Using the Oxford Cognitive Screen to detect cognitive impairment in stroke patients: a comparison with the Mini-Mental State Examination

Background: The Oxford Cognitive Screen (OCS) was recently developed with the aim of describing the cognitive deficits after stroke. The scale consists of 10 tasks encompassing five cognitive domains: attention and executive function, language, memory, number processing, and praxis. OCS was devised to be inclusive and un-confounded by aphasia and neglect. As such, it may have a greater potential to be informative on stroke cognitive deficits of widely used instruments, such as the Mini-Mental State Examination (MMSE) or the Montreal Cognitive Assessment, which were originally devised for demented patients. Objective: The present study compared the OCS with the MMSE with regards to their ability to detect cognitive impairments post-stroke. We further aimed to examine performance on the OCS as a function of subtypes of cerebral infarction and clinical severity. Methods: 325 first stroke patients were consecutively enrolled in the study over a 9-month period. The OCS and MMSE, as well as the Bamford classification and NIHSS, were given according to standard procedures. Results: About a third of patients (35.3%) had a performance lower than the cutoff (<22) on the MMSE, whereas 91.6% were impaired in at least one OCS domain, indicating higher incidences of impairment for the OCS. More than 80% of patients showed an impairment in two or more cognitive domains of the OCS. Using the MMSE as a standard of clinical practice, the comparative sensitivity of OCS was 100%. Out of the 208 patients with normal MMSE performance 180 showed impaired performance in at least one domain of the OCS. The discrepancy between OCS and MMSE was particularly strong for patients with milder strokes. As for subtypes of cerebral infarction, fewer patients demonstrated widespread impairments in the OCS in the Posterior Circulation Infarcts category than in the other categories. Conclusion: Overall, the results showed a much higher incidence of cognitive impairment with the OCS than with the MMSE and demonstrated no false negatives for OCS vs MMSE. It is concluded that OCS is a sensitive screen tool for cognitive deficits after stroke. In particular, the OCS detects high incidences of stroke-specific cognitive impairments, not detected by the MMSE, demonstrating the importance of cognitive profiling

Hemispheric contribution to categorical and coordinate representational processes: a study on brain damaged patients

According to Kosslyn, two types of spatial relations can be used to arrange parts in mental imagery, i.e., categorical spatial relations and coordinate spatial relations, which are processed respectively by the left and right hemispheres. To investigate this possible hemispheric specialization in the imagery domain, we tested 34 left or right brain-damaged patients using both a categorical and a coordinate mental imagery task. The results show that left brain-damaged patients were selectively impaired on processing categorical representations, while right brain-damaged patients were more impaired on the processing the coordinate ones, regardless of the presence of visuo-spatial neglect. The present study partly support Kosslyn's theory and, despite data reported in previous studies of brain-damaged patients, it also supports the hypothesis of a possible bilateral neural representation of mental imagery, with the two hemispheres taking part in this process in different ways.According to Kosslyn, two types of spatial relations can be used to arrange parts in mental imagery, i.e., categorical spatial relations and coordinate spatial relations, which are processed respectively by the left and right hemispheres. To investigate this possible hemispheric specialization in the imagery domain, we tested 34 left or right brain-damaged patients using both a categorical and a coordinate mental imagery task. The results show that left brain-damaged patients were selectively impaired on processing categorical representations, while right brain-damaged patients were more impaired on the processing the coordinate ones, regardless of the presence of visuo-spatial neglect. The present study partly support Kosslyn's theory and, despite data reported in previous studies of brain-damaged patients, it also supports the hypothesis of a possible bilateral neural representation of mental imagery, with the two hemispheres taking part in this process in different ways

Mirror writing resulting from an egocentric representation disorder: A case report

Buchwald (1878 ) used the term 'mirror writing' to indicate writing in the reverse direction to what is normal in a particular language and in which the individual letters are also reversed. Cases of healthy individuals (i.e., Leonardo da Vinci and Lewis Carroll) as well as brain-damaged patients have been described in the literature. Here, we report the case of PM, a 70-year-old right-handed woman who showed right hemiplegia and mirror writing following a stroke in the left lenticular nucleus and internal capsulae. PM underwent a complete neuropsychological evaluation, which included copying, dictation and spontaneous writing in both hemispaces with both hands. She was also tested for topographical disorientation, visuo-spatial disorders and body schema deficits. We observed isolated mirror writing only when PM wrote with the left hand, without differences between hemispaces. She also showed a left-right disorientation, a body topological map disorder and an egocentric misrepresentation. The presence of mirror writing not confined to one hemispace and the co-presence of executive function disorders, as well as anosognosia, suggests damage to our patient's sub-cortical frontal network. As no previous interpretation fits with PM's symptoms, we hypothesize that mirror writing resulted from damage to her egocentric frame of reference. This hypothesis allows us to interpret the patient's array of disorders, including mirror writing, body topological map disorder, left-right confusion and egocentric representation.Buchwald (1878 ) used the term 'mirror writing' to indicate writing in the reverse direction to what is normal in a particular language and in which the individual letters are also reversed. Cases of healthy individuals (i.e., Leonardo da Vinci and Lewis Carroll) as well as brain-damaged patients have been described in the literature. Here, we report the case of PM, a 70-year-old right-handed woman who showed right hemiplegia and mirror writing following a stroke in the left lenticular nucleus and internal capsulae. PM underwent a complete neuropsychological evaluation, which included copying, dictation and spontaneous writing in both hemispaces with both hands. She was also tested for topographical disorientation, visuo-spatial disorders and body schema deficits. We observed isolated mirror writing only when PM wrote with the left hand, without differences between hemispaces. She also showed a left-right disorientation, a body topological map disorder and an egocentric misrepresentat

Impact of participation on rehabilitation results: a multivariate study.

Background. Participation in inpatients is commonly considered as a relevant factor influencing rehabilitation results, but its effects are still not exhaustively investigated. Aim. To clarify and quantify the impact of level of participation in rehabilitation on functional outcome in inpatients. Design. Prospective, observational multivariate study. Settings. Rehabilitation hospital. Population. Three hundred and sixty-two patients (mean age 59.41 +/- 12.85 years) with stroke or orthopedic diseases consecutively admitted to rehabilitation hospital. Methods. Rehabilitation program participation was assessed by means of Pittsburgh Rehabilitation Participation Scale (PRPS). Patients who scored below 4 in 25% of the physical and occupational therapy treatment were classified as "low" participants. Multiple and logistic regressions were performed to identify variables associated not only with participation but also with rehabilitation results. Results. Nearly one third of patients (33.88%, primarily stroke) showed low participation. Low early participation (within the first two weeks) was associated with disability and depressive symptoms at admission, and late participation with early participation, age and years of schooling. Both early and late participation were associated with effectiveness of treatment on both ADL and mobility, even if there was much unexplained variance in both models. Patients with low early participation had a greater risk (OR=2.45, 95% CI 1.27-4.71) of a low response to treatment on mobility than the patients who had participated more. Among other prognostic factors, early start of rehabilitation treatment and the presence of cognitive and neuropsychological impairments have significant roles. Conclusions. Our results confirm the importance of participation in rehabilitation programs, which should be encouraged. Further studies are needed to improve knowledge about the overall effects of participation. Clinical Rehabilitation Impact. Early participation should be considered a treatment target as well as a prognostic factor

Psychological features and outcomes of the Back School treatment in patients with chronic non-specific low back pain. A randomized controlled study

Background. Low back pain is a worldwide health problem, affecting up to 80% of adult population. Psychological factors are involved in its development and maintenance. Many clinical trials have evaluated the efficacy of different interventions for chronic nonspecific low back pain. In this field, Back School program has been demonstrated effective for people with chronic non-specific low back. Aim. To evaluate the relationship between the effects of the Back School treatment and psychological features measured by MMPI-II of patients with chronic non-specific low back pain. Design. A randomised controlled trial with three and six-month follow-up. Setting. Ambulatory rehabilitative university centre. Population. Fifty patients with chronic non-specific low back pain out of 77 screened patients. Methods. Patients were randomly placed in a 3:2 form and were allocated into two groups (Treatment versus Control). The Treatment Group participated to an intensive multidisciplinary Back School program (BSG, N.=29), while the Control Group received medical assistance (CG, N.=21). Medication was the same in both groups. Then, patients were subgrouped in those with at least an elevation in one scale of MMPI-II, and those without it. The Short Form 36 Health Status Survey for the assessment of quality of life (primary outcome measure), pain Visual Analogue Scale, Waddel Index and Oswestry Disability Index were collected at baseline, at the end of treatment, and at the three and six-month follow-up. Results. Only the two treated subgroups showed a significant improvements in terms of quality of life, disability and pain. Among treated subjects, only those with at least one scale elevation in MMPI-II showed also a significant improvement in terms of Short Form 36 mental composite score and relevant subscores. Conclusion. These results suggest that Back School program has positive effects, even in terms of mental components of quality of life in patients with scale elevations of MMPI-H. Probably these findings are due to its educational and cognitive-behavioural characteristics. Clinical rehabilitation impact. Because of its educational purposes, the Back School treatment can have positive effects also on the mental status of patients with low back pain when it affects their psychological features

Quality of life improved by multidisciplinary back school program in patıents wıth chronıc non-specıfıc low back paın: a sıngle blınd randomızed controlled trıal.

STUDY DESIGN: A three and six months follow-up in a randomized controlled trial. BACKGROUND: Back School has become a widespread exercise program for low back pain (LBP), since its introduction in 1969. Back School could improve quality of life (QoL), but there are controversial data regarding its effectiveness. AIM: To evaluate the effects of the Back School program on quality of life (primary outcome), disability and pain perceptions (secondary outcomes) in patients with chronic and non-specific low back pain. SETTING: Rehabilitative specialized centre. POPULATION: Seventy four patients with chronic non-specific LBP. METHODS: Patients were randomly placed in a 3:2 form and were allocated into 2 groups (treated-control). Treatment group participated in a intensive multidisciplinary Back School program including brief education and active back exercises (BSG, N.=41), while the control group received medical assistance (CG, N.=29). Medication was the same in both groups. The Short Form 36 Health Status Survey, Waddel Index, Oswestry Disability Index and Visual Analogue Scale were collected at baseline, at the end of treatment, and at the three and six month follow-up. RESULTS: Quality of life significantly improved along time more in BSG, both in Physical and Mental Composite Score (repeated measure Anova: interaction time per group: P<0.001 and P=0.002, respectively). We also observed a significant improvement in disability scores along time (P<0.001) in BSG with significant differences between groups at three and at six months for Waddell Index (P=0.006 and P=0.009 respectively) and for Oswestry Disability Index (P=0.018 and 0.011 respectively). Moreover, pain perception score VAS showed a reduction in both groups, but it was significantly lower in BSG at end of treatment and both follow-ups (P<0.001). CONCLUSION: Our Back School program can be considered an effective treatment in people with chronıc non-specıfıc LBP