Personalized Neurophysiological and Neuropsychological Assessment of Patients with Left and Right Hemispheric Damage in Acute Ischemic Stroke

Abstract

The leading factors of post-stroke disability are motor disorders and cognitive dysfunctions. The aim of the study was to identify and provide a rationale for the variable early cognitive dysfunction in right and left hemispheric damage in patients with acute stroke. The study included 80 patients diagnosed with ischemic stroke. All patients were assessed for cognitive status, depression, fatigue and anxiety. For objectification, the method of evoked potentials (P300) and neuroimaging were used. Our findings revealed distinguishing features of cognitive dysfunction and identified a combination of the most informative markers characteristic of right and left hemispheric damage in patients with acute ischemic stroke. In patients with damage to the left hemisphere, a predominance of dysregulation syndrome (decrease in executive function and attention) was revealed, accompanied by various disorders such as severe anxiety and fatigue. The causes of this cognitive dysfunction may be directly related to stroke (damage to subcortical structures), as well as to a preexisting reduction in higher mental functions associated with age and vascular conditions. Cognitive impairments in patients with lesions of the right hemisphere were characterized by polymorphism and observed in the mental praxis, speech (with predominant semantic component) and abstract thinking domains. They are closely linked to each other and are more related to the lateralization of the lesion and preexisting neurodegeneration than to the localization of the ischemic lesion. The study of P300-evoked potentials is a good tool for confirming cognitive dysfunction. The latent period of the P300 wave is more sensitive to neurodegeneration, while the amplitude factor characterizes vascular pathology to a greater extent. The results of the study provide a rationale for a comprehensive assessment of lateralization, stroke localization, underlying diseases, neurophysiological parameters and identified cognitive impairments when developing a plan of rehabilitation and neuropsychological measures aimed at cognitive and emotional recovery of patients both in the acute phase of ischemic stroke and when selecting further personalized rehabilitation programs.

Clinical and paraclinical features of psychopathological disorders in right hemisphere stroke

“…They are interrelated and have less to do with the location of the ischemic lesion and more to do with the lateralisation of the lesion and underlying neurodegeneration. P300-evoked potential analysis is a useful method for verifying cognitive impairment [27]. The presence of anxiety and depression with a total HADS score of at least 11 points was found in the qualitative assessment of these disorders, supporting the previous finding that patients with right-hemispheric stroke were more likely to experience anxiety than depression.…”

Neuroimaging correlates of post-stroke fatigue: A systematic review and meta-analysis

“…Twenty-nine studies ( n = 3709 participants) assessed whether lesion lateralization was associated with PSF. 9 , 16 – 43 Of these, 24 showed no association, 3 reported a higher prevalence of PSF with right-sided stroke, 29 , 34 , 38 and 1 showed a higher prevalence of PSF in right-sided stroke at 6-month follow-up but not at baseline. 43 One study reported higher rates of general and mental fatigue in those with left-sided lesion lateralization.…”

“… 43 One study reported higher rates of general and mental fatigue in those with left-sided lesion lateralization. 42 …”

“…43 One study reported higher rates of general and mental fatigue in those with left-sided lesion lateralization. 42 Sixteen studies had group data or summary data suitable for meta-analysis. 9,16,17,19,21,24,25,27,28,32,34,37,38,43,52,54 Two studies had data for both baseline and follow-up, 9,43 we used only the earliest timepoint to remain consistent with the other studies.…”

Effects of dual-task training in patients with post-stroke cognitive impairment: A randomized controlled trial

“…Many studies have shown that the latency of P300 is a more sensitive index than amplitude in patients with stroke ( 21 , 29 ). Some studies have found that the latency of P300 in patients with vascular cognitive impairment is significantly prolonged, but the amplitude of P300 has no significant difference from that of normal subjects ( 30 ). The results of this study confirmed that P300 latency is a sensitive index to detect the improvement of cognitive function in patients with PSCI from the point of view of cognitive improvement.…”