The brief executive language screen: sensitivity and specificity in acute to early sub-acute stroke.

INTRODUCTION: Propositional language and underlying executive functions can be impaired post-stroke and affect communication and quality of life. Current stroke screening tools are largely tailored to patients with aphasia, being either non-verbal or focussed on core language skills such as naming and repetition. The Brief Executive Language Screening Test (BELS) is a newly developed cognitive screening tool that assesses memory, oral apraxia, core language, as well as propositional language and associated executive functions that can be impacted and overlooked in stroke patients without aphasia. This study examines BELS sensitivity and specificity, and performance in acute to early sub-acute stroke relative to controls. METHOD: Cross-sectional BELS data from 88 acute left and right hemisphere stroke patients (within 7 weeks of stroke) and 116 age-matched healthy controls were compared using independent samples t-tests. ROC Curve Analysis was performed to determine a cutoff score for the BELS. RESULTS: Left and right stroke patients were reduced on all propositional language subtests, and executive function subtests of inhibition, strategy, and selection. Differences were also observed for Oral Apraxia, Naming, and Memory. By contrast, Word Comprehension and Repetition, and Sentence Completion Initiation (after corrections applied) did not differ between groups. A total BELS score of 79.25/100 was highly sensitive (.89) and specific (.89) when classifying stroke patients and healthy controls. CONCLUSION: The BELS is brief, sensitive, suitable for bedside administration, and can aid in detection and rehabilitation of subtle executive language impairments. This in turn will help improve relationships and quality of life post-stroke.

Hayling and stroop tests tap dissociable deficits and network-level neural correlates.

Although many executive function screens have been developed, it is not yet clear whether these assessments are equally effective in detecting post-stroke deficits of initiation and inhibition. This study presents a comparative analysis of the Stroop and Hayling tests aiming to evaluate whether these tests measure the same underlying cognitive functions and to identify the neural correlates of the deficits detected by both tasks. Sixty six stroke survivors and 70 healthy ageing controls completed the Hayling and Stroop tests. Stroke patients were found to exhibit qualitative performance differences across analogous Stroop and Hayling Test metrics intended to tap initiation and inhibition. The Stroop test was found to have high specificity to abnormal performance, but low sensitivity relative to the Hayling Test. Minimal overlap was present between the network-level correlates of analogous Stroop and Hayling Test metrics. Hayling Task strategy use metrics were significantly associated with distinct patterns of disconnection in stroke survivors, providing novel insight into the neural correlates of fine-grained behavioural patterns. Overall, these findings strongly suggest that the functions tapped by the Stroop and Hayling Test are both behaviourally and anatomically dissociable. The Hayling Test was found to offer improved sensitivity and detail relative to the Stroop test. This novel demonstration of the Hayling Test within the stroke population suggests that this task represents an effective measure for quantifying post-stroke initiation and inhibition deficits.

RESPONSE AND PHYSIOLOGIC OUTCOMES AFTER BUTORPHANOL, MIDAZOLAM, AND MEDETOMIDINE IMMOBILIZATION AND REVERSAL IN CAPTIVE REINDEER (RANGIFER TARANDUS).

Sedation, recovery response, and physiologic outcomes were evaluated in five captive reindeer (Rangifer tarandus) in Minnesota using a completely reversible immobilization protocol. Reindeer were immobilized with butorphanol (0.23-0.32 mg/kg), midazolam (0.23-0.32 mg/kg), and medetomidine (0.15 mg/kg) (BMM) via IM dart. Induction time (IT), recumbency time (DT), and recovery time (RT) were recorded. Temperature (T), respiratory rate (RR), pulse rate (PR), pulse oximetry (SpO2), arterial blood gas values including oxygen (PaO2), and carbon dioxide (PaCO2) tensions and lactate (Lac) were recorded preoxygen supplementation and 15 min postoxygen supplementation. Reversal was done using naltrexone (2.3-3.0 mg/kg), flumazenil (0.008-0.01 mg/kg) and atipamezole (0.62-0.78 mg/kg) (NFA) IM, limiting recumbency to 1 h. Median IT, DT, and RT were 5 min, 46 min, and 7 min, respectively. SpO2 (92 to 99%, P = 0.125), PaO2 (45.5 to 97 mmHg, P = 0.25), and PaCO2 (46.5 to 54.6 mmHg, P = 0.25) all increased, whereas Lac (3.02 to 1.93 mmol/L, P = 0.25) decreased between baseline and 15 min postoxygen supplementation, without statistical significance. BMM immobilization, and reversal with NFA provided rapid and effective immobilization and recovery, respectively. Oxygen supplementation mitigated hypoxemia in all reindeer.

Post-stroke apathy: A case series investigation of neuropsychological and lesion characteristics.

Apathy is a multi-dimensional syndrome associated with reduced initiation, executive function and emotion toward goal-directed behaviour. Affecting ∼30% of stroke patients, apathy can negatively impact rehabilitation outcomes and increase caregiver burden. However, relatively little is known about the multi-dimensional nature of post-stroke apathy and whether these dimensions map onto neuropsychological and neuroanatomical correlates. The present study aimed to address this question in a case series of stroke patients with apathy. 65 patients with acute stroke were assessed on a comprehensive battery of neuropsychological tasks and 12 patients were identified as having clinically significant apathy on one or more domains on the Dimensional Apathy Scale. Individual scores were compared to a group of healthy controls and normative data where available. Lesion mapping was completed from clinical CT and MRI scans to characterise the extent and locations of each patient's lesion. All participants performed significantly poorer than controls on one or more tasks. Difficulties with inhibition were observed across all dimensions. Prospective memory deficits were also common, while speed and social cognition were only reduced in initiation and emotional apathy, respectively. Verbal fluency was not impaired in any of the patients, despite previously established relationships with apathy. Lesions were predominantly located in right subcortical regions, with some additional frontal, temporal and cerebellar/brainstem involvement. There was substantial overlap in lesion locations within and between dimensions, such that similar apathy symptoms occurred in patients with very different lesion sites. Overall, our results suggest that neuropsychological and lesion profiles of apathy in stroke patients may be more complex and heterogenous than in neurodegenerative disease, possibly due to functional changes occurring beyond the lesion site.

How configurations of binocular disparity determine whether stereoscopic slant or stereoscopic occlusion is seen.

A partially occluded contour and a slanted contour may generate identical binocular horizontal disparities. We investigated conditions promoting an occlusion resolution indicated by an illusory contour in depth along the aligned ends of horizontally disparate line sets. For a set of identical oblique lines with a constant width added to one eye's view, strength, depth, and stability of the illusory contour were poor, whereas for oblique lines of alternating orientations the illusory contours were strong, indicating a reliance on vertical size disparities rather than vertical positional disparities in generating perceived occlusion. For horizontal lines, occlusion was seen when the lines were of different lengths and absolute width disparity was invariant across the set. In all line configurations, when the additional length was on the wrong eye to be attributed to differential occlusion, lines appeared slanted consistent with their individual horizontal disparities. This rules out monocular illusory contours as the determining factor.