Executive (dys)function after stroke: special considerations for behavioral pharmacology

Abstract

Stroke is a worldwide leading cause of death and long-term disability with concurrent secondary consequences that are largely comprised of mood dysfunction, as well as sensory, motor, and cognitive deficits. This review focuses on the cognitive deficits associated with stroke specific to executive dysfunction (including decision making, working memory, and cognitive flexibility) in humans, nonhuman primates, and additional animal models. Further, we review some of the cellular and molecular underpinnings of the individual components of executive dysfunction and their neuroanatomical substrates after stroke, with an emphasis on the changes that occur during biogenic monoamine neurotransmission. We concentrate primarily on changes in the catecholaminergic (dopaminergic and noradrenergic) and serotonergic systems at the levels of neurotransmitter synthesis, distribution, reuptake, and degradation. We also discuss potential secondary stroke-related behavioral deficits (specifically, poststroke depression as well as drug-abuse potential and addiction) and their relationship with stroke-induced deficits in executive function, an especially important consideration given that the average age of the human stroke population is decreasing. In the final sections, we address pharmacological considerations for the treatment of ischemia and the subsequent functional impairment, as well as current limitations in the field of stroke and executive function research.

Emotional and Psychological Effects of Dysphagia: Validation of the Jugendwerk Dysphagia Emotion and Family Assessment (JDEFA)

“…With respect to concentration deficits [ 33 ]and fatigue [ 34 ] especially for stroke patients suffering from dysphagia (and aphasia), a shortened questionnaire comprising the factors with best loadings (bold items in Table 4 ) may be more useful after intensive reevaluation of the tool itself and a possible reliability–validity dilemma in other populations.…”

A Novel Perspective on the Proactive and Reactive Controls of Executive Function in Chronic Stroke Patients.

“…Proactive control in AX-CPT was reported to be relied upon the anticipation and prevention of interference before it occurred in the working memory (Braver, 2012;Ryman et al, 2019). Several studies have indicated working memory de cits in patients with stroke (Povroznik, Ozga, Vonder Haar, & Engler-Chiurazzi, 2018;van Geldorp, Kessels, & Hendriks, 2013). In the study by van Geldorp et al (2013), the participants were required to remember which cue was presented after a short temporal delay in a computerized delayed-match-to-sample task which included spatial, object, or binding (spatial + object) cues.…”

Mini-Review of Studies Testing the Cardiorespiratory Hypothesis With Near-Infrared Spectroscopy (NIRS): Overview and Perspectives

“…A recent meta-analysis showed that a program combining aerobic and resistance exercise (i.e., performed at moderate intensity, three times a week for 20 weeks) had a greater effect on cardiorespiratory fitness, muscle strength, and walking ability in stroke patients ( Lee and Stone, 2020 ) than aerobic or resistance training alone. However, this effect of exercise on cardiorespiratory fitness is not related to executive functions, which are dysfunctional in 75% of stroke patients ( Povroznik et al, 2018 ). Hence, future studies may explore the links between executive functions, cardiorespiratory fitness and cerebral oxygenation in stroke patients and even in other populations suffering from other chronic pathologies using a randomized controlled protocol.…”