- Email: [email protected]
Impact of cognitive rehabilitation on episodic memory and life habits in persons with stroke
200
Abstracts / Brain and Cognition 63 (2007) 197–201
Preclinical vascular cognitive impairment and Alzheimer’s disease: Different neuropsychological deficits are present five years before diagnosis J. Ingles, D. White, J. Fisk, K. Rockwood Dalhousie University, Halifax, Canada Neuropsychological deficits that precede a diagnosis of vascular cognitive impairment (VCI) are not well understood. Our sample comprised 332 individuals diagnosed with no cognitive impairment (NCI) in the baseline phase of the population-based Canadian Study of Health and Aging. After five years, 41 were diagnosed with VCI, 25 with AD and 266 with NCI. The incident VCI group performed worse on an abstract reasoning test (WAIS-R Similarities) compared to incident AD and NCI groups. The incident AD group performed worse on memory tests (WAIS-R Information, Buschke Cued Recall) compared to incident VCI and NCI groups. This suggests a preclinical phase may exist in VCI that differs from that in AD. Neuropsychological measures may help in the design and implementation of preventive strategies for VCI. doi:10.1016/j.bandc.2006.08.030
Do hyperintensities in cholinergic pathways influence functional and behavioral outcomes in treated Alzheimer’s patients? P. Behla,c,d, C. Boctih,i, R.H. Swartz b,c,d, D.J. Sahlasb,c,d,e,j, K. Lanctoˆtc,d,f, D.L. Streinerc,d,f,g, S.E. Blacka,b,c,d,e,j a
Linda Campbell Cognitive Neurology Research Unit, Sunnybrook Health Sciences Centre, Toronto, Canada b Sunnybrook Health Sciences Centre, Toronto, Canada c Institute of Medical Science, University of Toronto, Toronto, Canada d University of Toronto, Toronto, Canada e Department of Medicine/(Neurology), Sunnybrook Health Sciences Centre, Toronto, Canada f Department of Psychiatry, University of Toronto, Toronto, Canada g Rotman Research Institute, Baycrest, Toronto, Canada h Division of Neurology, Department of Medicine, Maisonneuve-Rosemont Hospital, Montreal, Canada i University of Montreal, Montreal, Canada j HSFO Centre for Stroke Recovery, Toronto, Canada We investigated change in functional and behavioral outcomes over one year in 57 AD patients treated with cholinesterase inhibitors, in relation to white matter hyperintensities (WMH) involving the cholinergic pathways. CHIPS and ARWMC rating scales rated WMH in cholinergic pathways and general white matter lesion burden in the brain. The lower CHIPS group was younger, but equivalent to the higher group on other baseline demographics.
No differences emerged at one year in the functional domains (DAD) and most domains on the BEHAVEAD, except activity disturbances, which showed more decline in the severe group. For the ARWMC scale, groups were equivalent on baseline demographics and outcome. Cerebrovascular compromise of cholinergic pathways may be a factor contributing to heterogeneity of response to cholinergic treatment in AD. doi:10.1016/j.bandc.2006.08.031
The relationship of subcortical MRI hyperintensities and medial temporal lobe atrophy N. Levy a,d, F. Gao a, J. Ramirez a,d, S.E. Black a,b,c,d a
L.C. Campbell Cognitive Neurology Research Unit, Sunnybrook Health Sciences Centre, Toronto, Canada b HSFO Centre for Stroke Recovery, Toronto, Canada c Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada d Institute of Medical Science and Medical Biophysics, University of Toronto, Toronto, Canada The goal of this study was to investigate the relationship between deep white (DWH) and periventricular (PVH) hyperintensities to medial temporal lobe width (MTL) and ventricular cerebrospinal fluid (VCSF) volume in a group of Alzheimer’s disease (AD) patients. MRI was obtained in 59 AD patients (mean age 76.2 ± 6.3; mean MMSE, 13.6 ± 3). Brain volumes were determined using an in-house semi-automatic segmentation process. Thinnest medial temporal lobe width was measured bilaterally. PVH, not DWH volumes were inversely related to MTL width (r2 = 0.17, p < 0.01). No relationship was seen between VCSF and hyperintensities. In this study, only PVH were correlated to MTL atrophy. These findings suggest that PVH and DWH may have overlapping but not identical pathophysiological origins and should be differentiated in future studies. doi:10.1016/j.bandc.2006.08.032
GROUP III
Impact of cognitive rehabilitation on episodic memory and life habits in persons with stroke S. Blancheta, S. Bellevilleb, L. Noreaua,c, P. Fougeyrollasa,c, F. Cre´peaud a
Centre interdisciplinaire de recherche en re´adaptation et inte´gration sociale, Institut de Re´adaptation en De´ficience Physique de Que´bec, Quebec City, Canada b Centre de Recherche, Institut Universitaire de Ge´riatrie de Montre´al & De´partement de Psychologie, Universite´ de Montre´al, Montreal, Canada
Abstracts / Brain and Cognition 63 (2007) 197–201 c
De´partement de Re´adaptation, Universite´ Laval, Quebec City, Canada d Centre de Re´adaptation Lucie-Bruneau, Montre´al, Canada Although memory disorders frequently occur following a stroke, the effect of their rehabilitation has seldom been investigated. We assessed in patients with stroke the impact of a rehabilitation program that targets episodic memory and memory-involved processes on these specific cognitive functions, and on life habits. Six persons with stroke who exhibited memory disorders participated in a rehabilitation program that emphasized the learning of encoding and retrieval strategies, as well as the training of attentional and executive processes. Following rehabilitation, in comparison with control participants, persons with stroke exhibited improvement in their learning abilities in episodic memory, sustained attention, and their understanding of their financial responsibilities. Thus, persons with stroke would benefit from cognitive rehabilitation efforts and these benefits would also transfer to some complex life habits. doi:10.1016/j.bandc.2006.08.033
Investigation of a phonologically based treatment for anomia: Behavioral and neural changes E. Rochon a,d, C. Leonard a,b, L. Laird a, H. Burianova c, P. Soros d,e, S. Graham c,e,g, C. Grady c,f a
Department of Speech-Language Pathology, University of Toronto, Toronto, Canada b Audiology and Speech-Language Pathology Program, School of Rehabilitation Sciences, University of Ottawa, Ottawa, Canada c Rotman Research Institute, Baycrest, Toronto, Canada d Toronto Rehabilitation Institute, Toronto, Canada e Imaging Research, Sunnybrook Health Sciences Centre, Toronto, Canada f Department of Psychology, University of Toronto, Toronto, Canada g Department of Medical Biophysics, University of Toronto, Toronto, Canada Treatment for anomia in aphasia has been found to be effective; however, the linguistic and cortical mechanisms underlying treatment and recovery in aphasia are poorly
201
understood. This study investigated the effectiveness of a phonological feature analysis treatment for anomia, using a multiple-baseline across behaviours design, as well as associated neural processing changes related to recovery after treatment. Six participants with aphasia were included. A subset of these patients received fMRI scans before and after treatment, as did patient control participants. Four of the patients improved substantially after treatment. Preliminary analysis of scan data suggest a shift from greater right to left hemisphere activation in one participant who improved after treatment, with no notable changes between scans 1 and 2 for the untreated control. doi:10.1016/j.bandc.2006.08.034
Development of executive and language disorders in stroke patients and effects on quality of life and vocational integration B. Stemmer a, T. Leim b, S. Lacher b a
Faculty of Arts and Sciences and Faculty of Medicine, Laboratory of Neuroscience and Neuropragmatics, Universite´ de Montre´al, Montreal, Canada b Laboratory of Neuroscience and Neuropragmatics, CRIUGM, Montreal, Canada Two hundred and twenty-one first time stroke patients with aphasia, executive impairment and a control group were investigated at the time of admission to and one year after discharge from neurological rehabilitation. The aphasic and the executively impaired stroke group showed significant improvement of their cognitive status one year after discharge. Aphasic syndromes accompanying a stroke were more likely to negatively influence employment and quality of life than impairment of executive functions accompanying a stroke. Severity of neurological impairment and language comprehension deficits at the time of admission proved important factors for future employment of aphasic patients. Although stroke patients with executive impairments seemed to fare better than aphasic stroke patients, compared to TBI patients with executive impairment they recovered more slowly over the same time period. doi:10.1016/j.bandc.2006.08.035
Abstracts / Brain and Cognition 63 (2007) 197–201
Preclinical vascular cognitive impairment and Alzheimer’s disease: Different neuropsychological deficits are present five years before diagnosis J. Ingles, D. White, J. Fisk, K. Rockwood Dalhousie University, Halifax, Canada Neuropsychological deficits that precede a diagnosis of vascular cognitive impairment (VCI) are not well understood. Our sample comprised 332 individuals diagnosed with no cognitive impairment (NCI) in the baseline phase of the population-based Canadian Study of Health and Aging. After five years, 41 were diagnosed with VCI, 25 with AD and 266 with NCI. The incident VCI group performed worse on an abstract reasoning test (WAIS-R Similarities) compared to incident AD and NCI groups. The incident AD group performed worse on memory tests (WAIS-R Information, Buschke Cued Recall) compared to incident VCI and NCI groups. This suggests a preclinical phase may exist in VCI that differs from that in AD. Neuropsychological measures may help in the design and implementation of preventive strategies for VCI. doi:10.1016/j.bandc.2006.08.030
Do hyperintensities in cholinergic pathways influence functional and behavioral outcomes in treated Alzheimer’s patients? P. Behla,c,d, C. Boctih,i, R.H. Swartz b,c,d, D.J. Sahlasb,c,d,e,j, K. Lanctoˆtc,d,f, D.L. Streinerc,d,f,g, S.E. Blacka,b,c,d,e,j a
Linda Campbell Cognitive Neurology Research Unit, Sunnybrook Health Sciences Centre, Toronto, Canada b Sunnybrook Health Sciences Centre, Toronto, Canada c Institute of Medical Science, University of Toronto, Toronto, Canada d University of Toronto, Toronto, Canada e Department of Medicine/(Neurology), Sunnybrook Health Sciences Centre, Toronto, Canada f Department of Psychiatry, University of Toronto, Toronto, Canada g Rotman Research Institute, Baycrest, Toronto, Canada h Division of Neurology, Department of Medicine, Maisonneuve-Rosemont Hospital, Montreal, Canada i University of Montreal, Montreal, Canada j HSFO Centre for Stroke Recovery, Toronto, Canada We investigated change in functional and behavioral outcomes over one year in 57 AD patients treated with cholinesterase inhibitors, in relation to white matter hyperintensities (WMH) involving the cholinergic pathways. CHIPS and ARWMC rating scales rated WMH in cholinergic pathways and general white matter lesion burden in the brain. The lower CHIPS group was younger, but equivalent to the higher group on other baseline demographics.
No differences emerged at one year in the functional domains (DAD) and most domains on the BEHAVEAD, except activity disturbances, which showed more decline in the severe group. For the ARWMC scale, groups were equivalent on baseline demographics and outcome. Cerebrovascular compromise of cholinergic pathways may be a factor contributing to heterogeneity of response to cholinergic treatment in AD. doi:10.1016/j.bandc.2006.08.031
The relationship of subcortical MRI hyperintensities and medial temporal lobe atrophy N. Levy a,d, F. Gao a, J. Ramirez a,d, S.E. Black a,b,c,d a
L.C. Campbell Cognitive Neurology Research Unit, Sunnybrook Health Sciences Centre, Toronto, Canada b HSFO Centre for Stroke Recovery, Toronto, Canada c Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada d Institute of Medical Science and Medical Biophysics, University of Toronto, Toronto, Canada The goal of this study was to investigate the relationship between deep white (DWH) and periventricular (PVH) hyperintensities to medial temporal lobe width (MTL) and ventricular cerebrospinal fluid (VCSF) volume in a group of Alzheimer’s disease (AD) patients. MRI was obtained in 59 AD patients (mean age 76.2 ± 6.3; mean MMSE, 13.6 ± 3). Brain volumes were determined using an in-house semi-automatic segmentation process. Thinnest medial temporal lobe width was measured bilaterally. PVH, not DWH volumes were inversely related to MTL width (r2 = 0.17, p < 0.01). No relationship was seen between VCSF and hyperintensities. In this study, only PVH were correlated to MTL atrophy. These findings suggest that PVH and DWH may have overlapping but not identical pathophysiological origins and should be differentiated in future studies. doi:10.1016/j.bandc.2006.08.032
GROUP III
Impact of cognitive rehabilitation on episodic memory and life habits in persons with stroke S. Blancheta, S. Bellevilleb, L. Noreaua,c, P. Fougeyrollasa,c, F. Cre´peaud a
Centre interdisciplinaire de recherche en re´adaptation et inte´gration sociale, Institut de Re´adaptation en De´ficience Physique de Que´bec, Quebec City, Canada b Centre de Recherche, Institut Universitaire de Ge´riatrie de Montre´al & De´partement de Psychologie, Universite´ de Montre´al, Montreal, Canada
Abstracts / Brain and Cognition 63 (2007) 197–201 c
De´partement de Re´adaptation, Universite´ Laval, Quebec City, Canada d Centre de Re´adaptation Lucie-Bruneau, Montre´al, Canada Although memory disorders frequently occur following a stroke, the effect of their rehabilitation has seldom been investigated. We assessed in patients with stroke the impact of a rehabilitation program that targets episodic memory and memory-involved processes on these specific cognitive functions, and on life habits. Six persons with stroke who exhibited memory disorders participated in a rehabilitation program that emphasized the learning of encoding and retrieval strategies, as well as the training of attentional and executive processes. Following rehabilitation, in comparison with control participants, persons with stroke exhibited improvement in their learning abilities in episodic memory, sustained attention, and their understanding of their financial responsibilities. Thus, persons with stroke would benefit from cognitive rehabilitation efforts and these benefits would also transfer to some complex life habits. doi:10.1016/j.bandc.2006.08.033
Investigation of a phonologically based treatment for anomia: Behavioral and neural changes E. Rochon a,d, C. Leonard a,b, L. Laird a, H. Burianova c, P. Soros d,e, S. Graham c,e,g, C. Grady c,f a
Department of Speech-Language Pathology, University of Toronto, Toronto, Canada b Audiology and Speech-Language Pathology Program, School of Rehabilitation Sciences, University of Ottawa, Ottawa, Canada c Rotman Research Institute, Baycrest, Toronto, Canada d Toronto Rehabilitation Institute, Toronto, Canada e Imaging Research, Sunnybrook Health Sciences Centre, Toronto, Canada f Department of Psychology, University of Toronto, Toronto, Canada g Department of Medical Biophysics, University of Toronto, Toronto, Canada Treatment for anomia in aphasia has been found to be effective; however, the linguistic and cortical mechanisms underlying treatment and recovery in aphasia are poorly
201
understood. This study investigated the effectiveness of a phonological feature analysis treatment for anomia, using a multiple-baseline across behaviours design, as well as associated neural processing changes related to recovery after treatment. Six participants with aphasia were included. A subset of these patients received fMRI scans before and after treatment, as did patient control participants. Four of the patients improved substantially after treatment. Preliminary analysis of scan data suggest a shift from greater right to left hemisphere activation in one participant who improved after treatment, with no notable changes between scans 1 and 2 for the untreated control. doi:10.1016/j.bandc.2006.08.034
Development of executive and language disorders in stroke patients and effects on quality of life and vocational integration B. Stemmer a, T. Leim b, S. Lacher b a
Faculty of Arts and Sciences and Faculty of Medicine, Laboratory of Neuroscience and Neuropragmatics, Universite´ de Montre´al, Montreal, Canada b Laboratory of Neuroscience and Neuropragmatics, CRIUGM, Montreal, Canada Two hundred and twenty-one first time stroke patients with aphasia, executive impairment and a control group were investigated at the time of admission to and one year after discharge from neurological rehabilitation. The aphasic and the executively impaired stroke group showed significant improvement of their cognitive status one year after discharge. Aphasic syndromes accompanying a stroke were more likely to negatively influence employment and quality of life than impairment of executive functions accompanying a stroke. Severity of neurological impairment and language comprehension deficits at the time of admission proved important factors for future employment of aphasic patients. Although stroke patients with executive impairments seemed to fare better than aphasic stroke patients, compared to TBI patients with executive impairment they recovered more slowly over the same time period. doi:10.1016/j.bandc.2006.08.035