ABSTRACT
OBJECTIVE: We examined the utility of the Birmingham Cognitive Screen (BCoS) in discriminating cognitive profiles and recovery of function across stroke survivors. BCoS was designed for stroke-specific problems across 5 cognitive domains: (a) controlled and spatial attention, (b) language, (c) memory, (d) number processing, and (e) praxis. METHOD: On the basis of specific inclusion criteria, this cross-section observational study analyzed cognitive profiles of 657 subacute stroke patients, 331 of them reassessed at 9 months. Impairments on 32 measures were evaluated by comparison with 100 matched healthy controls. Measures of affect, apathy, and activities of daily living were also taken. Between-subjects group comparisons of mean performance scores and impairment rates and within-subject examination of impairment rates over time were conducted. Logistic regressions and general linear modeling were used for multivariate analysis of domain-level effects on outcomes. RESULTS: Individuals with repeated stroke experienced significantly less cognitive recovery at 9 months than those with a first stroke despite similar initial level of cognitive performance. Individuals with left hemisphere lesions performed more poorly than those with right hemisphere lesions, but both groups showed similar extent of recovery at 9 months. BCoS also revealed lesion-side-specific deficits and common areas of persistent problems. Functional outcome at 9 months correlated with domain-level deficits in controlled attention, spatial attention, and praxis over and above initial dependency and concurrent levels of affect and apathy. CONCLUSION: The study demonstrates how BCoS can identify differential cognitive profiles across patient groups. This can potentially help predict outcomes and inform rehabilitation.
Subject(s)
Cognition Disorders/psychology , Cognition , Neuropsychological Tests , Stroke/psychology , Activities of Daily Living , Affect , Aged , Apathy , Aphasia/etiology , Attention , Cognition Disorders/etiology , Cross-Sectional Studies , Female , Functional Laterality , Humans , Linear Models , Male , Mathematics , Memory , Middle Aged , Perceptual Disorders/etiology , Perceptual Disorders/psychology , Predictive Value of Tests , Psychomotor Performance , Recovery of Function , Recurrence , SurvivorsABSTRACT
We report data on stored knowledge of everyday tasks in a patient, FK, with 'action disorganisation syndrome'. In section 1, we analysed his explicit knowledge of the component actions, and their temporal order. FK showed generally impaired knowledge of everyday tasks relative to controls, and, when knowledge of the temporal order of the actions was probed, he showed particular impairments for the actions making up the final steps in tasks. In section 2 we assessed FK's implicit knowledge of the tasks, by evaluating how knowledge of the tasks influenced his ability to act out sets of instructions. We demonstrate that FK had some implicit knowledge of the tasks, but also, when actions had to be performed in the order as instructed, there was better knowledge of order for actions performed early rather than late in the task. We suggest that disordered task schema contributed to FK's deficits, with impairments on 'end' actions being vulnerable when task order was important for performance.
