Perceived performance of activities of daily living by stroke patients: key in decision to call EMS and outcomes.

Background: Until recently, public education campaigns aimed at improving help-seeking behavior by acute stroke patients have achieved only limited or even no effects. Better understanding of psychological factors determining help-seeking behavior may be relevant in the design of more effective future campaigns. Methods: In this prospective, cross-sectional study, we interviewed 669 acute stroke patients within 72 h after hospital admission. The primary endpoint was the effect of psychological factors on the decision to call emergency medical services (EMS). Secondary endpoints were the effects of such factors on treatment rates and clinical improvement (difference between modified Rankin scale (MRS) scores at admission and at discharge). Results: Only 48.7% of the study population called the EMS. Multivariate logistic and linear regression analyses revealed that perception of unimpaired performance of activities of daily living (ADL) was the only psychological factor that predicted EMS use and outcomes. Thus, patients who perceived only minor impairment in performing ADL were less likely to use EMS (odds ratio, 0.54 [95% confidence interval, 0.38-0.76]; p = 0.001), had lower treatment rates, and had less improvement in MRS scores (b = 0.40, p = 0.004). Additional serial mediation analyses involving ischemic stroke patients showed that perception of low impairment in ADL decreased the likelihood of EMS notification, thereby increasing prehospital delays, leading to reduced thrombolysis rates and, finally, to reduced clinical improvement. Conclusion: Perception of unimpaired performance of ADL is a crucial barrier to appropriate help-seeking behavior after acute stroke, leading to undertreatment and less improvement in clinical symptoms. Thus, beyond improving the public's knowledge of stroke symptoms, future public education campaigns should focus on the need for calling the EMS in case of stroke symptoms even if daily activities do not seem to be severely impaired.

Task context dissociates the FN400 and the N400.

In event-related potential studies, familiarity-based recognition has been associated with the FN400, that is, more positive-going waveforms for old items than new items 300-500 ms post-stimulus onset, maximal at frontal electrodes. We tested the proposition that the FN400 reflects the attribution of unexpected processing fluency to familiarity. This implies that the FN400 is greater when fluency is less expected, that is, for less familiar stimuli. Moreover, the FN400 should be modulated by the goal of remembering and only elicited when fluency is correctly attributed to the past, that is, by correct old responses in recognition memory tests. In the absence of a retrieval task, enhanced fluency for repeated items should be associated with an N400 attenuation as no episodic attribution takes place. In an incidental study-test design with words of low and high life-time familiarity, participants made pleasantness judgments for half of the studied words. The other half re-appeared in a recognition test. Only in the latter task, participants had the goal of remembering. As both tasks included also new words, we could compare old/new effects under conditions in which both effects are driven by increased fluency for repeated words. We did not find the expected differences in the FN400 for low vs. high life-time familiarity items. However, as expected, we found a frontally distributed FN400 in the recognition test whereas the old/new effect in the pleasantness task resembled an N400 effect. This supports the view that the FN400 occurs when fluency is attributed to familiarity during a recognition decision.

The ERP correlate of episodic recollection is a neurocognitive determinant of subjective memory complaints: Implications on their predictive validity.

Objective: Subjective memory complaints (SMCs) seem to be a promising marker of cognitive decline and progressing dementia in healthy older adults. However, SMCs have not been invariably related to memory performance, probably because objective tests do not always target the specific neurocognitive processes that underlie SMCs. This study disentangles the neurocognitive basis of memory-specific SMCs by investigating their dependence on episodic recollection which relies on the hippocampal relational memory system as well as their predictive value for memory tests that target such processes. Method: In 29 healthy participants, aged 52-70 years, we assessed SMCs, using the Memory Assessment Clinics Self-Rating Scale (MAC-S), episodic recollection and associated event-related potentials (ERPs), the Verbal Learning and Memory Test (VLMT), which assesses hippocampal functions, as well as depressive symptomology, using Beck Depression Inventory II (BDI). We used correlational and regression models to estimate the association of SMCs with recollection and VLMT performance, independent of age, depressive symptomology, and the P300, an ERP correlate of attentional processes. Results: The ERP correlate of source-recollection significantly accounted for 9% unique variance in SMCs. Moreover, SMCs explained unique proportions of variance in several VLMT measures (ΔR 2 ranging from .07 to .17). Conclusions: SMCs are partially determined by malfunctioning of the hippocampal relational memory system. In line with this, SMCs predict performance in objective memory tests if they also target hippocampally dependent processes. The study emphasizes the prognostic relevance of SMCs as episodic memory decline is an important preclinical marker for the development of Alzheimer's Disease (AD). (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Effects of state-wide implementation of the Los Angeles Motor Scale for triage of stroke patients in clinical practice.

BACKGROUND: The prehospital identification of stroke patients with large-vessel occlusion (LVO), that should be immediately transported to a thrombectomy capable centre is an unsolved problem. Our aim was to determine whether implementation of a state-wide standard operating procedure (SOP) using the Los Angeles Motor Scale (LAMS) is feasible and enables correct triage of stroke patients to hospitals offering (comprehensive stroke centres, CSCs) or not offering (primary stroke centres, PSCs) thrombectomy. METHODS: Prospective study involving all patients with suspected acute stroke treated in a 4-month period in a state-wide network of all stroke-treating hospitals (eight PSCs and two CSCs). Primary endpoint was accuracy of the triage SOP in correctly transferring patients to CSCs or PSCs. Additional endpoints included the number of secondary transfers, the accuracy of the LAMS for detection of LVO, apart from stroke management metrics. RESULTS: In 1123 patients, use of a triage SOP based on the LAMS allowed triage decisions according to LVO status with a sensitivity of 69.2% (95% confidence interval (95%-CI): 59.0-79.5%) and a specificity of 84.9% (95%-CI: 82.6-87.3%). This was more favourable than the conventional approach of transferring every patient to the nearest stroke-treating hospital, as determined by geocoding for each patient (sensitivity, 17.9% (95%-CI: 9.4-26.5%); specificity, 100% (95%-CI: 100-100%)). Secondary transfers were required for 14 of the 78 (17.9%) LVO patients. Regarding the score itself, LAMS detected LVO with a sensitivity of 67.5% (95%-CI: 57.1-78.0%) and a specificity of 83.5% (95%-CI: 81.0-86.0%). CONCLUSIONS: State-wide implementation of a triage SOP requesting use of the LAMS tool is feasible and improves triage decision-making in acute stroke regarding the most appropriate target hospital.