Predicting Stroke Inpatient Rehabilitation Outcome: The Prominent Role of Neuropsychological Disorders

Paolucci, Stefano; Antonucci, Gabriella; Gialloreti, Emberti; Traballesi, Marco; Lubich, S.; Pratesi, Luca; Palombi, Leonardo

doi:10.1159/000117298

Cited by 140 publications

(87 citation statements)

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“…Stroke severity and the presence of unilateral neglect are independently related to a worse prognosis in activities of daily living (ADL), greater morbidity and lethality rates, and prolonged hospital stay 14 . Different types of neglect exist, which vary according to the lesion location 15 .…”

Section: Discussionmentioning

confidence: 99%

Screening tests are not enough to detect hemineglect

Lopes

Ferreira

Carvalho

et al. 2007

Arq. Neuro-Psiquiatr.

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-Objective: To verify the sensitivity of the conventional subtests of the Behavioral Inattention Test (BIT) in the diagnosis of hemineglect after stroke. Method: One hundred and two patients with cerebral infarct or hemorrhage were prospectively evaluated. In 22, hemineglect was diagnosed using standard BIT criteria. The frequency of hemineglect using 6 commonly used screening subtests of this battery was assessed. Results: Hemineglect would not be recognized in 10 patients if they were only screened using the line crossing test; this would be the case in 2 patients with the letter cancellation test; and in 4 patient with the line bisection test. Three patients would not be diagnosed even if both line crossing and line bisection tests were used. Conclusion: Hemineglect may not be recognized with single screening tests commonly used. The use of a standard battery is recommended to improve diagnostic sensitivity in individuals with various subtypes of hemineglect.KEY WORDS: perceptual disorders, hemispatial neglect , stroke, diagnosis. Testes de triagem não são suficientes para diagnosticar heminegligência RESUMO -Objetivo: Verificar a sensibilidade dos subtestes convencionais da Behavioral Inattention Test (BIT) no diagnóstico da heminegligência após o acidente vascular cerebral (AVC). Método:Foram avaliados prospectivamente 102 pacientes com AVC. Em 22 casos heminegligência foi diagnosticada através do BIT. A freqüência de diagnóstico correto utilizando os 6 subtestes específicos desta bateria foi analisada. Resultados: 10 pacientes não seriam diagnosticados como heminegligentes se fossem avaliados apenas com o "line crossing", 2 se o teste de triagem escolhido fosse o "letter cancellation", e 4 se utilizássemos apenas o "line bisection". Além disso, 3 pacientes não teriam recebido o diagnóstico correto mesmo utilizando dois testes usuais de triagem -"line crossing" e "line bisection". Conclusão: O uso de testes isolados de triagem pode falhar em diagnosticar heminegligência após o AVC. O uso de uma bateria formal de avaliação é necessá-rio para identificar indivíduos com diferentes tipos de heminegligência. PALAVRAS-CHAVE: transtornos da percepção, heminegligência, acidente cerebrovascular, diagnóstico.

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Section: Discussionmentioning

confidence: 99%

Screening tests are not enough to detect hemineglect

Lopes

Ferreira

Carvalho

et al. 2007

Arq. Neuro-Psiquiatr.

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“…8,9 Moreover, most of these studies have used global cognitive screening measures in the early phase of stroke, although these measures demonstrate poor sensitivity in detecting cognitive impairment in stroke patients.…”

Section: Abstract-objectivementioning

confidence: 99%

Ischemic optic neuropathy and carotid dissection

Koch¹,

Lorenzo²,

Rabinstein³

et al. 2005

Neurology

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Abstract-Objective:To evaluate the prognostic value of domain-specific cognitive abilities in acute stroke with respect to long-term cognitive and functional outcome in addition to neurologic and demographic predictors. Methods: The authors evaluated 168 patients within the first 3 weeks after first-ever stroke. The prevalence of neuropsychological impairment was calculated vs 75 matched healthy controls. The authors also recorded demographic data, vascular risk factors, lesion characteristics, and clinical factors at admission. Independent predictor variables associated with long-term cognitive impairment (assessed with a follow-up neuropsychological examination) and functional impairment (assessed with the modified Barthel Index and the Frenchay Activities Index) were identified with stepwise multiple logistic regression. Areas under receiver operator characteristic curves were used to compare the predictive value of three models, i.e., a standard medical model, a purely cognitive model, and a model consisting of both medical and cognitive predictors. Results: Thirty-one percent of patients showed long-term cognitive impairment. Basic and instrumental ADL disturbances remained present in 19% and 24% of patients. Domain-specific cognitive functioning predicted cognitive and functional outcome better than any other variable. Moreover, the prediction of instrumental ADL functioning improved when cognitive predictors were added to the standard medical model (p Ͻ 0.05). Impairments in abstract reasoning and executive functioning were independent predictors of long-term cognitive impairment. Inattention and perceptual disorders were more important in predicting long-term functional impairment. Conclusion: Domain-specific cognitive abilities in the early phase of stroke are excellent independent predictors of long-term cognitive and functional outcome. NEUROLOGY 2005;64:821-827 Several factors have been identified as predictors for long-term disability and adverse outcome, such as initial stroke severity and lesion characteristics, functional status at admission with respect to activities of daily life (ADL), vascular risk factors, and demographic factors.1-5 While cognitive disorders are among the most frequent and devastating early consequences of stroke, 6,7 few studies have examined the prognostic importance of these acute disorders. 8,9 Moreover, most of these studies have used global cognitive screening measures in the early phase of stroke, although these measures demonstrate poor sensitivity in detecting cognitive impairment in stroke patients.10 Also, these global measures do not allow evaluation of cognitive performance in specific domains. Other studies on poststroke cognitive impairment have focused on the prognostic value of isolated impairments such as unilateral neglect, 11,12 anosognosia, 13 aphasia, 14 or apraxia. 15 A detailed neuropsychological evaluation covering the whole cognitive spectrum in acute stroke has not been reported, probably because of uncertainty about the feasibility and reliabi...

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“…In most recent years, the rates of mortality are decreasing, resulting in a significant increase in the number of survivors living with the disabilities0handicaps associated with stroke (Thorvaldsen et al, 1997). Not only is stroke a common health problem, but the cognitive disorders that result are common as well (Mayo, 1993;Paolucci et al, 1996).…”

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confidence: 99%

Introduction—The changing view of neurorehabilitation: A new era of optimism

Rothi

Barrett

2006

J. Inter. Neuropsych. Soc.

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Stroke is the leading health care problem requiring rehabilitation services today (CDC, 2001; Lee et al., 1996) with the worldwide incidence estimated to be between 300 and 500 per 100,000 people (Sudlow & Warlow, 1997). In most recent years, the rates of mortality are decreasing, resulting in a significant increase in the number of survivors living with the disabilities/handicaps associated with stroke (Thorvaldsen et al., 1997). Not only is stroke a common health problem, but the cognitive disorders that result are common as well (Mayo, 1993; Paolucci et al., 1996).This article is based in part on a Presidential Address by the first author to the Annual meeting of the International Neuropsychological Society in Honolulu, Hawaii in February, 2002.

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Predicting Stroke Inpatient Rehabilitation Outcome: The Prominent Role of Neuropsychological Disorders

Cited by 140 publications

References 0 publications

Screening tests are not enough to detect hemineglect

Screening tests are not enough to detect hemineglect

Ischemic optic neuropathy and carotid dissection

Introduction—The changing view of neurorehabilitation: A new era of optimism

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