Post-Stroke Cognitive Impairments and Responsiveness to Motor Rehabilitation: A Review

VanGilder, Jennapher Lingo; Hooyman, Andrew; Peterson, Daniel S.; Schaefer, Sydney Y.

doi:10.1007/s40141-020-00283-3

Cited by 44 publications

(27 citation statements)

References 83 publications

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“…Previous studies have shown connections between executive and attention function and motor control, including gait functions (3) [e.g., (20,22,(44)(45)(46)]. While the connections between cognition and motor function have been mostly investigated in cohorts of healthy elderly persons and persons with stroke and Parkinson's disease, our study for the first time shows similar connections in TBI recovery.…”

Section: Discussionsupporting

confidence: 57%

Relationship Between Cognition and Gait at 2- and 12-Months Post-Traumatic Brain Injury

Vuong

Patterson

Cole

et al. 2021

Front. Rehabilit. Sci.

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Background: A common and debilitating challenge experienced by people with TBI is gait-associated mobility impairment and persisting cognitive impairments. Cognitive and physical impairments are often addressed independently during rehabilitation, however, increasing evidence links cognitive and motor processes more closely.Objectives: (1) To determine if correlations exist between measures of cognitive and gait recovery, post-TBI. (2) To investigate the predictive power of cognition at 2-months on gait outcomes at 12-months post-TBI.Methods: In this secondary, longitudinal study of cognitive and neural recovery, data from 93 participants admitted to an inpatient neurorehabilitation program were analyzed. Spatiotemporal gait variables [velocity, step time variability (STV), step length variability (SLV)] were collected along with cognitive variables [Trail Making Test-B (TMT-B), Digit Span-Forward (DS-F)]. Spearman's correlation coefficients were calculated between gait and cognitive variables. Multilinear and step wise regression analyses were calculated to determine predictive value of cognitive variables at 2-months on gait performance at 12-months-post TBI.Results: At 2-months post-injury, TMT-B was significantly correlated with gait velocity and STV; and DS-F was significantly correlated with velocity. At 12-months post-injury, TMT-B and DS-F was still significant correlated with velocity. TMT-B at 2-months was correlated with SLV and STV at 12-months; and DS-F correlated significantly with velocity. Regression models showed TMT-B at 2-months predicting STV, SLV, and velocity at 12-months.Conclusions: Significant associations and predictions between physical and cognitive recovery post-TBI were observed in this study. Future directions may consider a “neural internetwork” model as a salient rehabilitation approach in TBI that integrates physical and cognitive functions.

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Section: Discussionsupporting

confidence: 57%

Relationship Between Cognition and Gait at 2- and 12-Months Post-Traumatic Brain Injury

Vuong

Patterson

Cole

et al. 2021

Front. Rehabilit. Sci.

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show abstract

“…Therefore, we believe that, as part of the routine follow-up protocol after stroke, assessments of cognition and global motor functions should be performed to gain more information that may be relevant for prognosis and may indicate a need for continued rehabilitation even 3 months after a stroke [45]. Further cognitive function is very important for planning and performing rehabilitation and cognitive impairment, such as impaired memory or executive dysfunction, might change responsiveness to motor rehabilitation, which should be taken into consideration when developing targeted interventions in stroke populations [46]. We did not find support for motor performance being more closely associated with specific cognitive domains, and we suggest using global tests like MoCA and SPPB in order to assess cognitive and motor function.…”

Section: Discussionmentioning

confidence: 99%

Associations between post-stroke motor and cognitive function: a cross-sectional study

et al. 2021

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Background Motor and cognitive impairments are frequently observed following stroke, but are often managed as distinct entities, and there is little evidence regarding how they are related. The aim of this study was to describe the prevalence of concurrent motor and cognitive impairments 3 months after stroke and to examine how motor performance was associated with memory, executive function and global cognition. Methods The Norwegian Cognitive Impairment After Stroke (Nor-COAST) study is a prospective multicentre cohort study including patients hospitalized with acute stroke between May 2015 and March 2017. The National Institutes of Health Stroke Scale (NIHSS) was used to measure stroke severity at admission. Level of disability was assessed by the Modified Rankin Scale (mRS). Motor and cognitive functions were assessed 3 months post-stroke using the Montreal Cognitive Assessment (MoCA), Trail Making Test Part B (TMT-B), 10-Word List Recall (10WLR), Short Physical Performance Battery (SPPB), dual-task cost (DTC) and grip strength (Jamar®). Cut-offs were set according to current recommendations. Associations were examined using linear regression with cognitive tests as dependent variables and motor domains as covariates, adjusted for age, sex, education and stroke severity. Results Of 567 participants included, 242 (43%) were women, mean (SD) age was 72.2 (11.7) years, 416 (75%) had an NIHSS score ≤ 4 and 475 (84%) had an mRS score of ≤2. Prevalence of concurrent motor and cognitive impairment ranged from 9.5% for DTC and 10WLR to 22.9% for grip strength and TMT-B. SPPB was associated with MoCA (regression coefficient B = 0.465, 95%CI [0.352, 0.578]), TMT-B (B = -9.494, 95%CI [− 11.726, − 7.925]) and 10WLR (B = 0.132, 95%CI [0.054, 0.211]). Grip strength was associated with MoCA (B = 0.075, 95%CI [0.039, 0.112]), TMT-B (B = -1.972, 95%CI [− 2.672, − 1.272]) and 10WLR (B = 0.041, 95%CI [0.016, 0.066]). Higher DTC was associated with more time needed to complete TMT-B (B = 0.475, 95%CI [0.075, 0.875]) but not with MoCA or 10WLR. Conclusion Three months after suffering mainly minor strokes, 30–40% of participants had motor or cognitive impairments, while 20% had concurrent impairments. Motor performance was associated with memory, executive function and global cognition. The identification of concurrent impairments could be relevant for preventing functional decline. Trial registration ClinicalTrials.gov Identifier: NCT02650531.

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“…Therefore, we believe that, as part of the routine follow-up protocol after stroke, assessments of cognition and global motor functions should be performed to gain more information that may be relevant for prognosis and may indicate a need for continued rehabilitation even three months after a stroke (46). Further cognitive impairments might change responsiveness to motor rehabilitation, which should be taken into consideration when developing targeted interventions in stroke populations (47). We did not nd support for motor performance being more closely associated with speci c cognitive domains, and we suggest using global tests like the MoCA and SPPB for risk strati cation.…”

Section: Discussionmentioning

confidence: 99%

Associations between Post-Stroke Motor and Cognitive Function: A Cross-Sectional Study

Einstad

Saltvedt

Lydersen

et al. 2020

Preprint

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BACKGROUND: Although both motor and cognitive impairments are frequently observed following stroke, these are often managed as distinct entities, and there is little evidence regarding how they are related. The aim of this study was to describe the prevalence of concurrent motor and cognitive impairments three months after stroke and to examine how motor performance was associated with memory, executive function and global cognition. METHODS: The Norwegian Cognitive Impairment After Stroke (Nor-COAST) study is a prospective multicentre cohort study including patients hospitalized with acute stroke. The National Institutes of Health Stroke Scale (NIHSS) was used to measure stroke severity, and function was measured by the Modified Rankin Scale (mRS). Motor and cognitive functions were assessed three months post-stroke using the Montreal Cognitive Assessment (MoCA), Trail Making Test Part B (TMT-B), 10-Word List Recall (10WLR), Short Physical Performance Battery (SPPB), dual-task cost (DTC) and grip strength. Cut-offs were set according to current recommendations. Associations were examined using linear regression with the cognitive tests as dependent variables and motor domains as covariates, adjusted for age, sex, education and stroke severity. RESULTS: Of 567 participants included, 242 (43%) were women, mean (SD) age was 72.2 (11.7) years, 416 (75%) had an NIHSS score ≤ 4 and 475 (84%) had an mRS score of ≤ 2. Prevalence of concurrent motor and cognitive impairment ranged from 9.5% for DTC and 10WLR to 22.9% for grip strength and TMT-B. The SPPB was associated with the MoCA (regression coefficient B=0.465, 95%CI [0.352, 0.578]), TMT-B (B=-9.494, 95%CI [-11.726, -7.925]) and 10WLR (B=0.132, 95%CI [0.054, 0.211]). Grip strength was associated with the MoCA (B=0.075, 95%CI [0.039, 0.112]), TMT-B (B=-1.972, 95%CI [-2.672, -1.272]) and 10WLR (B=0.041, 95%CI [0.016, 0.066]). Higher DTC was associated with more time needed to complete the TMT-B (B=0.475, 95%CI [0.075, 0.875]) but not with the MoCA or 10WLR.CONCLUSION: Three months after suffering mainly minor strokes, 30–40% of participants had motor or cognitive impairments, while 20% had concurrent impairments. Motor performance was associated with memory, executive function and global cognition. The identification of concurrent impairments could be relevant for preventing functional decline.Clinical Trial Registration: ClinicalTrials.gov Identifier: NCT02650531

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Post-Stroke Cognitive Impairments and Responsiveness to Motor Rehabilitation: A Review

Cited by 44 publications

References 83 publications

Relationship Between Cognition and Gait at 2- and 12-Months Post-Traumatic Brain Injury

Relationship Between Cognition and Gait at 2- and 12-Months Post-Traumatic Brain Injury

Associations between post-stroke motor and cognitive function: a cross-sectional study

Associations between Post-Stroke Motor and Cognitive Function: A Cross-Sectional Study

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