The assessment of hemineglect syndrome with cancellation tasks. A comparison between the bells test and the Apples test

Unilateral spatial neglect (USN) is a frequent consequence of acquired brain injury, especially following right hemisphere damage. Traditionally, unilateral spatial neglect is assessed with cancellation tests such as the Bells test. Recently, a new cancellation test, the Apples test, has been proposed. The present study aims at comparing the accuracy of these two tests in detecting hemispatial neglect, on a sample of 56 right hemisphere stroke patients with a diagnosis of USN. In order to evaluate the agreement between the Apples and Bells tests, Cohen's kappa and McNemar's test were used to assess differences between the two methods of evaluation. Poor agreement and statistically significant differences emerged between the Apples and Bells tests. Overall, the Apples test was significantly more sensitive than the Bells test in detecting USN. Based on these results, the use of the Apples test for peripersonal neglect assessment is therefore highly recommende

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 de cits after stroke. The scale consists of 10 tasks encom- passing ve 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 de cits 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 perfor- mance on the OCS as a function of subtypes of cerebral infarction and clinical severity. Methods: 325 rst stroke patients were consecutively enrolled in the study over a 9-month period. The OCS and MMSE, as well as the Bamford classi cation 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 de cits after stroke. In particular, the OCS detects high incidences of stroke-specific cognitive impairments, not detected by the MMSE, demonstrating the importance of cognitive pro ling.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. © 2018 Mancuso, Demeyere, Abbruzzese, Damora, Varalta, Pirrotta, Antonucci, Matano, Caputo, Caruso, Pontiggia, Coccia, Ciancarelli, Zoccolotti and The Italian OCS Grou

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

Correlati neurocognitivi della Sindrome di Capgras e della paramnesia reduplicativa per i luoghi

Introduzione La sindrome di Capgras (CS) è caratterizzata dalla ferma convinzione che una o più persone familiari, siano state sostituite da impostori, che sono fisicamente molto simili all’originale. La paramnesia reduplicativa per i luoghi (RP) è caratterizzata dalla convinzione che un luogo sia stato duplicato, esistendo contemporaneamente in due luoghi. CS e RP, sono state tradizionalmente considerate come il risultato di un conflitto psicodinamico, ma in seguito alla descrizione di numerosi casi ad eziologia organica, sono state ipotizzate basi neuropsicologiche. Il presente studio si propone di chiarire tali ipotesi approfondendo i diversi domini neuropsicologici. Materiali e Metodi Sono stati inclusi 14 pazienti affetti da Demenza con corpi di Lewy (LBD), 14 pazienti con Malattia di Alzheimer (AD), e 14 soggetti di controllo esenti da patologie neuro-psichiatriche. Sono stati eseguiti due lavori sperimentali: nell’indagine sulla CS, il gruppo LBD era formato da 8 pazienti con CS e 6 privi di tale sindrome., nell’indagine sulla PR, il gruppo LBD era formato da 7 pazienti con PR e 7 privi di tale sindrome. La batteria costruita (prove con i volti per l’indagine sulla CS e prove con gli edifici per la PR) esplora differenti domini neuropsicologici: Abilità percettive: analizzate attraverso i test di identificazione di genere, identificazione di età, discriminazione percettiva di volti, associazione di edifici nella stessa prospettiva, associazione di edifici in prospettiva diversa. Riconoscimento di familiarità: analizzato attraverso i test di riconoscimento di volti familiari, discriminazione di volti famosi, riconoscimento di edifici familiari (esternamente), riconoscimento di edifici familiari (internamente). Riconoscimento di emozioni del volto (solo per l’indagine sulla CS): studiato attraverso il test di associazione di emozioni. Risultati I pazienti affetti da LBD con CS e PR, rispetto ai soggetti con LBD privi di tali sindromi, commettono più errori nell’assegnare la familiarità ai volti ed edifici. (differenza statisticamente significativa). Diversamente, non sono state riscontrate differenze significative nelle prestazioni dei soggetti affetti da LBD con CS e PR, rispetto ai soggetti privi di deliri, nelle prove che esplorano le abilità visuopercettive e il riconoscimento di emozioni del volto. Discussione Questi risultati consentono di ipotizzare che le basi cognitive della CS e della RP sono da ricondurre ad una compromissione di attribuzione della familiarità

Prism adaptation improves egocentric but not allocentric unilateral neglect. A case study

BACKGROUND: Rehabilitation of unilateral neglect has focused on the ego-centric form of the disturbance. However, allocentric neglect is known to predict failure in the activities of daily life even more than egocentric neglect. CASE REPORT: We submitted a patient with severe egocentric and allocentric left-sided neglect to an extensive prism adaptation training. After treatment, the patient persisted in errors on the left side of targets (allocentric neglect) and actually it increased in parallel with her increased exploration of left space (egocentric neglect). Despite the improvement in a number of cognitive and motor areas, the patient showed limited improvement in activities of daily living (ADL). CLINICAL REHABILITATION IMPACT: These observations confirm the dissociation between egocentric and allocentric neglect and the selective efficacy of the prism adaptation method on the former form. There is a need to develop new rehabilitation methods for allocentric neglect as this limits the complete recovery of patients particularly in terms of AD

Action Observation Therapy for Upper Limb Recovery in Patients with Stroke: A Randomized Controlled Pilot Study

Due to the complexity of the interventions for upper limb recovery, at the moment there is a lack of evidence regarding innovative and effective rehabilitative interventions. Action Observation Training (AOT) constitutes a promising rehabilitative method to improve upper limb motor recovery in stroke patients. The aim of the present study was to evaluate the potential efficacy of AOT, both in upper limb recovery and in functional outcomes when compared to patients treated with task oriented training (TOT). Both treatments were added to traditional rehabilitative treatment. Thirty-two acute stroke patients at 15.6 days (±8.3) from onset, with moderate to severe upper limb impairment at baseline following their first-ever stroke, were enrolled and randomized into two groups: 16 in the experimental group (EG) and 16 in the control group (CG). The EG underwent 30 min sessions of AOT, and the CG underwent 30 min sessions of TOT. All participants received 20 sessions of treatment for four consecutive weeks (five days/week). The Fugl-Meyer Assessment for Upper Extremity (FMA-UE), Box and Block Test (BBT), Functional Independence Measure (FIM) and Modified Ashworth Scale (MAS) were administered at baseline (T0) and at the end of treatment (T1). No statistical differences were found at T0 for inclusion criteria between the CG and EG, whereas both groups improved significantly at T1. After the treatment period, the rehabilitative gain was greater in the EG compared to the CG for FMA-UE and FIM (all p < 0.05). Our results suggest that AOT can contribute to increased motor recovery in subacute stroke patients with moderate to severe upper limb impairment in the early phase after stroke. The improvements presented in this article, together with the lack of adverse events, confirm that the use of AOT should be broadened out to larger pools of subacute stroke patients

VRT (verbal reasoning test): a new test for assessment of verbal reasoning. Test realization and Italian normative data from a multicentric study

Verbal reasoning is a complex, multicomponent function, which involves activation of functional processes and neural circuits distributed in both brain hemispheres. Thus, this ability is often impaired after brain injury. The aim of the present study is to describe the construction of a new verbal reasoning test (VRT) for patients with brain injury and to provide normative values in a sample of healthy Italian participants. Three hundred and eighty healthy Italian subjects (193 women and 187 men) of different ages (range 16–75 years) and educational level (primary school to postgraduate degree) underwent the VRT. VRT is composed of seven subtests, investigating seven different domains. Multiple linear regression analysis revealed a significant effect of age and education on the participants’ performance in terms of both VRT total score and all seven subtest scores. No gender effect was found. A correction grid for raw scores was built from the linear equation derived from the scores. Inferential cut-off scores were estimated using a non-parametric technique, and equivalent scores were computed. We also provided a grid for the correction of results by z scores

Cognition in COVID-19 infected patients undergoing invasive ventilation: results from a multicenter retrospective study.

A growing number of scientific contributions suggest that COVID-19 infection can lead to impairment of cognition, mainly in executive functions and memory domains, even in the absence of frank neurological pathologies. The primary objective of this retrospective study is to evaluate the frequency and type of inefficiencies in a selection of cognitive tests administered to a sample of subjects who, following infection, required invasive assisted ventilation and were admitted to rehabilitation wards for the treatment of functional impairment. Fifty-seven subjects were enrolled. The recruited patients undergone an assessment of verbal and visuospatial memory and executive functions, upon entry into the rehabilitation department, after discharge from intensive care. The following tests were administered: Rey Auditory Verbal Learning Test (AVLT) (immediate and delayed recall), Rey-Osterrieth Complex Figure Test (ROCFT) (copy and delayed recall), Stroop Color-Word Test, and Trail Making Test (TMT, A and B). Deficient scores, in beyond 25% of subjects, were found in the copy of the ROCFT (32.1% of subjects), and in the delayed recall of ROCFT (27.2%). Between 10 and 20% of patients presented an abnormal result in delayed recall of AVLT (16.07%), and Stroop Test (time, 15.6%, error, 11.5%). Less than 10% of the sample had abnormal performances on TMT (A, 3.5%, and B, 9.4%), and in AVLT immediate recall (8.9%). Correlations of the performances with age, sex, and education were also found. This paper highlights the high incidence of abnormal cognitive performances in this specific subpopulation of patients with COVID-19 infection

A NEW STANDARDIZATION 1 OF THE BELLS TEST: AN ITALIAN MULTI-CENTER NORMATIVE STUDY

Objective: The Bells Test is a cancellation task that is widely used for the diagnosis of unilateral spatial neglect (USN). With the aim of fostering more reliable use of this instrument, we set out to develop new norms adjusted for the possible influence of age, gender and education. We worked on the original version of the test. Method: Normative data were collected from 401 healthy participants aged between 20 and 80 years. Individual factors that could affect performance (i.e. gender, age, years of education) were considered. We computed several indices on the Bells Test including an asymmetry score, an accuracy score and execution time. Multiple regression analyses (for time measures) and generalized linear models (for accuracy measures) were used to check for the influence of individual predictors of performance on the Bells Test. Results: Data indicated a significant influence of age on the accuracy score and execution time variables and a marginally significant effect of education on the accuracy score variable. Wherever appropriate, cut-offs are provided for the three dependent scores on the Bells Test corrected for age and education. Conclusions: Based on a large normative sample, the present study provides new normative data on the Bells Test, which could lead to its reliable use in the diagnosis of USN