Virtual reality tasks with eye tracking for mild spatial neglect assessment: a pilot study with acute stroke patients.

Objective: Increasing evidence shows that traditional neuropsychological tests are insensitive for detecting mild unilateral spatial neglect (USN), lack ecological validity, and are unable to clarify USN in all different spatial domains. Here we present a new, fully immersive virtual reality (VR) task battery with integrated eye tracking for mild visual USN and extinction assessment in the acute state of stroke to overthrow these limitations. Methods: We included 11 right-sided stroke patients and 10 healthy controls aged 18-75 years. Three VR tasks named the Extinction, the Storage and the Shoot the target tasks were developed to assess USN. Furthermore, neuropsychological assessment examining various parts of cognitive functioning was conducted to measure general abilities. We compared VR and neuropsychological task performance in stroke patients - those with (USN+, n = 5) and without USN (USN-, n = 6) - to healthy controls (n = 10) and tentatively reported the usability of VR system in the acute state of stroke. Results: Patients had mostly mild neurological and USN symptoms. Nonetheless, we found several differences between the USN+ and healthy control groups in VR task performance. Compared to controls, USN+ patients showed visual extinction and asymmetry in gaze behavior and detection times in distinct spatial locations. Extinction was most evident in the extrapersonal space and delayed detection times on the extreme left and on the left upper parts. Also, USN+ patients needed more time to complete TMT A compared with USN- patients and TMT B compared with controls. VR system usability and acceptance were rated high; no relevant adverse effects occurred. Conclusion: New VR technology with eye tracking enables ecologically valid and objective assessment methods with various exact measures for mild USN and thus could potentially improve future clinical assessments.

Domain-Specific Cognitive Recovery after First-Ever Stroke: A 2-Year Follow-Up.

OBJECTIVES: The aim of this work was to study the change in different cognitive domains after stroke during a 2-year follow-up. METHOD: We evaluated both neuropsychologically and neurologically a consecutive cohort of working-age patients with a first-ever stroke at baseline (within the first weeks), 6 months, and 2 years after stroke-onset. A total of 153 patients participated in all examinations and were compared to 50 healthy controls. RESULTS: Forty-nine percent of the patients were cognitively impaired at baseline, 41% at 6 months, and 39% at 2-year follow-up. We analyzed seven cognitive domains (impairment rates at baseline and 2-year follow-up): psychomotor speed (34%; 23%), executive functions (27%; 17%), visual memory (21%; 4%), visuospatial function (20%; 14%), verbal memory (18%; 12%), basic language processing (baseline 11%; 6 months 5%), and reasoning (2 years 14%). The patients who were cognitively impaired at baseline improved more within 6 months, than either the controls or cognitively intact patients in all cognitive domains (all p<.05). Later on, between 6 months and 2 years, the domain-specific change scores did not differ between patients who were cognitively intact and impaired at 6 months. Also, the cognitive status (intact or impaired) remained the same in 90% of patients between 6-month and 2-year follow-ups. At 2 years, half of the patients, who were categorized cognitively impaired, were rated as well-recovered according to neurological evaluation. CONCLUSIONS: Most of the cognitive improvement took place within 6 months. Long-lasting cognitive impairment was common even after good neurological recovery. An early neuropsychological examination is essential in evaluating cognitive dysfunction and need for rehabilitation. (JINS, 2018, 24, 117-127).

Post-stroke fatigue is associated with impaired processing speed and memory functions in first-ever stroke patients.

OBJECTIVE: Fatigue is a common consequence of stroke that frequently co-occurs with depression. Data on the cognitive associations of post-stroke fatigue (PSF) is scarce. We investigated the relationship of PSF with depressive symptoms and cognitive functioning after stroke. METHODS: One hundred and thirty-three working-aged patients with first-ever ischaemic strokes underwent neuropsychological and clinical assessment and evaluation for PSF and depressive symptoms at three months, six months, and two years after stroke. Cognitive domains evaluated included processing speed, memory, executive functions, and reasoning. Fatigue and depressive symptoms were assessed with subscales of the Profile of Mood States. RESULTS: Patients (mean age: 54 ± 9.5 years, 64.7% male) were divided into groups with (n=33) and without (n=100) PSF at three months after stroke. Patients with PSF at three months after stroke had slower processing speed at three months (p=0.003) and six months (p=0.013) after stroke and worse memory performance at six months (p=0.003) after stroke than patients without PSF. Fatigue was also associated with more depressive symptoms. Impairments in processing speed at 3 months and memory at 6 months after stroke persisted after the depressive symptoms were controlled for. PSF was related to a lower rate of returning to work two years after stroke (p=0.046). CONCLUSION: PSF at three months after stroke is associated with depressive symptoms and negative cognitive and work-related outcomes following stroke. Deficits in processing speed and memory in patients with PSF were partly observed even after depressive symptoms were controlled for.