Background: The National Institutes of Health Stroke Scale (NIHSS) has been criticized for limited representation of cognitive dysfunction and bias towards dominant hemisphere functions. Patients may therefore receive a low NIHSS score despite a fairly large stroke. A broader scale including simple cognitive tests would improve the clinical and research utility of the NIHSS.Methods: We studied 200 patients with acute non-dominant hemispheric stroke who underwent cognitive testing and had MRI with diffusion-weighted imaging (DWI) within 5 days of presentation. We measured DWI volumes and retrospectively calculated NIHSS scores. We used linear regression to determine the role of selected cognitive tests, when added to the NIHSS, in predicting DWI volume.Results: The NIHSS predicted DWI volume in a univariate analysis, as did total line cancellation and a visual perception task. In a multivariate model, using log-transformed variables, the NIHSS (p = 0.0002), line cancellation errors (p = 0.02) and visual perception (p = 0.004) each improved prediction of total infarct volume.Conclusion: The addition of line cancellation and visual perception tasks significantly adds to the model of NIHSS alone in predicting DWI volume. We propose that these two cognitive tests, which together can be completed in 2&#x2013;3 minutes, could be combined with the NIHSS to create an “NIHSS-plus” that more accurately represents a patient’s ischemic tissue volume after a stroke. This scale requires further validation in a prospective study.

Rebecca F. Gottesman

Jonathan T. Kleinman

Cameron Davis

Jennifer Heidler-Gary

Melissa Newhart

Argye E. Hillis

The NIHSS-Plus: Improving Cognitive Assessment with the NIHSS

In order to assess the capacity of neurological patients to process syntactic features unique to Korean, such as the heavy dependence of parsing on syntactic morphemes rather than the word order in a sentence, the Korean Syntactic Comprehension Test (KSCT) was newly developed. To examine the correlation between lesion locations and the test performance, we did voxel-based lesion-symptom mapping (VLSM) analysis in a group of 39 patients with ischemic stroke. As a result, KSCT scores of the aphasic patients were significantly lower than those of 18 normal subjects. Within the patient group, VLSM analysis showed significant association between lower KSCT performance and the lesions mainly located in left perisylvian area and anterior temporal lobe. The KSCT results were also closely correlated with the results of two subtests in the Korean version-the Western Aphasia Battery. We conclude therefore that brain localization of syntactic comprehension in Korean native speakers is similar to that in other language speakers, despite the unique features of the Korean syntax, and that the KSCT will be of diagnostic value in assessing left fronto-temporal functions in Korean patients.

M. J. Kim

H. A. Jeon

K. M. Lee

Impairments of Syntactic Comprehension in Korean and the Location of Ischemic Stroke Lesions: A Voxel-Based Lesion-Symptom Mapping Study

Several studies have shown that people with Alzheimer's disease (AD) demonstrate difficulties in doing two things at once or 'dual-tasking' and that this dual task impairment is insensitive to normal ageing, chronic depression or prodromal conditions like Mild Cognitive Impairment. It is not known, however, if this impairment is specific to AD, or also present in other dementias, such as vascular dementia (VaD). In this study 15 people with VaD, 25 healthy age-matched and 25 healthy young controls were assessed using a paper and pencil dual tasking paradigm and several measures of working and episodic memory. Age had no effect on dual task performance, but the VaD patients demonstrated a significant impairment in dual tasking ability. Performance on the memory measures was instead affected by age with a further deterioration in the VaD patients. Both dual tasking and memory ability were significantly correlated with disease severity, as assessed by the MMSE. These results indicate that performance on the dual task could be a specific indicator of pathological ageing.

Kate Inasaridze

Jennifer A. Foley

Robert H. Logie

Sergio  Della Sala

Dual Task Impairments in Vascular Dementia

Vascular Cognitive Impairment

The introduction of diagnostic criteria for vascular dementia has helped to re-define the impact of various subcortical neuropathologies on aging; however, state-of-the-art neuroimaging techniques and autopsy studies suggest that not all structural brain alterations associated with vascular dementia are exclusive to this neurodegenerative process alone. Thus, a detailed analysis of the cognitive phenotype associated with ischaemic vascular disease is key to our understanding of subcortical neuropathology and its associated behaviors. Over the past twenty years, we have operationally defined this cognitive phenotype using the Boston Process Approach to neuropsychological assessment. This has led to both an empirical, as well as a theoretical understanding of three core constructs related to the dysexecutive syndrome associated with ischaemic vascular disease affecting periventricular and deep white matter as well as subcortical structures connecting these regions with the prefrontal cortex. Thus, difficulties with mental set, cognitive control and mental manipulation negatively impact executive functioning. This review will outline the subtle markers underlying this prefrontal dysfunction, i.e., the dysexecutive phenotype, associated with ischaemic vascular disease and relate it to fundamental impairments of gating subserved by basal ganglia-thalamic pathways within and across various dementia syndromes.

Melissa Lamar

Cate C. Price

Tania Giovannetti

Rod Swenson

David J. Libon

The Dysexecutive Syndrome Associated with Ischaemic Vascular Disease and Related Subcortical Neuropathology: A Boston Process Approach

One of the main sources of information regarding the underlying processes involved in both normal and impaired reading has been the study of reading deficits that occur as a result of brain damage. However, patterns of reading deficits found acutely after brain injury have been little explored. The observed patterns of performance in chronic stroke patients might reflect reorganization of the cognitive processes underlying reading or development of compensatory strategies that are not normally used to read. Method: 112 acute left hemisphere stroke patients were administered a task of oral reading of words and pseudowords within 1&#x2013;2 days of hospital admission; performance was examined for error rate and type, and compared to that on tasks involving visual lexical decision, visual/auditory comprehension, and naming. Results: Several distinct patterns of performance were identified. Although similarities were found between the patterns of reading performance observed acutely and the classical acquired dyslexias generally identified more chronically, some notable differences were observed. Of interest was the finding that no patient produced any pure semantic errors in reading, despite finding such errors in comprehension and naming.

Lauren L. Cloutman

Cameron L. Davis

Vijay C. Kannan

Patterns of Reading Performance in Acute Stroke: A Descriptive Analysis

The evolution in time of a number of language tasks in a longitudinal study of a 61-year-old aphasic patient is described. The patient, examined twice, in a 10 month follow-up, showed a dissociation between preserved reading with respect to impaired other modalities as well as a qualitative change in errors' type. A reduction of neologisms and phonologically based errors, with a concurrent increase of semantic paraphasias in naming and repetition, as well as an amelioration in reading, with a reduction of stress assignment errors was exhibited at the follow-up. The results are interpreted by postulating an improved performance of the phonological output processes, allowing non-phonologically based errors to emerge, thus revealing the underlying semantic damage. The Summation Hypothesis [14] seems a general framework better interpreting these findings, more than highly specialized production models, which could explain separately only different modalities&#x2019; impairments.

Flavia Mattioli

The Relative Role of Semantic and Sublexical Processes in Reading, Writing and Repetition: Evidence from a Follow-Up Study

Patient-reported, subjective outcomes are promoted as a standard for ethical, valid studies in many neurological disorders. Such outcomes are considered potentially more sensitive and specific to important therapeutic effects, and may be more linked to disability and disease-related life losses than conventional assessments of impairment (e.g. ability to walk, performance on language tests, serological or radiological indices). Self-report is invaluable to identify social and emotional consequences of brain injury: depression, changes in intimate and family relationships, social role and community participation losses. However, common stroke-related neuropsychological deficits are likely to confound subjective stroke outcome measures. The scientific community focused on stroke-related health outcomes may arrive at significantly underestimated patient reports of stroke-related disability, caused by a failure to adjust for the effect on self-report of spatial neglect, deficits of magnitude estimation, pathologic alteration of self-awareness, and alteration in distributed cortical systems supporting emotional semantics and abstraction.

Anna M. Barrett

Rose-Colored Answers: Neuropsychological Deficits and Patient-Reported Outcomes after Stroke

Background and Purpose: Impaired cardiac function can adversely affect the brain via decreased perfusion. The purpose of this study was to determine if cardiac ejection fraction (EF) is associated with cognitive performance, and whether this is modified by low blood pressure.Methods: Neuropsychological testing evaluating multiple cognitive domains, measurement of mean arterial pressure (MAP), and measurement of EF were performed in 234 individuals with coronary artery disease. The association between level of EF and performance within each cognitive domain was explored, as was the interaction between low MAP and EF.Results: Adjusted global cognitive performance, as well as performance in visuoconstruction and motor speed, was significantly directly associated with cardiac EF. This relationship was not entirely linear, with a steeper association between EF and cognition at lower levels of EF than at higher levels. Patients with low EF and low MAP at the time of testing had worse cognitive performance than either of these alone, particularly for the global and motor speed cognitive scores.Conclusions: Low EF may be associated with worse cognitive performance, particularly among individuals with low MAP and for cognitive domains typically associated with vascular cognitive impairment. Further care should be paid to hypotension in the setting of heart failure, as this may exacerbate cerebral hypoperfusion.

Maura A. Grega

Maryanne M. Bailey

Scott L. Zeger

William A. Baumgartner

Guy M. McKhann

Ola A. Selnes

Association between Hypotension, Low Ejection Fraction and Cognitive Performance in Cardiac Patients

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Behavioural Neurology

Vascular Cognitive Impairment

Vascular Cognitive Impairment

Articles

The NIHSS-Plus: Improving Cognitive Assessment with the NIHSS

Impairments of Syntactic Comprehension in Korean and the Location of Ischemic Stroke Lesions: A Voxel-Based Lesion-Symptom Mapping Study

Dual Task Impairments in Vascular Dementia

Vascular Cognitive Impairment

The Dysexecutive Syndrome Associated with Ischaemic Vascular Disease and Related Subcortical Neuropathology: A Boston Process Approach

Patterns of Reading Performance in Acute Stroke: A Descriptive Analysis

The Relative Role of Semantic and Sublexical Processes in Reading, Writing and Repetition: Evidence from a Follow-Up Study

Rose-Colored Answers: Neuropsychological Deficits and Patient-Reported Outcomes after Stroke

Association between Hypotension, Low Ejection Fraction and Cognitive Performance in Cardiac Patients