Publications by authors named "Abhishek Jaywant"

24 Publications

  • Page 1 of 1

A systematic review of neuropsychological and psychiatric sequalae of COVID-19: implications for treatment.

Curr Opin Psychiatry 2021 07;34(4):420-433

Department of Psychiatry, Weill Cornell Medicine.

Purpose Of Review: COVID-19 impacts multiple organ systems and is associated with high rates of morbidity and mortality. Pathogenesis of viral infection, co-morbidities, medical treatments, and psychosocial factors may contribute to COVID-19 related neuropsychological and psychiatric sequelae. This systematic review aims to synthesize available literature on psychiatric and cognitive characteristics of community-dwelling survivors of COVID-19 infection.

Recent Findings: Thirty-three studies met inclusion/exclusion criteria for review. Emerging findings link COVID-19 to cognitive deficits, particularly attention, executive function, and memory. Psychiatric symptoms occur at high rates in COVID-19 survivors, including anxiety, depression, fatigue, sleep disruption, and to a lesser extent posttraumatic stress. Symptoms appear to endure, and severity of acute illness is not directly predictive of severity of cognitive or mental health issues. The course of cognitive and psychiatric sequelae is limited by lack of longitudinal data at this time. Although heterogeneity of study design and sociocultural differences limit definitive conclusions, emerging risk factors for psychiatric symptoms include female sex, perceived stigma related to COVID-19, infection of a family member, social isolation, and prior psychiatry history.

Summary: The extant literature elucidates treatment targets for cognitive and psychosocial interventions. Research using longitudinal, prospective study designs is needed to characterize cognitive and psychiatric functioning of COVID-19 survivors over the course of illness and across illness severity. Emphasis on delineating the unique contributions of premorbid functioning, viral infection, co-morbidities, treatments, and psychosocial factors to cognitive and psychiatric sequelae of COVID-19 is warranted.
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http://dx.doi.org/10.1097/YCO.0000000000000713DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8183238PMC
July 2021

Use of virtual reality in the inpatient rehabilitation of COVID-19 patients.

Gen Hosp Psychiatry 2021 Apr 29;71:76-81. Epub 2021 Apr 29.

Department of Medicine, Weill Cornell Medicine, New York, NY; Division of Hospital Medicine, Ascension Saint Thomas Hospital West, Nashville, TN.

Introduction: Use of virtual reality (VR) in healthcare has expanded in recent years. The challenges faced by patients with prolonged COVID-19-related hospitalizations - social isolation, disability, neurologic sequelae, adjustment-related anxiety, depression, and stress - may be mitigated by the novel use of VR as one modality of a comprehensive rehabilitation plan. This descriptive study aimed to understand patient satisfaction and perceived benefit of virtual reality on a COVID-19 recovery unit, as well as the logistical and operational feasibility of providing VR content for patients and staff.

Materials And Methods: During the COVID-19 surge in New York City in 2020, the COVID-19 Recovery Unit (CRU) of a large academic hospital invited patients and staff to participate in VR sessions with three categories of experience: (1) Guided meditation, (2) Exploration of natural environments, (3) Cognitive stimulation games. Patients and staff were surveyed about satisfaction and perceived benefit.

Results: 13 patients and 11 staff were surveyed, with median patient satisfaction scores of 9 out of 10, with ten representing "extremely satisfied," and median staff satisfaction scores of 10. 13/13 patients answered "yes" to recommending the therapy to others, and 12/13 answered "yes" to perceived enhancement of their treatment. 11/11 staff answered "yes" to recommending the therapy to others, and 11/11 answered "yes" to perceived enhancement of their wellbeing.

Discussion: A VR program implemented on a COVID-19 rehabilitation unit for patients and healthcare providers was rated as highly satisfactory with perceived benefit by survey respondents. Participants commented that the use of VR was useful in coping with isolation and loneliness, and could be implemented within the context of clinical care for COVID-19 patients as part of a comprehensive rehabilitation model. The use of VR was also logistically and operationally feasible on the CRU. Future work to compare benefits of VR to standard neuropsychological rehabilitation is needed.
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http://dx.doi.org/10.1016/j.genhosppsych.2021.04.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8081572PMC
April 2021

Distinct functional and structural connections predict crystallised and fluid cognition in healthy adults.

Hum Brain Mapp 2021 Jul 8;42(10):3102-3118. Epub 2021 Apr 8.

Department of Radiology, Weill Cornell Medicine, New York, New York, USA.

White matter pathways between neurons facilitate neuronal coactivation patterns in the brain. Insight into how these structural and functional connections underlie complex cognitive functions provides an important foundation with which to delineate disease-related changes in cognitive functioning. Here, we integrate neuroimaging, connectomics, and machine learning approaches to explore how functional and structural brain connectivity relate to cognition. Specifically, we evaluate the extent to which functional and structural connectivity predict individual crystallised and fluid cognitive abilities in 415 unrelated healthy young adults (202 females) from the Human Connectome Project. We report three main findings. First, we demonstrate functional connectivity is more predictive of cognitive scores than structural connectivity, and, furthermore, integrating the two modalities does not increase explained variance. Second, we show the quality of cognitive prediction from connectome measures is influenced by the choice of grey matter parcellation, and, possibly, how that parcellation is derived. Third, we find that distinct functional and structural connections predict crystallised and fluid abilities. Taken together, our results suggest that functional and structural connectivity have unique relationships with crystallised and fluid cognition and, furthermore, studying both modalities provides a more comprehensive insight into the neural correlates of cognition.
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http://dx.doi.org/10.1002/hbm.25420DOI Listing
July 2021

Outcomes of a COVID-19 recovery program for patients hospitalized with SARS-CoV-2 infection in New York City: A prospective cohort study.

PM R 2021 06 22;13(6):609-617. Epub 2021 Mar 22.

Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, New York, USA.

Background: In the spring of 2020, New York City was an epicenter of coronavirus disease 2019 (COVID-19). The post-hospitalization needs of COVID-19 patients were not understood and no outpatient rehabilitation programs had been described.

Objective: To evaluate whether a virtual rehabilitation program would lead to improvements in strength and cardiopulmonary endurance when compared with no intervention in patients discharged home with persistent COVID-19 symptoms.

Design: Prospective cohort study.

Setting: Academic medical center.

Patients: Between April and July 2020, 106 patients discharged home with persistent COVID-19 symptoms were treated. Forty-four patients performed virtual physical therapy (VPT); 25 patients performed home physical therapy (HPT); 17 patients performed independent exercise program (IE); and 20 patients did not perform therapy.

Interventions: All patients were assessed by physiatry. VPT sessions were delivered via secure Health Insurance Portability and Accountability Act compliant telehealth platform 1-2 times/week. Patients were asked to follow up 2 weeks after initial evaluation.

Main Outcome Measures: Primary study outcome measures were the change in lower body strength, measured by the 30-second sit-to-stand test; and the change in cardiopulmonary endurance, measured by the 2-minute step test.

Results: At the time of follow-up, 65% of patients in the VPT group and 88% of patients in the HPT group met the clinically meaningful difference for improvement in sit-to-stand scores, compared with 50% and 17% of those in the IE group and no-exercise group (P = .056). The clinically meaningful difference for improvement in the step test was met by 74% of patients in the VPT group and 50% of patients in the HPT, IE, and no-exercise groups (P = .12).

Conclusions: Virtual outpatient rehabilitation for patients recovering from COVID-19 improved lower limb strength and cardiopulmonary endurance, and an HPT program improved lower limb strength. Virtual rehabilitation seems to be an efficacious method of treatment delivery for recovering COVID-19 patients.
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http://dx.doi.org/10.1002/pmrj.12578DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8014069PMC
June 2021

Frequency and profile of objective cognitive deficits in hospitalized patients recovering from COVID-19.

Neuropsychopharmacology 2021 Feb 15. Epub 2021 Feb 15.

Department of Psychiatry, Weill Cornell Medicine, New York, NY, US.

Early reports and case series suggest cognitive deficits occurs in some patients with COVID-19. We evaluated the frequency, severity, and profile of cognitive dysfunction in patients recovering from prolonged COVID-19 hospitalization who required acute inpatient rehabilitation prior to discharge. We analyzed cross-sectional scores from the Brief Memory and Executive Test (BMET) in a cohort of N = 57 COVID-19 patients undergoing inpatient rehabilitation, calculating the frequency of impairment based on neuropsychologist diagnosis and by age-normed BMET subtests. In total, 43 patients (75%) were male, 35 (61%) were non-white, and mean age was 64.5 (SD = 13.9) years. In total, 48 (84%) were previously living at home independently. Two patients had documented preexisting cognitive dysfunction; none had known dementia. Patients were evaluated at a mean of 43.2 (SD = 19.2) days after initial admission. In total, 50 patients (88%) had documented hypoxemic respiratory failure and 44 (77%) required intubation.  Forty-six patients (81%) had cognitive impairment, ranging from mild to severe. Deficits were common in working memory (26/47 [55%] of patients), set-shifting (21/44 [47%]), divided attention (18/39 [46%]), and processing speed (14/35 [40%]). Executive dysfunction was not significantly associated with intubation length or the time from extubation to assessment, psychiatric diagnosis, or preexisting cardiovascular/metabolic disease. Attention and executive functions are frequently impaired in COVID-19 patients who require acute rehabilitation prior to discharge. Though interpretation is limited by lack of a comparator group, these results provide an early benchmark for identifying and characterizing cognitive difficulties after COVID-19. Given the frequency and pattern of impairment, easy-to-disseminate interventions that target attention and executive dysfunctions may be beneficial to this population.
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http://dx.doi.org/10.1038/s41386-021-00978-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7884062PMC
February 2021

Changes in the Activity Measure for Post-Acute Care Domains in Persons With Stroke During the First Year After Discharge From Inpatient Rehabilitation.

Arch Phys Med Rehabil 2021 04 10;102(4):645-655. Epub 2021 Jan 10.

Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, New York; Department of Allied Health and Natural Sciences, Mercy College, Dobbs Ferry, New York.

Objective: To describe functional changes after inpatient stroke rehabilitation using the Activity Measure for Post-Acute Care (AM-PAC), an assessment measure sensitive to change and with a low risk of ceiling effect.

Design: Retrospective, longitudinal cohort study.

Setting: Inpatient rehabilitation unit of an urban academic medical center.

Participants: Among 433 patients with stroke admitted from 2012-2016, a total of 269 (62%) were included in our database and 89 of 269 patients (33.1%) discharged from inpatient stroke rehabilitation had complete data. Patients with and without complete data were very similar. The group had a mean age of 68.0±14.2 years, National Institutes of Health Stroke Score of 8.0±8.0, and rehabilitation length of stay of 14.7±7.4 days, with 84% having an ischemic stroke and 22.5% having a recurrent stroke.

Intervention: None.

Main Outcome Measures: Changes in function across the first year after discharge (DC) were measured in a variety of ways. Continuous mean scores for the basic mobility (BM), daily activity (DA), and applied cognitive domains of the AM-PAC were calculated at and compared between inpatient DC and 6 (6M) and 12 months (12M) post DC. Categorical changes among individuals were classified as "improved," "unchanged," or "declined" between the 3 time points based on the minimal detectable change, (estimated) minimal clinically important difference, and a change ≥1 AM-PAC functional stage (FS).

Results: For the continuous analyses, the Friedman test was significant for all domains (P≤.002), with Wilcoxon signed-rank test significant for all domains from DC to 6M (all P<.001) but with no change in BM and DA between 6M and 12M (P>.60) and a decline in applied cognition (P=.002). Despite group improvements from DC to 6M, for categorical changes at an individual level 10%-20% declined and 50%-70% were unchanged. Despite insignificant group differences from 6M-12M, 15%-25% improved and 20%-30% declined in the BM and DA domains.

Conclusions: Despite group gains from DC to 6M and an apparent "plateau" after 6M post stroke, there was substantial heterogeneity at an individual level. Our results underscore the need to consider individual-level outcomes when evaluating progress or outcomes in stroke rehabilitation.
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http://dx.doi.org/10.1016/j.apmr.2020.11.020DOI Listing
April 2021

The Structural and Functional Neuroanatomy of Post-Stroke Depression and Executive Dysfunction: A Review of Neuroimaging Findings and Implications for Treatment.

J Geriatr Psychiatry Neurol 2020 Oct 19:891988720968270. Epub 2020 Oct 19.

Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA.

Post-stroke depression and executive dysfunction co-occur and are highly debilitating. Few treatments alleviate both depression and executive dysfunction after stroke. Understanding the brain network changes underlying post-stroke depression with executive dysfunction can inform the development of targeted and efficacious treatment. In this review, we synthesize neuroimaging findings in post-stroke depression and post-stroke executive dysfunction and highlight the network commonalities that may underlie this comorbidity. Structural and functional alterations in the cognitive control network, salience network, and default mode network are associated with depression and executive dysfunction after stroke. Specifically, post-stroke depression and executive dysfunction are both linked to changes in intrinsic functional connectivity within resting state networks, functional over-connectivity between the default mode and salience/cognitive control networks, and reduced cross-hemispheric frontoparietal functional connectivity. Cognitive training and noninvasive brain stimulation targeted at these brain network abnormalities and specific clinical phenotypes may help advance treatment for post-stroke depression with executive dysfunction.
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http://dx.doi.org/10.1177/0891988720968270DOI Listing
October 2020

Neuropsychological functioning in severe acute respiratory disorders caused by the coronavirus: Implications for the current COVID-19 pandemic.

Clin Neuropsychol 2020 Oct - Nov;34(7-8):1453-1479. Epub 2020 Sep 9.

Department of Psychiatry, Weill Cornell Medicine/New York Presbyterian Hospital, New York, NY, USA.

The coronavirus class of respiratory viruses - including Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19) - has been associated with central nervous system (CNS) disease. In fact, multiple mechanisms of CNS involvement have been proposed, making it difficult to identify a unitary syndrome that can be the focus of clinical work and research. Neuropsychologists need to understand the potential cognitive and psychological sequelae of COVID-19 and the impact of the interventions (e.g., ICU, ventilation) that have been used in treating patients with severe forms of the illness. We briefly review the literature regarding the neurological and neuropsychological effects of similar coronaviruses, the limited information that has been published to date on COVID-19, and the literature regarding the long-term cognitive and psychological effects of undergoing treatment in the intensive care unit (ICU). We discuss the roles that neuropsychologists can play in assessing and treating the cognitive difficulties and psychiatric symptoms described. At this time, the mechanisms, correlates, and effects of COVID-19 are poorly understood, but information gleaned from the literature on similar viruses and utilized interventions should help inform neuropsychologists as they begin to work with this population.
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http://dx.doi.org/10.1080/13854046.2020.1803408DOI Listing
October 2020

Feasibility and acceptability of the multicontext approach for individuals with acquired brain injury in acute inpatient rehabilitation: A single case series.

Neuropsychol Rehabil 2020 Sep 2:1-20. Epub 2020 Sep 2.

Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, NY, USA.

The Multicontext (MC) approach, a metacognitive intervention designed to improve awareness, strategy use, and executive functioning, may be beneficial for individuals with acquired brain injury (ABI) undergoing acute inpatient rehabilitation. The goal of this study was to provide evidence of feasibility and acceptability of the MC approach and to explore clinical outcomes. A case series of eight individuals with acquired brain injury and at least mild executive functioning impairment were recruited from an acute inpatient rehabilitation unit. The MC approach - involving guided questioning and patient self-generation of strategies practiced across everyday functional cognitive tasks - was implemented within routine occupational therapy. Occupational therapists implemented the MC approach with high adherence to the treatment protocol. Therapists' perceived challenges were the time constraints of inpatient rehabilitation as well as client factors. Participants rated the MC approach as highly satisfying and engaging. They described subjective improvements in their ability to use executive functioning strategies. The MC approach was associated with improvement in awareness, strategy use, and executive functioning at the conclusion of treatment. The MC approach may be a beneficial intervention for individuals with acquired brain injury and executive dysfunction undergoing acute inpatient rehabilitation. Further evaluation with larger samples in controlled trials is warranted. ClinicalTrials.gov identifier: NCT04363645..
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http://dx.doi.org/10.1080/09602011.2020.1810710DOI Listing
September 2020

Behavioral interventions in acute COVID-19 recovery: A new opportunity for integrated care.

Gen Hosp Psychiatry 2021 Mar-Apr;69:113-114. Epub 2020 Jul 7.

Department of Psychiatry, Weill Cornell Medicine, 525 E. 68th Street, New York, NY 10065, United States of America; NewYork-Presbyterian Hospital/Weill Cornell Medical Center, 525 E. 68th Street, New York, NY 10065, United States of America.

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http://dx.doi.org/10.1016/j.genhosppsych.2020.07.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7340026PMC
March 2021

Participation in Younger and Older Adults Post-stroke: Frequency, Importance, and Desirability of Engagement in Activities.

Front Neurol 2019 18;10:1108. Epub 2019 Oct 18.

Rehabilitation Medicine Department, Weill Cornell Medicine, New York, NY, United States.

To characterize and compare frequency and subjective dimensions of post-stroke participation in younger (<65) and older adults (>age 65), in social, productivity and leisure activities, 6 months post-inpatient rehabilitation. Secondary aims included exploration of demographic and clinical factors influencing desire for increased participation and comparison of two measures of participation. A prospective cohort study of people with stroke ( = 99) who were identified during their inpatient rehabilitation stay and followed-up 6 months post-discharge with telephone interviews using two self-report participation measures. The Stroke Impact Participation subscale (SIS-P) measured the frequency of perceived limitations in social, leisure, productive activities and extent of stroke recovery. The Community Participation Indicators (CPI) examined activity frequency, importance, and desire for increased activity engagement. Descriptive statistics were used to summarize demographic variables and characterize SIS-P and CPI items. Differences between age groups on individual items were examined. Associations between measures and demographic variables were explored. Both groups reported a wide variation in participation restrictions that was not associated with stroke severity and weakly associated with discharge functional status (rho = 0.20-0.35). There were no significant differences between age groups in CPI frequency (for 18/19 items), or the SIS-P. However, there was a trend toward more participation restrictions on the SIS-P among those <65 ( = 0.07). Younger adults ( = 46; median age = 53) were significantly more likely to indicate that they were not doing selected activities enough on the CPI, compared with older adults ( = 56; median age = 76). While age and ethnicity were independently associated with some activities, it was not associated with other activities. The CPI and SIS-P were moderately related at a correlation of rho = 0.54, < 0.001. The CPI demonstrated value and utility in examining subjective perspectives of activity importance and desire for change for people who are 6 months post-stroke. Although the CPI and SIS-P are moderately related, subjective appraisal of participation in selected individual activities (CPI) better distinguished between age groups and provided unique and distinct information from the SIS-P.
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http://dx.doi.org/10.3389/fneur.2019.01108DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6813672PMC
October 2019

Subgroups Defined by the Montreal Cognitive Assessment Differ in Functional Gain During Acute Inpatient Stroke Rehabilitation.

Arch Phys Med Rehabil 2020 02 10;101(2):220-226. Epub 2019 Sep 10.

Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, New York; NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York.

Objective: To validate subgroups of cognitive impairment on the Montreal Cognitive Assessment (MoCA)-defined as normal (score of 25-30), mildly impaired (score of 20-24), and moderately impaired (score less than 19)-by determining whether they differ in rehabilitation gain during inpatient stroke rehabilitation.

Design: Observational study. Linear regression models were conducted and predictors included MoCA subgroups and relevant baseline demographic and clinical covariates. Separate models included the cognitive subscale of the FIM instrument as a predictor.

Setting: Inpatient rehabilitation facility of an urban, academic medical center.

Participants: Inpatients (N=334) with mild-moderate strokes who were administered the MoCA on admission.

Interventions: Not applicable.

Main Outcome Measures: The mean relative functional gain (mRFG) and mean relative functional efficiency (mRFE, which adjusts for length of stay) on the FIM total.

Results: MoCA subgroups significantly predicted mRFG and mRFE after accounting for age, sex, education, stroke severity, and recurrent vs first stroke. The normal group exhibited greater mRFG and mRFE than the mildly impaired group, while the moderately impaired group had significantly worse mRFG and mRFE than the mildly impaired group. The moderately impaired group had a significantly smaller proportion of individuals who made a clinically meaningful change on the total-FIM than the mildly impaired and normal groups. MoCA subgroups better accounted for mRFG and mRFE than a standard-of-care cognitive assessment (cognitive-FIM).

Conclusions: Use of MoCA-defined subgroups can assist providers in predicting functional gain in survivors of stroke being treated in inpatient rehabilitation.
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http://dx.doi.org/10.1016/j.apmr.2019.08.474DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8075065PMC
February 2020

The impact of white matter hyperintensities on the structural connectome in late-life depression: Relationship to executive functions.

Neuroimage Clin 2019 3;23:101852. Epub 2019 May 3.

Department of Psychiatry, Weill Cornell Medicine, 525 E 68(th) St, New York, NY 10065, USA; Weill Cornell Institute of Geriatric Psychiatry, 21 Bloomingdale Road, White Plains, NY 10605, USA. Electronic address:

Background: White matter hyperintensities (WMH) represent ischemic white matter damage in late-life depression (LLD) and are associated with cognitive control dysfunction. Understanding the impact of WMH on the structural connectivity of gray matter and the cognitive control correlates of WMH-related structural dysconnectivity can provide insight into the pathophysiology of LLD.

Methods: We compared WMH burden and performance on clinical measures of cognitive control in patients with LLD (N = 44) and a control group of non-depressed older adults (N = 59). We used the Network Modification (NeMo) Tool to investigate the impact of WMH on structural dysconnectivity in specific gray matter regions, and how such connectivity was related to cognitive control functions.

Results: Compared to the control group, LLD participants had greater WMH burden, poorer performance on Trail Making Test (TMT) A & B, and greater self-reported dysexecutive behavior on the Frosntal Systems Behavior Scale-Executive Function subscale (FrSBe-EF). Within the LLD group, disrupted connectivity in the left supramarginal gyrus, paracentral lobule, thalamus, and pallidum was associated with psychomotor slowing (TMT-A). Altered connectivity in the left supramarginal gyrus, paracentral lobule, precentral gyrus, postcentral gyrus, thalamus, and pallidum was associated with poor attentional set-shifting (TMT-B). A follow-up analysis that isolated set-shifting ability (TMT-B/A ratio) confirmed the association with dysconnectivity in the bilateral paracentral lobule, right thalamus, left precentral gyrus, postcentral gyrus, and pallidum; additionally, it revealed associations with dysconnectivity in the right posterior cingulate, and left anterior cingulate, middle frontal cortex, and putamen.

Conclusions: In LLD, WMH are associated with region-specific disruptions in cortical and subcortical gray matter areas involved in attentional aspects of cognitive control systems and sensorimotor processing, which in turn are associated with slower processing speed, and reduced attentional set-shifting.

Clinical Trials Registration: https://clinicaltrials.gov/ct2/show/NCT01728194.
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http://dx.doi.org/10.1016/j.nicl.2019.101852DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6514361PMC
March 2020

The clinical utility of a 30-minute neuropsychological assessment battery in inpatient stroke rehabilitation.

J Neurol Sci 2018 07 9;390:54-62. Epub 2018 Apr 9.

Department of Rehabilitation Medicine, Weill Cornell Medicine, 525 East 68th St, New York, NY 10065, United States; NewYork-Presbyterian Hospital, Weill Cornell Medical Center, 525 East 68th St, New York, NY 10065, United States. Electronic address:

Cognitive assessment is an important component of inpatient stroke rehabilitation. Few studies have empirically evaluated the clinical utility of specific neuropsychological measures in this setting. We investigated the psychometric properties and clinical utility of a 30-minute neuropsychological battery developed by the National Institute of Neurologic Disorders and Stroke (NINDS) and the Canadian Stroke Network (CSN). Clinical data were analyzed from 100 individuals with mild-moderate stroke severity on an acute inpatient rehabilitation unit who completed the NINDS-CSN battery at admission. The battery comprised the Symbol-Digit Modalities Test (SDMT), Trail Making Test, Controlled Oral Word Association Test, Animal Naming, and the Hopkins Verbal Learning Test-Revised. We evaluated the battery's distribution of scores, frequency of impaired performance, internal consistency, and ability to predict rehabilitation gain and independence in cognitively-based instrumental activities of daily living (IADL) at discharge. Results indicated that the NINDS-CSN battery was sensitive to cognitive impairment, demonstrated moderately strong internal consistency, and predicted discharge IADL. The SDMT demonstrated the strongest sensitivity to impairment and predictive validity. The NINDS-CSN battery is a clinically useful assessment battery in acute inpatient stroke rehabilitation. Complex attention and processing speed performance may be most informative in predicting amount of rehabilitation gain and IADL functioning at discharge.
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http://dx.doi.org/10.1016/j.jns.2018.04.012DOI Listing
July 2018

The diagnostic accuracy of the Montreal Cognitive Assessment in inpatient stroke rehabilitation.

Neuropsychol Rehabil 2019 Sep 18;29(8):1163-1176. Epub 2017 Sep 18.

a Department of Rehabilitation Medicine , Weill Cornell Medicine , New York , NY , USA.

The Montreal Cognitive Assessment (MoCA) is a commonly used screening measure for cognitive impairment; however, the diagnostic accuracy and optimal cutoff points in inpatients with mild stroke severity is unknown. We examined the diagnostic accuracy of the MoCA in an acute inpatient stroke rehabilitation unit ( = 95). The criterion neuropsychological assessment was the 30-minute National Institute of Neurological Disorders and Stroke-Canadian Stroke Network battery, modified to include the Symbol-Digit Modalities Test and Trail Making Test A & B. The MoCA had moderately strong diagnostic accuracy in receiver operating curve analyses, with areas under the curve ranging from .80 to .89 depending on the threshold for defining cognitive impairment. Sensitivity ranged from .72 to .87, and was generally greater than specificity, which ranged from .60 to .81. The optimal cutoff on the MoCA for detecting mild or greater cognitive impairment was <25/30. The optimal cutoff using more conservative definitions of cognitive impairment ranged from <23-24/30. Exploratory analyses of MoCA subgroups ("normal," "mildly impaired," and "functionally impaired") differed in the frequency and magnitude of impairment on the criterion neuropsychological assessment. These findings inform the clinical use of the MoCA in individuals with mild stroke in an inpatient rehabilitation setting.
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http://dx.doi.org/10.1080/09602011.2017.1372297DOI Listing
September 2019

Neuropsychological assessment without upper limb involvement: a systematic review of oral versions of the Trail Making Test and Symbol-Digit Modalities Test.

Neuropsychol Rehabil 2018 Oct 18;28(7):1055-1077. Epub 2016 Oct 18.

a Center of Excellence for Neurorestoration and Neurotechnology , Providence VA Medical Center , Providence , RI , USA.

The Trail Making Test (TMT) and written version of the Symbol Digit Modalities Test (SDMT) assess attention, processing speed, and executive functions but their utility is limited in populations with upper limb dysfunction. Oral versions of the TMT and SDMT exist, but a systematic review of their psychometric properties and clinical utility has not been conducted, which was the goal of this study. Searches were conducted in PubMed and PsycINFO, test manuals, and the reference lists of included articles. Four measures were identified: the SDMT-oral, oral TMT-A, oral TMT-B, and the Mental Alternation Test (MAT). Two investigators independently reviewed abstracts to identify peer-reviewed articles that reported on these measures in adult populations. From each article, one investigator extracted information on reliability, validity, responsiveness, minimum detectable change, normative data, and demographic influences. A second investigator verified the accuracy of the data in a random selection of 10% of papers. The quality of the evidence for each psychometric property was rated on a 4-point scale (unknown, poor, adequate, excellent). Results showed excellent evidence for the SDMT-oral, adequate evidence for the oral TMT-B and MAT, and adequate to poor evidence for the oral TMT-A. These findings inform the clinical assessment of attention, processing speed, and executive functions in individuals with upper limb disability.
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http://dx.doi.org/10.1080/09602011.2016.1240699DOI Listing
October 2018

Perception of Communicative and Non-communicative Motion-Defined Gestures in Parkinson's Disease.

J Int Neuropsychol Soc 2016 May 8;22(5):540-50. Epub 2016 Apr 8.

1Department of Psychological and Brain Sciences,Boston University,Boston,Massachusetts.

Objectives: Parkinson's disease (PD) is associated with deficits in social cognition and visual perception, but little is known about how the disease affects perception of socially complex biological motion, specifically motion-defined communicative and non-communicative gestures. We predicted that individuals with PD would perform more poorly than normal control (NC) participants in discriminating between communicative and non-communicative gestures, and in describing communicative gestures. We related the results to the participants' gender, as there are gender differences in social cognition in PD.

Methods: The study included 23 individuals with PD (10 men) and 24 NC participants (10 men) matched for age and education level. Participants viewed point-light human figures that conveyed communicative and non-communicative gestures and were asked to describe each gesture while discriminating between the two gesture types.

Results: PD as a group were less accurate than NC in describing non-communicative but not communicative gestures. Men with PD were impaired in describing and discriminating between communicative as well as non-communicative gestures.

Conclusions: The present study demonstrated PD-related impairments in perceiving and inferring the meaning of biological motion gestures. Men with PD may have particular difficulty in understanding the communicative gestures of others in interpersonal exchanges.
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http://dx.doi.org/10.1017/S1355617716000114DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5467699PMC
May 2016

Impaired perception of biological motion in Parkinson's disease.

Neuropsychology 2016 09 7;30(6):720-30. Epub 2016 Mar 7.

Department of Psychological and Brain Sciences, Boston University.

Objective: We examined biological motion perception in Parkinson's disease (PD). Biological motion perception is related to one's own motor function and depends on the integrity of brain areas affected in PD, including posterior superior temporal sulcus. If deficits in biological motion perception exist, they may be specific to perceiving natural/fast walking patterns that individuals with PD can no longer perform, and may correlate with disease-related motor dysfunction.

Method: Twenty-six nondemented individuals with PD and 24 control participants viewed videos of point-light walkers and scrambled versions that served as foils, and indicated whether each video depicted a human walking. Point-light walkers varied by gait type (natural, parkinsonian) and speed (0.5, 1.0, 1.5 m/s). Participants also completed control tasks (object motion, coherent motion perception), a contrast sensitivity assessment, and a walking assessment.

Results: The PD group demonstrated significantly less sensitivity to biological motion than the control group (p < .001, Cohen's d = 1.22), regardless of stimulus gait type or speed, with a less substantial deficit in object motion perception (p = .02, Cohen's d = .68). There was no group difference in coherent motion perception. Although individuals with PD had slower walking speed and shorter stride length than control participants, gait parameters did not correlate with biological motion perception. Contrast sensitivity and coherent motion perception also did not correlate with biological motion perception.

Conclusion: PD leads to a deficit in perceiving biological motion, which is independent of gait dysfunction and low-level vision changes, and may therefore arise from difficulty perceptually integrating form and motion cues in posterior superior temporal sulcus. (PsycINFO Database Record
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http://dx.doi.org/10.1037/neu0000276DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5003689PMC
September 2016

Randomized Controlled Trial of a Home-Based Action Observation Intervention to Improve Walking in Parkinson Disease.

Arch Phys Med Rehabil 2016 05 22;97(5):665-73. Epub 2016 Jan 22.

Department of Psychological and Brain Sciences, Boston University, Boston, MA. Electronic address:

Objective: To examine the feasibility and efficacy of a home-based gait observation intervention for improving walking in Parkinson disease (PD).

Design: Participants were randomly assigned to an intervention or control condition. A baseline walking assessment, a training period at home, and a posttraining assessment were conducted.

Setting: The laboratory and participants' home and community environments.

Participants: Nondemented individuals with PD (N=23) experiencing walking difficulty.

Intervention: In the gait observation (intervention) condition, participants viewed videos of healthy and parkinsonian gait. In the landscape observation (control) condition, participants viewed videos of moving water. These tasks were completed daily for 8 days.

Main Outcome Measures: Spatiotemporal walking variables were assessed using accelerometers in the laboratory (baseline and posttraining assessments) and continuously at home during the training period. Variables included daily activity, walking speed, stride length, stride frequency, leg swing time, and gait asymmetry. Questionnaires including the 39-item Parkinson Disease Questionnaire (PDQ-39) were administered to determine self-reported change in walking, as well as feasibility.

Results: At posttraining assessment, only the gait observation group reported significantly improved mobility (PDQ-39). No improvements were seen in accelerometer-derived walking data. Participants found the at-home training tasks and accelerometer feasible to use.

Conclusions: Participants found procedures feasible and reported improved mobility, suggesting that observational training holds promise in the rehabilitation of walking in PD. Observational training alone, however, may not be sufficient to enhance walking in PD. A more challenging and adaptive task, and the use of explicit perceptual learning and practice of actions, may be required to effect change.
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http://dx.doi.org/10.1016/j.apmr.2015.12.029DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4844795PMC
May 2016

Normal discrimination of spatial frequency and contrast across visual hemifields in left-onset Parkinson's disease: evidence against perceptual hemifield biases.

Vision Res 2015 Feb 11;107:94-100. Epub 2014 Dec 11.

Department of Psychological and Brain Sciences, Boston University, USA. Electronic address:

Individuals with Parkinson's disease (PD) with symptom onset on the left side of the body (LPD) show a mild type of left-sided visuospatial neglect, whereas those with right-onset (RPD) generally do not. The functional mechanisms underlying these observations are unknown. Two hypotheses are that the representation of left-space in LPD is either compressed or reduced in salience. We tested these hypotheses psychophysically. Participants were 31 non-demented adults with PD (15 LPD, 16 RPD) and 17 normal control adults (NC). The spatial compression hypothesis was tested by showing two sinusoidal gratings, side by side. One grating's spatial frequency (SF) was varied across trials, following a staircase procedure, whereas the comparison grating was held at a constant SF. While fixating on a central target, participants estimated the point at which they perceived the two gratings to be equal in SF. The reduced salience hypothesis was tested in a similar way, but by manipulating the contrast of the test grating rather than its SF. There were no significant differences between groups in the degree of bias across hemifields for SF discrimination or for contrast discrimination. Results did not support either the spatial compression hypothesis or the reduced salience hypothesis. Instead, they suggest that at this perceptual level, LPD do not have a systematically biased way of representing space in the left hemifield that differs from healthy individuals, nor do they perceive stimuli on the left as less salient than stimuli on the right. Neglect-like syndrome in LPD instead presumably arises from dysfunction of higher-order attention.
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http://dx.doi.org/10.1016/j.visres.2014.12.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4308520PMC
February 2015

The effect of Parkinson's disease subgroups on verbal and nonverbal fluency.

J Clin Exp Neuropsychol 2014 17;36(3):278-89. Epub 2014 Feb 17.

a Department of Psychological and Brain Sciences , Boston University , Boston , MA , USA.

Background: Parkinson's disease (PD) leads to deficits in executive function, including verbal and nonverbal fluency, as a result of compromised frontostriatal circuits. It is unknown whether deficits in verbal and nonverbal fluency in PD are driven by certain subgroups of patients, or how strategy use may facilitate performance.

Participants: Sixty-five nondemented individuals with PD, including 36 with right-body onset (RPD; 20 with tremor as their initial symptom, 16 nontremor) and 29 with left-body onset (LPD; 14 with tremor as their initial symptom, 15 nontremor), and 52 normal control participants (NC) took part in the study.

Measurements: Verbal fluency was assessed using the FAS and Animals tests. Nonverbal fluency was assessed using the Ruff Figural Fluency Test.

Results: Both RPD and LPD were impaired in generating words and in using clustering and switching strategies on phonemic verbal fluency, whereas different patterns of impairment were found on nonverbal fluency depending on the interaction of side of onset and initial motor symptom (tremor vs. nontremor). Strategy use correlated with number of correct responses on verbal fluency in LPD, RPD, and NC. By contrast, on nonverbal fluency, strategy use correlated with correct responses for RPD and LPD, but not for NC.

Conclusion: Our findings demonstrate the importance of considering subgroups in PD and analyzing subcomponents of verbal and nonverbal fluency (correct responses, errors, and strategies), which may depend differently on the integrity of dorsolateral prefrontal cortex, inferior frontal cortex, and anterior cingulate cortex.
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http://dx.doi.org/10.1080/13803395.2014.889089DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4003916PMC
November 2014

Emotional speech processing: disentangling the effects of prosody and semantic cues.

Cogn Emot 2011 Aug 24;25(5):834-53. Epub 2011 May 24.

McGill University, Montréal, Canada.

To inform how emotions in speech are implicitly processed and registered in memory, we compared how emotional prosody, emotional semantics, and both cues in tandem prime decisions about conjoined emotional faces. Fifty-two participants rendered facial affect decisions (Pell, 2005a), indicating whether a target face represented an emotion (happiness or sadness) or not (a facial grimace), after passively listening to happy, sad, or neutral prime utterances. Emotional information from primes was conveyed by: (1) prosody only; (2) semantic cues only; or (3) combined prosody and semantic cues. Results indicated that prosody, semantics, and combined prosody-semantic cues facilitate emotional decisions about target faces in an emotion-congruent manner. However, the magnitude of priming did not vary across tasks. Our findings highlight that emotional meanings of prosody and semantic cues are systematically registered during speech processing, but with similar effects on associative knowledge about emotions, which is presumably shared by prosody, semantics, and faces.
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http://dx.doi.org/10.1080/02699931.2010.516915DOI Listing
August 2011

Listener impressions of speakers with Parkinson's disease.

J Int Neuropsychol Soc 2010 Jan 16;16(1):49-57. Epub 2009 Sep 16.

School of Communication Sciences and Disorders, McGill University, Montréal, Québec, Canada.

Parkinson's disease (PD) has several negative effects on speech production and communication. However, few studies have looked at how speech patterns in PD contribute to linguistic and social impressions formed about PD patients from the perspective of listeners. In this study, discourse recordings elicited from nondemented PD speakers (n = 18) and healthy controls (n = 17) were presented to 30 listeners unaware of the speakers' disease status. In separate conditions, listeners rated the discourse samples based on their impressions of the speaker or of the linguistic content. Acoustic measures of the speech samples were analyzed for comparison with listeners' perceptual ratings. Results showed that although listeners rated the content of Parkinsonian discourse as linguistically appropriate (e.g., coherent, well-organized, easy to follow), the PD speakers were perceived as significantly less interested, less involved, less happy, and less friendly than healthy speakers. Negative social impressions demonstrated a relationship to changes in vocal intensity (loudness) and temporal characteristics (dysfluencies) of Parkinsonian speech. Our findings emphasize important psychosocial ramifications of PD that are likely to limit opportunities for communication and social interaction for those affected, because of the negative impressions drawn by listeners based on their speaking voice.
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http://dx.doi.org/10.1017/S1355617709990919DOI Listing
January 2010