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Objective To explore the cognitive impairment of stroke survivors using magnetic resonance spectra (MRS) and the Loewenstein occupational therapy cognitive assessment (LOTCA),and to analyze their correlation and their clinical significance.Methods Thirty stroke survivors diagnosed with cognitive impairment using the mini-mental state examination formed a cognitive impairment group.Another 30 stroke survivors without cognitive impairment served as stroke controls,while a third group of 30 healthy counterparts were the normal controls.All were assessed using magnetic resonance imaging and the LOTCA and the results were correlated.Results The average LOTCA total score and sub-scores of the impaired group were significantly lower than those of the other two groups.The average LOTCA total scores and the orientation and spatial perception,apparent motion and thinking operation sub-scores of the stroke control group were also significantly lower than those of the normal control group,though their average visual perception and motor praxis scores were not.The average levels of N-acetyl aspartate and creatine (NAA and Cr) in the bilateral hippocampus of the cognitively impaired group were significantly lower than among the controls,while their choline and creatine (Cho/Cr) levels were significantly higher.The average NAA/Cr and Cho/Cr levels in the bilateral hippocampus of the stroke control group were similarly significantly lower and higher than among the healthy controls.The average NAA/Cr levels in the left and right hippocampus were weakly to moderately correlated with the total LOTCA scores and the LOTCA sub-score for attention (r=0.376-0.661 and r=0.396-0.691 respectively).The average value of Cho/Cr in the left hippocampus showed weak to moderate negative correlation with the LOTCA total scores (r=-0.368-0.619),but not with the attention scores.The value of Cho/Cr in the right hippocampus had weak to moderate negative correlation with the LOTCA total score and with the orientation,visual perception,visuo-motor organization and thinking operations sub-scores (r=-0.391-0.632),but no obvious correlation with the scores for spatial perception,motor praxis or attention.Conclusion MRS can be used to assess the cognitive impairment of stroke survivors.MRS and LOTCA scores are closely correlated.MRS combined with LOTCA can evaluate cognitive dysfunction more comprehensively and objectively.
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Objective To investigate the clinical efficacy of Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) battery for patients at the early stage of traumatic brain injury (TBI). Methods 72 patients with TBI hospitalized from January, 2013 to October, 2014 and 30 healthy controls matched gender, age and educational background were assessed with the Chinese version of LOTCA battery and Mini-Mental State Examination (MMSE) respectively. Results The score of MMSE and LOTCA were correlated (r=0.56, P<0.01). Compared with the controls, the scores of all the subtests of LOTCA decreased (P<0.01) in the patients, especially the orientation, visuomo-tor organization and thinking operation;with the more incidence of medium and serious dysfunction of all the subtests of LOTCA except perception (P<0.01), in which thinking operation was the most and attention was the least. The area under the receiver operating curve (ROC) was (0.84±0.04) in LOTCA, less than that of (0.91±0.03) in MMSE (P<0.05). Conclusion Cognition is widely impaired in patients after TBI, most involved thinking operation. LOTCA is less effective to identify cognitive dysfunction than MMSE, and can be used as an al-ternation or a supplement.
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Objective To explore the applicability of the Loewenstein occupational therapy cognitive assessment (LOTCA) in evaluating cognitive function and observing the curative effect of stroke treatment.Methods Thirty stroke patients with cognitive impairment (the cognitive impairment group) and thirty stroke patients without marked cognitive impairment (the stroke control group) were screened using the mini-mental status examination (MMSE),and thirty healthy subjects served as a normal control group.The gender distributions,ages and levels of education of the three groups were matched.All cases were examined with the LOTCA.After two months of treatment,the three groups were assessed again.Results The average total scores and the scores on the LOTCA subitems were significantly lower in the cognitive impairment group than in the stroke control group and were even lower than those in the normal control group.Particularly conspicuous were their lower scores on the thinking operations and orientation and visuo-motor organization LOTCA sub-items,In the stroke control group the average scores on the thinking operations,visuo-motor organization,attention,orientation and spatial perception sub-items were all significantly lower than those in the normal control group,especially on the thinking operations and visuo-motor organization sub-items.After treatment,the LOTCA scores in all three groups had improved significantly compared with before treatment.Conclusion The LOTCA can assess the severity and characteristics of cognitive impairment in stroke patients.It offers an effective method for identifying cognitive impairment and tracking any improvements.The scores reflect patients' cognitive levels,and so have clinical value.
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Objective To compare the assessment results of Loewenstein occupational therapy cognitive assessment (LOTCA) and mini-mental state examination(MMSE) in stroke patients,and to analyze the correlation between the two assessments and to explore the applicable values of LOTCA in assessing vascular cognitive function impairment (VCI).Methods According to the diagnostic standard of cognitive impairment with MMSE,thirty stroke patients with cognitive impairment were selected as cognitive impairment group,thirty stroke patients without markedly cognitive impairment as stroke control group,and thirty normal subjects served as normal control group.All the subjects' age,gender and level of education were matched in the three groups. All the subjects were assessed with LOTCA and MMSE.ResultsThe total scores of LOTCA had high positive correlation with the total scores of MMSE in cognitive impairment group ( r =0.934,P ＜ 0.01 ),the correlations were also found between every sub-items of LOTCA and those of MMSE (P ＜ 0.01 ).The total scores and the scores of sub-items of LOTCA in cognitive impairment group were significantly lower than those in stroke control group and were those in normal control group(P ＜ 0.01 ),particularly lower scores in LOTCA sub-items of thinking operations,orientation,visuomotor organization.The scores of sub-items of LOTCA,including thinking operations,visuo-motor organization,attention,orientation,spatial perception were all significantly lower in stroke control group than those in normal control group(P ＜0.01 ),especially in thinking operations and visuo-motor organization sub-items.Conclusions Correlations were found between LOTCA and MMSE.Compared to MMSE,LOTCA could detect vascular cognitive function impairment earlier and is much more comprehensive,so it is suitable to assess vascular cognitive impairment patients with no dementia.
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Objective To explore the correlation between P300 and Loewenstein occupational therapy cognitive assessment (LOTCA) results, and to analyze its clinical significance. Also to explore whether P300 might represent specific cognitive functions. Methods Sixty stroke patients were matched with 30 healthy persons serving as a control group. All were examined with auditory evoked potential P300 and the LOTCA, and the correlation between the results was analyzed.Results The stroke patients had significantly longer P200,N200 and P300 latencies and significantly lower P300 amplitude compared with the controls. The LOTCA total scores and each sub-item score in the patient group were all significantly lower than those in the control group. In the patient group, there was strong negative correlation between P300 latency and the total LOTCA score, weak positive correlation between P300 amplitude and the total LOTCA score, and medium to high negative correlation between P300 latency and LOTCA sub-item scores. Stepwise regression and multivariate analysis revealed that sub-items of LOTCA, followed by thinking operations, motor praxis and spatial perception, were strongly correlated with P300 latencies.Conclusions Significant correlation were found between P300 and LOTCA. The combination of P300 and LOTCA can enable earlier, more objective and more comprehensive assessment of vascular cognitive impairment. The latency of P300 has no obvious specificity in reflecting cognitive function, and it is affected by thinking operations most.
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@#Objective To explore the associated factors influencing the prognosis of upper limb function and ability of activities daily living(ADL)in stroke patients with left side hemiplegia.Methods 64 stroke patients with left side hemiplegia were treated regularly last for 1 month.At admission,the assessment procedure for cognitive function were performed with scales of Mini-Mental State Examination(MMSE),Loewenstein Occupational Therapy Cognitive Assessment(LOTCA),Motor Impersistence(MI),Schenkenberg Line Bisection Test.Brunnstrom stage,Modified Barthel Index(MBI),Ueda,Bin Hemiplegic Finger Function Assessment Scale,Upper Limb Function Assessment Scale were graded for the upper limb function and ADL ability before and after training.The multinominal logistic regression analysis was used to analyze the relationship between those factors and the upper limb function and ADL ability.Results The extent of resumption of upper limb function of patients was positively correlated with the ability of formal operational thinking(P<0.01)in LOTCA score before training.However,the extent of resumption of hand was negatively correlated with MI score before training(P<0.01).The extent of resumption of the hand practicability was positively correlated with the ability of operational thinking and score of ADL in LOTCA before training(P<0.01).The extent of the resumption of ADL was positively correlated with the ability score of operational thinking in LOTCA and diseased region.It was negatively correlated with the score of Schenkenberg line bisection(P<0.01).Conclusion The ability of operational thinking in LOTCA before training and the scores of Schenkenberg line bisection,ADL and MI are helpful in prognosis for the upper limb function in stroke patients with left side hemiplegia.
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@#ObjectiveTo develop the manipulation and scoring system of Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) into a Chinese software.MethodsThe manual manipulation and scoring system of LOTCA was developed into a technological procedure and changed into primary product of software through conforming computer programs such as Basic, C, C++ and Flash Maker. The primary product was tested in clinic and feedback suggestions were collected. The questions found during assessment and items with reliability and validity not satisfied were optimized.ResultsThe Chinese software of LOTCA, including mandarin and Cantonese, composed manipulation system, scoring system, administer system and affiliated system. It could run on systems of Windows 2000 and Windows XP.ConclusionThe Chinese software of LOTCA is objective, standard and convenient for clinic.
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Objective To assess the cognitive function of subjects with brain injury with Loewenstein occupational therapy cognitive assessment (LOTCA) and mini-mental status examination (MMSE). Methods Two groups of subjects participated in this study. One group consisted of 36 subjects with brain injury (patient group). They were 28 males and 8 females,aged 61.0?16.7 years old. The other group was made of 44 healthy subjects (control group),with 25 males and 19 females,aged 55.4?23.7 years old. All subjects were assessed using LOTCA and MMSE and the results of them were analyzed. Results There was high correlation between the total scores of LOTCA and those of MMSE ( r =0.892,P
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Objective To study the validity and reliability of the simplified Chinese version of Loewenstein Occupational Therapy Cognitive Assessment (LOTCA). MethodsThe English version of LOTCA was translated into the simplified Chinese first and then translated back to English to ensure its reliability in Chinese version.The we recruited two groups of volunteers to participate in the study. One group consisted of 36 patients with brain disorders (patient group), The other group consisted of 43 subjects without neurological disorders (control group). All the subjects were assessed with LOTCA and Mini-Mental State Examination (MMSE) within one session and on different days, respectively by two independent raters. Scores of LOTCA and MMSE were analyzed with Spearman correlation coefficient to test the validity of LOTCA. Intra-class coefficients (ICCs) were used to examine the intra-rater and inter-rater reliability of LOTCA. And Mann-Whitney test of non-parameters analysis was used to detect the sensitivity of LOTCA. ResultsThere was high correlation between the scores of LOTCA and that of MMSE ( r =0.9852- 0.9939 ). ICCs of LOTCA were 0.9923( P
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The Loewenstein Occupational Therapy Cognitive Assessment(LOTCA) battery provides an initial profile of the cognitive abilities of the brain-injured patient that can be used as a starting point for occupational therapy intervention and as a screening test for further assessment. Reliability and validity for the LOTCA have been reported in the literatures. This study investigated the relationship between LOTCA scores and functional assessments in 34 brain-injured patients, consisting of 21 stroke patients and 13 traumatic brain injury patients. Subjects were administered the LOTCA and, as functional assessment tools, the Cognitive Capacity Screening Examination(CCSE) and the Modified Barthel Index(MBI) upon referral to occupational therapy initially, and again at discharge. The initial and the last LOTCA scores were significantly related to the initial and the last CCSE scores and the MBI scores, respectively, in brain-injured patients. Each of the last LOTCA scores, CCSE scores, and MBI scores increased significantly compared to the initial scores. There were no significant differences in the initial and the last LOTCA scores, CCSE scores, and MBI scores between stroke patients and traumatic brain injury patients. Greater LOTCA gain was significantly related to greater MBI gain. These results suggest that the LOTCA battery for brain-injured patients is related not only to cognitive function, but also to functional evaluation as activities of daily living and functional recovery at discharge.