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We are delighted with the latest paper now out from our lab, which introduces the OCS-Plus, our brief tablet based cognitive screening tool developed to detect subtle changes in domain general cognitive function in memory and executive functioning. Here we present the tasks and provide normative data from 320 and validation and reliability data within this neurologically healthy normative sample. With this important initial step now complete, we are looking forward to further research the validity and usefulness of the OCS-Plus in clinical populations which present with more subtle cognitive deficits.

This new paper, entitled Association of Depression and Anxiety With Cognitive Impairment 6 Months After Stroke, was published today. Below is a summary of the paper for the general public.

After a stroke, many hidden or less visible consequences are often overlooked, these include changes in mood and thinking abilities. We know that stroke survivors are at an increased risk of suffering from depression and anxiety. We also know that many stroke survivors experience difficulties with cognition: how they process, react, and remember information, difficulties with language and numbers, with paying attention and perception and with planning complex tasks.

In this study, we investigated whether or not, at 6 months after stroke, impairments in specific types of cognition were associated with an increased risk of having more severe depression or anxiety symptoms. Using data from stroke participants recruited from 37 NHS sites across England, we found that impairment in a range of cognitive processes including visual processing, memory, language and number processing, and how well they complete complex tasks were all associated with more severe depressive symptoms but not with anxiety symptoms.

This work is important in highlighting that common struggles with a wide range of thinking processes due to the incurred stroke can affect a person’s recovery from stroke and have a negative impact on their quality of life. More work is needed to investigate how these associations between cognition and mood might change over time as patients recover from stroke. However, the results suggest that in addition to typical post-stroke rehabilitation which tends to focus on physical recovery, developing therapies to improve cognition has the potential to positively impact patient’s mood and with that their quality of life.

Reference:

Williams OA, Demeyere N. Association of Depression and Anxiety With Cognitive Impairment 6 Months After Stroke. Neurology. 2021 Feb 15; Available from: https://n.neurology.org/content/early/2021/02/25/WNL.0000000000011748

The below poem was sent to us by one of the participants in the ox-chronic study about his recent participation in the remote assessment. For context: Participants are sent a series of paper folders which are opened during the call, as well as an activity monitor to monitor sleep and overall activity over 7 days.

STROKE STUDY

A very large envelope came through my door

I pondered what this can be

Opening it up wondering what I would find

Wow it,s brain testing time just for me

This was followed up by a phone call

It was Grace on the other end

We fixed a time when she would be calling

I just hope my brain box won,t bend

Grace read a short story,

Later for me to recall

I must hold this story inside me

After all I don,t want to fall

Small hearts and big hearts were presented

I just had to circle the small

If I made a mess of this one

I must have been quite a fool

With circles and squares in a picture

I next had to join with a line

Not a straight one but zig zag all over

If I do this it all should be fine

They sent me a watch with no dial

To wear for seven long days

A watch you can,t see what the time is

This could start a new craze.

(Poem by John S, 92, stroke survivor)

Wonderful news and many congratulations to Jacob Levenstein who has now successfully passed his PhD Viva. Even though it was on videocall in these times of COVID, Jacob kindly sent this wonderful Oxford SubFusc picture to share with you.

Jacob’s thesis was entitled. “Neurochemical and Structural Brain Imaging of Human Motor Control in Health and Post-Stroke” supervised by Profs Charlie Stagg and Nele Demeyere.  The viva examination was conducted with Prof Holly Bridge (internal examiner) and Prof Paul Mullins (Bangor University).

Many stroke survivors have difficulties with complex thinking tasks following their stroke, with around 80% of survivors showing some form of this. Any problems in any or all of these complex abilities, such as planning, organisation, stopping actions or swapping actions can make it difficult to do many tasks of everyday life, affecting people’s independence and enjoyment of life. Tests that assess these complex mental abilities are typically quite abstract, involving connecting shapes, or finding patterns. These kind of tests also commonly miss those survivors who do well in a structured environment, like a lab or hospital, but have difficulties when having to organise their days or behaviour when distractions and interruptions are more common. The Oxford Digital Multiple Errands Test (OxMET) is a short to administer but powerful new test that uses a shopping scenario, more like the everyday real life complex situations, in an engaging and friendly way, without intimidating and abstract contexts.

This simple test is based around a common shopping scenario where an individual has 6 items to buy and 2 questions to answer. The trick is that there are rules to follow when completing the task that trips people up. Performance on this relatively simple task can reveal  a person’s ability to manage complex tasks. Further research will investigate whether this test done before a home-discharge can be helpful to understand how well people will cope independently once home, and what levels of support to put in place

paper reference:

Sam S. Webb, Anders Jespersen, Evangeline G. Chiu, Francesca Payne, Romina Basting, Mihaela D. Duta & Nele Demeyere (2021) The Oxford digital multiple errands test (OxMET): Validation of a simplified computer tablet based multiple errands test, Neuropsychological Rehabilitation, DOI: 10.1080/09602011.2020.1862679

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Up to three quarters of people have visual perception problems after stroke. These problems can be difficulties with recognising objects, faces, shapes or with reading. Unfortunately, only 20% of these problems are discovered in routine clinical practice. This means many stroke survivors and their families do not get support in understanding and managing their visual perception problems. A first step to improving the diagnosis of visual perception problems after stroke is to better understand the current clinical practice and the challenges that clinicians face in making a diagnosis. We interviewed 25 clinicians involved in visual perception screening after stroke. We asked them how they currently screen for visual perceptual difficulties, what they find challenging, and what they would recommend to improve services. They told us visual perception was difficult to understand. For many it was unclear how it differed from sensory vision and visual inattention (or hemispatial neglect). They told us the biggest challenges were a lack of time and training. Many of the existing assessments were not suitable for stroke survivors with communication difficulties or with difficulties concentrating for more than 10 minutes. To improve services, they recommend:

1) More training and awareness

2) Quick and practical assessment tools

3) Good local relationships between orthoptists and occupational therapists

In a follow-up survey, we will ask a large number of clinicians from all over the UK if they agree with our conclusions. Next, we will use their advice to develop an instrument that meets their needs and hopefully improve diagnosis of visual perception difficulties after stroke.

Dissociating Word-Centred Neglect Dyslexia from Spatial Attention: A Case Study

Neglect dyslexia is a group of post-stroke reading impairments in which people have trouble reading letters on one side of individual words. For example, a patient with right neglect dyslexia might read the word PLANETS as “planet”, “plan”, or “planned”. These reading impairments are all thought to be caused by neglect, a condition in which people have trouble distributing attention equally across space. However, it is not yet clear whether this is an accurate explanation of all cases of neglect dyslexia.

In this experiment, we conducted a single case study of CD, a stroke survivor with right, word-centred neglect dyslexia. CD was found to exhibit right word-centred neglect dyslexia as well as left visuospatial neglect. If CD’s reading problems were caused by his neglect, this conjunction of neglect dyslexia and neglect in opposite lateralisations would not be expected. CD was consistently able to name all individual letters within words, but still committed neglect dyslexia errors when immediately reading the same words as a whole. This behavioural pattern would not be expected if CD’s reading problem was caused by a spatial attention problem.  Finally, factors which are known to modulate the severity of neglect had no effect on the severity of CD’s neglect dyslexia. These findings strongly suggest that CD’s neglect dyslexia cannot be accurately characterised as a neglect-related impairment.

These findings are important because they suggest that we may need to change the way we think about word-centred neglect dyslexia. Current therapies which aim to help people with word-centred neglect dyslexia try to improve neglect attentional biases. If not all cases of neglect dyslexia are not actually caused by these biases, new therapies are needed to help people with neglect dyslexia. However, before these new therapies can be designed, we need to get a better understanding of what causes word-centred neglect dyslexia.

In this new paper, led by Hannah Hobson, we found that self-reported communication difficulties associated with higher scores of alexithymia.

Lay summary:

Some people report that they struggle to identify and communicate their emotions after experiencing a stroke. Problems recognising your own feelings – sometimes called “alexithymia” – has been found to be a predictor of mental health difficulties in people who have not had a stroke, so understanding what causes this problem could be useful to supporting the mental health of stroke patients.

One idea is that disrupted language abilities might contribute to emotional problems: we might use language to help us make sense of, label, and communicate how we are feeling. If our language abilities are disrupted, our emotional abilities might suffer as a result.

This project examined the links between alexithymia and language problems in stroke survivors. Interestingly, while behavioural language abilities (those measured with a task, such as being able to give the right word for a picture) did not predict alexithymia. However, when patients were asked about how they felt their communication abilities had changed, these self-reported measures of language were associated with alexithymia.

These findings partly replicate previous results from studies with Traumatic Brain Injury patients. One reason that we see differences between the task-based and self-reported measures could be that the task-based measures only reflect quite severe language impairments, while asking patients might reflect more subtle impairments.

The full text (accepted author-version of the paper) can be accessed here.

In December 2019, the Translational Neuropsychology Group travelled to Telford for the 14^th annual UK Stroke Forum, hosted at the Telford International Centre. The UK Stroke Forum is a multidisciplinary conference for any stroke care professional. There was a mix of practicing clinicians, occupational therapists, physiotherapists, doctors, researchers, and also stroke survivors and their families. This unique mixture of those involved in stroke care enabled us to focus our efforts on disseminating information related to our new and improved cognitive screening tools. Thanks to the efforts of our Research Coordinator Romina Basting we were able to coordinate the group’s efforts through three intense days of talks, training workshops, demonstrations, and networking.

Talks and Demonstrations

On the first day, Prof. Nele Demeyere & Dr Kathleen Vancleef ran two back to back interactive workshops for over 200 attendees as part of the clinical training stream hosted by Dr Charlie Chung (Stroke Specialist Occupational Therapist), to explain the how, what and why of the Oxford Cognitive Screen (OCS) for screening post-stroke cognitive impairment.

Another talk by Prof. Nele Demeyere was our most anticipated, where we launched the OCS-Plus. The OCS-Plus is a stand-alone computer-tablet based extension of the OCS which screens for milder cognitive impairments, teasing out subtle impairments which are missed by gross level cognitive screens. As expected, this talk garnered much interest from the attendees and our stall was flooded with interested clinicians. Sam Webb was kept busy for the bulk of the Stroke Forum, where he demonstrated the OCS-Plus in action to many interested groups. Through sign-up sheets we were able to see just how many clinicians and clinical groups are interested in running the OCS-Plus in their own settings. We are currently only able to set up research collaborations, but will be keeping everyone posted on when the tests will be available clinically.

Posters

Both of our DPhil Students, Elise Milosevich and Margaret Moore presented on their latest projects, as well our Postdoctoral research fellow Dr Kathleen Vancleef and our Research Assistant Sam Webb. During 3 minute-slot poster tours our group were able to test our quick dissemination skills by running groups through our projects from start to finish. It was an excellent opportunity to show stroke care professionals what our research group does and how our individual projects are merging to improve current clinical practice regarding screening for impairments.

Sam Webb presented our ongoing norming and validation study of the COMPASS tool, his poster is uploaded here. Prof. Nele Demeyere presented the poster for our newly launched OCS-Plus app, including healthy normative data and validation information, the poster is accessible here. All other posters were logged in the UK Stroke Forum 2019 app and journal indexed.

On Sunday 20th October, Nele and Richard teamed up to talk to members of the general audience as part of the public engagement IF festival (Oxford Science and Ideas Festival).

Richard Raynor described how his world was turned upside down at the age of 31, when a severe stroke led to a loss of language. In this vibrant, colourful and coming-to-terms talk, Richard described the day of his stroke, his recovery, intensive rehabilitation, and his involvement in our neuropsychology research. Associate Professor of Psychology, Nele Demeyere, explained how cognitive neuropsychology studies of these often hidden consequences of brain injuries have provided essential windows into understanding how our brains work.

Richard’s positive outlook and message on living life is awe-inspiring, and led him to be awarded as Stroke Association Life after Stroke Award