Posts Tagged cognitive function

[ARTICLE] Effect of Whole Brain Radiation Therapy on Cognitive Function – Full Text

Brain metastases (BM) are common and can be detrimental in patients with primary cancers. Lung cancer accounts for over 40% of BM cases and breast cancer is responsible for 10% to 20% of BM. Typically, patients present with oligometastatic disease—1 to 3 intracranial metastases. Stereotactic radiosurgery (SRS) is often used to good effect in treating these tumors. To investigate intracranial tumor progression control, researchers have conducted randomized clinical trials (RCTs) in which whole brain radiotherapy (WBRT) was added to the clinical regimen following SRS. RCTs demonstrated that WBRT did in fact show improvement in intracranial tumor control; however, WBRT does not confer a survival advantage. In fact, previous RCTs have suggested that WBRT may cause deterioration of cognitive function and quality of life (QOL).13

Brown et al1 conducted the largest, multi-institutional study utilizing a plethora of cognitive and QOL assessments to determine the effects of WBRT. They enrolled 213 randomized participants with 1 to 3 BM at 34 participating institutions. One group underwent SRS alone and the second group had SRS plus WBRT that began within 14 days of SRS. The WBRT dose regimen was 30 Gy in 12 fractions and the SRS dose was 18 to 22 Gy in the SRS plus WBRT group, and 20 to 24 Gy in SRS alone. Baseline evaluations were made starting at week 6 and subsequently at months 3, 6, 9, and eventually, at month 60. QOL was assessed using the Functional Assessment of Cancer Therapy-Brain. Scores ranged between 0 and 200 where higher scores signified better QOL. The Barthel Index of Activities of Daily Living (ADL Index) was used to determine functional independence where a score of 100 indicated complete independence and a lower score demonstrated the need for supervision and assistance. Seven other assessments were used to evaluate immediate memory, fine motor control, delayed memory, and other cognitive abilities. The primary endpoint was deemed to be cognitive deterioration at 3 months after SRS defined as a decline in any of the cognitive tests. Secondary endpoints included time to intracranial failure, overall survival, QOL, as well as other parameters.

Brown et al1 showed that there was significantly more cognitive deterioration at the 3-month evaluation mark in the SRS plus WBRT group. Additionally, this group showed to have decline in immediate memory, delayed memory, and verbal fluency when compared to the SRS alone group. The SRS alone group demonstrated a significantly better QOL and functional well-being; however, time to intracranial tumor progression was significantly shorter for SRS alone vs SRS plus WBRT. Intracranial tumor control rates at 3 months were higher (93.7%) in SRS plus WBRT vs (75.3%) SRS alone. The 6- and 12-month control rates were also significantly higher in SRS plus WBRT vs SRS alone (32.4% vs 7.8%, respectively). For long-term survivors—defined as evaluable patients who survived past 12 months—the intracranial tumor control rate at 12 months in SRS plus WBRT vs SRS alone was 89.5% vs 20.0%, respectively. Cognitive deterioration, however, occurred more often in the SRS plus WBRT group. Decline in intermediate memory was most pronounced at 3 months; deterioration in fine motor control was most pronounced at 6 months.

The study by Brown et al1 gives some insight into the controversial issue of WBRT. Although the SRS plus WBRT group had a higher intracranial tumor control rate, patients experienced significant cognitive decline and no improvement in survival occurred. Chang et al2 (Figure) conducted a randomized controlled trial similar to Brown et al,1 where the study was forced to be halted due to the high probability (96%) that patients randomly assigned to receive SRS plus WBRT (n = 28), vs patients in the SRS alone group (n = 30), were likely to show a significant decline in learning and memory function at 4 months. Aoyama et al3 on the other hand believes that WBRT should be considered for patients’ BMs from nonsmall-cell lung cancer and has a favorable prognosis. Studies have been done to avoid the hippocampal neural stem-cell area during WBRT to preserve memory and cognitive functions. Gondi et al4 demonstrated that the mean relative decline in the Hopkins Verbal Learning Test–Revised Delayed Recall at 4 months was significantly lower when avoiding the hippocampal compartment, but QOL did not change.

Figure. A, Actuarial time to death (all causes). SRS: stereotactic radiosurgery; WBRT: whole brain radiotherapy. B, Actuarial freedom from local tumor progression. SRS: stereotactic radiosurgery; WBRT: whole brain radiotherapy. Reprinted from Lancet Oncology,2 Copyright (2009), with permission from Elsevier.

Figure. A, Actuarial time to death (all causes). SRS: stereotactic radiosurgery; WBRT: whole brain radiotherapy. B, Actuarial freedom from local tumor progression. SRS: stereotactic radiosurgery; WBRT: whole brain radiotherapy. Reprinted from Lancet Oncology,2 Copyright (2009), with permission from Elsevier.

The study by Brown et al1 lends more emphasis to the necessity to balance the need for tumor control and potential cognitive decline when deciding to administer WBRT. New, promising research in radiosensitizer drugs may allow for lower doses of radiation to normal brain while improving tumor control.5 Refinements in neuroimaging and increasing use of SRS in treating multiple metastases may offer benefit as well.6 Indeed, in patients with cancer, cognitive dysfunction can greatly lower patients’ abilities to carry out basic activities of daily living, increase strain on families and other support systems, and decrease eligibility in potentially effective clinical trials. These various treatment strategies should be carefully evaluated when considering SRS plus WBRT.

Julia R. Schneider, BS

Shamik Chakraborty, MD

John A. Boockvar, MD

Department of Neurosurgery Lenox Hill Hospital and Hofstra Northwell School of Medicine New York, New York

Source: Science Times | Neurosurgery | Oxford Academic

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[ARTICLE] Does a combined intervention program of repetitive transcranial magnetic stimulation and intensive occupational therapy affect cognitive function in patients with post-stroke upper limb hemiparesis? – Full Text HTML

 

Abstract

Low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) to the contralesional hemisphere and intensive occupational therapy (iOT) have been shown to contribute to a significant improvement in upper limb hemiparesis in patients with chronic stroke. However, the effect of the combined intervention program of LF-rTMS and iOT on cognitive function is unknown. We retrospectively investigated whether the combined treatment influence patient’s Trail-Making Test part B (TMT-B) performance, which is a group of easy and inexpensive neuropsychological tests that evaluate several cognitive functions. Twenty-five patients received 11 sessions of LF-rTMS to the contralesional hemisphere and 2 sessions of iOT per day over 15 successive days. Patients with right- and left-sided hemiparesis demonstrated significant improvements in upper limb motor function following the combined intervention program. Only patients with right-sided hemiparesis exhibited improved TMT-B performance following the combined intervention program, and there was a significant negative correlation between Fugl-Meyer Assessment scale total score change and TMT-B performance. The results indicate the possibility that LF-rTMS to the contralesional hemisphere combined with iOT improves the upper limb motor function and cognitive function of patients with right-sided hemiparesis. However, further studies are necessary to elucidate the mechanism of improved cognitive function.

 

Introduction
Upper limb hemiparesis is reported to be observed in 55–75% of post-stroke patients, and affects the patient’s activities of daily living and quality of life (Nichols-Larsen et al., 2005; Wolf et al., 2006). Duncan et al. (1992) reported that dramatic recovery of motor function was completed by 1month post-stroke, and that recovery often plateaued by 6 months. In recent years, repetitive transcranial magnetic stimulation (rTMS) has attracted attention as a treatment technique for the sequelae of stroke. It is a non-invasive, painless method to stimulate regions of the cerebral cortex, in which a figure-8 or a round coil converts electrical current into a rapidly variable magnetic field that is orthogonal to the current. Eddy currents generated by the changes of the magnetic field directly affect neurons (Barker, 1999). In addition, it has been known that different stimulation frequencies have different effects on the activities of the cerebral cortex, with high-frequency (> 5 Hz) stimulation facilitating local neuronal excitability and low-frequency (< 1 Hz) stimulation showing inhibitory effects (Lefaucheur, 2006; Butler and Wolf, 2007). Low-frequency rTMS (LF-rTMS) aims at increasing the excitability of the ipsilesional hemisphere by exerting its effects on the disrupted interhemispheric inhibition following stroke and thereby providing inhibitory stimulation to the contralesional hemisphere. Meta-analyses of rTMS in patients with stroke indicate that LF-rTMS is recommended for stroke patients in the chronic phase (> 6 months post-stroke), showing a strong possibility of a significant improvement of their upper limb function (Hsu et al., 2012; Le et al., 2014). In the past, our research group implemented a 15-day treatment protocol consisting of LF-rTMS and an intensive individualized rehabilitation program for patients with upper limb hemiparesis following stroke, and demonstrated a significant improvement of upper limb hemiparesis (Kakuda et al., 2011, 2012, 2016). Furthermore, we investigated the effects of our treatment protocol on brain activity and demonstrated a significant increase in the fMRI laterality index, indicating increased neuronal activity in the ipsilesional hemisphere (Yamada et al., 2013). Our single photon emission computed tomography (SPECT) study also demonstrated a significant decrease in perfusion in the middle frontal gyrus (Brodmann area; BA6), precentralgyrus (BA4), and post central gyrus (BA3) of the contralesional hemisphere, as well as an increased perfusion in the insula (BA13) and precentral gyrus (BA44) of the ipsilesional hemisphere (Hara et al., 2013). Thus, we demonstrated changes in brain activity between pre- and post-treatment that combined LF-rTMS and an intensive occupational therapy (iOT) program.

In recent studies, rTMS was used not only in treating upper limb hemiparesis after stroke, but also for other conditions, including neurological and psychiatric disorders, pain, and Parkinson’s disease (Lefaucheur et al., 2014). Furthermore, some studies conducted neuropsychological examinations at the time of rTMS to evaluate its effect on cognitive function (Nardone et al., 2014; Drumond Marra et al., 2015). One study reported an improvement in cognitive function following rTMS in patients with mild cognitive impairment (Nardone et al., 2014). Drumond Marra et al. (2015) reported an improved performance on the Rivermead Behavioral Memory Test following high-frequency rTMS (HF-rTMS) to the left dorsolateral prefrontal cortex (DLPFC).

Furthermore, the effects of rTMS on cognitive function in addition to motor disorders, aphasia, and affective disorders have been attracting attention (Lefaucheur et al., 2014; Nardone et al., 2014; Drumond Marra et al., 2015). One study reported an improvement in Trail-Making Test part B (TMT-B) performance by HF-rTMS, while another study reported a lack of significant improvement relative to a control group (Moser et al., 2002; Mittrach et al., 2010). However, few studies have investigated the effects of LF-rTMS on cognitive function. As described earlier, LF-rTMS exerts an inhibitory stimulation to the side of administration and is considered to affect the contralateral cerebral cortices via a modulation of interhemispheric inhibition. Therefore, LF-rTMS possibly affects a broader region than that affected by HF-rTMS. Meta-analyses of rTMS in patients with stroke indicate that LF-rTMS is recommended for stroke patients in the chronic phase (> 6 months post-stroke).

Although previous studies indicate a possibility of positive effects of rTMS on cognitive function; however, to the best of our knowledge, there has been no report describing the effect of a combined intervention program of LF-rTMS and intensive occupational therapy (iOT) on cognitive function in post-stroke patients. Therefore, the present study aimed to explore the therapeutic effect of the combined intervention program on patients with post-stroke upper limb hemiparesis.

Continue —> Does a combined intervention program of repetitive transcranial magnetic stimulation and intensive occupational therapy affect cognitive function in patients with post-stroke upper limb hemiparesis? Hara T, Abo M, Kakita K, Masuda T, Yamazaki R – Neural Regen Res

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[WEB site] First trial of Cognition Kit wearables demonstrates effectiveness in measuring mental health

The neuroscience company Cambridge Cognition Holdings PLC, which develops near patient technologies for the assessment of brain health, has announced results from a new technology feasibility study. The results demonstrate for the first time that consumer grade wearables such as the Apple Watch® and Microsoft Band can be used to accurately measure clinically relevant cognitive performance in everyday life using the Company’s new Cognition Kit software.

Mental health conditions are among the leading causes of disability worldwide. With more than 450 million people living with mental illnesses, the cost of treatment and care to global economies will double by 2030 to over $6 trillion (Source: World Health Organization).

Current methods of brain health assessment rely on infrequent snapshots to characterise impairment and recovery. Such sparse sampling will often miss clinically significant changes, which can impact on a patient’s quality of life and limit the ability to accurately measure the effect of intervention and treatment.

Cognition Kit is a wearable software platform developed under a joint venture between Cambridge Cognition and London research agency Ctrl Group to address this growing need. The technology will enable doctors, scientists and patients to better understand and manage day-to-day brain health by measuring the key biological and psychological factors affecting mental performance accurately in real time.

The new study shows for the first time that wearable consumer devices can be used clinically to measure cognitive performance accurately when programmed with the Cognition Kit software.

During the study participants wore a wearable device to monitor their levels of stress and physiological activity using built-in sensors of heart rate, galvanic skin response and skin temperature.

Throughout each day, subjects completed game-like micro tests of cognition on the device to measure attention, memory, mood and reaction speed.

After each cognitive game, subjects reported how they felt by selecting one of six faces to convey their current mood. On June 24th, the day of the EU referendum results in the UK, the researchers observed a significant drop in the general mood of the British participants in the study.

The 30 million data points recorded demonstrate distinct patterns of performance within and across days, allowing a rich picture of a subject’s cognitive health to emerge. Cognition Kit thus has the potential to revolutionise brain health treatment at all stages – from patient assessments during the development of disease-modifying interventions to monitoring of patient health.

With drug development companies increasingly being required to demonstrate clinical outcomes-based value of treatments in patients, this Cognition Kit study provides evidence that new technologies could transform healthcare and medical research in a wearable health industry estimated to be worth $2 billion (Source: Soreon Research Wearable Healthcare Report 2014).

Cambridge Cognition is in discussion with a number of pharmaceutical partners following significant early interest boosted by the results of the study and expects to sign the first Cognition Kit contracts in the near future.

Francesca Cormack, PhD, Director of Research and Innovation, Cambridge Cognition commented

”This proof of concept study demonstrates for the first time that these consumer devices are enabling the rapid and accurate collection of largescale scientific datasets. This not only allows dramatically more detailed knowledge of moment-by-moment brain function but also opens up new possibilities to develop machine learning algorithms that will enable earlier detection and intervention in brain disorders.”

Ben Fehnert, Co-founder of Ctrl Group and Director of Cognition Kit commented

”Simple, regular interaction with peoples own phones and wearable devices is key to helping understand daily and longer term fluctuations in cognitive function. This study is the first demonstration of how Cognition Kit software can build a rich picture of brain health using peoples own devices during their daily lives.”

About Cognition Kit

Cognition Kit is a joint venture between Cambridge Cognition and Ctrl Group formed in 2016 to develop digital health tools on mobile and wearable devices. Cognition Kit software takes research out of the lab and into daily life, enabling doctors, scientists and the public to better understand and manage day-to-day brain health.

Source: First trial of Cognition Kit wearables demonstrates effectiveness in measuring mental health

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[Press Announcements] FDA allows marketing of first-of-kind computerized cognitive tests to help assess cognitive skills after a head injury.

August 22, 2016

Release

The U.S. Food and Drug Administration today permitted marketing of two new devices to assess a patient’s cognitive function immediately after a suspected brain injury or concussion. The Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) and ImPACT Pediatric are the first medical devices permitted for marketing that are intended to assess cognitive function following a possible concussion. They are intended as part of the medical evaluation that doctors perform to assess signs and symptoms of a head injury.

ImPACT and ImPACT Pediatric are not intended to diagnose concussions or determine appropriate treatments. Instead the devices are meant to test cognitive skills such as word memory, reaction time and word recognition, all of which could be affected by a head injury. The results are compared to an age-matched control database or to a patient’s pre-injury baseline scores, if available.

“These devices provide a useful new tool to aid in the evaluation of patients experiencing possible signs of a concussion, but clinicians should not rely on these tests alone to rule out a concussion or determine whether an injured player should return to a game,” said Carlos Peña, Ph.D., M.S., director of the division of neurological and physical medicine devices at the FDA’s Center for Devices and Radiological Health.

ImPACT software runs on a desktop or laptop and is intended for those ages 12 to 59, while the ImPACT Pediatric runs on an iPad and is designed for children ages 5 to 11. Only licensed health care professionals should perform the test analysis and interpret the results.

Traumatic brain injuries account for more than 2 million emergency room visits in the United States each year, according to the U.S. Centers for Disease Control and Prevention, and contribute to the deaths of more than 50,000 Americans. A significant percentage of these injuries are considered to be mild. A concussion is considered to be a mild traumatic brain injury.

The manufacturer submitted over 250 peer-reviewed articles, of which half were independently conducted clinical research studies. The research publications analyzed the scientific value of the ImPACT devices including the devices’ validity, reliability and ability to detect evidence of cognitive dysfunction that might be associated with a concussive head injury. The FDA concluded that these studies provide valid scientific evidence to support the safety and effectiveness of the ImPACT and ImPACT Pediatric devices.

The FDA reviewed the ImPACT device through its de novo classification process, a regulatory pathway for novel, low- to-moderate-risk medical devices that are first-of-a-kind, for which special controls can be developed, in addition to general controls, to provide a reasonable assurance of safety and effectiveness of the devices. The device is manufactured by ImPACT Applications, located in Pittsburgh, Pennsylvania.

The FDA, an agency within the U.S. Department of Health and Human Services, protects the public health by assuring the safety, effectiveness, and security of human and veterinary drugs, vaccines and other biological products for human use, and medical devices. The agency also is responsible for the safety and security of our nation’s food supply, cosmetics, dietary supplements, products that give off electronic radiation, and for regulating tobacco products.

Source: Press Announcements > FDA allows marketing of first-of-kind computerized cognitive tests to help assess cognitive skills after a head injury

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[Poster] Acupuncture as a Treatment to Improve Cognitive Function After Brain Injury: A Case Study

Explore the relationship between acupuncture and cognitive therapy with change in cognitive domains following traumatic brain injury. The secondary objective was to evaluate the potential relationship between acupuncture and cognitive therapy with volume activation in select brain areas as shown by functional MRI (fMRI).

Source: Acupuncture as a Treatment to Improve Cognitive Function After Brain Injury: A Case Study – Archives of Physical Medicine and Rehabilitation

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[Poster] Cognitive Rehabilitation Information for the Families of Individuals with Traumatic Brain Injury: A Review of Online Resources

To identify and critically appraise the content, readability, accessibility and usability of websites providing information on cognitive rehabilitation for the families of adults with traumatic brain injury (TBI).

Source: Cognitive Rehabilitation Information for the Families of Individuals with Traumatic Brain Injury: A Review of Online Resources – Archives of Physical Medicine and Rehabilitation

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[WEB SITE] Virtual Reality Rehab After Stroke May Aid Arm Function and ADL

http://www.dreamstime.com/stock-images-virtual-reality-image27204

The use of virtual reality as a rehabilitation aid after experiencing a stroke may have some effect on the patient’s arm function and activities of daily living.

In the study, published recently in Cochrane Database of Systematic Reviews, researchers compared the use of virtual reality with an alternative intervention or no intervention in its ability to improve upper limb function, cognitive function, activity limitation, participation restriction, and quality of life, according to a news item in Neurology Times.

The results listed in the news item note that the review revealed a statistically significant effect of virtual reality-based rehabilitation on arm function (standardized mean difference (SMD), 0.28; 95% confidence interval (CI), 0.08-0.49) and the activities of daily living (SMD, 0.43; 95% CI, 0.18-0.69). Grip strength, gait speed, or global motor function did not differ significantly, and results for cognitive function, participation restriction, quality of life, or imaging studies could not be analyzed.

Adverse events were rare and relatively mild. Still, the quality of this evidence is low, eligibility rates were only 26%, and the most therapeutically relevant characteristics of virtual reality remain unknown, continues the Neurology Times item.

[Source: Neurology Times]

Source: Virtual Reality Rehab After Stroke May Aid Arm Function and ADL – Rehab Managment

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[ARTICLE] Effects of a virtual reality-based exercise program on functional recovery in stroke patients: part 1 – Full Text PDF

[Purpose]This study aimed to determine the effects of a virtual reality exercise program using the Interactive Rehabilitation and Exercise System (IREX) on the recovery of motor and cognitive function and the performance of activities of daily living in stroke patients.

[Subjects] The study enrolled 10 patients diagnosed with stroke who received occupational therapy at the Department of Rehabilitation Medicine of Hospital A between January and March 2014.

[Methods] The patients took part in the virtual reality exercise program for 30 minutes each day, three times per week, for 4 weeks. Then, the patients were re-evaluated to determine changes in upper extremity function, cognitive function, and performance of activities of daily living 4 weeks after the baseline assessment.

[Results] In the experimental group, there were significant differences in the Korea-Mini Mental Status Evaluation, Korean version of the modified Barthel index, and Fugl-Meyer assessment scores between the baseline and endpoint.

[Conclusion] The virtual reality exercise program was effective for restoring function in stroke patients. Further studies should develop systematic protocols for rehabilitation training with a virtual reality exercise program.

via Effects of a virtual reality-based exercise program on functional recovery in stroke patients: part 1.

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[WEB SITE] Brain training games: No proof they prevent cognitive decline

cognitive testThe idea of playing a game to make you sharper seems like a no-brainer. That’s the thinking behind a billion-dollar industry selling brain training games and programs designed to boost cognitive ability.

But an investigation by CBC’s Marketplace reveals that brain training games such as Lumosity may not make your brain perform better in everyday life.

Brain training games, such as Lumosity, are a billion-dollar industry. Many people are worried about maintaining their brain health and want to prevent a decline in their mental abilities. (CBC)

Almost 15 per cent of Canadians over the age of 65 are affected by some kind of dementia. And many people of all ages are worried about maintaining their brain health and possibly preventing a decline in their mental abilities.

“I don’t think there’s anything to say that you can train your brain to be cognitively better in the way that we know that we can train our bodies to be physically better,” neuroscientist Adrian Owen told Marketplace co-host Tom Harrington.

  • CBC Marketplace: Mind Games
  • Dementia patients sold unproven ‘brainwave optimization’

To test how effective the games are at improving cognitive function, Marketplace partnered with Owen, who holds the Canada Excellence Research Chair in Cognitive Neuroscience and Imaging at the Brain and Mind Institute at Western University.

Continue —>  Brain training games: No proof they prevent cognitive decline – Health – CBC News.

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[ARTICLE] Cognitive impairment after stroke: frequency, patterns, and relationship to functional abilities – Full Text PDF

Abstract

Cognitive function was examined in 227 patients three months after admission to hospital for ischaemic stroke, and in 240 stroke-free controls, using 17 scored items that assessed memory, orientation, verbal skills, visuospatial ability, abstract reasoning, and attentional skills.

After adjusting for demographic factors with standardised residual scores in all subjects, the fifth percentile was used for controls as the criterion for failure on each item. The mean (SD) number of failed items was 3-4 (3.6) for patients with stroke and 0-8 (1.3) for controls (p < 0-001).

Cognitive impairment, defined as failure on any four or more items, occurred in 35-2% of patients with stroke and 3-8% of controls (p < 0-001). Cognitive domains most likely to be defective in stroke compared with control subjects were memory, orientation, language, and attention.

Among patients with stroke, cognitive impairment was most frequently associated with major cortical syndromes and with infarctions in the left anterior and posterior cerebral artery territories. Functional impairment was greater with cognitive impairment, and dependent living after discharge either at home or nursing home was more likely (55.0% with, v 32-7% without cognitive impairment, p = 0-001).

In a logistic model examining the risks related to dependent living after stroke, cognitive impairment was a significant independent correlate (odds ratio, OR = 2-4), after adjusting for age (OR = 5’2, 80 + v 60-70 years) and physical impairment (OR = 3.7, Barthel index < 40 v > 40). It is concluded that cognitive impairment occurs frequently after stroke, commonly involving memory, orientation, language, and attention.

The presence of cognitive impairment in patients with stroke has important functional consequences, independent of the effects of physical impairment. Studies of stroke outcome and intervention should take into account both cognitive and physical impairments.

Full Text PDF

 

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