Stroke Recovery: Surprising Influences and Residual Consequences

Argye E Hillis, Donna C Tippett, Argye E Hillis, Donna C Tippett

Abstract

There is startling individual variability in the degree to which people recover from stroke, and the duration of time over which recovery of some symptoms occur. There are a variety of mechanisms of recovery from stroke, which take place at distinct time points after stroke and are influenced by different variables. We review recent studies from our laboratory that unveil some surprising findings, such as the role of education in chronic recovery. We also report data showing that the consequences that most plague survivors of stroke and their caregivers are not dependence in activities of daily living, but loss of more high level functions, such as empathy or written language. These results have implications for rehabilitation and management of stroke.

Figures

Figure 1
Figure 1
Contrasting performance of patients with viewer-centered and stimulus-centered neglect on the gap-detection test [24] (in this task the patient is asked to circle all the complete circles and put an X over circles that have a gap on the left or right side). (a) Performance by a patient with a right frontoparietal stroke and viewer-centered neglect on the gap-detection test. Note that he misses all of the stimuli on the left side of the view but detects left gaps in circles on the right view. (b) Performance by a patient with a right temporal stroke and stimulus-centered neglect on the gap-detection test. Note that he fails to detect the left gaps in circles on the right and left sides of the view.
Figure 2
Figure 2
(a) Diffusion-weighted image (DWI; left), showing small subcortical infarct and perfusion-weighted image (PWI; right) of a patient with severe viewer-centered neglect at Day 1. (b) DWI and PWI of the same patient at Day 3, after viewer-centered neglect recovered, as indicated by recovery of detecting stimuli on the left and copying stimuli on the left of a scene. PWI shows that reperfusion of the right frontoparietal cortex was associated with recovery of viewer-centered neglect. In this case, reperfusion was brought about with induced blood pressure elevation.
Figure 3
Figure 3
(a) PWI of a patient with severe stimulus-centered neglect at Day 1. (b) PWI of the same patient at Day 6, after stimulus-centered neglect recovered, as indicated by recovery of detecting gaps on the left sides of circles (irrespective of their location w.r.t. the viewer) and copying the left halves of stimuli on both sides of a scene. PWI shows that reperfusion of the right temporal cortex was associated with recovery of stimulus-centered neglect. In this case, reperfusion was brought about by urgent carotid endarterectomy.

References

    1. Farrell B., Godwin J., Richards S., Warlow C. The United Kingdom transient ischaemic attack (UK-TIA) aspirin trial: final results. Journal of Neurology Neurosurgery and Psychiatry. 1991;54(12):1044–1054. doi: 10.1136/jnnp.54.12.1044.
    1. Wade D., Collin C. The Barthel ADL index: a standard measure of physical disability? Disability & Rehabilitation. 1988;10(2):64–67. doi: 10.3109/09638288809164105.
    1. Cameron J. I., Stewart D. E., Streiner D. L., Coyte P. C., Cheung A. M. What makes family caregivers happy during the first 2 years post stroke? Stroke. 2014;45(4):1084–1089. doi: 10.1161/STROKEAHA.113.004309.
    1. Acler M., Robol E., Fiaschi A., Manganotti P. A double blind placebo RCT to investigate the effects of serotonergic modulation on brain excitability and motor recovery in stroke patients. Journal of Neurology. 2009;256(7):1152–1158. doi: 10.1007/s00415-009-5093-7.
    1. Nys G., Van Zandvoort M., De Kort P., et al. Domain-specific cognitive recovery after first-ever stroke: A follow-up study of 111 cases. Journal of the International Neuropsychological Society. 2005;11(7):795–806. doi: 10.1017/S1355617705050952.
    1. Woo D., Broderick J. P., Kothari R. U., et al. Does the National Institutes of Health Stroke Scale favor left hemisphere strokes? Stroke. 1999;30(11):2355–2359. doi: 10.1161/01.STR.30.11.2355.
    1. Lyden P., Claesson L., Havstad S., Ashwood T., Lu M. Factor analysis of the National Institutes of Health Stroke Scale in patients with large strokes. Archives of Neurology. 2004;61(11):1677–1680. doi: 10.1001/archneur.61.11.1677.
    1. Glymour M. M., Berkman L. F., Ertel K. A., Fay M. E., Glass T. A., Furie K. L. Lesion characteristics, NIH stroke scale, and functional recovery after stroke. The American Journal of Physical Medicine and Rehabilitation. 2007;86(9):725–733. doi: 10.1097/PHM.0b013e31813e0a32.
    1. Hillis A. E., Wityk R. J., Barker P. B., Ulatowski J. A., Jacobs M. A. Change in perfusion in acute nondominant hemisphere stroke may be better estimated by tests of hemispatial neglect than by the national institutes of health stroke scale. Stroke. 2003;34(10):2392–2396. doi: 10.1161/01.STR.0000089681.84041.69.
    1. Gottesman R. F., Kleinman J. T., Davis C., Heidler-Gary J., Newhart M., Hillis A. E. The NIHSS-plus: improving cognitive assessment with the NIHSS. Behavioural Neurology. 2010;22(1-2):11–15. doi: 10.3233/BEN-2009-0259.
    1. Pearce L. A., McClure L. A., Anderson D. C., Jacova C., Sharma M., Benavente O. R. Effects of long-term blood pressure lowering and dual antiplatelet therapy on cognition in patients with recent lacunar stroke: secondary prevention of small subcortical strokes (SPS3) trial. Lancet Neurology. In press.
    1. Hilari K., Needle J. J., Harrison K. L. What are the important factors in health-related quality of life for people with aphasia? A systematic review. Archives of Physical Medicine and Rehabilitation. 2012;93(1):S86–S95. doi: 10.1016/j.apmr.2011.05.028.
    1. Nichols-Larsen D. S., Clark P. C., Zeringue A., Greenspan A., Blanton S. Factors influencing stroke survivors' quality of life during subacute recovery. Stroke. 2005;36(7):1480–1484. doi: 10.1161/01.STR.0000170706.13595.4f.
    1. Niemi M.-L., Laaksonen R., Kotila M., Waltimo O. Quality of life 4 years after stroke. Stroke. 1988;19(9):1101–1107. doi: 10.1161/01.STR.19.9.1101.
    1. Carod-Artal J., Egido J. A., González J. L., Seijas E. V. Quality of life among stroke survivors evaluated 1 year after stroke: experience of a stroke unit. Stroke. 2000;31(12):2995–3000. doi: 10.1161/01.STR.31.12.2995.
    1. Urrutia V., Johnson B., Hillis A. Relative importance of stroke sequelae according to patients and caregivers. Abstract Presented at the Annual Meeting of the American Academy of Neurology; April 2014; Philadelphia, Pa, USA.
    1. Eslinger P. J., Parkinson K., Shamay S. G. Empathy and social-emotional factors in recovery from stroke. Current Opinion in Neurology. 2002;15(1):91–97. doi: 10.1097/00019052-200202000-00014.
    1. Zarahn E., Alon L., Ryan S. L., et al. Prediction of motor recovery using initial impairment and fMRI 48 h poststroke. Cerebral Cortex. 2011;21(12):2712–2721. doi: 10.1093/cercor/bhr047.
    1. Hope T. M. H., Seghier M. L., Leff A. P., Price C. J. Predicting outcome and recovery after stroke with lesions extracted from MRI images. NeuroImage: Clinical. 2013;2(1):424–433. doi: 10.1016/j.nicl.2013.03.005.
    1. Jarso S., Li M., Faria A., et al. Distinct mechanisms and timing of language recovery after stroke. Cognitive Neuropsychology. 2013;30(7-8):454–475. doi: 10.1080/02643294.2013.875467.
    1. Zeiler S. R., Krakauer J. W. The interaction between training and plasticity in the poststroke brain. Current Opinion in Neurology. 2013;26(6):609–616. doi: 10.1097/WCO.0000000000000025.
    1. Hillis A. E., Ulatowski J. A., Barker P. B., et al. A pilot randomized trial of induced blood pressure elevation: effects on function and focal perfusion in acute and subacute stroke. Cerebrovascular Diseases. 2003;16(3):236–246. doi: 10.1159/000071122.
    1. Khurshid S., Trupe L. A., Newhart M., et al. Reperfusion of specific cortical areas is associated with improvement in distinct forms of hemispatial neglect. Cortex. 2012;48(5):530–539. doi: 10.1016/j.cortex.2011.01.003.
    1. Ota H., Fujii T., Suzuki K., Fukatsu R., Yamadori A. Dissociation of body-centered and stimulus-centered representations in unilateral neglect. Neurology. 2001;57(11):2064–2069.
    1. Hillis A. E., Newhart M., Heidler J., Barker P. B., Herskovits E. H., Degaonkar M. Anatomy of spatial attention: insights from perfusion imaging and hemispatial neglect in acute stroke. The Journal of Neuroscience. 2005;25(12):3161–3167. doi: 10.1523/JNEUROSCI.4468-04.2005.
    1. Medina J., Kannan V., Pawlak M. A., et al. Neural substrates of visuospatial processing in distinct reference frames: evidence from unilateral spatial neglect. Journal of Cognitive Neuroscience. 2009;21(11):2073–2084. doi: 10.1162/jocn.2008.21160.
    1. Hillis A. E., Kane A., Tuffiash E., et al. Reperfusion of specific brain regions by raising blood pressure restores selective language functions in subacute stroke. Brain and Language. 2001;79(3):495–510. doi: 10.1006/brln.2001.2563.
    1. Hillis A. E., Kleinman J. T., Newhart M., et al. Restoring cerebral blood flow reveals neural regions critical for naming. Journal of Neuroscience. 2006;26(31):8069–8073. doi: 10.1523/JNEUROSCI.2088-06.2006.
    1. Hillis A. E., Wityk R. J., Barker P. B., Caramazza A. Neural regions essential for writing verbs. Nature Neuroscience. 2003;6(1):19–20. doi: 10.1038/nn982.
    1. Plowman E., Hentz B., Ellis C. Post-stroke aphasia prognosis: a review of patient-related and stroke-related factors. Journal of Evaluation in Clinical Practice. 2012;18(3):689–694. doi: 10.1111/j.1365-2753.2011.01650.x.
    1. EClipSE Collaborative Members, Brayne C., Ince P. G., et al. Education, the brain and dementia: neuroprotection or compensation? Brain. 2010;133, part 8:2210–2216. doi: 10.1093/brain/awq185.
    1. Roe C. M., Xiong C., Miller J. P., Morris J. C. Education and Alzheimer disease without dementia: support for the cognitive reserve hypothesis. Neurology. 2007;68(3):223–228. doi: 10.1212/01.wnl.0000251303.50459.8a.
    1. Stern Y., Albert S., Tang M.-X., Tsai W.-Y. Rate of memory decline in AD is related to education and occupation: cognitive reserve? Neurology. 1999;53(9):1942–1947. doi: 10.1212/WNL.53.9.1942.
    1. Stern Y. Cognitive reserve and Alzheimer disease. Alzheimer Disease & Associated Disorders. 2006;20(2):112–117. doi: 10.1097/01.wad.0000213815.20177.19.
    1. Alexander G. E., Furey M. L., Grady C. L., et al. Association of premorbid intellectual function with cerebral metabolism in Alzheimer's disease: implications for the cognitive reserve hypothesis. The American Journal of Psychiatry. 1997;154(2):165–172.
    1. Ojala-Oksala J., Jokinen H., Kopsi V., et al. Educational history is an independent predictor of cognitive deficits and long-term survival in postacute patients with mild to moderate ischemic stroke. Stroke. 2012;43(11):2931–2935. doi: 10.1161/STROKEAHA.112.667618.
    1. Suneja A. M., Gonzalez-Fernandez M., Hillis A. E. Predictors of recovery of chronic aphasia. Proceedings of the Annual Meeting of the American Academy of Neurology; April 2014; Philadelphia, Pa, USA.
    1. Chollet F., Tardy J., Albucher J.-F., et al. Fluoxetine for motor recovery after acute ischaemic stroke (FLAME): a randomised placebo-controlled trial. The Lancet Neurology. 2011;10(2):123–130. doi: 10.1016/S1474-4422(10)70314-8.
    1. Mead G. E., Hsieh C.-F., Hackett M. Selective serotonin reuptake inhibitors for stroke recovery. JAMA—Journal of the American Medical Association. 2013;310(10):1066–1067. doi: 10.1001/jama.2013.107828.
    1. González-Fernández M., Davis C., Molitoris J. J., Newhart M., Leigh R., Hillis A. E. Formal education, socioeconomic status, and the severity of aphasia after stroke. Archives of Physical Medicine and Rehabilitation. 2011;92(11):1809–1813. doi: 10.1016/j.apmr.2011.05.026.
    1. Posner J., Trupe L. A., Davis C. L., Gomez Y., Tippett D., Hillis A. E. Predictors of recovery of allocentric and egocentric neglect: the role of education. Proceedings of the Annual Meeting of the American Academy of Neurology; April 2014; Philadelphia, Pa, USA.

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