INS NYC 2024 Program

Poster	Poster Session 08 Program Schedule 02/16/2024 01:45 pm - 03:00 pm Room: Shubert Complex (Posters 1-60) Poster Session 08: Cognition \| Cognitive Reserve Variables Final Abstract #20 Cognitive Reserve Protects Executive Abilities After CVA to Feedforward and Feedback Loops of the Executive Function Network Kieran Paddock, Texas A&M University School of Medicine, College Station, United States Riya Sreenivasan, Texas A&M University School of Medicine, College Station, United States Alyssa Day-Gorman, University of Houston, Dept. of Psychology, Houston, United States Caitlin Dulay, Texas A&M University, Dept. of Psychology, College Station, United States Jonathan Wiese, Houston Methodist Neurological Institute, Houston, United States Amber Criswell, Houston Methodist Neurological Institute, Houston, United States Timea Hodics, Houston Methodist Neurological Institute, Houston, United States John Volpi, Houston Methodist Neurological Institute, Houston, United States David Chiu, Houston Methodist Neurological Institute, Houston, United States Rajan Gadhia, Houston Methodist Neurological Institute, Houston, United States Tanu Garg, Houston Methodist Neurological Institute, Houston, United States Vivek Misra, Houston Methodist Neurological Institute, Houston, United States Gavin Britz, Houston Methodist Neurological Institute, Houston, United States Mario Dulay, Houston Methodist Neurological Institute, Houston, United States Category: Executive Functions/Frontal Lobes Keyword 1: cognitive reserve Keyword 2: executive functions Keyword 3: stroke recovery Objective: Executive function (EF) deficits are commonly associated with damage to the frontal lobe, but functional neuroimaging and lesion studies have also identified deficits with damage to subcortical regions. The presence of feedforward and feedback executive function networks among the frontal lobe, cerebellum, thalamus, basal ganglia, and pons have been hypothesized (e.g., De Benedictis et al., 2022). In a pilot project, we previously compared the frequency of EF difficulties after stroke to the frontal lobe, cerebellum, thalamus, or pons and found a high rate of impairment in EF activities consistent across stroke locations. The current study aimed to extend our previous research by investigating the association between cognitive reserve and EF outcomes after strokes to areas implicated in the EF network. Cognitive reserve refers to the brain’s ability to resist or adapt to new onset neurological damage, and associated functional declines, based on prestroke protective factors that may strengthen neural networks (Durani et al., 2021; Stern, 2002). Participants and Methods: Two-hundred-and-ten patients (sex [46% female]; age [M=58.8 years; range=18-87]; education [M=14.8 years]) underwent standard neuropsychological assessment an average of 5 months after stroke. The sample included patients with damage to areas of executive function networks (88 frontal, 57 cerebellum, 18 thalamus, 15 pons, and 32 basal ganglia; 96 left-sided, 88 right-sided, 26 bilateral). Exclusion criteria were multifocal strokes, history of stroke on multiple occasions, strokes in other areas of the brain, diagnosis of dementia, and comprehension difficulties (N=257). Executive function ability was dichotomized (impaired, intact). Cognitive Reserve Index questionnaire was used to estimate cognitive reserve using pre-stroke level of education, cognitive load of occupation, and level of leisure engagement (Nucci et al., 2012). Independent variables used included side of stroke, location of stroke, cognitive reserve, emotional reserve (DSM-IV/5 diagnosed mood or anxiety disorders; Sheehan et al., 1998), and physical energy reserve (four-point scale quantifying level of fatigue). Results: There were no demographic differences by stroke location in level of education, gender, or race/ethnicity. Cerebellar stroke patients were significantly older; thus, age was used as a covariate. Executive deficits were prevalent in all groups, as we previously demonstrated. Frontal stroke patients had significantly higher prevalence of EF deficits than patients with pons, thalamus, or cerebellar stroke (Fisher’s exact test p > 0.05) but did not differ from patients with basal ganglia stroke (72% after frontal CVA, 63% basal ganglia, 51% cerebellar, 46% thalamus, and 44% pons). Logistic regression indicated that an increased odds of intact executive functioning was associated with higher cognitive reserve (OR=3.42, p=0.017) and higher emotional reserve (absence of psychiatric issues poststroke, OR=2.98, p=0.025). Conclusions: Results show that between 44-72% of patients who sustained a stroke to feedforward-feedback EF networks exhibited executive difficulties, with a higher percentage of difficulties in patients with frontal lobe and basal ganglia strokes. Higher prestroke cognitive reserve and greater poststroke emotional reserve were demonstrated to be protective factors. Damage to executive networks may result in a type of dysexecutive disconnection syndrome. Recommendations to replenish cognitive and emotional reserve will likely contribute to optimal outcome.

Poster

02/16/2024
01:45 pm - 03:00 pm
Room: Shubert Complex (Posters 1-60)

Poster Session 08: Cognition | Cognitive Reserve Variables

Final Abstract #20

Cognitive Reserve Protects Executive Abilities After CVA to Feedforward and Feedback Loops of the Executive Function Network

Kieran Paddock, Texas A&M University School of Medicine, College Station, United States
Riya Sreenivasan, Texas A&M University School of Medicine, College Station, United States
Alyssa Day-Gorman, University of Houston, Dept. of Psychology, Houston, United States
Caitlin Dulay, Texas A&M University, Dept. of Psychology, College Station, United States
Jonathan Wiese, Houston Methodist Neurological Institute, Houston, United States
Amber Criswell, Houston Methodist Neurological Institute, Houston, United States
Timea Hodics, Houston Methodist Neurological Institute, Houston, United States
John Volpi, Houston Methodist Neurological Institute, Houston, United States
David Chiu, Houston Methodist Neurological Institute, Houston, United States
Rajan Gadhia, Houston Methodist Neurological Institute, Houston, United States
Tanu Garg, Houston Methodist Neurological Institute, Houston, United States
Vivek Misra, Houston Methodist Neurological Institute, Houston, United States
Gavin Britz, Houston Methodist Neurological Institute, Houston, United States
Mario Dulay, Houston Methodist Neurological Institute, Houston, United States

Category: Executive Functions/Frontal Lobes

Keyword 1: cognitive reserve
Keyword 2: executive functions
Keyword 3: stroke recovery

Objective:

Executive function (EF) deficits are commonly associated with damage to the frontal lobe, but functional neuroimaging and lesion studies have also identified deficits with damage to subcortical regions. The presence of feedforward and feedback executive function networks among the frontal lobe, cerebellum, thalamus, basal ganglia, and pons have been hypothesized (e.g., De Benedictis et al., 2022). In a pilot project, we previously compared the frequency of EF difficulties after stroke to the frontal lobe, cerebellum, thalamus, or pons and found a high rate of impairment in EF activities consistent across stroke locations. The current study aimed to extend our previous research by investigating the association between cognitive reserve and EF outcomes after strokes to areas implicated in the EF network. Cognitive reserve refers to the brain’s ability to resist or adapt to new onset neurological damage, and associated functional declines, based on prestroke protective factors that may strengthen neural networks (Durani et al., 2021; Stern, 2002).

Participants and Methods:

Two-hundred-and-ten patients (sex [46% female]; age [M=58.8 years; range=18-87]; education [M=14.8 years]) underwent standard neuropsychological assessment an average of 5 months after stroke. The sample included patients with damage to areas of executive function networks (88 frontal, 57 cerebellum, 18 thalamus, 15 pons, and 32 basal ganglia; 96 left-sided, 88 right-sided, 26 bilateral). Exclusion criteria were multifocal strokes, history of stroke on multiple occasions, strokes in other areas of the brain, diagnosis of dementia, and comprehension difficulties (N=257). Executive function ability was dichotomized (impaired, intact). Cognitive Reserve Index questionnaire was used to estimate cognitive reserve using pre-stroke level of education, cognitive load of occupation, and level of leisure engagement (Nucci et al., 2012). Independent variables used included side of stroke, location of stroke, cognitive reserve, emotional reserve (DSM-IV/5 diagnosed mood or anxiety disorders; Sheehan et al., 1998), and physical energy reserve (four-point scale quantifying level of fatigue).

Results:

There were no demographic differences by stroke location in level of education, gender, or race/ethnicity. Cerebellar stroke patients were significantly older; thus, age was used as a covariate. Executive deficits were prevalent in all groups, as we previously demonstrated. Frontal stroke patients had significantly higher prevalence of EF deficits than patients with pons, thalamus, or cerebellar stroke (Fisher’s exact test p > 0.05) but did not differ from patients with basal ganglia stroke (72% after frontal CVA, 63% basal ganglia, 51% cerebellar, 46% thalamus, and 44% pons). Logistic regression indicated that an increased odds of intact executive functioning was associated with higher cognitive reserve (OR=3.42, p=0.017) and higher emotional reserve (absence of psychiatric issues poststroke, OR=2.98, p=0.025).

Conclusions:

Results show that between 44-72% of patients who sustained a stroke to feedforward-feedback EF networks exhibited executive difficulties, with a higher percentage of difficulties in patients with frontal lobe and basal ganglia strokes. Higher prestroke cognitive reserve and greater poststroke emotional reserve were demonstrated to be protective factors. Damage to executive networks may result in a type of dysexecutive disconnection syndrome. Recommendations to replenish cognitive and emotional reserve will likely contribute to optimal outcome.