Dual-Task Stroop Paradigm for Detecting Cognitive Deficits in High-Functioning Stroke Patients

Songjun Lin; Qiang Lin; Biyi Zhao; Yongchun Jiang; Wanqi Zhuang; Delong Chen; Yajie Zhang; Aijia Chen; Qianrong Zhang; Yuxin Zheng; Jianjun Wang; Fangqiu Xu; Xi Qin; Yefeng Cai

doi:10.3791/63991

JoVE Journal
Neuroscience

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JoVE Journal Neuroscience

Dual-Task Stroop Paradigm for Detecting Cognitive Deficits in High-Functioning Stroke Patients

检测高功能卒中患者认知缺陷的双任务斯特鲁普范式

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07:42 min

December 16, 2022

DOI: 10.3791/63991-v

Songjun Lin^1,2, Qiang Lin^3,4,5, Biyi Zhao^3,4,6, Yongchun Jiang^3,4, Wanqi Zhuang^3,4, Delong Chen^3,4, Yajie Zhang^3,4, Aijia Chen^3,4, Qianrong Zhang⁷, Yuxin Zheng^3,4, Jianjun Wang¹, Fangqiu Xu⁸, Xi Qin^3,4,9, Yefeng Cai¹⁰

¹Department of Neurology and Psychology, the Fourth Clinical Medical College,Guangzhou University of Chinese Medicine, Shenzhen Traditional Chinese Medicine Hospital, ²Guangzhou University of Chinese Medicine, ³Department of Rehabilitation Medicine,The Fifth Affiliated Hospital of Guangzhou Medical University, ⁴Department of Rehabilitation Medicine,Guangzhou Medical University, ⁵Key Laboratory of Biological Targeting Diagnosis, Therapy and Rehabilitation of Guangdong Higher Education Institutes,The Fifth Affiliated Hospital of Guangzhou Medical University, ⁶School of Traditional Chinese Medicine,Jinan University, ⁷Health College of Guangdong Pharmaceutical University, ⁸Department of Clinical Medicine,Guangzhou Medical University, ⁹Department of Rehabilitation Medicine,Panzhihua Central Hospital, ¹⁰Department of Neurology and Psychology,the Second Affiliated Hospital of Guangzhou University of Chinese Medicine

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Overview

This study introduces a dual-task Stroop paradigm aimed at detecting cognitive dysfunction in high-functioning stroke patients, a group often overlooked by traditional assessment scales. The research evaluates the performance of stroke patients using fNIRS, aiming to enhance clinical assessment and cognitive training methods.

Key Study Components

Area of Science

Neuroscience
Cognitive Assessment
Stroke Rehabilitation

Background

Conventional clinical assessment scales often fail to detect cognitive deficits in high-functioning stroke patients.
Identifying cognitive dysfunction accurately is crucial for effective rehabilitation.
Elevating assessment methods can pave the way for tailored cognitive training.

Purpose of Study

To establish a novel assessment protocol utilizing the dual-task Stroop paradigm.
To identify cognitive deficits that conventional skills miss in high-functioning stroke patients.
To enhance treatment strategies based on cognitive performance metrics.

Methods Used

Utilized fNIRS for real-time brain activity monitoring during cognitive tasks.
Implemented a series of cognitive assessments including MoCA, CDR, and Stroop tasks.
Conducted tests while participants performed specified cognitive tasks, integrating a balance component to evaluate dual-task performance.
Assured participant safety with strict observational guidelines during testing.

Main Results

Stroke patients exhibited longer reaction times and lower accuracy during dual-task evaluations compared to healthy subjects.
Notable differences in brain function metrics were observed, specifically lower beta values in stroke patients.
Results underscore the effectiveness of the dual-task approach in revealing cognitive deficits.

Conclusions

This study establishes a framework for more sensitive cognitive assessment in high-functioning stroke patients.
The dual-task Stroop paradigm may lead to more individualized treatment strategies.
Ultimately, these findings contribute to understanding cognitive mechanisms in stroke recovery.

Frequently Asked Questions

What advantages does the dual-task Stroop paradigm offer?

It allows for the identification of subtle cognitive deficits in stroke patients not detectable by standard assessments, enhancing rehabilitation strategies.

How are cognitive deficits assessed in this study?

Cognitive assessments include MoCA, CDR, and dual-task Stroop tests, measuring attention, memory, and executive function.

What is the role of fNIRS in this protocol?

fNIRS is used to monitor brain activity in real-time while patients perform the Stroop tasks, facilitating a link between cognitive performance and neural correlates.

What safety measures are taken during the assessment?

Participants are observed closely to prevent injuries, particularly when performing dual tasks that involve physical balance.

Can the protocol be adapted for other patient populations?

Yes, the dual-task Stroop paradigm could be modified for use with other neurological conditions where cognitive deficits need identification.

What future research directions does this study suggest?

Future studies should explore different types and difficulty levels of dual tasks to further refine cognitive assessments.

临床评估量表对高功能卒中患者的认知功能障碍不够敏感。双任务范式在认知功能障碍的评估和认知训练中具有优势和潜力。这里的研究提出了一种双任务斯特鲁普范式来识别高功能中风患者的认知功能障碍。

我们的研究方案可用于识别高功能中风患者的认知缺陷，这些患者不容易被常规评估技能发现。本研究方案旨在为高功能脑卒中患者在一般临床评估失败中的影响提供新思路。该研究方案可以很容易地用于临床实践。

例如，临床医生可以根据斯特鲁普反应时间和正确速率修改治疗策略。演示该程序的将是康复治疗师黄思琪;王思清，职业治疗师;张雅杰，物理治疗师，赵碧怡，我们实验室的职业治疗师。招募经影像学检查确认的 Brunnstrom 4 期病情稳定的中风患者。

确保受试者自愿参加测试并签署知情同意书。记录参与者的信息，包括姓名、性别、出生日期、教育水平、体重指数、病史和用药史。对于认知评估，通过询问11个问题对参与者进行MoCA，这些问题涉及他们的注意力和注意力，执行功能，记忆力，语言，视觉结构技能，抽象思维，计算和方向。

然后通过在与参与者及其家人的结构化访谈中收集信息来执行CDR，以评估参与者在记忆，定向，判断和解决问题，工作和社会互动，家庭生活，个人爱好和独立生活等方面的能力。进行阿尔伯特试验以检测卒中患者是否存在单侧空间忽视。要求受试者划掉一张纸上随机放置的所有线条。

接下来，对参与者进行Fugl-Meyer评估，以评估中风后偏瘫患者的感觉，平衡，关节运动范围和关节疼痛。运动功能包括评估肩膀、肘部、前臂、手腕、手、臀部、膝盖和脚踝的运动、协调和反射动作的项目。同时对中风患者进行Berg平衡量表，从易到难共14个项目，包括坐姿平衡、站立平衡、身体转移、转身和单腿站立。

执行定时测试。让受试者从椅子上站起来，走三米，转动身体，然后返回并坐在椅子上。同时，安排从发出出发令到坐在椅子上的整个过程。

通过确保测试帽顶部的 CZ 位点（即从前额到枕叶的第四点）位于全帽的中线上，为参与者做好准备。确保连接的中点位于鼻根与枕骨突起下缘之间，双耳上耳窝之间的连接或从鼻根到枕突的连接点的交点。然后单击预采集按钮开始预采集并校准测试信号。

执行与fNIRS同步的斯特鲁普单任务评估。然后执行与fNIRS同步的斯特鲁普双任务评估。首先，让患者坐在稳定的椅子上。

运行商业刺激演示软件并选择全等测试试验。为患者制作新的个人资料。选择 Stroop 任务的全等检验试验并重复三个试验。

在休息阶段，要求患者放松。当实验处于刺激阶段时，要求患者进行注意力相关测试，并在六秒内完成任务。患者应在 60 秒内完成 10 次。

要求患者遵循两个测试试验的说明。选择全等检验试验。显示左侧时，单击左侧的箭头按钮。

显示右侧时单击右侧的箭头按钮。选择不协调任务试验。当右箭头按钮显示在正方形的左侧时，请尽快单击左侧的箭头按钮。

当左箭头显示在正方形的右侧时，请尽快单击右侧的箭头按钮。完成任务，保存数据并将数据导出到自建数据库。要进行斯特鲁普双重任务评估，请患者坐在平衡球上。

让患者按照上一步所示的步骤完成斯特鲁普实验范式。当实验处于休息阶段时，要求患者保持平衡并在平衡球上放松。当实验在刺激时，要求患者在尽可能保持平衡球平衡的同时进行与注意力相关的测试。

本研究对高功能卒中患者与健康受试者进行了认知评估。在双任务全等试验中，脑卒中患者的反应时间高于健康的年轻受试者，其准确性相对较低。这种差异在不一致测试试验中更大。

脑功能结果表明，在执行双重任务Stroop时，脑卒中患者感兴趣区域的β值低于健康年轻受试者。显示大脑区域的血氧浓度。在双重任务表现期间，脑卒中患者的β值低于健康年轻受试者。

在双重任务案件中，评估人员应保护参与者，以避免发生跌倒等意外伤害。我们的研究方案主要用于评估敏锐度功能。未来应该研究双重任务的不同类型和难度。