Cognitive deficits following stroke in the basal ganglia

Abstract

Objective: To examine the effect of a stroke in the basal ganglia on cognitive functioning.

Design: As part of a larger prospective study on the neuropsychological and psychosocial consequences of stroke, 12 patients with a stroke confined to the basal ganglia were examined.

Setting: The patients were assessed in one of the three participating hospitals.

Subjects: The results of 12 patients with a stroke in the basal ganglia (mean age 55 years), were compared to 24 controls (mean age 54.3 years).

Main outcome measures: Different aspects of memory, attention and concentration, visuospatial and visuoconstructive functions, language and arithmetic were assessed using neuropsychological tests.

Results: The data show a significant abnormality in cognitive functioning on all cognitive domains.

Conclusions: The results stress the notion that subcortical damage may lead to substantial neuropsychological disorders and have clear implications for neurological rehabilitation.

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References

Bhatia KP , Marsden CD . The behavioural and motor consequences of focal lesions of the basal ganglia in man. Brain 1994; 117: 859–876.

Damasio AR , Damasio H , Rizzo M , Varney N , Gersh F . Aphasia with nonhemorrhagic lesions in the basal ganglia and the internal capsule. Arch Neurol 1982; 39: 15–20.

Healton EB , Navarro C , Bressman S , Brust JC . Subcortical neglect. Neurology 1982; 32: 776–778.

Tanridag O , Kirshner HS . Aphasia and agraphia in lesions of the posterior internal capsule and putamen. Neurology 1985; 35: 1797–1801.

Alexander MP , Naeser MA , Palumbo CL . Correlates of subcortical CT lesion sites and aphasia profiles. Brain 1987; 110: 961–991.

Ferro JM , Kertesz A , Black SE . Subcortical neglect: Quantitation, anatomy, and recovery. Neurology 1987; 37: 1487–1492.

Basso A , Della Sala S , Farabola M . Aphasia arising from purely deep lesions. Cortex 1987; 23: 29–44.

Caplan LR , Schmahmann JD , Kase CS et al. Caudate infarcts. Arch Neurol 1990; 47: 133–143.

Kirk A , Kertesz A . Subcortical contributions to drawing. Brain Cognition 1993; 21: 57–70.

10.

Leiguarda R , Lees AJ , Merello M , Starkstein S , Marsden CD . The nature of apraxia in corticobasal degeneration. J Neurol Neurosurg Psychiatry 1994; 57: 455–459.

11.

Rey GJ , Tomer R , Levin BE , Sanchez-Ramos J , Bowen B , Bruce JH . Psychiatric symptoms, atypical dementia, and left visual field inattention in corticobasal ganglionic degeneration. Mov Disord 1995; 10: 106–110.

12.

Pramstaller PP , Marsden CD . The basal ganglia and apraxia. Brain 1996; 119: 319–340.

13.

Ellis S , Small M . Localization of lesion in denial of hemiplegia after acute stroke. Stroke 1997; 28: 67–71.

14.

Schmidt RF. Motor systems. In: Schmidt RF ed. Fundamentals of neurophysiology. New York: Springer-Verlag, 1985: 155–200.

15.

Côté L , Crutcher MD . The basal ganglia. In: Kandell ER , Schwartz JH , Jessell JM eds. Principles of neural science. New York: Elsevier, 1991: 647–659.

16.

Marsden CD , Obeso JA . The functions of the basal ganglia and the paradox of stereotaxic surgery in Parkinson's disease. Brain 1994; 117: 877–897.

17.

Hochstenbach J , Mulder Th , Van Limbeek J , Joosten A , Schoonderwaldt H . A general overview of the neuropsychological consequences following stroke. J Clin Exp Neuropsychol (in press).

18.

Rey A. L'examen clinique en psychologie. Paris: Presses Universitaires de France, 1964.

19.

Wechsler D. Wechsler Adult Intelligence Scale. Manual. New York: Psychological Corp, 1955.

20.

Stinissen J , Willems PJ , Coetsier P , Hulsman WLL . Handleiding bij de Nederlandstalige bewerking van de Wechsler Adult Intelligence Scale (WAIS). Amsterdam: Swets & Zeitlinger, 1970.

21.

Wilson BA , Cockburn J , Baddeley AD . The Rivermead Behavioural Memory Test. Titchfield, Fareham, Hants: Thames Valley Test Company, 1985.

22.

Wilson BA , Cockburn J , Baddeley AD , Hiorns RW . The development and validation of a test battery for detecting and monitoring everyday memory problems. J Clin Exp Neuropsychol 1989; 11: 855–870.

23.

Van Balen HGG , Groot Zwaaftink AJM . The Rivermead Behavioural Memory Test. Handleiding. Reading: Thames Valley Test Company, 1987.

24.

Reitan RM . Validity of the Trail Making test as an indicator of organic brain damage. Percept Mot Skills 1958; 8: 271–276.

25.

Halligan PW , Robertson IH . The assessment of unilateral neglect. In: Crawford JR , Parker DM , McKinlay WW eds. A handbook of neuropsychological assessment. Hove: Lawrence Erlbaum, 1994: 151–177.

26.

Friedman PJ. Clock drawing in acute stroke. Age Ageing 1991; 20: 140–145.

27.

Bobertag O. Uber intelligenzprüfungen. Leipzig: Ambrosius Barth, 1914.

28.

Karpov BA , Luria AR , Yarbuss AL . Disturbances of the structure of active perception in lesions of the posterior and anterior regions of the brain. Neuropsychologia 1968; 6: 157–158.

29.

Wilson BA , Cockburn J , Halligan P . Behavioural Inattention Test. Titchfield, Fareham, Hants: Thames Valley Test Company, 1987.

30.

Money J. A standardized Road Map Test of direction sense. Manual. San Rafael: Academic Therapy Publications, 1976.

31.

Deelman BG , Liebrand WBG , Koning-Haanstra M , Van den Burg W . Een afasietest voor auditief taalbegrip en mondeling taalgebruik. Lisse: Swets & Zeitlinger, 1987.

32.

Dvir Z. Grade 4 in manual muscle testing: The problem with submaximal strength assessment. Clin Rehabil 1997; 11: 36–41.

33.

Luria AR. Higher cortical functions in man. New York: Basic Books, 1966.

34.

Lezak M. Neuropsychological assessment. New York: Oxford University Press, 1995.

35.

Dubois B , Defontaines B , Deweer B , Malapani C , Pillon B . Cognitive and behavioral changes in patients with focal lesions of the basal ganglia. In: Weiner WJ , Lang AE eds. Advances in neurology: behavioral neurology of movement disorders, Volume 65. New York: Raven Press, 1995: 29–41.

36.

Levin BE , Katzen HL . Early cognitive changes in Parkinson's disease. In: Weiner WJ , Lang AE eds. Advances in neurology: behavioral neurology of movement disorders, Volume 65. New York: Raven Press, 1995: 85–95.

37.

Cools A , Van den Bercken JHL , Horstink MWI , Van Spaendonck KPM , Berger, HJC . Cognitive and motor shifting aptitude disorder in Parkinson's disease. J Neurol Neurosurg Psychiatry 1984; 47: 443–453.

38.

Jayaraman A. The basal ganglia and cognition: An interpretation of anatomical connectivity patterns. In: Schneider JS , Lidsky TI eds. Basal ganglia and behavior: Sensory aspects of motor functioning. Stuttgart: Hans Huber, 1987: 169–174.

39.

Van Spaendonck KPM , Berger HJC , Horstink MWIM , Borm GF , Cools AR . Card sorting performance in Parkinson's disease: A comparison between acquisition and shifting performance. J Clin Exp Neuropsychol 1995; 17: 918–925.

40.

Finger S. Lesion momentum and behavior. In: Finger S ed. Recovery from brain damage. New York: Plenum Press, 1976: 135–164.

41.

Keschner M , Bender MB , Strauss I . Mental symptoms associated with brain tumor. JAMA 1938; 110: 714–718.

42.

Fitzhugh KB , Fitzhugh LC , Reitan RM . Psychological deficits in relation to acuteness of brain dysfunction. J Consult Psychol 1961; 25: 61–66.

43.

Fitzhugh KB , Fitzhugh LC , Reitan RM . The relationship of acuteness of organic brain dysfunction to Trail Making Test performance. Percept Mot Skills 1962; 15: 399–403.

44.

Fitzhugh KB , Fitzhugh LC , Reitan RM . Effects of ‘chronic’ and ‘current’ lateralized and non-lateralized cerebral lesions upon Trail Making test performances. J Nerv Ment Dis 1963; 137: 82–87.

45.

Hom J , Reitan RM . Neuropsychological correlates of rapidly vs. Slowly growing intrinsic cerebral neoplasms. J Clin Neuropsychol 1984; 6: 309–324.

46.

Price TRP , Goetz KL , Lovell MR : Neuropsychiatric aspects of brain tumors. In: Yudofsky SC , Hales RE eds. American Psychiatric Press textbook. Washington DC: American Psychiatric Press, 1992: 212–246.

47.

Abu-Zeid HAH , Choi NW , Hsu PH , Maini KK . Prognostic factors in the survival of 1,484 stroke cases observed for 30 to 48 months. I. Diagnostic types and descriptive variables. Arch Neurol 1978; 35: 121–125.

48.

Allen CMC . Predicting outcome of acute stroke: a prognostic score. J Neurol Neurosurg Psychiatry 1984; 47: 475–480.

49.

Bamford J , Sandercock P , Dennis M , Burn J , Warlow C . A prospective study of acute cerebrovascular disease in the community: the Oxfordshire community stroke project – 1981–1986. 2. Incidence, case fatality rates and overall outcome at one year of cerebral infarction, primary intracerebral and subarachnoid haemorrhage. J Neurol Neurosurg Psychiatry 1990; 53: 16–22.

50.

Bonita R , Ford FA , Stewart AW . Predicting survival after stroke: A three-year follow-up. Stroke 1988; 19: 669–673.

51.

Foulkes MA , Wolf PA , Price TR , Mohr JP , Hier DB . The stroke data bank: Design, methods, and baseline characteristics. Stroke 1988; 19: 547–554.

52.

De Haan R , Limburg M , Van der Meulen J , Jacobs H , Aaronson R . Quality of life after stroke: impact of stroke type and lesion location. Stroke 1995; 26: 402–408.

53.

Mori S , Sadoshima S , Ibayashi S , Iino K , Fujishima M . Relation of cerebral blood flow to motor and cognitive functions in chronic stroke patients. Stroke 1994; 25: 309–317.