³

et al. 2020

Preprint

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“…Some cognitive decline occurs in what is usually considered normal ageing (Deary et al, 2009;Nyberg, Lovden, Riklund, Lindenberger, & Backman, 2012), and it is a prominent feature in several predominantly age-related pathological conditions, including neurodegenerative and neurovascular diseases (Aarsland et al, 2017;Cumming, Marshall, & Lazar, 2013;Weintraub, Wicklund, & Salmon, 2012). Given the functional consequences of cognitive impairment in aging, and the subsequent personal, societal and financial costs, development of effective interventions that could maintain levels of cognitive functioning and delay cognitive and functional decline is a key priority in the field.…”

Section: Introductionmentioning

confidence: 99%

Cognition-Oriented Treatments for Older Adults: a Systematic Overview of Systematic Reviews

et al. 2020

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Cognition-oriented treatmentscommonly categorized as cognitive training, cognitive rehabilitation and cognitive stimulationare promising approaches for the prevention of cognitive and functional decline in older adults. We conducted a systematic overview of meta-analyses investigating the efficacy of cognition-oriented treatments on cognitive and non-cognitive outcomes in older adults with or without cognitive impairment. Review quality was assessed by A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR). We identified 51 eligible reviews, 46 of which were included in the quantitative synthesis. The confidence ratings were "moderate" for 9 (20%), "low" for 13 (28%) and "critically low" for 24 (52%) of the 46 reviews. While most reviews provided pooled effect estimates for objective cognition, non-cognitive outcomes of potential relevance were more sparsely reported. The mean effect estimate on cognition was small for cognitive training in healthy older adults (mean Hedges' g = 0.32, range 0.13-0.64, 19 reviews), mild cognitive impairment (mean Hedges' g = 0.40, range 0.32-0.60, five reviews), and dementia (mean Hedges' g = 0.38, range 0.09-1.16, seven reviews), and small for cognitive stimulation in dementia (mean Hedges' g = 0.36, range 0.26-0.44, five reviews). Meta-regression revealed that higher AMSTAR score was associated with larger effect estimates for cognitive outcomes. The available evidence supports the efficacy of cognition-oriented treatments improving cognitive performance in older adults. The extent to which such effects are of clinical value remains unclear, due to the scarcity of high-quality evidence and heterogeneity in reported findings. An important avenue for future trials is to include relevant non-cognitive outcomes in a more consistent way and, for meta-analyses in the field, there is a need for better adherence to methodological standards. PROSPERO registration number: CRD42018084490.

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“…However, it seems that these principles are either not explicitly declared in the interventions, or the field still needs to evaluate the exact mechanisms behind cognitive rehabilitation that would positively alter cognitive function and behaviour [14]. This leads to the paradoxical situation, that although many cognitive rehabilitation protocols rely on technology (18 out of 44 studies in the meta-analyses mentioned here [10][11][12]31]), VR appears to be rarely used in cognitive rehabilitation (4 studies in [29]). More specifically, certain principles of neurorehabilitation can be better implemented in virtual than in physical reality.…”

Section: Introductionmentioning

confidence: 99%

Adaptive conjunctive cognitive training (ACCT) in virtual reality for chronic stroke patients: a randomized controlled pilot trial

Maier

Ballester

Bañuelos

et al. 2020

J NeuroEngineering Rehabil

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Background: Current evidence for the effectiveness of post-stroke cognitive rehabilitation is weak, possibly due to two reasons. First, patients typically express cognitive deficits in several domains. Therapies focusing on specific cognitive deficits might not address their interrelated neurological nature. Second, co-occurring psychological problems are often neglected or not diagnosed, although post-stroke depression is common and related to cognitive deficits. This pilot trial aims to test a rehabilitation program in virtual reality that trains various cognitive domains in conjunction, by adapting to the patient's disability and while investigating the influence of comorbidities. Methods: Thirty community-dwelling stroke patients at the chronic stage and suffering from cognitive impairment performed 30 min of daily training for 6 weeks. The experimental group followed, so called, adaptive conjunctive cognitive training (ACCT) using RGS, whereas the control group solved standard cognitive tasks at home for an equivalent amount of time. A comprehensive test battery covering executive function, spatial awareness, attention, and memory as well as independence, depression, and motor impairment was applied at baseline, at 6 weeks and 18weeks follow-up. Results: At baseline, 75% of our sample had an impairment in more than one cognitive domain. The experimental group showed improvements in attention (χ 2 F (2) = 9.57, p < .01), spatial awareness (χ 2 F (2) = 11.23, p < .01) and generalized cognitive functioning (χ 2 F (2) = 15.5, p < .001). No significant change was seen in the executive function and memory domain. For the control group, no significant change over time was found. Further, they worsened in their depression level after treatment (T = 45, r = .72, p < .01) but returned to baseline at follow-up. The experimental group displayed a lower level of depression than the control group after treatment (Ws = 81.5, z = − 2.76, r = − .60, p < .01) and (Ws = 92, z = − 2.03, r = − .44, p < .05). Conclusions: ACCT positively influences attention and spatial awareness, as well as depressive mood in chronic stroke patients. Trial registration: The trial was registered prospectively at ClinicalTrials.gov (NCT02816008) on June 21, 2016.

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Cognitive rehabilitation for memory deficits after stroke

Abstract: Background Memory problems are a common cognitive complaint following stroke and can potentially affect ability to complete functional activities. Cognitive rehabilitation programmes either attempt to retrain lost or poor memory functions, or teach patients strategies to cope with them.

Cited by 105 publications

References 74 publications

Experimental Stroke Induces Chronic Gut Dysbiosis and Neuroinflammation in Male Mice

Experimental Stroke Induces Chronic Gut Dysbiosis and Neuroinflammation in Male Mice

Cognition-Oriented Treatments for Older Adults: a Systematic Overview of Systematic Reviews

Adaptive conjunctive cognitive training (ACCT) in virtual reality for chronic stroke patients: a randomized controlled pilot trial

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