This project was approved by the Medical Ethics Association of the Fifth Affiliated Hospital of Guangzhou Medical University (No. KY01-2020-08-06) and has been registered at the China Clinical Trial Registration Center (No. ChiCTR2000036514). Informed consent was obtained from patients for using their data in this study.
1. Recruitment
2. Clinical evaluation
3. Stroop task evaluations
4. fNIRS evaluation
5. Data processing and analysis
This study presents results from a high-functioning stroke patient, who was a 71-year-old male who suffered from ischemic stroke with left hemiplegia 2 years ago. The magnetic resonance imaging (MRI) presented bilateral chronic infarction from the basal ganglia to the radiating crown. He was able to walk and live independently in the community but was not satisfied with his cognitive recovery. However, the functional assessments were all within the normal range: FMA = 100, BBS = 56/56, TUGT = 6, MoCA = 26/30, CDR = 0.5, Albert's Test = 0. Moreover, we also recruited one young female healthy subject as the control. The subjects' information is shown in Table 1.
The single/dual-task assessment results based on the Stroop paradigm showed that, in high-functioning stroke patient performing the single-task Stroop test, the RT of the congruence test trials was shorter than that of the incongruence test trials, and the ACC was comparable to the incongruence test trials (RTCongruence = 547.62 ms, RTIncongruence = 565.07 ms; ACCCongruence = ACCIncongruence = 100%). When performing dual-task congruence test trials, the RT of high-functioning stroke patients was higher than that of healthy young subjects, and their ACC was also relatively lower (RTstroke = 587.03 ms, RThealth = 363.07 ms; ACCstroke = 93.33%, ACChealth = 100%), and the difference in the incongruence test trials was greater than that in the congruence test trials (RTstroke = 613.03 ms, RThealth= 384.67 ms; ACCstroke = 90%, ACChealth = 100%; Table 2).
The results for brain function showed that the β value of ROIs in the stroke patient was lower than that in the healthy young subject during the process of performing dual tasks (RDLPFC: βstroke = −0.006, βhealth = 0.1366; LDPFC: βstroke = −0.0196, βhealth = 0.0976). The rest of the brain regions are shown in Figure 2 and Figure 3.
Figure 1: The single/dual-task Stroop paradigm and the fNIRS design. (A) Congruence test trials. (B) Incongruence test trials. (C) The timeline diagram of the single/dual-task Stroop paradigm. Abbreviations:ms = millisecond; s = second; = left;
= right. Please click here to view a larger version of this figure.
Figure 2: The β values in ROIs of the dual-task Stroop effect. The β values of ROIs in the stroke patient was lower than that of the healthy young subject during the dual-task Stroop. Abbreviations: ROIs = regions of interest; RDLPFC = right dorsolateral prefrontal cortex; LDPFC = left dorsolateral prefrontal cortex; RPMC = right promoter cortex; LPMC = left promotor cortex; RSM1 = right primary sensory-motor cortex 1; RPMC = right primary sensory-motor cortex. Please click here to view a larger version of this figure.
Figure 3: Blood oxygen concentration in brain regions of the stroke patient and healthy young subject under the dual-task Stroop effect. (A) Blood oxygen concentration in brain regions of the stroke patient under the dual-task Stroop effect. (B) Blood oxygen concentration in brain regions of the healthy young subject under the dual-task Stroop effect. The β values are indicated by color bars. The results of brain function showed that the β value of ROIs in the stroke patient was lower than that in the healthy young subject during dual-task performance. Abbreviations: R-DLPFC = right dorsolateral prefrontal cortex; L-DLPFC = left dorsolateral prefrontal cortex; R-PMC = right promoter cortex; L-PMC = left promotor cortex; R-SMI = right primary sensory-motor cortex; R-PMC = right primary sensory-motor cortex. Please click here to view a larger version of this figure.
Characteristics | Healthy young subject | Stroke patient |
Age (year) | 21 | 71 |
Gender | female | male |
BMI (kg/m2) | 22.27 | 23.81 |
Cognitive assessment | ||
Montreal Cognitive Assessment (MoCA) | 30/30 | 26/30 |
Clinical Dementia Rating (CDR) | 0 | 0.5 |
Albert’s Test | 0 | 0 |
Motor and balance assessment | ||
Brunnstrom stage | NT | V stage |
Fugl-Meyer Assessment (FMA) | 100 | 100 |
Berg Balance Scale (BBS) | 56/56 | 52/56 |
Timed Up and Go Test (TUGT) (s) | 6 | 11 |
Abbreviations: BMI, Body Mass Index; kg/m2, kilogram per square meter; NT, Not testable; s, second. |
Table 1: The baseline information and characteristics of the healthy young subject and the stroke patient.
Congruence test trials | Incongruence test trials | |||
ACC | RT(ms) | ACC | RT(ms) | |
the stroke patient | 93.33% | 587.03 | 90% | 613.03 |
the healthy young subject | 100% | 363.07 | 100% | 384.67 |
Abbreviations: ACC, accuracy; RT, reaction time; ms, millisecond. |
Table 2: The ACC and RT of the healthy young subject and the stroke patient in the dual task. Abbreviations: ACC = accuracy; RT = reaction time; ms = millisecond.
Balance Ball | Shanghai Fanglian Industrial Co, China | PVC-KXZ-EVA01-2015 | NA |
E-Prime 3.0 | Psychology softwares Tools | commercial stimulus presentation software | |
fNIRS | Hui Chuang, China | NirSmart-500 | NA |
General clinical cognitive assessment scales are not sensitive enough to cognitive impairment in high-functioning stroke patients. The dual-task assessment has advantages for identifying cognitive deficits in high-functioning stroke patients and has been gradually applied in clinical assessment and cognitive training. Moreover, the Stroop paradigm has higher sensitivity and specificity for attentional assessment than conventional clinical cognitive assessment scales. Therefore, this study presents the dual-task assessment based on the Stroop paradigm to identify cognitive deficits in high-functioning stroke patients. This study demonstrates a single- and dual-task evaluation based on the Stroop paradigm and confirms its feasibility through case experiments and synchronized functional near-infrared spectroscopy evaluation. The Stroop reaction time and correct rate are used as the main indicators to evaluate the cognitive level of the subjects. This study protocol aims to provide new ideas to figure out the ceiling effect in general clinical assessment failure for high-functioning stroke patients.
General clinical cognitive assessment scales are not sensitive enough to cognitive impairment in high-functioning stroke patients. The dual-task assessment has advantages for identifying cognitive deficits in high-functioning stroke patients and has been gradually applied in clinical assessment and cognitive training. Moreover, the Stroop paradigm has higher sensitivity and specificity for attentional assessment than conventional clinical cognitive assessment scales. Therefore, this study presents the dual-task assessment based on the Stroop paradigm to identify cognitive deficits in high-functioning stroke patients. This study demonstrates a single- and dual-task evaluation based on the Stroop paradigm and confirms its feasibility through case experiments and synchronized functional near-infrared spectroscopy evaluation. The Stroop reaction time and correct rate are used as the main indicators to evaluate the cognitive level of the subjects. This study protocol aims to provide new ideas to figure out the ceiling effect in general clinical assessment failure for high-functioning stroke patients.
General clinical cognitive assessment scales are not sensitive enough to cognitive impairment in high-functioning stroke patients. The dual-task assessment has advantages for identifying cognitive deficits in high-functioning stroke patients and has been gradually applied in clinical assessment and cognitive training. Moreover, the Stroop paradigm has higher sensitivity and specificity for attentional assessment than conventional clinical cognitive assessment scales. Therefore, this study presents the dual-task assessment based on the Stroop paradigm to identify cognitive deficits in high-functioning stroke patients. This study demonstrates a single- and dual-task evaluation based on the Stroop paradigm and confirms its feasibility through case experiments and synchronized functional near-infrared spectroscopy evaluation. The Stroop reaction time and correct rate are used as the main indicators to evaluate the cognitive level of the subjects. This study protocol aims to provide new ideas to figure out the ceiling effect in general clinical assessment failure for high-functioning stroke patients.