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

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.

[1]  V. Hachinski,et al.  Executive dysfunction is a strong stroke predictor , 2015, Journal of the Neurological Sciences.

[2]  D. Nyenhuis,et al.  Validation of an integrated method for determining cognitive ability: Implications for routine assessments and clinical trials , 2014, Cortex.

[3]  O. Martinaud,et al.  Cognitive impairment after cerebral venous thrombosis: a two-center study , 2013, Journal of Neurology.

[4]  F. Assal,et al.  French Adaptation of the Vascular Cognitive Impairment Harmonization Standards: The GRECOG-VASC Study , 2012, International journal of stroke : official journal of the International Stroke Society.

[5]  A. Lee,et al.  Vascular Dementia , 2011, Chonnam medical journal.

[6]  J. Bugnicourt,et al.  Is the Montreal Cognitive Assessment Superior to the Mini-Mental State Examination to Detect Poststroke Cognitive Impairment?: A Study With Neuropsychological Evaluation , 2011, Stroke.

[7]  H. Yamashita,et al.  Post‐stroke depression and apathy: Interactions between functional recovery, lesion location, and emotional response , 2011, Psychogeriatrics : the official journal of the Japanese Psychogeriatric Society.

[8]  P. Robert,et al.  Dysexecutive syndrome: Diagnostic criteria and validation study , 2010, Annals of neurology.

[9]  M. Boucart,et al.  Stroke and Action Slowing: Mechanisms, Determinants and Prognosis Value , 2010, Cerebrovascular Diseases.

[10]  S. Pendlebury,et al.  Prevalence, incidence, and factors associated with pre-stroke and post-stroke dementia: a systematic review and meta-analysis , 2009, The Lancet Neurology.

[11]  L. Fellows,et al.  A Longitudinal View of Apathy and Its Impact After Stroke , 2009, Stroke.

[12]  O. Martinaud,et al.  Anatomy of executive deficit following ruptured anterior communicating artery aneurysm , 2009, European journal of neurology.

[13]  M. O’Sullivan,et al.  Apathy: A major symptom in CADASIL , 2009, Neurology.

[14]  松本 哲夫,et al.  皮質下梗塞患者における遂行機能障害に関する研究 : Behavioural Assessment of the Dysexecutive Syndromeを用いた検討 , 2008 .

[15]  H. Yamashita,et al.  Depression or apathy and functional recovery after stroke , 2007, International journal of geriatric psychiatry.

[16]  S. Black,et al.  National Institute of Neurological Disorders and Stroke–Canadian Stroke Network Vascular Cognitive Impairment Harmonization Standards , 2006, Stroke.

[17]  P. Sachdev,et al.  Frequency and clinical, neuropsychological and neuroimaging correlates of apathy following stroke – the Sydney Stroke Study , 2005, Psychological Medicine.

[18]  J. Jolles,et al.  Cognitive Functioning after Stroke: A One-Year Follow-Up Study , 2004, Dementia and Geriatric Cognitive Disorders.

[19]  A. Cantagallo,et al.  Development of neuropsychiatric symptoms in poststroke patients: a cross‐sectional study , 2004, Acta psychiatrica Scandinavica.

[20]  H. Brodaty,et al.  The neuropsychological profile of vascular cognitive impairment in stroke and TIA patients , 2004, Neurology.

[21]  M. Tovée,et al.  Profile of Neuropsychological Deficits in Older Stroke Survivors without Dementia , 2003, Dementia and Geriatric Cognitive Disorders.

[22]  O. Godefroy,et al.  SRT lengthening: role of an alertness deficit in frontal damaged patients , 2002, Neuropsychologia.

[23]  M. Kaste,et al.  Post‐stroke depression, executive dysfunction and functional outcome , 2002, European journal of neurology.

[24]  Tim Shallice,et al.  Bizarre Responses, Rule Detection and Frontal Lobe Lesions , 1996, Cortex.

[25]  O. Godefroy,et al.  Non-spatial attention disorders in patients with frontal or posterior brain damage. , 1996, Brain : a journal of neurology.

[26]  A. Baddeley,et al.  Dual‐Task Paradigm: A Means To Examine the Central Executive , 1995, Annals of the New York Academy of Sciences.

[27]  M. Mega,et al.  The Neuropsychiatric Inventory , 1994, Neurology.

[28]  Y. Stern,et al.  Cognitive impairment after stroke: frequency, patterns, and relationship to functional abilities. , 1994, Journal of neurology, neurosurgery, and psychiatry.

[29]  A. Destée,et al.  Frontal lobe dysfunction in unilateral lenticulostriate infarcts. Prominent role of cortical lesions. , 1992, Archives of neurology.

[30]  E. DeLong,et al.  Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. , 1988, Biometrics.

[31]  H. Nelson.  A Modified Card Sorting Test Sensitive to Frontal Lobe Defects , 1976, Cortex.

[32]  S. Folstein,et al.  "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. , 1975, Journal of psychiatric research.

[33]  D. Cox,et al.  An Analysis of Transformations , 1964 .

[34]  R. Reitan.  Validity of the Trail Making Test as an Indicator of Organic Brain Damage , 1958 .

[35]  J. Bugnicourt,et al.  Cognitive impairment and dementia after intracerebral hemorrhage: a cross-sectional study of a hospital-based series. , 2013, Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association.

[36]  D. Nyenhuis,et al.  The Behavioral and Cognitive Neurology of Stroke: Cognitive and behavioral assessment of vascular cognitive impairment , 2013 .

[37]  O. Godefroy,et al.  Frontal syndrome and disorders of executive functions , 2003, Journal of Neurology.

[38]  J. Ridley.  Studies of Interference in Serial Verbal Reactions , 2001 .

[39]  J. Stroop.  Studies of interference in serial verbal reactions. , 1992 .

[40]  D B Hier,et al.  Caudate infarcts. , 1990, Archives of neurology.

[41]  Y. Joanette,et al.  [Formal and semantic lexical evocation in normal subjects. Performance and dynamics of production as a function of sex, age and educational level]. , 1990, Acta neurologica Belgica.