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. 2016 Jan 29;11(1):e0147602.
doi: 10.1371/journal.pone.0147602. eCollection 2016.

The Behavioral and Cognitive Executive Disorders of Stroke: The GREFEX Study

Martine Roussel  1 , Olivier Martinaud  2 , Hilde Hénon  3 , Martine Vercelletto  4 , Claire Bindschadler  5 , Pierre-Alain Joseph  6 , Philippe Robert  7 , Pierre Labauge  8 , Olivier Godefroy  1 ; GREFEX Study Group
Collaborators, Affiliations

The Behavioral and Cognitive Executive Disorders of Stroke: The GREFEX Study

Martine Roussel et al. PLoS One. .

Abstract

Background: Many studies have highlighted the high prevalence of executive disorders in stroke. However, major uncertainties remain due to use of variable and non-validated methods. The objectives of this study were: 1) to characterize the executive disorder profile in stroke using a standardized battery, validated diagnosis criteria of executive disorders and validated framework for the interpretation of neuropsychological data and 2) examine the sensitivity of the harmonization standards protocol proposed by the National Institute of Neurological Disorders and Stroke and Canadian Stroke Network (NINDS-CSN) for the diagnosis of Vascular Cognitive Impairment.

Methods: 237 patients (infarct: 57; cerebral hemorrhage: 54; ruptured aneurysm of the anterior communicating artery (ACoA): 80; cerebral venous thrombosis (CVT): 46) were examined by using the GREFEX battery. The patients' test results were interpreted with a validated framework derived from normative data from 780 controls.

Results: Dysexecutive syndrome was observed in 88 (55.7%; 95%CI: 48-63.4) out of the 156 patients with full cognitive and behavioral data: 40 (45.5%) had combined behavioral and cognitive syndromes, 29 (33%) had a behavioral disorder alone and 19 (21.6%) had a cognitive syndrome alone. The dysexecutive profile was characterized by prominent impairments of initiation and generation in the cognitive domain and by hypoactivity with disinterest and anticipation loss in the behavioral domain. Cognitive impairment was more frequent (p = 0.014) in hemorrhage and behavioral disorders were more frequent (p = 0.004) in infarct and hemorrhage. The harmonization standards protocol underestimated (p = 0.007) executive disorders in CVT or ACoA.

Conclusions: This profile of executive disorders implies that the assessment should include both cognitive tests and a validated inventory for behavioral dysexecutive syndrome. Initial assessment may be performed with a short cognitive battery, such as the harmonization standards protocol. However, administration of a full cognitive battery is required in selected patients.

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Conflict of interest statement

Competing Interests: The authors declare that no competing interests exist.

Figures

Fig 1
Fig 1. The profile (frequency %) of cognitive (left) and behavioral (right) disorders as a function of the stroke subtype.
See this image and copyright information in PMC

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References

    1. Tatemichi TK, Desmond DW, Stern Y, Paik M, Sano M, Bagiella E. Cognitive impairment after stroke: Frequency, patterns, and relationship to functional abilities. J Neurol Neurosurg Psychiatry. 1994;57: 202–207. - PMC - PubMed
    1. Pohjasvaara T, Leskela M, Vataja R, Kalska H, Ylikoski R, Hietanen M, et al. Post-stroke depression, executive dysfunction and functional outcome. Eur J Neurol. 2002;9: 269–75. - PubMed
    1. Ballard C, Stephens S, Kenny R, Kalaria R, Tovee M, O'Brien J. Profile of neuropsychological deficits in older stroke survivors without dementia. Dement Geriatr Cogn Disord. 2003;16: 52–6. - PubMed
    1. Rasquin SM, Lodder J, Ponds RW, Winkens I, Jolles J, Verhey FR. Cognitive Functioning after Stroke: A One-Year Follow-Up Study. Dement Geriatr Cogn Disord. 2004;18: 138–144. - PubMed
    1. Sachdev PS, Brodaty H, Valenzuela MJ, Lorentz L, Looi JC, Wen W, Zagami AS. The neuropsychological profile of vascular cognitive impairment in stroke and TIA patients. Neurology. 2004;23; 62: 912–9. - PubMed

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