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.

中风是发达国家主要残疾的主要原因，许多人患有言语、感知、运动控制和记忆的长期缺陷。急性中风患者及其家人首先要问的一些问题是：“完全康复的可能性有多大？”对于我的情况来说，什么是现实的康复？到目前为止，还没有针对这个紧迫问题的个人回应。目前，我们关于长期恢复的建议仅来自非常一般的观察。大约三分之二的急性中风引起的认知缺陷会恢复；三分之一的患者会经历慢性损伤。我们建议脑成像可以与急性行为相结合，为个体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，还可以指导个体化治疗（例如康复与补偿）。作为一般原则的展示，我们将集中讨论中风对右半球的影响，即空间定向和注意力障碍。这些缺陷是多种日常任务恢复不良的有力预测因素，包括运动恢复不良、一般认知功能障碍和康复阻力。根据我们之前的工作，我们现在对常见右半球疾病的解剖学基础有了明确的预测。具体来说，对侧裂周围区域的损伤会导致姿势和凝视的被动偏差，以及主动知觉忽视任务期间的以身体为中心的偏差（我们称之为自我中心忽视）。另一方面，更多的后部损伤似乎会导致个体对象内的空间偏差（异向中心忽视）。相反，颞顶交界处的损伤会导致灭绝（当面对同时发生的多个物体时会产生偏差）。我们的目标是根据这些最新发现进行首次前瞻性纵向研究，以了解个人的长期康复情况。我们断言，急性结构和功能性脑成像的结合，以及一套精心设计的急性和结果行为测量，将使我们能够了解潜在的生理学，并帮助我们确定准确的预后需要哪些措施。