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The presence and prediction of lateralized inattention 7 years post-stroke
University of Skövde, School of Bioscience. University of Skövde, Systems Biology Research Environment. Faculty of Social Sciences, Department of Psychology, University of Gothenburg, Sweden / Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Sweden / The Skaraborg Institute for Research and Development, Skövde, Sweden. (Kognitiv neurovetenskap och filosofi, Consciousness and Cognitive Neuroscience)ORCID iD: 0000-0002-7344-6586
Faculty of Social Sciences, Department of Psychology, University of Gothenburg, Sweden / Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Sweden.
Faculty of Social Sciences, Department of Psychology, University of Gothenburg, Sweden / Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Sweden.
Department of Laboratory Medicine, Institute of Biomedicine, The Sahlgrenska Academy at University of Gothenburg, Sweden.
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2020 (English)In: Acta Neurologica Scandinavica, ISSN 0001-6314, E-ISSN 1600-0404, Vol. 141, no 5, p. 423-430Article in journal (Refereed) Published
Abstract [en]

Objective: Lateralized inattention is a typical sign of neglect and related to poor functional outcome. Knowledge of the long-term course of this phenomenon is limited. The purpose of this study was to investigate presence and predictors for signs of lateralized inattention 7 years after stroke. Methods: From a cohort of acute ischemic stroke patients, aged 18-69 years (n = 297), a consecutive series of 188 survivors without recurrent stroke at follow-up 7 years later were included. Within the first week after stroke onset, stroke severity was assessed according to the Scandinavian Stroke Scale. Target omissions, asymmetry of omissions, and perceptual speed according to Star- and Letter Cancellation Tests were also assessed. Presence of lateralized inattention at the 7-year follow-up was investigated with the Star- and Letter Cancellation Tests and with the neglect item in the National Institutes of Health Stroke Scale. Results: At the follow-up, 22 (11.7%) participants had lateralized inattention and the multivariable regression showed that independent significant baseline predictors were total omissions in target cancellations (P <.001) and inferior baseline performance on visual processing speed (P =.008). Conclusion: About one of ten individuals exhibited signs of lateralized inattention 7 years after stroke. Baseline performance in perceptual processing speed and target omissions independently predicted presence of late signs of lateralized inattention. This is the first time processing speed is recognized as a significant predictor of lateralized inattention several years after the stroke incidence, indicating that the longitudinal course of processing speed following stroke is a critical subject for future research. © 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd

Place, publisher, year, edition, pages
John Wiley & Sons, 2020. Vol. 141, no 5, p. 423-430
Keywords [en]
inattention, ischemic stroke, neglect, perceptual processing speed, prospective
National Category
Neurology Public Health, Global Health and Social Medicine Cardiology and Cardiovascular Disease
Research subject
Consciousness and Cognitive Neuroscience
Identifiers
URN: urn:nbn:se:his:diva-18206DOI: 10.1111/ane.13221ISI: 000509002300001PubMedID: 31930478Scopus ID: 2-s2.0-85078750988OAI: oai:DiVA.org:his-18206DiVA, id: diva2:1393831
Available from: 2020-02-17 Created: 2020-02-17 Last updated: 2025-02-20Bibliographically approved
In thesis
1. Visuospatial inattention and processing speed: Predictors of long-term outcome and patterns of change after ischemic stroke
Open this publication in new window or tab >>Visuospatial inattention and processing speed: Predictors of long-term outcome and patterns of change after ischemic stroke
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Impairments of visuospatial attention, language, and processing speed (PS) are common early after stroke and have been associated with unfavorable short-term functional outcomes but little is known about this relationship in the long-term. This thesis investigates 1) the potential importance of visuospatial inattention (VSI) and language impairments (LI) as predictors of functional outcomes 7 years after an ischemic stroke (studies I-II) and 2) presence of lateralized inattention 7 years after stroke and potential predictors of this phenomenon (study III). Study IV gives a detailed description of the long-term course of PS across 3 months and 7 years after an ischemic stroke. A cohort of 375 consecutive stroke patients was assessed early after stroke for the occurrence (studies I–II and IV) and severity (studies III-IV) of VSI using the Star Cancellation Test (SCT, studies I-IV) and Letter Cancellation Test (LCT, studies III-IV). Language impairments were investigated (studies I-II) by the language item from the Scandinavian Stroke Scale (SSS). At the 7-year follow-up, functional outcomes were measured by the modified Rankin Scale (mRS), the Frenchay Activities Index (FAI) (studies I-II and IV), and the recovery item of Stroke Impact Scale (SIS) (study IV). Patients with a recurrent stroke during the follow-up period were excluded (all studies). The presence of lateralized inattention at the 7-year follow-up (study III) was assessed with the SCT, the LCT, and the neglect item from the NIH Stroke Scale (NIHSS). The long-term course of PS (study IV) was measured by a mirrored copy of the SCT with a time limit of 30 seconds, follow-up assessments of SCT, LCT, and NIHSS were also included in this study. In study I, 235 stroke survivors were included at the follow-up and VSI and stroke severity (SSS) were identified as the significant independent predictors of unfavorable outcomes in mRS and FAI. The early screening of LI did not provide independent prognostic information beyond the information provided by VSI and stroke severity. In study II, 105 individuals with left hemispheric stroke were included at the 7-year follow-up. It was found that the presence of VSI was rather common observed in about one of five patients. VSI was the most important independent predictor of unfavorable outcomes in mRS and FAI. Individuals with both VSI and LI had increased risk of poor outcome compared to those with signs of one of these symptoms. In study III, 188 stroke survivors were included at the 7-year follow-up and about one of ten had signs of lateralized inattention. Independent baseline predictors for these long-term signs were total omissions in target cancellations and inferior performance on visual processing speed. In study IV, 148 subjects were included at follow-up and impaired PS was observed in about one of three individuals at baseline with significant improvement in scores at 3 months followed by a clear decline at 7 years. It was also found that slow PS was related with inferior functional outcome at the 7-year follow-up, also after adjusting for age. Age was related with scores in PS but did not explain the scores of PS for those with lowest speed. Conclusions: Studies I-II emphasize the importance of identifying early symptoms of VSI not only after right hemispheric stroke but also after left hemispheric stroke and particularly for individuals with severe symptoms of LI. A combination of attention and language deficits at the acute phase seems to be rather common among patients with left hemispheric stroke and indicates an increased risk of unfavorable outcomes. Studies III-IV are the first studies to recognize PS as a significant predictor of long-term lateralized inattention and to describe changes in speed across two follow-ups up to 7 years in a stroke cohort. The results from these two studies emphasize the importance of further long-term studies of PS after stroke.

Place, publisher, year, edition, pages
Göteborgs universitet, 2019. p. 67
Series
Avhandling / Göteborgs universitet, Psykologiska institutionen, ISSN 1101-718X
Keywords
Visuospatial inattention, language impairment, long-term functional outcome, ischemic stroke, neglect, aphasia, lateralized inattention, processing speed
National Category
Neurology Neurosciences
Research subject
Consciousness and Cognitive Neuroscience
Identifiers
urn:nbn:se:his:diva-19206 (URN)978-91-7833-713-2 (ISBN)978-91-7833-712-5 (ISBN)
Public defence
2019-11-29, sal F1, Psykologiska institutionen, Haraldsgatan 1, Göteborg, Haraldsgatan 1, Göteborg, 10:00 (English)
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Doctoral dissertation in Psychology. Två av fyra delarbeten (övriga se rubriken Delarbeten/List of papers): II. Gerafi, J., Samuelsson, H., Viken, J. I., Blomgren, C., Claesson, L., Kallio, S., Jern, C., Blomstrand, C., & Jood, K. Visuospatial inattention following a left hemispheric stroke predicts long-term functional outcome / IV. Gerafi, J., Samuelsson, H., Viken, J. I., Jern, C., Blomstrand, C., & Jood, K. Patterns of change in visual processing speed after ischemic stroke: A longterm descriptive study.

Available from: 2020-11-13 Created: 2020-10-28 Last updated: 2020-11-13Bibliographically approved

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