The Neuropsychology of Acute Stroke

224 Pages·2005·2.65 MB·English

The Neuropsychology of Acute Stroke

Characterisation & Prognostic Implications

Neuropsychologische gevolgen in het vroege stadium na een beroerte
(met een samenvatting in het Nederlands)

Proefschrift

ter verkrijging van de graad van doctor aan de Universiteit Utrecht
op gezag van de Rector Magnificus, Prof. dr. W.H. Gispen
ingevolge het besluit van het College voor Promoties
in het openbaar te verdedigen

op vrijdag 3 juni 2005 des middags te 12.45 uur

door

Gudrun Maria Stefaan Nys
geboren op 31 oktober 1977, te Roeselare (België)
Promotores Prof. dr. L.J. Kappelle
(Faculty of Medicine, Utrecht University)
Prof. dr. E.H.F. de Haan
(Faculty of Social Sciences, Utrecht University)

Co-promotores dr. M.J.E. van Zandvoort
(Faculty of Social Sciences, Utrecht University)
dr. P.L.M. de Kort
(St. Elisabeth & Tweesteden Hospital, Tilburg)

The study described in this thesis was supported by a grant of the Netherlands Heart
Foundation (NHS 2000.023) and with support from the Helmholtz Institute.

Financial support by the Netherlands Heart Foundation for the publication of this
thesis is gratefully acknowledged. Publication of this thesis was also supported by
‘Stichting Ab Laane (Bilthoven): Fonds ter ondersteuning van de algemene identiteit
in de ouderenzorg’ and ‘Internationale Stichting Alzheimer Onderzoek’.

The studies were conducted at the University Medical Centre Utrecht, St. Elisabeth
Hospital Tilburg, and Tweesteden Hospital Tilburg.
The Neuropsychology of Acute Stroke

Characterisation & Prognostic Implications

Gudrun M.S. Nys
ISBN 90-393-3867-1

Copyright © 2005 Gudrun M.S. Nys

Production: Febodruk BV
Cover: Geert Clarisse & Gudrun Nys

Alle rechten voorbehouden. Niets uit deze opgave mag worden verveelvoudigd,
opgeslagen in een automatisch gegevensbestand, of openbaar gemaakt, in enige vorm
of op enige wijze, hetzij elektronisch, mechanisch, door fotokopieën, opname of op
enigerlei andere manier, zonder voorafgaande schriftelijke toestemming van de auteur.

All rights reserved. No part of this publication may be reproduced in any form by any electronic or
mechanical means (including photocopying, recording, or information storage and retrieval) without the
prior written permission of the author.
Contents

General introduction

1. Cognitive impairment early after stroke: aetiology and diagnosis 11

Cognitive deficits after stroke: phenomenology and prognostic implications

2. Cognitive disorders in acute stroke: prevalence and clinical determinants 23
3. Restrictions of the Mini-Mental State Examination in acute stroke 41
4. The prognostic value of domain-specific cognitive abilities in acute 53
first-ever stroke
5. Domain-specific cognitive recovery after first-ever stroke: 77
a follow-up study of 111 cases

The association between cognitive and emotional deficits after stroke

6. Early depressive symptoms after stroke: neuropsychological 103
correlates and lesion characteristics
7. Early cognitive impairment predicts long-term depressive 119
symptoms and a reduced quality of life after stroke

Neurological treatment effects on cognition

8. Cognitive and functional outcome after intravenous Recombinant 139
Tissue Plasminogen Activator treatment in patients with a first
symptomatic brain infarct

Uncommon cognitive disorders in acute stroke

9. The role of executive functioning in spontaneous confabulation 153
10. The physiological basis of visual hallucinations after damage to 167
the primary visual cortex

Conclusions

11. General discussion 181

Summary 203
Samenvatting in het Nederlands 209
Publications 217
Dankwoord 221
Curriculum Vitae 223

Brain explorer its for you

Fragment by Tommy McHugh, who suffered a stroke in 2001.
Published in: Lythgoe MFX et al. (2005). Neurology, 64, 397-398.

Just thought I would explain to you
The changes in my mental view
Life that’s changed inside my head
Fun and fear turn to dread
To feel and see two separate thought lines
Makes thinking really odd at times
Sleeping patterns now totally changed
Mental thinking increasing range
Feelings of hunger don’t touch me no more
My brain is split in a neuron war
Wandering and arguing on what to do
Looking for a brain explorer is, is it you
Can you help me link up my brain
Will it always for me be a strain
Why do I visualise the twin of me
Will these feelings always be
Strange thinking and nightmare dreams
Silent calls for help silent lonely screams
Technically it’s so confusing
Can you say what side I am using
I will always be honest, tell you straight
My survival has been by accepting my fate
It’s so unreal, at sudden odd times
As I watch my thoughts ride out on parallel lines
Flashing out straight from my head
Never stopping, ongoing, straight ahead
Where they go and what they see
Is blank and discomforting to me
I cannot understand the thoughts I am thinking
Somewhere inside my brains are blinking
Car headlights are what I see
When my other side thinks for me
Like railway lines thoughts fly out
But half of me only wants to shout
What’s going on inside my head...

Voor mijn ouders

General Introduction