Individual recovery of cognitive defects after stroke

中风后认知缺陷的个体恢复

• 批准号: 318452167
• 负责人: Professor Dr. Hans-Otto Karnath
• 金额: --
• 依托单位: Department of Psychology
• 依托单位国家: 德国
• 项目类别: Research Grants
• 财政年份: 2016
• 资助国家: 德国
• 起止时间: 2015-12-31 至 2022-12-31
• 项目状态: 已结题
• 来源: https://gepris.dfg.de/gepris/projekt/318452167?language=en
• 关键词: Individual; recovery; cognitive; defects; after

Stroke is the leading cause of major disability throughout the developed world with many individuals suffering from long term deficits in speech, perception, motor control and memory. Some of the first questions of acute stroke patients and their families are: 'What is the likelihood for a full recovery? What is a realistic recovery in my case?' So far, there is no individual response to this urgent question. Currently our advice regarding long-term recovery is only informed by very general observations. About two-thirds of the cognitive deficits evoked by an acute stroke will recover; one-third of the patients will experience chronic impairments. We propose that brain imaging can be combined with acute behaviour to provide an important biomarker for individual long-term prognosis. Improved prognosis could not only provide realistic expectations, but would also guide individually tailored treatment (e.g. rehabilitation versus compensation). As a showcase for the general principle we will concentrate on the consequences of stroke to the right hemisphere, namely the disorders of spatial orientation and attention. These deficits are strong predictors for poor recovery on a wide range of everyday tasks including poor motor recovery, general cognitive dysfunction and resistance to rehabilitation. Based on our previous work, we now have clear predictions regarding the anatomical underpinnings of common right hemisphere disorders. Specifically, injury to perisylvian regions leads to passive biases in posture and gaze, as well as body-centered biases during active perceptual neglect tasks (which we refer to as egocentric neglect). On the other hand, more posterior injury appears to lead to spatial biases within individual objects (allocentric neglect). In contrast, injury to the temporoparietal junction results in extinction (a bias when confronted by multiple objects that share a simultaneous onset). Our objective is to conduct the first prospective longitudinal study informed by these recent findings in order to understand individual long-term recovery. We assert that the combination of acute structural and functional brain imaging, as well as a carefully designed set of acute and outcome behavioral measures, will allow us to understand the underlying physiology and help us determine which measures are required for accurate prognosis.

中风是整个发达国家主要残疾的主要原因，许多人在语音，感知，运动控制和记忆中遭受了长期缺陷。急性中风患者及其家人的一些第一个问题是：“完全康复的可能性是什么？在我的情况下，什么是现实的恢复？到目前为止，还没有对这个紧急问题的个人回应。目前，我们关于长期恢复的建议只有非常一般的观察才能为您提供。急性中风唤起的认知缺陷中约有三分之二将恢复；三分之一的患者会遭受慢性障碍。我们建议将大脑成像与急性行为结合使用，为个人长期预后提供重要的生物标志物。改善的预后不仅可以提供现实的期望，而且还可以指导单独量身定制的治疗方法（例如康复与补偿）。作为一般原则的展示，我们将集中于右半球中风的后果，即空间取向和注意力的疾病。这些缺陷是在各种日常任务中恢复不良的强大预测因素，包括运动率不佳，一般认知功能障碍和对康复的抵抗力。基于我们以前的工作，我们现在就普通右半球疾病的解剖基础有明确的预测。具体而言，对perisylvian区域的伤害导致姿势和凝视中的被动偏见，以及在主动感知忽视任务中以身体为中心的偏见（我们称为以以中心为中心的忽视）。另一方面，后部损伤似乎会导致单个物体内部的空间偏见（同种中为中心的忽视）。相反，颞叶交界处的损伤导致灭绝（当由共享同时发作的多个物体面对时，偏见）。我们的目标是进行这些最新发现的第一个前瞻性纵向研究，以了解个人的长期恢复。我们断言，急性结构和功能性脑成像以及精心设计的急性和结果行为度量的组合将使我们能够理解潜在的生理学，并帮助我们确定哪些措施是准确预后所必需的。