Cognitive impairment, spontaneous recovery and environmental enrichment post stroke

by Helen Marie Andrews

Institution: University of Newcastle
Year: 2015
Keywords: stroke; cognitive impairment; spontaneous recovery; enviroenmental enrichment
Record ID: 1033452
Full text PDF: http://hdl.handle.net/1959.13/1060107


Professional Doctorate - Doctor of Clinical Psychology (DCP) Background: Cognitive impairment post stroke is common yet few studies have investigated cognitive deficits in the early stages post stroke. Spontaneous recovery of post stroke cognitive deficits has been reported. Studies assessing this phenomenon require the use of repeated neuropsychological assessments, however, the majority of this research fails to account for practice effects. The effects of intervention for cognitive deficits have also been explored. Stroke animal models reveal significant improvements in cognition following environmental enrichment, although human stroke studies are limited. Aims: The current study aims to 1) assess cognitive impairment in the early stages of stroke 2) assess spontaneous recovery of cognitive deficits while accounting for practice effects 3) assess the effects of enrichment on cognitive functioning post stroke. Method: Forty one stroke patients were assessed on memory, attention and executive functioning tasks on admission to and on discharge from a rehabilitative ward. Results were compared to 15 aged matched health controls. Cognitive performance was also compared between stroke participants allocated to a control or intervention (enrichment) group. Enrichment took place during the patient’s rehabilitative stay and consisted of individual enrichment (books, music magazines) and communal enrichment (Nintendo Wii games, board games). Results: Stroke participants were impaired on all neuropsychological tasks compared to healthy controls. Stroke patients improved at the same rate as healthy controls on tasks of memory and attention therefore suggesting improvement was a result of practice effects, not spontaneous recovery. Stroke patients improved at a significantly greater rate than healthy controls on the executive functioning task therefore suggesting evidence of spontaneous recovery in this particular cognitive domain. Enrichment did not enhance any of the cognitive deficits experienced by stroke patients. Conclusion: Cognitive impairment and spontaneous recovery in the early stages of stroke requires further attention. In particular, practice effects need to be accounted for. Further research on environmental enrichment should include increasing the duration of the enrichment period, and providing satisfactory methods for documenting patients’ engagement in enrichment activities.