Dissecting the cognitive phenotype of post‐stroke fatigue using computerized assessment and computational modeling of sustained attention

Ulrichsen, Kristine M.; Alnæs, Dag; Kolskår, Knut-Kristian; Richard, Geneviève; Sanders, Anne-Marthe; Dørum, Erlend S.; Ihle‐Hansen, Hege; Pedersen, Mads Lund; Tornås, Sveinung; Nordvik, Jan Egil

doi:10.1111/ejn.14861

Cited by 32 publications

(48 citation statements)

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“…b One patient had intracerebral hemorrhage. (Kolskår et al, 2020;Ulrichsen et al, 2020). history of stroke, dementia, or other neurologic and psychiatric diseases, alcoholand substance abuse, medications significantly affecting the nervous system and contraindications for MRI.…”

Section: Healthy Controlsmentioning

confidence: 99%

“…The computerized working memory training program (Cogmed Systems AB, Stockholm, Sweden) consisted of 25 online training sessions. In this study, to increase feasibility, we utilized 17 sessions over a period of three to four weeks, corresponding to approximately five weekly training sessions (Kolskår et al, 2020;. On average, patients completed two training sessions combined with tDCS (stimulation was applied during the first 20 min of the training session) per week with a minimum of one day between each tDCS session.…”

Section: Cct Protocolmentioning

confidence: 99%

“…The details of the protocol have been described previously (Kolskår et al, 2020). Briefly, participants were randomly assigned to an active or a sham condition.…”

Section: Tdcs Protocolmentioning

confidence: 99%

“…We used the same performance improvement scores as in previous publications (Kolskår et al, 2020;. Briefly, we used linear modeling with performance as dependent variable and session as independent variable to quantify the changes in performance across the training period for each participant and for each trained task.…”

Section: Processing Of Cogmed Datamentioning

confidence: 99%

“…Here, we combined a cross-sectional case-control comparison in 70 chronic stroke patients who suffered mild to moderate stroke (>6 months since hospital admission, National Institute of Health Stroke Scale (NIHSS;Lyden et al, 2009) ≤ 7 at hospital discharge) and healthy controls (n = 140) with a longitudinal assessment during the course of a computerized cognitive training (CCT), in which 54 of the stroke patients completed an intensive CCT program and were either assigned to an active transcranial direct current stimulation (tDCS) or sham-tDCS condition in order to test for putative beneficial effects of brain stimulation in combination with CCT (Kolskår et al, 2020). We assessed the sensitivity and reliability of TVA parameters reflecting short-term memory capacity (K ), processing speed (C) and perceptual threshold (t 0 ) based on a whole-report behavioral paradigm.…”

Section: Introductionmentioning

confidence: 99%

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TVA-based modeling of short-term memory capacity, speed of processing and perceptual threshold in chronic stroke patients undergoing cognitive training: case-control differences, reliability, and associations with cognitive performance

Richard

Petersen

Ulrichsen

et al. 2020

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Attentional deficits following stroke are common and pervasive, and are important predictors for functional recovery. Attentional functions comprise a set of specific cognitive processes allowing to attend, filter and select among a continuous stream of stimuli. These mechanisms are fundamental for more complex cognitive functions such as learning, planning and cognitive control, all crucial for daily functioning. The distributed functional neuroanatomy of these processes is a likely explanation for the high prevalence of attentional impairments following stroke, and underscores the importance of a clinical implementation of computational approaches allowing for sensitive and specific modeling of attentional sub-processes. The Theory of Visual Attention (TVA) offers a theoretical, computational, neuronal and practical framework to assess the efficiency of visual selection performance and parallel processing of multiple objects. Here, in order to assess the sensitivity and reliability of TVA parameters reflecting short-term memory capacity (K), processing speed (C) and perceptual threshold (t0), we used a whole-report paradigm in a cross-sectional case-control comparison and across six repeated assessments over the course of a three-week computerized cognitive training (CCT) intervention in chronic stroke patients (> 6 months since hospital admission, NIHSS ≤ 7 at hospital discharge). Cross-sectional group comparisons documented lower short-term memory capacity, lower processing speed and higher perceptual threshold in patients (n = 70) compared to age-matched healthy controls (n = 140). Further, longitudinal analyses in stroke patients during the course of CCT (n = 54) revealed high reliability of the TVA parameters, and higher processing speed at baseline was associated with larger cognitive improvement after the intervention. The results support the feasibility, reliability and sensitivity of TVA-based assessment of attentional functions in chronic stroke patients.

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Section: Healthy Controlsmentioning

confidence: 99%

Section: Cct Protocolmentioning

confidence: 99%

“…The details of the protocol have been described previously (Kolskår et al, 2020). Briefly, participants were randomly assigned to an active or a sham condition.…”

Section: Tdcs Protocolmentioning

confidence: 99%

Section: Processing Of Cogmed Datamentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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TVA-based modeling of short-term memory capacity, speed of processing and perceptual threshold in chronic stroke patients undergoing cognitive training: case-control differences, reliability, and associations with cognitive performance

Richard

Petersen

Ulrichsen

et al. 2020

PeerJ

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No add‐on effect of tDCS on fatigue and depression in chronic stroke patients: A randomized sham‐controlled trial combining tDCS with computerized cognitive training

et al. 2022

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Background Fatigue and emotional distress rank high among self‐reported unmet needs in life after stroke. Transcranial direct current stimulation (tDCS) may have the potential to alleviate these symptoms for some patients, but the acceptability and effects for chronic stroke survivors need to be explored in randomized controlled trials. Methods Using a randomized sham‐controlled parallel design, we evaluated whether six sessions of 1 mA tDCS (anodal over F3, cathodal over O2) combined with computerized cognitive training reduced self‐reported symptoms of fatigue and depression. Among the 74 chronic stroke patients enrolled at baseline, 54 patients completed the intervention. Measures of fatigue and depression were collected at five time points spanning a 2 months period. Results While symptoms of fatigue and depression were reduced during the course of the intervention, Bayesian analyses provided evidence for no added beneficial effect of tDCS. Less severe baseline symptoms were associated with higher performance improvement in select cognitive tasks, and study withdrawal was higher in patients with more fatigue and younger age. Time‐resolved symptom analyses by a network approach suggested higher centrality of fatigue items (except item 1 and 2) than depression items. Conclusion The results reveal no add‐on effect of tDCS on fatigue or depression but support the notion of fatigue as a relevant clinical symptom with possible implications for treatment adherence and response.

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Exploring the associations between physical activity level, cognitive performance, and response to computerized cognitive training among chronic stroke patients

Sanders,

Richard,

Kolskår

et al. 2024

Brain and Behavior

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BackgroundPost‐stroke attentional and working memory deficits are common and represent relevant predictors of long‐term functional recovery and outcome. The individual responses to cognitive rehabilitation and interventions vary between patients and are influenced by multiple factors. Recently, a link between the level of engagement in physical activities and cognitive rehabilitation has been suggested. However, few previous studies have tested the predictive value of physical activity on cognitive performance and response to cognitive training among chronic stroke patients. There is also a lack of knowledge concerning the prognostic value of index stroke characteristics on physical activity in chronic phase.MethodIn this cross‐sectional and longitudinal study, including stroke survivors suffering mild‐to‐moderate strokes (n = 52, mean age = 70 years), we used Bayesian regression to test the association between cognitive performance and response to a 3‐week intervention with a commonly used computerized cognitive training (CCT) system and baseline physical activity level measured with International Physical Activity Questionnaire. We also tested the association between physical activity level in chronic phase and stroke characteristics, including stroke severity (National Institutes of Health Stroke Scale), ischemic stroke etiology (Trial of Org 10172 in Acute Stroke Treatment), and stroke location (n = 66, mean age = 68 years). For descriptive purposes, we included 104 sex‐ and age‐matched healthy controls (mean age = 69 years).ResultsThe analyses revealed anecdotal evidence of a positive association between overall cognitive performance and daily minutes of sedentary behavior, indicating that better cognitive performance was associated with more daily hours of sitting still. We found no support for an association between cognitive performance and response to CCT with activity level. In addition, the analysis showed group differences in sedentary behavior between patients with small‐vessel disease (n = 20) and cardioembolism (n = 7), indicating more sedentary behavior in patients with small‐vessel disease. There was no further support for a predictive value of index stroke characteristics on physical activity level.ConclusionThe results do not support that baseline physical activity level is a relevant predictor of the overall performance or response to CCT in this sample of chronic stroke patients. Similarly, the analyses revealed little evidence for an association between index stroke characteristics and future activity level in patients surviving mild‐to‐moderate stroke.

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Dissecting the cognitive phenotype of post‐stroke fatigue using computerized assessment and computational modeling of sustained attention

Abstract: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Cited by 32 publications

References 62 publications

TVA-based modeling of short-term memory capacity, speed of processing and perceptual threshold in chronic stroke patients undergoing cognitive training: case-control differences, reliability, and associations with cognitive performance

TVA-based modeling of short-term memory capacity, speed of processing and perceptual threshold in chronic stroke patients undergoing cognitive training: case-control differences, reliability, and associations with cognitive performance

No add‐on effect of tDCS on fatigue and depression in chronic stroke patients: A randomized sham‐controlled trial combining tDCS with computerized cognitive training

Exploring the associations between physical activity level, cognitive performance, and response to computerized cognitive training among chronic stroke patients

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