217 results on '"van Heugten CM"'
Search Results
2. Course of Social Participation in the First 2 Years After Stroke and Its Associations With Demographic and Stroke-Related Factors
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Verberne, DPJ, Post, MWM, Kohler, S, Carey, LM, Visser-Meily, JMA, van Heugten, CM, Verberne, DPJ, Post, MWM, Kohler, S, Carey, LM, Visser-Meily, JMA, and van Heugten, CM
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BACKGROUND: Many persons with stroke experience physical, cognitive, and emotional problems that contribute to restrictions in social participation. There is, however, a lack of knowledge on the long-term course of participation over time post-stroke. OBJECTIVE: To describe the time course of participation up to 2 years post-stroke and to identify which demographic and stroke-related factors are associated with this time course. METHODS: This was a multicenter, prospective cohort study following 390 persons with stroke from hospital admission up to 2 years (at 2, 6, 12, and 24 months). Multilevel modeling with linear and quadratic time effects was used to examine the course of the frequency of vocational and social/leisure activities, experienced restrictions, and satisfaction with participation. RESULTS: The frequency of vocational activities increased up to 1 year post-stroke and leveled off thereafter. Older and lower-educated persons showed less favorable courses of participation than younger and higher-educated persons, respectively. The frequency of social/leisure activities decreased post-stroke. Participation restrictions declined up to 1 year post-stroke and leveled off thereafter. Persons dependent in activities of daily living (ADL) kept experiencing more restrictions throughout time than independent persons. Satisfaction with participation increased slightly over time. CONCLUSIONS: Changes in participation occurred mostly in the first year post-stroke. Particularly older and lower-educated persons, and those dependent in ADL showed less favorable courses of participation up to 2 years post-stroke. Clinicians can apply these findings in identifying persons most at risk of long-term unfavorable participation outcome and, thus, target rehabilitation programs accordingly.
- Published
- 2018
3. Intervention and societal costs of residential community reintegration for patients with acquired brain injury: A cost-analysis of the Brain Integration Programme
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Geurtsen, G, primary, van Heugten, CM, additional, Derksen, RE, additional, Martina, JD, additional, Geurts, ACH, additional, and Evers, SMAA, additional
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- 2011
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4. Comprehensive rehabilitation programmes in the chronic phase after severe brain injury: A systematic review
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Geurtsen, GJ, primary, van Heugten, CM, additional, Martina, JD, additional, and Geurts, ACH, additional
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- 2010
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5. Determinants of quality of life in survivors of cardiac arrest
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Moulaert, VRMP, primary, Wachelder, EM, additional, Verbunt, JA, additional, Wade, DT, additional, and van Heugten, CM, additional
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- 2010
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6. Occurrence and measurement of transfer in cognitive rehabilitation: A critical review
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Geusgens, CAV, primary, Winkens, I, additional, van Heugten, CM, additional, Jolles, J, additional, and van den Heuvel, WJA, additional
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- 2007
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7. Is cognitive functioning 1 year poststroke related to quality of life domain?
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Verhoeven CL, Post MW, Schiemanck SK, van Zandvoort MJ, Vrancken PH, van Heugten CM, Verhoeven, Clara L M, Post, Marcel W M, Schiemanck, Sven K, van Zandvoort, Martine J E, Vrancken, Peter H, and van Heugten, Caroline M
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Previous studies on the association between poststroke cognitive impairment and quality of life (QoL) have shown divergent results. In this study, we investigated the relationships between cognitive functioning and various QoL domains at 1 year poststroke. This was a cross-sectional study, examining 92 patients at 1 year poststroke. Cognitive functioning was measured with a neuropsychological test battery covering language, attention and psychomotor function, memory, visuoperception, and neglect. QoL domains were functional independence (Barthel Index), social participation (Frenchay Activities Index), depressive mood (Center for Epidemiological Studies Depression Scale), and life satisfaction (Life Satisfaction Questionnaire). Bivariate and multivariate relationships between cognitive and QoL variables were analyzed, the latter both with and without controlling for demographic variables and motor impairment. The prevalence of cognitive impairments varied between 19.3% (neglect) and 72% (attention and psychomotor function). Correlations between cognitive functioning and QoL were strongest for social participation (0.41-0.60, P < .01) and functional independence (0.13-0.58, P < .05). The percentages of variance explained by the total cognition score were 19% for functional independence, 40% for participation, 8% for life satisfaction, and 5% for depression. Controlling for demographic factors and motor impairments resulted in negligible percentages of variance additionally explained by cognitive functioning. The percentages of explained variance were somewhat lower in the analyses with the separate cognitive domains and not significant for depression. Poor cognitive functioning was associated with reduced functional independence, social participation, depressive mood, and life satisfaction 1 year post; however, motor impairment was a stronger determinant of long-term QoL than cognitive functioning. [ABSTRACT FROM AUTHOR]
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- 2011
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8. Relationship between measures of dementia severity and observation of daily life functioning as measured with the Assessment of Motor and Process Skills (AMPS)
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Bouwens SFM, van Heugten CM, Aalten P, Wolfs CAG, Baarends EM, van Menxel DAJ, and Verhey FRJ
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BACKGROUND: Cognitive impairment is mostly regarded as the core symptom of dementia, but several other domains (such as daily functioning) are equally relevant to assess the severity of dementia. The relationship between these domains is unclear. The Assessment of Motor and Process Skills (AMPS) is a relatively unexplored instrument in people with dementia, measuring severity by direct observation. OBJECTIVE: To study the relationship between the AMPS and scores on several commonly used outcome measures for the assessment of dementia severity, and to examine the possible influence of neuropsychiatric symptoms on these relationships in patients with cognitive disorders. METHODS: Cross-sectional data of 118 patients with cognitive disorders were used; data on cognition (Mini-Mental State Examination, MMSE; CAMCOG), global severity (Global Deterioration Scale, GDS), daily life functioning (Instrumental Activities of Daily Living, IADL), and neuropsychiatric symptoms (Neuropsychiatric Inventory, NPI) were collected and analyzed using correlation and regression analyses. Different combinations of the severity measures were tested for their ability to predict the AMPS process ability scores. RESULTS: Scores on the MMSE, CAMCOG and GDS were moderately associated with the AMPS process ability score. These measures explained between 27 and 44% of the variance in the AMPS score. The presence of apathy influenced the association between the cognitive measures and the AMPS score. CONCLUSION: Commonly used measures of dementia severity are only moderately associated with observation of performance on daily activities. This underlines the need for direct observation of daily activities in dementia patients. This relationship between several approaches of assessing dementia severity needs further study. [ABSTRACT FROM AUTHOR]
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- 2007
9. Spouses' satisfaction with caregiver support in stroke rehabilitation.
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Visser-Meily JMA, Post MWM, Schepers VPM, Ketelaar M, van Heugten CM, and Lindeman E
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Objective: To examine the satisfaction of spouses of stroke patients with the support given to them during clinical rehabilitation and to explore the relationships between satisfaction and characteristics of the support received. Methods: Spouses of patients with a first-ever supratentorial stroke were included (n = 194). Satisfaction was measured on a 0-10 scale. Bivariate and multivariate relationships were studied between overall satisfaction score and characteristics of the support provided (number of full days of attendance, participation in caregiver group, discipline providing most support), the spouses (age, gender, family situation, education and employment) and the patients (activity of daily living (ADL) dependency (Functional Independence Measure), length of stay). Results: The median satisfaction score was 7, and 44% of all spouses scored >/=8 (very satisfied) but 23% were dissatisfied. Spouses' and patients' characteristics and satisfaction scores were not associated. Of the support characteristics the number of full days of attendance (p = 0.02), participation in a caregiver group (p = 0.006) and support received from a team member (p = 0.000) were related to satisfaction. No differences in spouses' satisfaction scores were found between the participating rehabilitation centres. Only 39% of the spouses participated in a caregiver group. The most important reason for not participating in such a group was not being aware of the opportunity to take part in a group (49%). Spouses participating in a group showed more depressive symptoms and had a more severely disabled partner. Caregiver support was primarily given by the nurse and the social worker. One in five spouses indicated not to have been supported at all by the rehabilitation team. Conclusion: A large proportion of the caregivers were satisfied with the care they had received, although one in four was dissatisfied. Satisfaction was related to support characteristics. [ABSTRACT FROM AUTHOR]
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- 2005
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10. Rehabilitation and management of apraxia after stroke.
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van Heugten CM
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- 2001
11. Rehabilitation of stroke patients with apraxia: the role of additional cognitive and motor impairments.
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Van Heugten CM, Dekker J, Deelman BG, Stehmann-Saris JC, and Kinebanian A
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- 2000
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12. Changes in the coping styles of spouses and the influence of these changes on their psychosocial functioning the first year after a patient's stroke.
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Wolters Gregório G, Visser-Meily JM, Tan FE, Post MW, and van Heugten CM
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- 2011
13. Acceptance and commitment therapy for people with depressive and anxiety symptoms following acquired brain injury: Results of the BrainACT randomized controlled trial.
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Rauwenhoff JCC, Bol Y, Peeters F, Smits P, Duits A, Wijenberg M, Blok A, and van Heugten CM
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Objective: This study aimed to investigate the effectiveness of an adapted ACT intervention (BrainACT) in people who experience anxiety and/or depressive symptoms following acquired brain injury., Methods: The study is a multicentre randomized controlled two-arm parallel trial. In total, 72 people who survived a stroke or traumatic brain injury were randomized into an eight-session ACT or control (i.e. psycho-education and relaxation) intervention. The primary outcome measures were the Hospital Anxiety and Depression Scale (HADS) and the Depression Anxiety and Stress Scale (DASS). Secondary outcomes were ACT process measures, participation, and quality of life. Outcome assessments were performed by trained assessors, blinded to treatment condition, pre-treatment, during treatment, post-treatment, and at 7 and 12 months follow-up., Results: There were no differences between groups on any outcome measure. Participants in both groups significantly improved on all outcome measures, except for participation frequency. More clinically relevant long-term improvements (i.e. recovered or reliable changes on the HADS) were found in favour of ACT for depressive and anxiety symptoms., Conclusion: The study was negative on the primary outcome measures. On an individual level, this study showed that especially on the long term ACT seems to show a more clinically relevant decrease in anxiety and depressive symptoms compared to an active control intervention. However, ACT was not superior in improving ACT-related processes such as psychological flexibility, cognitive defusion, and valued living nor in increasing participation or quality of life. Further large-scale group studies are warranted., Trial Registration: The study was originally registered in the Dutch Trial Register (now Clinical Trial Registry Platform), NL-OMON50203. Registered on 18/07/2018 and now to be found under https://trialsearch.who.int/Trial2.aspx?TrialID=NL-OMON50203., Competing Interests: Declaration of competing interest The authors have no conflicts of interest concerning the work presented in this manuscript., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)
- Published
- 2024
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14. Case management for people with acquired brain injury: feasibility and effectiveness of a two-year pragmatic randomized controlled trial.
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Stiekema APM, Rauwenhoff JCC, Bierlaagh D, Donkervoort M, Jansen N, Jurrius KHM, Zadoks J, and van Heugten CM
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Background: Case management (CM) aims to facilitate access to and integration of health care and social services. We investigated the feasibility and effectiveness of CM., Methods: Randomized controlled trial with 219 patients and 114 caregivers randomly allocated to CM (109/59) or care as usual (110/55). CM was based on early and continuous online monitoring of problems and needs. Outcomes were assessed every 6 months with the Hospital Anxiety and Depression Scale (HADS). Secondary outcome domains were participant restrictions, life satisfaction, self-efficacy, caregiver burden, and needs. Multilevel modeling was used. Feasibility aspects were protocol delivery, participants' and case managers' satisfaction, and factors affecting implementation., Results: There were no significant differences between groups. Participation restrictions and unmet needs decreased in both groups within 6 months. Monitoring was successful in 38, and 10 participants asked the CM for support. CM consisted mostly of providing information., Discussion: CM based on early and continuous online monitoring does not have benefit in identifying and addressing problems early after relatively mild injury. Unsuccessful monitoring may have hindered access to the case manager and prevented us from evaluating CM as a complex intervention. It remains a challenge to early identify those who could benefit from care coordination.
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- 2024
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15. Efficacy of an Intensive Exposure Intervention for Individuals With Persistent Concussion Symptoms Following Concussion: A Concurrent Multiple Baseline Single-Case Experimental Design (SCED) Study.
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King S, Stapert SZ, Winkens I, van der Naalt J, van Heugten CM, and Rijkeboer MM
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- Humans, Male, Adult, Female, Young Adult, Treatment Outcome, Single-Case Studies as Topic, Post-Concussion Syndrome therapy, Post-Concussion Syndrome rehabilitation, Post-Concussion Syndrome diagnosis, Brain Concussion therapy, Brain Concussion rehabilitation, Implosive Therapy methods
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Objective: After a concussion, 1 in 3 patients report persistent symptoms and experience long-term consequences interfering with daily functioning, known as persistent concussion symptoms (PCS). Evidence suggests PCS is (partly) maintained by anxious thoughts about brain functioning, recovery, and experienced symptoms, leading to avoidance behaviors, which may prevent patients from meeting life demands. We aimed to investigate the efficacy of a newly developed intensive exposure intervention for individuals with PCS after concussion aimed to tackle avoidance behavior., Setting: Participants took part in the intervention at the Maastricht University faculty., Participants: Four participants who experienced PCS after concussion partook in the exploratory study. Participants' age ranged between 20 and 32 (mean = 26.5, SD = 5.9) years, with an average length of time after the concussion of 9.8 months., Design: A concurrent multiple-baseline single-case design was conducted. The baseline period (A phase) length was randomly determined across participants (3, 4, 5, or 6 weeks). The exposure intervention (B phase) was conducted by psychologists over a 4-week period and consisted of 3 stages: exploration (2 sessions), active exposure (12 sessions conducted over 1 week), and 2 booster sessions., Main Measures: Participants answered daily questions on a visual analog scale related to symptom experience, satisfaction with daily functioning, and degree of avoidance of feared activities. Additional outcomes included symptom severity, catastrophizing, fear of mental activity, anxiety, depression, and societal participation., Results: Tau-U yielded significant effects ( P < .05) for all participants on all measures when comparing baseline and intervention phases. The pooled standardized mean difference was high for all measures (symptom experience = 0.93, satisfaction of daily functioning = 1.86, and activity avoidance = -2.05)., Conclusions: The results show efficacy of the newly developed intensive exposure treatment for PCS after concussion, which is based on the fear avoidance model. Replication in a larger heterogeneous sample is warranted and needed., Competing Interests: The authors declare no conflict of interest. This study was not preregistered. Datasets generated and analyzed during the study are not available., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2024
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16. Long term functioning with poor neurologic outcome after cardiac arrest.
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Nutma S, Roesink O, van Heugten CM, and Hofmeijer J
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Aim: Around six percent of comatose patients after cardiac arrest have a Cerebral Performance Categories score of three (CPC3) at six months after the arrest, classified as severe neurological disability. There is limited knowledge regarding the likelihood of further recovery in the cognitive, emotional, and quality of life domains. We aimed to estimate the probability of recovery towards independency., Methods: From a prospective Registry on comatose cardiac arrest patients admitted between 2013 and 2017 in two Dutch hospitals, we included patients with a CPC3 at six months after cardiac arrest. We followed patients up to November 2023. The primary outcome measure was the CPC score at time of follow up. Secondary outcomes were scores on questionnaires on cognition, mood, and quality of life according to the minimal dataset of acquired brain injury., Results: In our cohort of 667 patients, 29 (4.3%) had a CPC3 score at six months (median age 68 years, 83% male). At a median time of eight years after cardiac arrest, sixteen patients had died. Twelve of thirteen alive patients still had a CPC3 score (92%) and one a CPC2 (8%). Seven patients agreed with further interviewing, one showed independency in activities of daily living (14%). Six patients (86%) reported limitations due to physical and one (14%) due to emotional problems. All had severe cognitive impairment. Six (86%) missed cognitive rehabilitation., Conclusion: Our study shows that while the probability of recovery towards independence for patients with severe neurological disability at six months after cardiac arrest is limited, most long-term survivors are satisfied with their quality of life., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: ‘J. Hofmeijer is supported by a Dutch governmental grant from ZonMW (grant number 95105001). J. Hofmeijer is supported by a grant from the Dutch Heart Association (grant number CEI 2018T070). Furthermore there is nothing to declare’., (Copyright © 2024 Elsevier B.V. All rights reserved.)
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- 2024
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17. Prevalence and predictors of persistent cognitive and psychological symptoms in non-hospitalized post-COVID-19 patients seeking care at an outpatient post-COVID-19 clinic.
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Claessens G, Gerritzen I, van Osch F, van den Bergh JP, Verberne D, Gach D, van Balen E, and van Heugten CM
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Introduction: There is still much uncertainty about why some people develop persistent cognitive and mental health problems after SARS-CoV-2 infection and require additional care while others do not. In this study, we investigated the cognitive and psychological outcomes of non-hospitalized post-COVID-19 patients referred to an outpatient post-COVID-19 clinic for persistent symptoms more than 3 months after infection. Additionally, we aimed to explore the influence of demographic, physical, and personal factors on these outcomes., Methods: This cross-sectional study was conducted at an outpatient post-COVID-19 clinic located at a prominent clinical teaching hospital in the Netherlands. Participants included non-hospitalized patients referred between 2020 and 2022, more than 3 months after SARS-CoV-2 infection, experiencing persistent symptoms. Main outcome measures included levels of anxiety and depression (Hospital Anxiety and Depression Scale), post-traumatic stress symptoms (PTSS) (Post-traumatic Stress Symptoms Checklist 14), and cognitive symptoms (Checklist for Cognitive and Emotional Consequences). Data analysis employed Spearman correlation and hierarchical multiple regression analyses., Results: A total of 265 patients (61% female; mean age of 51.7 ± 13.7 years) were included in the study, with an average of 7.6 ± 4.5 months following SARS-CoV-2 infection. Among them, 104 patients (40%) reported high levels of anxiety, 111 patients (43%) showed high levels depressive symptoms, and 71 patients (31%) demonstrated high levels of PTSS. Additionally, 200 patients (79%) reported experiencing more than 2 cognitive symptoms. Bivariate analyses indicated associations between psychiatric history and increased cognitive and psychological symptoms. Multivariate analyses revealed positive associations between physical symptoms and cognitive and psychological symptoms, and catastrophizing thoughts were associated with higher anxiety levels ( β = 0.217, p < 0.001). Conversely, positive refocusing was associated with lower depressive symptoms ( β = -0.325, p < 0.001), PTSS ( β = -0.290, p < 0.001), and cognitive symptoms ( β = -0.220, p < 0.001)., Discussion: Among non-hospitalized COVID-19 patients seeking care for persistent symptoms, approximately one-third reported high levels of psychological symptoms, and more than three-quarter experienced cognitive symptoms. Physical symptoms, psychiatric history, and a tendency to catastrophize were identified as potential risk factors for persistent psychological and cognitive symptoms. Conversely, positive refocusing demonstrated a protective effect. These findings contribute to the understanding of long-term COVID-19 outcomes and emphasize the importance of integrating a biopsychosocial perspective into treatment approaches., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Claessens, Gerritzen, van Osch, van den Bergh, Verberne, Gach, van Balen and van Heugten.)
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- 2024
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18. Resting state EEG relates to short- and long-term cognitive functioning after cardiac arrest.
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Glimmerveen AB, Verhulst MMLH, de Kruijf NLM, van Gils P, Delnoij T, Bonnes J, van Heugten CM, Van Putten MJAM, and Hofmeijer J
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- Humans, Male, Female, Middle Aged, Prospective Studies, Aged, Cognition physiology, Longitudinal Studies, Neuropsychological Tests, Time Factors, Electroencephalography methods, Heart Arrest complications, Heart Arrest physiopathology, Cognitive Dysfunction etiology, Cognitive Dysfunction diagnosis, Cognitive Dysfunction physiopathology
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Background: Approximately half of cardiac arrest survivors have persistent cognitive impairment. Guidelines recommend early screening to identify patients at risk for cognitive impairment, but there is no consensus on the best screening method. We aimed to identify quantitative EEG measures relating with short- and long-term cognitive function after cardiac arrest for potential to cognitive outcome prediction., Methods: We analyzed data from a prospective longitudinal multicenter cohort study designed to develop a prediction model for cognitive outcome after cardiac arrest. For the current analysis, we used twenty-minute EEG registrations from 80 patients around one week after cardiac arrest. We calculated power spectral density, normalized alpha-to-theta ratio (nATR), peak frequency, and center of gravity (CoG) of this peak frequency. We related these with global cognitive functioning (scores on the Montreal Cognitive Assessment (MoCA)) at one week, three and twelve months follow-up with multivariate mixed effect models, and with performance on standard neuropsychological examination at twelve months using Pearson correlation coefficients., Results: Each individual EEG parameter related to MoCA at one week (β
nATR = 7.36; P < 0.01; βpeak frequency = 1.73, P < 0.01; βCoG = -9.88, P < 0.01). The nATR also related with the MoCA at three months ((βnATR = 2.49; P 0.01). No EEG metrics significantly related to the MoCA score at twelve months. nATR and peak frequency related with memory performance at twelve months. Results were consistent in sensitivity analyses., Conclusion: Early resting-state EEG parameters relate with short-term global cognitive functioning and with memory function at one year after cardiac arrest. Additional predictive values in multimodal prediction models need further study., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)- Published
- 2024
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19. The Montreal Cognitive Assessment detects cognitive deficits that go unnoticed during clinical observation in the acute phase after stroke.
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Stiekema APM, Vreven LWA, Hummel RSO, Mott AS, Verrijt SJGM, Chin Kwie Joe R, Alberto NAS, Ravindran PK, Thommes C, van der Kwaak A, Staals J, and van Heugten CM
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- Humans, Male, Female, Aged, Middle Aged, Aged, 80 and over, Patient Discharge, Stroke complications, Stroke psychology, Mental Status and Dementia Tests, Cognitive Dysfunction diagnosis, Cognitive Dysfunction etiology
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Background: Detecting cognitive impairments early after stroke is essential for appropriate referrals. Although recommended in stroke guidelines, early cognitive screening is not always implemented. We assessed whether the Montreal Cognitive Assessment (MoCA) adds diagnostic value compared to clinical observation alone. In addition, discharge destinations for stroke patients with and without cognitive deficits detected with the screening tool or the treatment team were explored., Methods: Forty-four stroke patients were screened with the MoCA during stroke unit admission. Their charts were studied for cognitive impairments reported by the stroke care team, who were blinded to screening scores. Proportions of detected cognitive deficits were compared between screening (score <26) and patient charts. Discharge destination distribution (home vs. rehabilitation) was explored., Results: The proportion of cognitively impaired patients indicated by the MoCA (84%) and reported in patients' charts (25%) differed significantly ( p < 0.001). The distribution of discharge destination did not suggest an association with the detection of cognitive deficits by the treatment team or the cognitive screening., Conclusions: The MoCA detects more cognitive deficits than clinical impression alone, emphasizing the importance of standard screening for cognitive impairments in acute stroke patients. Ultimately, systematic screening may enhance discharge planning and improve long-term outcomes.
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- 2024
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20. Neuropsychological functioning after COVID-19: minor differences between individuals with and without persistent complaints after SARS-CoV-2 infection.
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Verveen A, Verfaillie SCJ, Visser D, Koch DW, Verwijk E, Geurtsen GJ, Roor J, Appelman B, Boellaard R, van Heugten CM, Horn J, Hulst HE, de Jong MD, Kuut TA, van der Maaden T, van Os YMG, Prins M, Visser-Meily JMA, van Vugt M, van den Wijngaard CC, Nieuwkerk PT, van Berckel B, Tolboom N, and Knoop H
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Objective: It is unclear how self-reported severe fatigue and difficulty concentrating after SARS-CoV-2 infection relate to objective neuropsychological functioning. The study aimed to compare neuropsychological functioning between individuals with and without these persistent subjective complaints. Method : Individuals with and without persistent severe fatigue (Checklist Individual Strength (CIS) fatigue ≥ 35) and difficulty concentrating (CIS concentration ≥ 18) at least 3 months after SARS-CoV-2 infection were included. Neuropsychological assessment was performed on overall cognitive functioning, attention, processing speed, executive functioning, memory, visuo-construction, and language (18 tests). T-scores -1.5 SD below population normative data ( T ≤ 35) were classified as "impaired". Results: 230 participants were included in the study, of whom 22 were excluded from the analysis due to invalid performance. Of the participants included in the analysis, 111 reported persistent complaints of severe fatigue and difficulty concentrating and 97 did not. Median age was 54 years, 59% ( n = 126) were female, and participants were assessed a median of 23 months after first infection (IQR: 16-28). With bivariate logistic regression, individuals with persistent complaints had an increased likelihood of slower information processing speed performance on the Stroop word reading (OR = 2.45, 95%CI = 1.02-5.84) compared to those without persistent complaints. Demographic or clinical covariates (e.g. hospitalization) did not influence this association. With linear regression techniques, persistent complaints were associated with lower t-scores on the D2 CP, TMT B, and TMT B|A. There were no differences in performance on the other neuropsychological tests. Conclusions: Individuals with subjective severe fatigue and difficulty concentrating after COVID-19 do not typically demonstrate cognitive impairment on extensive neuropsychological testing.
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- 2024
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21. Psychometric properties of two instruments assessing catastrophizing and fear-avoidance behavior in mild traumatic brain injury.
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King S, Stapert SZ, Wijenberg MLM, Winkens I, Verbunt JA, Rijkeboer MM, van der Naalt J, and van Heugten CM
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- Humans, Female, Male, Adult, Middle Aged, Reproducibility of Results, Young Adult, Surveys and Questionnaires, Self Report, Catastrophization psychology, Psychometrics instrumentation, Brain Concussion psychology, Fear psychology, Avoidance Learning physiology
- Abstract
Objective: Psychometrically sound measures of catastrophizing about symptoms and fear avoidance behavior are needed to further applications of the fear-avoidance model in mild traumatic brain injury (mTBI) for research and clinical purposes. To this end, two questionnaires were adapted (minor), the Postconcussion Symptom Catastrophizing Scale (PCS-CS) and the Fear of Mental Activity Scale (FMA). This study aimed to investigate the factor structure, internal consistency, test-retest reliability, and concurrent and construct validity of two adapted questionnaires in a sample of participants with mTBI compared to participants with orthopedic injury and healthy adults., Method: One hundred eighty-five mTBI participants (40% female), 180 participants with orthopedic injury (55% female), and 116 healthy adults (55% female) participated in the study. All participants were assessed at two time points (2 weeks postinjury and 3 months) using self-reported questionnaires. Data were collected using online questionnaires., Results: Findings indicated a three-factor model (magnification, rumination, helplessness) with a higher order factor (catastrophizing) for the PCS-CS and a two-factor model (activity avoidance and somatic focus) for the FMA. The results showed strong internal consistency, good test-retest reliability, and good concurrent and convergent validity for the PCS-CS and FMA across all samples., Conclusions: This study has shown that the PCS-CS and FMA are psychometrically sound instruments and can be considered for valid and reliable assessment of catastrophizing about postconcussion like symptoms and fear-avoidance beliefs about mental activities. These instruments can be used in research and clinical practice applications of the fear-avoidance model and add to explanations of prolonged recovery after mTBI. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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- 2024
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22. Young children's performance on a design fluency task: longitudinal data on total number of designs, clustering and switching, and regression-based norms.
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Resch C, Keulers E, Martens R, van Breukelen G, van Heugten CM, Hou W, and Hurks PPM
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- Humans, Female, Male, Child, Longitudinal Studies, Child, Preschool, Child Development physiology, Cluster Analysis, Attention physiology, Reference Values, Executive Function physiology, Neuropsychological Tests standards, Neuropsychological Tests statistics & numerical data
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Introduction: Design fluency (DF) tasks are commonly used to assess executive functions such as attentional control, cognitive flexibility, self-monitoring and strategy use. Next to the total number of correct designs, the standard outcome of a DF task, clustering and switching can help disentangle the processes underlying DF performance. We present the first longitudinal study of 4-8-year-old children's developmental DF trajectories., Method: At initial enrollment, children ( n = 228) were aged between 4.05 and 6.88 years ( M = 5.18, SD = 0.59) and attended Dutch primary schools. The DF task was administered at three time points, each time point separated by approximately 1 year. Data were analyzed using mixed regression for total number of correct designs and switching, and mixed logistic regression analysis for clustering., Results: The total number of correct designs increased linearly across the three time points. Across all time points, children made very few clusters, and most clusters consisted of only 3 designs. Clustering only increased at the third assessment compared to the two previous assessments. Switching increased up to the second assessment, but not after that. The number of switches was highly correlated with the total number of correct designs at all time points ( r = 0.78 to r = 0.85). These developmental trajectories were similar for all children regardless of their baseline age. Normative data are given for the total number of correct designs and switching., Conclusions: Children as of age 4 onwards can perform a DF task. For children as young as 4-8 years old, computing clustering, and switching measures is of limited value to study cognitive processes underlying DF performance, next to the total number of correct designs. There were no sex differences on any of the DF outcomes. Level of parental education (LPE) was positively associated with the total number of correct designs and switching.
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- 2024
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23. Does cognitive learning potential measured with the dynamic Wisconsin Card Sorting Test predict rehabilitation outcome in elderly patients post-stroke?
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Wilbers M, Geusgens C, and van Heugten CM
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- Humans, Aged, Activities of Daily Living, Wisconsin Card Sorting Test, Treatment Outcome, Cognition, Stroke Rehabilitation, Stroke complications
- Abstract
Objective: To determine whether cognitive learning potential measured with the dynamic Wisconsin Card Sorting Test has added value in predicting rehabilitation outcome in elderly patients post-stroke after controlling for age, ADL independence at admission, global cognitive functioning and depressive symptoms., Methods: Participants were patients with stroke admitted to a geriatric rehabilitation unit. ADL independence (Barthel Index) at discharge was used as measure for rehabilitation outcome. Predictor variables included age, ADL independence at admission, global cognitive functioning (Montreal Cognitive Assessment), depressive symptoms (Geriatric Depression Scale) and cognitive learning potential measured with the dWCST., Results: Thirty participants were included. Bivariate analyses showed that rehabilitation outcome was significantly correlated with ADL independence at admission ( r = 0.443, p = 0.014) and global cognitive functioning ( r = 0.491, p = 0.006). Regression analyses showed that the dWCST was not an independent predictor of rehabilitation outcome. ADL independence at admission was the only significant predictor of rehabilitation outcome (beta = 0.480, p = 0.007)., Conclusions: Cognitive learning potential, measured with the dWCST has no added value in predicting rehabilitation outcome in elderly patients post-stroke. ADL independence at admission was the only significant predictor of rehabilitation outcome., Registration Number Netherlands Trial Register: Trial NL7947.
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- 2024
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24. A Biopsychosocial Approach to Persistent Post-COVID-19 Fatigue and Cognitive Complaints: Results of the Prospective Multicenter NeNeSCo Study.
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Klinkhammer S, Duits AA, Deckers K, Horn J, Slooter AJC, Verwijk E, van Heugten CM, and Visser-Meily JMA
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- Humans, Male, Female, Prospective Studies, Middle Aged, Netherlands, Aged, Adult, SARS-CoV-2, Cognitive Dysfunction etiology, Magnetic Resonance Imaging, Severity of Illness Index, Surveys and Questionnaires, COVID-19 complications, COVID-19 psychology, Fatigue etiology
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Objective: To evaluate whether psychological and social factors complement biomedical factors in understanding post-COVID-19 fatigue and cognitive complaints. Additionally, to incorporate objective (neuro-cognitive) and subjective (patient-reported) variables in identifying factors related to post-COVID-19 fatigue and cognitive complaints., Design: Prospective, multicenter cohort study., Setting: Six Dutch hospitals., Participants: 205 initially hospitalized (March-June 2020), confirmed patients with SARS-CoV-2, aged ≥18 years, physically able to visit the hospital, without prior cognitive deficit, magnetic resonance imaging (MRI) contraindication, or severe neurologic damage post-hospital discharge (N=205)., Interventions: Not applicable., Main Outcome Measures: Nine months post-hospital discharge, a 3T MRI scan and cognitive testing were performed and patients completed questionnaires. Medical data were retrieved from medical dossiers. Hierarchical regression analyses were performed on fatigue severity (Fatigue Severity Scale; FSS) and cognitive complaints (Cognitive Consequences after Intensive Care Admission; CLC-IC; dichotomized into CLC-high/low). Variable blocks: (1) Demographic and premorbid factors (sex, age, education, comorbidities), (2) Illness severity (ICU/general ward, PROMIS physical functioning [PROMIS-PF]), (3) Neuro-cognitive factors (self-reported neurological symptoms, MRI abnormalities, cognitive performance), (4) Psychological and social factors (Hospital Anxiety and Depression Scale [HADS], Utrecht Coping List, Social Support List), and (5) Fatigue or cognitive complaints., Results: The final models explained 60% (FSS) and 48% (CLC-IC) variance, with most blocks (except neuro-cognitive factors for FSS) significantly contributing. Psychological and social factors accounted for 5% (FSS) and 11% (CLC-IC) unique variance. Higher FSS scores were associated with younger age (P=.01), lower PROMIS-PF (P<.001), higher HADS-Depression (P=.03), and CLC-high (P=.04). Greater odds of CLC-high were observed in individuals perceiving more social support (OR=1.07, P<.05)., Conclusions: Results show that psychological and social factors add to biomedical factors in explaining persistent post-COVID-19 fatigue and cognitive complaints. Objective neuro-cognitive factors were not associated with symptoms. Findings highlight the importance of multidomain treatment, including psychosocial care, which may not target biologically-rooted symptoms directly but may reduce associated distress., (Copyright © 2024. Published by Elsevier Inc.)
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- 2024
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25. Acceptance and Commitment Therapy is feasible for people with acquired brain injury: A process evaluation of the BrainACT treatment.
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Rauwenhoff JC, Bol Y, Peeters F, and van Heugten CM
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- Humans, Treatment Outcome, Anxiety etiology, Anxiety therapy, Anxiety Disorders, Acceptance and Commitment Therapy, Brain Injuries complications
- Abstract
Objective: To evaluate the feasibility of Acceptance and Commitment Therapy for people with acquired brain injury., Design: A process evaluation of the BrainACT treatment was conducted alongside a randomised controlled trial., Setting: Psychology departments of hospitals and rehabilitation centres., Subjects: Tweny-seven participants with acquired brain injury and 11 therapists., Intervention: BrainACT is an Acceptance and Commitment Therapy adapted for the needs and possible cognitive deficits of people with acquired brain injury, provided in eight one-hour face-to-face or video-conference sessions., Measurements: The attendance and compliance rates, engagement, satisfaction, and perceived barriers and facilitators for delivery in clinical practice were investigated using semi-structured interviews with participants and therapists and therapy logs., Results: 212 of the 216 sessions in total were attended and 534 of the 715 protocol elements across participants and sessions were delivered. Participants were motivated and engaged. Participants and therapists were satisfied with the intervention and participants reported to have implemented skills in their daily routines acquired during therapy. Key strengths are the structure provided with the bus of life metaphor, the experiential nature of the intervention, and the materials and homework. Participants and therapists often preferred face-to-face sessions, however, when needed video-conferencing is a good alternative., Conclusion: BrainACT is a feasible intervention for people with anxiety and depressive symptoms following acquired brain injury. However, when the content of the intervention is too extensive, we recommend adding two extra sessions., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
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- 2024
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26. The Effects of a Blended Care Intervention in Partners of Patients With Acquired Brain Injury - Results of the CARE4Carer Randomized Controlled Trial.
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Welten JJE, Cox VCM, van Eijk RPA, van Heugten CM, Visser-Meily JMA, and Schepers VPM
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- Humans, Anxiety, Caregivers psychology, Quality of Life, Brain Injuries
- Abstract
Objective: To assess effects of the CARE4Carer blended care intervention on caregiver mastery and psychosocial functioning compared with usual care in partners of patients with acquired brain injury (ABI)., Design: Multicenter randomized controlled trial., Setting: Nine sites for rehabilitation medicine., Participants: 120 partners of outpatients with ABI were randomly allocated to blended care (N=59) or usual care (N=61)., Intervention: The blended care intervention (20 weeks) was aimed at improving caregiving skills and consisted of 9 online sessions, combined with 2 face-to-face consultations with a social worker., Main Outcome Measures: Mastery was assessed with the Caregiver Mastery Scale, secondary outcome measures were caregiver strain (Caregiver Strain Index), family functioning (Family Assessment Device), anxiety and depression (Hospital Anxiety and Depression Scale), burden (self-rated), and quality of life (CarerQol). Assessments were performed at baseline, 24, and 40 weeks., Results: The adjusted mean difference in caregiver mastery between intervention and control group at week 24 was 1.31 (SD3.48, 95% confidence interval (CI) -0.12 to 2.74, P=.072) and at week 40 was 1.31 (SD3.69, 95% CI -0.26 to 2.88, P=.100). In the per protocol analysis, the adjusted mean difference in caregiver mastery at week 24 was 1.53 (SD3.38, 95% CI 0.10 to 2.96, P=.036) and at week 40 was 1.57 (SD3.63, 95% CI 0.01 to 3.14, P=.049). Regarding secondary outcomes, caregiver strain was lower in the intervention group in the per protocol analysis at week 40. Family functioning was higher in the intervention group in week 24, whereas anxiety was lower at both timepoints., Conclusions: In the subset of participants who were able to complete the intervention, caregiver mastery and psychosocial functioning improved. Future work should focus on improving adherence as this will optimize beneficial effects of blended care., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)
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- 2024
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27. A cross-sectional comparison of patient characteristics across healthcare settings using the minimal dataset for adults with acquired brain injury (MDS-ABI).
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Domensino AF, Winkens I, van Haastregt JCM, van Bennekom CAM, and van Heugten CM
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- Adult, Humans, Cross-Sectional Studies, Delivery of Health Care, Clinical Decision-Making, Brain Injuries, Disabled Persons
- Abstract
Acquired Brain Injury (ABI) can have lifelong consequences and accordingly, persons with ABI often receive various types of healthcare. Facilities have their own preferences towards measurement instruments used to evaluate patients, impeding data comparison across healthcare settings. In this cross-sectional study, we used the previously developed minimal dataset for persons with ABI (MDS-ABI) to uniformly document and compare characteristics and outcomes of ABI patients in three healthcare settings: (1) residential care ( n = 21), (2) non-residential care ( n = 80), and (3) no ABI-related care ( n = 22). Overall, patients of residential care settings had the lowest functional outcome compared with patients in the remaining groups. Nonetheless, all groups showed substantial disabilities within numerous life domains, indicating that the consequences of ABI are widespread among patients within and outside of healthcare facilities. These results demonstrate the need for a broad measurement of the potential consequences of ABI. The MDS-ABI covers twelve life domains most frequently affected by ABI and therefore helps to better recognize the consequences of ABI. In research contexts, implementation of the MDS-ABI allows for direct comparison of research findings. Future directions should be aimed at further implementation of the MDS-ABI to guide clinical decision-making and assist in identifying treatment goals specific to each healthcare setting.
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- 2024
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28. Participation in daily life activities at two months after stroke predicts long-term health-related quality of life.
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Slenders JPL, de Graaf JA, Post MWM, van Heugten CM, Van den Berg-Vos RM, Kwa VIH, and Visser-Meily JMA
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- Humans, Male, Middle Aged, Aged, Female, Quality of Life psychology, Prospective Studies, Activities of Daily Living, Stroke psychology, Stroke Rehabilitation methods
- Abstract
Background: After stroke, many patients experience problems with participation in daily activities. Improving participation is the main goal in stroke rehabilitation. However, the longitudinal relationship between participation and health-related quality of life (HRQoL) remains unclear., Objectives: This study aimed to examine (1) the predictive value of participation at two months on long-term HRQoL and (2) the longitudinal relationship between participation and HRQoL., Methods: In this multicenter, prospective cohort study, patients were assessed at two and 12 months after stroke. Participation was measured with the Restriction subscale of the Utrecht Scale for Evaluation of Rehabilitation - Participation. HRQoL was assessed with the three-level version of the EuroQoL five dimensions questionnaire index score., Results: This study included 291 patients. Mean age was 66.6 ± 12.4 years, 64.3% were male and mean National Institutes of Health Stroke Scale (NIHSS) was 2.5 ± 2.9. Multivariable linear regression, adjusted for demographic characteristics, stroke characteristics, physical and cognitive impairment, showed that a higher level of participation at two months correlated with a higher HRQoL at one year (B = .004; 95% CI =.002-.005). Patients whose participation improved had a greater increase in HRQoL, compared to patients without improvement (0.080 ± .21 versus -.054 ± .21; p < .001)., Conclusions: The level of participation at two months post-stroke predicts HRQoL at one year. Improvement in participation during the first year after stroke is associated with improvement in HRQoL. We recommend including the assessment of participation in daily activities at follow-up visits.
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- 2024
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29. Burden, anxiety and depressive symptoms in partners - course and predictors during the first two years after stroke.
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Cox VCM, Welten JJE, Schepers VPM, Ketelaar M, Kruithof WJ, van Heugten CM, and Visser-Meily JMA
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- Humans, Longitudinal Studies, Quality of Life psychology, Anxiety epidemiology, Anxiety etiology, Anxiety psychology, Caregivers psychology, Depression epidemiology, Depression etiology, Depression psychology, Stroke complications, Stroke epidemiology, Stroke psychology
- Abstract
Background: Partners of patients with stroke are at high risk for burden, anxiety and depressive symptoms. Previous studies have reported contradictory results and did not investigate these three courses simultaneously. In this study we comprehensively studied the courses and predictors of burden, anxiety and depressive symptoms in partners of patients with stroke during the first two years after stroke. They were analyzed as outcomes as well as predictors for each other., Methods: Six general hospitals recruited 215 patients with stroke and their partners for a longitudinal cohort study. Mixed model analyses were performed for burden (CSI), anxiety (HADS-A) and depressive symptoms (HADS-D) as time-varying outcome variables, measured at four time points during two years after stroke., Results: Burden and depressive symptoms did not significantly change over time, whereas anxiety symptoms initially decreased followed by an increase. Higher burden was predicted by partners' younger age, higher education, more symptoms of anxiety and depression, and by patients' greater stroke severity, lower cognitive functioning and more symptoms of anxiety and depression. More anxiety symptoms were predicted by higher burden, more depressive symptoms, and lower self-efficacy of the partner. More depressive symptoms were predicted by older age, higher burden, more symptoms of anxiety, less proactive coping strategies of the partner, and more depressive symptoms of the patients., Conclusions: Burden, anxiety and depressive symptoms are interrelated and become chronic in partners of patients with stroke. It is important to screen partners early after stroke to identify partners who are at risk for negative outcomes.
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- 2023
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30. Cognition, emotional state, and quality of life of survivors after cardiac arrest with rhythmic and periodic EEG patterns.
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van Gils PCW, Ruijter BJ, Bloo RJK, van Putten MJAM, Foudraine NA, van Hout MSE, Tromp SC, van Mook WNKA, Rouhl RPW, van Heugten CM, and Hofmeijer J
- Subjects
- Female, Humans, Male, Middle Aged, Cognition, Coma complications, Electroencephalography, Quality of Life, Survivors, Cardiopulmonary Resuscitation, Heart Arrest complications, Heart Arrest therapy
- Abstract
Aim: Rhythmic and periodic patterns (RPPs) on the electroencephalogram (EEG) in comatose patients after cardiac arrest have been associated with high case fatality rates. A good neurological outcome according to the Cerebral Performance Categories (CPC) has been reported in up to 10% of cases. Data on cognitive, emotional, and quality of life outcomes are lacking. We aimed to provide insight into these outcomes at one-year follow-up., Methods: We assessed outcome of surviving comatose patients after cardiac arrest with RPPs included in the 'treatment of electroencephalographic status epilepticus after cardiopulmonary resuscitation' (TELSTAR) trial at one-year follow-up, including the CPC for functional neurological outcome, a cognitive assessment, the hospital anxiety and depression scale (HADS) for emotional outcomes, and the 36-item short-form health survey (SF-36) for quality of life. Cognitive impairment was defined as a score of more than 1.5 SD below the mean on ≥ 2 (sub)tests within a cognitive domain., Results: Fourteen patients were included (median age 58 years, 21% female), of whom 13 had a cognitive impairment. Eleven of 14 were impaired in memory, 9/14 in executive functioning, and 7/14 in attention. The median scores on the HADS and SF-36 were all worse than expected. Based on the CPC alone, 8/14 had a good outcome (CPC 1-2)., Conclusion: Nearly all cardiac arrest survivors with RPPs during the comatose state have cognitive impairments at one-year follow-up. The incidence of anxiety and depression symptoms seem relatively high and quality of life relatively poor, despite 'good' outcomes according to the CPC., (Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.)
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- 2023
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31. Acceptance and commitment therapy for people with acquired brain injury: Rationale and description of the BrainACT treatment.
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Rauwenhoff JC, Bol Y, van Heugten CM, Batink T, Geusgens CA, van den Hout AJ, Smits P, Verwegen CR, Visser A, and Peeters F
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- Humans, Anxiety etiology, Anxiety therapy, Anxiety psychology, Anxiety Disorders, Acceptance and Commitment Therapy, Mindfulness, Brain Injuries complications
- Abstract
Background: The treatment of anxiety and depressive symptoms following acquired brain injury is complex and more evidence-based treatment options are needed. We are currently evaluating the BrainACT intervention; acceptance and commitment therapy for people with acquired brain injury., Rationale: This paper describes the theoretical underpinning, the development and content of BrainACT. Acceptance and commitment therapy focuses on the acceptance of feelings, thoughts and bodily sensations and on living a valued life, without fighting against what is lost. Since the thoughts that people with acquired brain injury can experience are often realistic or appropriate given their situation, this may be a suitable approach., Theory Into Practice: Existing evidence-based protocols were adapted for the needs and potential cognitive deficits after brain injury. General alterations are the use of visual materials, summaries and repetition. Acceptance and commitment therapy-specific adaptions include the Bus of Life metaphor as a recurrent exercise, shorter mindfulness exercises, simplified explanations, a focus on experiential exercises and the monitoring of committed actions. The intervention consists of eight one-hour sessions with a psychologist, experienced in acceptance and commitment therapy and in working with people with acquired brain injury. The order of the sessions, metaphors and exercises can be tailored to the needs of the patients., Discussion: Currently, the effectiveness and feasibility of the intervention is evaluated in a randomised controlled trial. The BrainACT intervention is expected to be a feasible and effective intervention for people with anxiety or depressive symptoms following acquired brain injury.
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- 2023
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32. Acceptance and commitment therapy for individuals with depressive and anxiety symptoms following acquired brain injury: A non-concurrent multiple baseline design across four cases.
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Rauwenhoff JCC, Bol Y, Peeters F, van den Hout AJHC, Geusgens CAV, and van Heugten CM
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- Humans, Quality of Life, Anxiety etiology, Anxiety therapy, Anxiety Disorders, Depression etiology, Depression therapy, Depression diagnosis, Acceptance and Commitment Therapy, Brain Injuries
- Abstract
Patients with acquired brain injury (ABI) often experience symptoms of anxiety and depression. Until now, evidence-based treatment is scarce. This study aimed to investigate the effectiveness of Acceptance and Commitment Therapy (ACT) for patients with ABI. To evaluate the effect of ACT for people with ABI, a non-concurrent multiple baseline design across four cases was used. Participants were randomly assigned to a baseline period, followed by treatment and then follow-up phases. Anxiety and depressive symptoms were repeatedly measured. During six measurement moments over a year, participants filled in questionnaires measuring anxiety, depression, stress, participation, quality of life, and ACT-related processes. Randomization tests and NAP scores were used to calculate the level of change across phases. Clinically significant change was defined with the Reliable Change Index. Three out of four participants showed medium to large decreases in anxiety and depressive symptoms (NAP = 0.85 till 0.99). Furthermore, participants showed improvements regarding stress, cognitive fusion, and quality of life. There were no improvements regarding psychological flexibility, value-driven behaviour, or social participation. This study shows that ACT is possibly an effective treatment option for people experiencing ABI-related anxiety and depression symptoms. Replication with single case or large scale group studies is needed to confirm these findings.
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- 2023
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33. Neurological and (neuro)psychological sequelae in intensive care and general ward COVID-19 survivors.
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Klinkhammer S, Horn J, Duits AA, Visser-Meily JMA, Verwijk E, Slooter AJC, Postma AA, and van Heugten CM
- Subjects
- Humans, Prospective Studies, Patients' Rooms, Post-Acute COVID-19 Syndrome, Depression epidemiology, Critical Care, Intensive Care Units, Survivors psychology, Fatigue etiology, Cerebral Hemorrhage, COVID-19 complications, Stress Disorders, Post-Traumatic epidemiology, Stress Disorders, Post-Traumatic etiology, Stress Disorders, Post-Traumatic diagnosis
- Abstract
Background and Purpose: Coronavirus disease 2019 (COVID-19) affects the brain, leading to long-term complaints. Studies combining brain abnormalities with objective and subjective consequences are lacking. Long-term structural brain abnormalities, neurological and (neuro)psychological consequences in COVID-19 patients admitted to the intensive care unit (ICU) or general ward were investigated. The aim was to create a multidisciplinary view on the impact of severe COVID-19 on functioning and to compare long-term consequences between ICU and general ward patients., Methods: This multicentre prospective cohort study assessed brain abnormalities (3 T magnetic resonance imaging), cognitive dysfunction (neuropsychological test battery), neurological symptoms, cognitive complaints, emotional distress and wellbeing (self-report questionnaires) in ICU and general ward (non-ICU) survivors., Results: In al, 101 ICU and 104 non-ICU patients participated 8-10 months post-hospital discharge. Significantly more ICU patients exhibited cerebral microbleeds (61% vs. 32%, p < 0.001) and had higher numbers of microbleeds (p < 0.001). No group differences were found in cognitive dysfunction, neurological symptoms, cognitive complaints, emotional distress or wellbeing. The number of microbleeds did not predict cognitive dysfunction. In the complete sample, cognitive screening suggested cognitive dysfunction in 41%, and standard neuropsychological testing showed cognitive dysfunction in 12%; 62% reported ≥3 cognitive complaints. Clinically relevant scores of depression, anxiety and post-traumatic stress were found in 15%, 19% and 12%, respectively; 28% experienced insomnia and 51% severe fatigue., Conclusion: Coronavirus disease 2019 ICU survivors had a higher prevalence for microbleeds but not for cognitive dysfunction compared to general ward survivors. Self-reported symptoms exceeded cognitive dysfunction. Cognitive complaints, neurological symptoms and severe fatigue were frequently reported in both groups, fitting the post-COVID-19 syndrome., (© 2023 The Authors. European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.)
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- 2023
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34. Neurobiological basis and risk factors of persistent fatigue and concentration problems after COVID-19: study protocol for a prospective case-control study (VeCosCO).
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Verveen A, Verfaillie SCJ, Visser D, Csorba I, Coomans EM, Koch DW, Appelman B, Barkhof F, Boellaard R, de Bree G, van de Giessen EM, Golla S, van Heugten CM, Horn J, Hulst HE, de Jong MD, Kuut TA, van der Maaden T, van Os YMG, Prins M, Slooter AJC, Visser-Meily JMA, van Vugt M, van den Wijngaard CC, Nieuwkerk PT, Knoop H, Tolboom N, and van Berckel BNM
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- Humans, SARS-CoV-2, Case-Control Studies, Quality of Life, Neuroinflammatory Diseases, Risk Factors, Fatigue etiology, COVID-19 complications
- Abstract
Introduction: The risk factors for persistent fatigue and cognitive complaints after infection with SARS-CoV-2 and the underlying pathophysiology are largely unknown. Both clinical factors and cognitive-behavioural factors have been suggested to play a role in the perpetuation of complaints. A neurobiological aetiology, such as neuroinflammation, could be the underlying pathophysiological mechanism for persisting complaints.To unravel factors associated with persisting complaints, VeCosCO will compare individuals with and without persistent fatigue and cognitive complaints >3 months after infection with SARS-CoV-2. The study consists of two work packages. The first work package aims to (1) investigate the relation between persisting complaints and neuropsychological functioning; (2) determine risk factors and at-risk phenotypes for the development of persistent fatigue and cognitive complaints, including the presence of postexertional malaise and (3) describe consequences of persistent complaints on quality of life, healthcare consumption and physical functioning. The second work package aims to (1) determine the presence of neuroinflammation with [
18 F]DPA-714 whole-body positron emission tomography (PET) scans in patients with persisting complaints and (2) explore the relationship between (neuro)inflammation and brain structure and functioning measured with MRI., Methods and Analysis: This is a prospective case-control study in participants with and without persistent fatigue and cognitive complaints, >3 months after laboratory-confirmed SARS-CoV-2 infection. Participants will be mainly included from existing COVID-19 cohorts in the Netherlands covering the full spectrum of COVID-19 acute disease severity. Primary outcomes are neuropsychological functioning, postexertional malaise, neuroinflammation measured using [18 F]DPA-714 PET, and brain functioning and structure using (f)MRI., Ethics and Dissemination: Work package 1 (NL79575.018.21) and 2 (NL77033.029.21) were approved by the medical ethical review board of the Amsterdam University Medical Centers (The Netherlands). Informed consent is required prior to participation in the study. Results of this study will be submitted for publication in peer-reviewed journals and shared with the key population., Competing Interests: Competing interests: FB: Steering committee or iDMC member for Biogen, Merck, Roche, EISAI and Prothena. Consultant for Roche, Biogen, Merck, IXICO, Jansen, Combinostics. Research agreements with Merck, Biogen, GE Healthcare, Roche. Co-founder and shareholder of Queen Square Analytics., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)- Published
- 2023
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35. Intra- and interpersonal effects of coping style and self-efficacy on anxiety, depression and life satisfaction in patient-partner couples after stroke.
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Welten JJE, Cox VCM, Kruithof WJ, Visser-Meily JMA, Post MWM, van Heugten CM, and Schepers VPM
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- Humans, Self Efficacy, Prospective Studies, Patient Satisfaction, Adaptation, Psychological, Anxiety etiology, Anxiety psychology, Personal Satisfaction, Interpersonal Relations, Depression etiology, Depression psychology, Stroke complications, Stroke psychology
- Abstract
Many stroke patients and partners suffer from anxiety, depression, and low life satisfaction. Psychological factors such as coping style and self-efficacy can be protective factors within individuals. The close relationship between stroke patients and partners suggests that there may be interdependence in psychological functioning. The aim of this study was to examine intra- and interpersonal effects of coping style and self-efficacy on anxiety, depression, and life satisfaction in patient-partners couples. In this prospective cohort study, pro-active coping (UPCC), general self-efficacy (GSES), anxiety (HADS-A), depression (HADS-D), and life satisfaction (1-6 scale) were assessed in 215 couples at 2 and 12 months post-stroke. Effects within couples were assessed using structural equation modelling. Several intra- and interpersonal effects of coping style and self-efficacy at 2 months post-stroke were related to emotional health at 12 months post-stroke. Most effects were intrapersonal effects. The interpersonal effects were small but showed that pro-active coping by the patient was associated with lower anxiety of the partner. Higher self-efficacy of the partner was associated with lower depression scores and higher life satisfaction of the patient. This study underscores the importance of a dyadic approach to post-stroke functioning. It supports a family-based approach for treating post-stroke emotional problems.
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- 2023
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36. Prevalence and risk factors of burden among caregivers of older emergency department patients.
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Zaalberg T, Barten DG, van Heugten CM, Klijnsma P, Knarren L, Hiemstra Y, Kurvers RAJ, Lekx AW, Mooijaart SP, and Janssen-Heijnen M
- Subjects
- Humans, Prevalence, Cross-Sectional Studies, Risk Factors, Emergency Service, Hospital, Caregivers psychology, Activities of Daily Living
- Abstract
The number of older individuals that live independently at home is rising. These older individuals often rely on caregivers who have a similar age and health status. Therefore, caregivers may experience a high burden. We determined the prevalence and associating factors of burden among caregivers of older patients in the emergency department (ED). A cross-sectional study of primary caregivers of patients aged ≥ 70 years visiting the ED of a Dutch teaching hospital was performed. Structured interviews were conducted with patients and their caregivers. Caregiver burden was measured using the caregiver strain index (CSI). Additionally, data from questionnaires and medical records were extracted to determine potential associating factors. Univariate and multivariate regression analyses were conducted to identify independent determinants for burden. Seventy-eight caregivers (39%) experienced a high burden. Multivariate analysis showed a significant association between high caregiver burden and patients with cognitive impairment or dependency for instrumental activities of daily living (IADL) and more self-reported hours of care per day. Almost 40% of older patients in the ED have a caregiver who experiences a high burden. Formal assessment in the ED may help provide adequate care to the patients and their caregivers., (© 2023. The Author(s).)
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- 2023
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37. Assessing learning potential in elderly stroke patients: The validity of the dynamic Clock Drawing Task in comparison with the dynamic Wisconsin Card Sorting Test.
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Wilbers M, Geusgens C, and van Heugten CM
- Abstract
Currently, there is no valid and feasible dynamic test available for assessing learning potential in elderly stroke patients. We designed a dynamic version of the Clock Drawing Task (dCDT) which we compared to the dynamic Wisconsin Card Sorting Test (dWCST). The dWCST has shown adequate validity in adult patients with brain injury but has a long administration time. Participants were 47 stroke patients admitted to a geriatric rehabilitation unit. All participants completed the dCDT, the mean administration time was 7 min. 90.7% of the participants were able to complete the dWCST, the mean administration time was 36 min. The numerical learning potential indices of the dCDT were not significantly correlated. Based on the dCDT, 70.2% of the participants were classified as high achiever, 10.6% as strong learner, 19.2% as poor learner, and none as decliner. The numerical learning potential indices of the dWCST correlated significantly. Based on the dWCST, 5.3% of the participants were classified as high achiever, 42.1% as strong learner, 50% as poor learner, and 2.6% as decliner. The learning potential indices of the dCDT and those of the dWCST were not significantly correlated, indicating poor convergent validity of the dCDT. The results provide no clear support for the use of the dCDT in elderly stroke patients. The dWCST does show adequate validity and feasibility in the elderly stroke population, despite longer administration time. Future research should focus on examining the validity of the dCDT in a larger sample as well as examining the predictive validity of the dWCST.
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- 2023
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38. Mental effort and recovery from task-induced fatigue in people with traumatic brain injury.
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Bruijel J, Vermeeren A, Stapert SZ, and van Heugten CM
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- Humans, Fatigue diagnosis, Emotions, Anxiety Disorders, Case-Control Studies, Brain Injuries, Traumatic complications
- Abstract
Purpose: This exploratory case-controlled study examined whether the same amount of effort leads to similar feelings of fatigue and whether feelings of fatigue decline at the same rate in people with traumatic brain injury (pwTBI) compared to controls., Methods: Twenty pwTBI and 20 healthy controls (HC) completed an adaptive n -back task to induce fatigue and reported mental effort upon task completion and state-fatigue pre-task and several times during 30-minutes rest-period post-task. Task difficulty adapted to performance allowing both groups to invest substantial amounts of mental effort., Results: Fatigue and effort levels were higher in pwTBI compared to controls. Multiple linear regression analyses showed that effort was positively related to post-task fatigue and this relationship did not differ between groups. Pre-task fatigue was the only predictor of post-task fatigue. Multilevel models showed no significant difference in decline of fatigue over the rest-period between groups., Conclusions: Excessive feelings of fatigue following TBI could not be explained by a higher vulnerability to the fatigue-inducing effects of mental effort needed to perform a specific task. In pwTBI pre-task fatigue levels might be more related to the complex demands of everyday life. Future studies should investigate recovery of fatigue and applications of this knowledge to rehabilitation interventions.Implications for rehabilitationPeople with TBI experience long-term fatigue as one of the most frequent and disabling symptoms and this long-term fatigue is a risk factor for development of secondary psychiatric symptoms such as depression or anxiety.Since people with TBI did not show a higher vulnerability to the fatigue-inducing effects of mental effort, fatigue following TBI might be better explained by the complex demands of everyday life such as external (environment) and internal (emotions) factors.Rehabilitation programs should be directed to this complex and highly individual interplay of fatigue in relation to other factors.
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- 2023
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39. MRI factors associated with cognitive functioning after acute onset brain injury: Systematic review and meta-analysis.
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Verhulst MMLH, Glimmerveen AB, van Heugten CM, Helmich RCG, and Hofmeijer J
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- Humans, Magnetic Resonance Imaging methods, Cognition, Diffusion Magnetic Resonance Imaging, Memory Disorders, Cognitive Dysfunction diagnostic imaging, Cognitive Dysfunction etiology, Brain Injuries
- Abstract
Impairments of memory, attention, and executive functioning are frequently reported after acute onset brain injury. MRI markers hold potential to contribute to identification of patients at risk for cognitive impairments and clarification of mechanisms. The aim of this systematic review was to summarize and value the evidence on MRI markers of memory, attention, and executive functioning after acute onset brain injury. We included ninety-eight studies, on six classes of MRI factors (location and severity of damage (n = 15), volume/atrophy (n = 36), signs of small vessel disease (n = 15), diffusion-weighted imaging measures (n = 36), resting-state functional MRI measures (n = 13), and arterial spin labeling measures (n = 1)). Three measures showed consistent results regarding their association with cognition. Smaller hippocampal volume was associated with worse memory in fourteen studies (pooled correlation 0.58 [95% CI: 0.46-0.68] for whole, 0.11 [95% CI: 0.04-0.19] for left, and 0.34 [95% CI: 0.17-0.49] for right hippocampus). Lower fractional anisotropy in cingulum and fornix was associated with worse memory in six and five studies (pooled correlation 0.20 [95% CI: 0.08-0.32] and 0.29 [95% CI: 0.20-0.37], respectively). Lower functional connectivity within the default-mode network was associated with worse cognition in four studies. In conclusion, hippocampal volume, fractional anisotropy in cingulum and fornix, and functional connectivity within the default-mode network showed consistent associations with cognitive performance in all types of acute onset brain injury. External validation and cut off values for predicting cognitive impairments are needed for clinical implementation., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)
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- 2023
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40. Can We Successfully Improve Attentional Impairments After Brain Injury With Computer-Based Interventions? Letter to the Editor on "Evidence-Based Cognitive Rehabilitation: Systematic Review of the Literature From 2009 Through 2014".
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Van Heugten CM, Bertens D, and Fasotti L
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- Humans, Cognition, Computers, Brain Injuries rehabilitation
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- 2022
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41. Nurse-led stroke aftercare addressing long-term psychosocial outcome: a comparison to care-as-usual.
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Verberne DPJ, Kroese MEAL, Staals J, Ponds RWHM, and van Heugten CM
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- Depression psychology, Humans, Nurse's Role, Prospective Studies, Quality of Life, Aftercare, Stroke complications, Stroke psychology
- Abstract
Purpose: To examine whether nurse-led stroke aftercare is beneficial for long-term psychosocial outcome of community-dwelling persons with stroke., Materials and Methods: Comparative effectiveness research design in which a prospective stroke aftercare cohort ( n = 87) was compared to care-as-usual ( n = 363) at six- and 12-months post stroke. Changes over time in cognitive and emotional problems experienced in daily life, fatigue and stroke impact on daily life were examined for stroke aftercare only. Multilevel modelling was used to compare stroke aftercare to care-as-usual concerning anxiety and depression symptoms, social participation and quality of life, over time., Results: Sample characteristics did not differ between cohorts except for stroke type and on average, more severe stroke in the stroke aftercare cohort ( p < 0.05). Following stroke aftercare, anxiety and emotional problems decreased significantly ( p < 0.05), whereas care-as-usual remained stable over time in terms of anxiety. No significant changes over time were observed on the other outcome domains., Conclusions: Nurse-led stroke aftercare showed to be beneficial for emotional well-being in comparison to care-as-usual. Providing psychoeducation and emotional support seem effective elements but adding other therapeutic elements such as self-management strategies might increase the effectiveness of nurse-led stroke aftercare.Implications for rehabilitationRoutine stroke follow-up care should pay attention to psychosocial and emotional outcome in a systematic manner, in addition to secondary prevention.Healthcare professionals such as (specialized) nurses are needed to appropriately address the hidden cognitive and emotional consequences of stroke.Providing psychoeducation and emotional support in stroke aftercare diminish insecurities and worries in community-dwelling persons with stroke, leading to better outcomes.
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- 2022
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42. The influence of psychological factors and mood on the course of participation up to four years after stroke.
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de Graaf JA, Schepers VPM, Nijsse B, van Heugten CM, Post MWM, and Visser-Meily JMA
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- Adaptation, Psychological, Affect, Depression psychology, Humans, Prospective Studies, Stroke psychology, Stroke Rehabilitation psychology
- Abstract
Purpose: (1) To explore the course of participation from two months up to four years after stroke, and (2) to examine if adaptive and maladaptive psychological factors and mood measured at two months after stroke are determinants of the course of participation during this period., Materials and Methods: Prospective cohort study in which 369 individuals with stroke were assessed at stroke onset, two months, six months, one year, two years and three to four years after stroke. The Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-Participation) restrictions subscale was used to measure participation. Psychological factors were clustered into adaptive (proactive coping, self-efficacy, extraversion and optimism) and maladaptive (passive coping, neuroticism and pessimism) psychological factors. The Hospital Anxiety and Depression Scale was used to assess mood., Results: Although improvements in participation were observed up to one year after stroke, considerable long-term restrictions in social and physical domains persisted. More mood problems and less adaptive psychological factors were independent determinants of worse participation up to four years after stroke., Conclusions: Participation improves in the first 12 months after stroke and stabilizes afterwards. Mood problems and less adaptive psychological factors negatively influence the course of participation over time up to four years after stroke.Implications for rehabilitationFollow-up assessments after stroke should not only focus on cognitive and motor impairment, but also encompass screening on mood problems and adaptive psychological factors.Implementation of a routine follow-up assessment one year after stroke can be beneficial as restrictions in participation are unlikely to diminish spontaneously from then onwards.
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- 2022
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43. Correction to: Long-term psychosocial outcome following mild traumatic brain injury and minor stroke: a direct longitudinal comparison.
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Verberne DPJ, Ponds RWHM, Kroese MEAL, Wijenberg MLM, Barten DG, Pasmans R, Staals J, and van Heugten CM
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- 2021
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44. Dutch multicentre, prospective follow-up, cohort study comparing the neurological and neuropsychological sequelae of hospitalised non-ICU- and ICU-treated COVID-19 survivors: a study protocol.
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Klinkhammer S, Horn J, Visser-Meilij JMA, Verwijk E, Duits A, Slooter AJC, and van Heugten CM
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- Cohort Studies, Follow-Up Studies, Humans, Intensive Care Units, Multicenter Studies as Topic, Prospective Studies, SARS-CoV-2, Survivors, COVID-19
- Abstract
Introduction: Owing to the novelty of COVID-19, there are still large knowledge gaps concerning its effect on the brain and the resulting impact on peoples' lives. This large-scale prospective follow-up study investigates COVID-19-associated brain damage, neuropsychological dysfunction and long-term impact on the well-being of patients and their close ones. It is hypothesised that structural brain damage and cognitive dysfunction primarily occur in severely ill patients, as compared with moderately ill patients. Cognitive complaints, emotional distress and impact on well-being are hypothesised to be less dependent on illness severity., Methods and Analysis: For this multicentre study, 200 patients with COVID-19 (100 intensive care unit (ICU) patients and 100 non-ICU patients) formerly hospitalised in one of the six recruiting hospitals during the first European infection wave (ie, March to June 2020) and their close ones will be recruited. At minimally 6 months posthospital discharge, patients will perform a set of neuropsychological tests and are subjected to a 3T MRI scan. Patients and close ones will fill out a set of questionnaires, also at minimally 6 months posthospital discharge and again another 6 months thereafter. Data related to COVID-19 hospitalisation will be extracted from the patients' medical records. MRI abnormalities will ultimately be related to neuropsychological test performance and questionnaire outcomes., Ethics and Dissemination: Ethics approval was granted by the medical research ethics committee of Maastricht University Medical Centre and Maastricht University (NL75102.068.20). The project is sponsored by The Brain Foundation Netherlands. Findings will be presented at national and international conferences, as well as published in peer-reviewed scientific journals., Trial Registration Number: NCT04745611., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2021
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45. The bidirectional relationship between sleep and physical activity following traumatic brain injury.
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Bruijel J, van Heugten CM, Murray J, Grima N, Ymer L, Walters EM, Sinclair K, Stapert SZ, Vermeeren A, and Ponsford JL
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- Actigraphy, Adult, Exercise, Humans, Male, Polysomnography, Brain Injuries, Traumatic complications, Sleep
- Abstract
Sleep and physical activity are both modifiable behavioural factors that are associated with better health and are potentially related. Following traumatic brain injury, damage to the brain caused by an external force, sleep disturbances are common. Exploring bidirectional relationships between sleep and physical activity might provide insight into whether increasing physical activity could decrease these sleep disturbances. The current study, therefore, examined inter- and intra-individual temporal associations between sleep and daytime physical activity in 64 people with traumatic brain injury reporting sleep problems or fatigue (47 males; mean age, 40 years). Sleep and physical activity were measured using actigraphy with corroborating sleep diaries over 14 consecutive days. Multilevel models were used to examine inter- and intra-individual associations between physical activity and sleep. Inter-individual variations showed that earlier bedtimes, earlier wake-up times and lower sleep efficiency were associated with more physical activity. Intra-individual temporal variations showed no significant association of daytime physical activity with sleep duration or continuity. However, shorter sleep time and less wake after sleep onset than usual were associated with more time spent in light-intensity activity the next day. Therefore, sleep may have more of an influence on physical activity than physical activity has on sleep in people with traumatic brain injury. In conclusion, the results do not confirm a potential beneficial effect of physical activity on sleep but suggest that improving sleep quality might be relevant to support of a physically active lifestyle in people with traumatic brain injury. Further research is necessary to confirm these results., (© 2021 The Authors. Journal of Sleep Research published by John Wiley & Sons Ltd on behalf of European Sleep Research Society.)
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- 2021
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46. Which approach to measure cognitive functioning should be preferred when exploring the association between cognitive functioning and participation after stroke?
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de Graaf JA, Nijsse B, Schepers VPM, van Heugten CM, Post MWM, and Visser-Meily JMA
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- Cognition, Cohort Studies, Humans, Neuropsychological Tests, Stroke complications, Stroke Rehabilitation
- Abstract
A variety of approaches are currently used to explore the relationship between cognitive functioning and participation after stroke. We aimed to gain insight into the preferred approach to measure cognitive functioning when exploring the association between cognitive functioning and participation in the long term after stroke. In this inception cohort study 128 individuals with stroke participated and were assessed at a single time point three to four years after the event. Participation was measured using the Restrictions subscale of the Utrecht Scale for Evaluation of Rehabilitation-Participation. Subjective cognitive complaints were assessed using the Cognition subscale of the Checklist for Cognitive and Emotional Consequences (CLCE-24-C). Objective cognitive performance was measured using the Montreal Cognitive Assessment (MoCA) and a neuropsychological test battery (NTB) testing multiple cognitive domains. Participation showed a strong correlation ( r = 0.51) with the CLCE-24-C and moderate correlations with the domains of visuospatial perception ( r = 0.37) and mental speed ( r = 0.36). Backward linear regression analyses showed that participation restrictions were best explained by the combination of the CLCE-24-C and a test for visuospatial perception ( R
2 = 0.31). Our findings suggest the use of a combination of subjective cognitive complaints and objective cognitive performance to explore the relationship between cognitive functioning and participation after stroke.- Published
- 2021
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47. Temporal evolution and predictors of subjective cognitive complaints up to 4 years after stroke.
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Nijsse B, Verberne DPJ, Visser-Meily JMA, Post MWM, de Kort PLM, and van Heugten CM
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- Aged, Female, Humans, Male, Middle Aged, Prospective Studies, Time Factors, Cognition Disorders epidemiology, Cognition Disorders etiology, Stroke complications
- Abstract
Objective: To examine the temporal evolution of subjective cognitive complaints in the long-term after stroke, and to identify predictors of long-term subjective cognitive complaints., Methods: Prospective cohort study including 395 stroke patients. Subjective cognitive complaints were assessed at 2 months, 6 months and 4 years post-stroke, using the Checklist for Cognitive and Emotional consequences following stroke (CLCE-24). The temporal evolution of subjective cognitive complaints was described using multilevel growth modelling. Associations between CLCE-24 cognition score at 4 years post-stroke and baseline characteristics, depression, anxiety, cognitive test performance, and adaptive and maladaptive psychological factors were examined. Significant predictors were entered in a multivariate multilevel model., Results: A significant increase in subjective cognitive complaints from 2 months up to 4 years (mean 3.7 years, standard deviation (SD) 0.6 years) post-stroke was observed (p≤0.001). Two months post-stroke, 76% of patients reported at least one cognitive complaint, 72% at 6 months, and 89% at 4 years post-stroke. A higher level of subjective cognitive complaints at 2 months and lower scores on adaptive and maladaptive psychological factors were significant independent predictors of a higher level of subjective cognitive complaints at 4 years post-stroke., Conclusion: Post-stroke subjective cognitive complaints increase over time and can be predicted by the extent of subjective cognitive complaints and the presence of adaptive and maladaptive psychological factors in the early phases after stroke.
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- 2021
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48. Long-term psychosocial outcome following mild traumatic brain injury and minor stroke: a direct longitudinal comparison.
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Verberne DPJ, Ponds RWHM, Kroese MEAL, Wijenberg MLM, Barten DG, Pasmans R, Staals J, and van Heugten CM
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- Humans, Longitudinal Studies, Prospective Studies, Quality of Life, Brain Concussion, Stroke complications, Stroke epidemiology
- Abstract
Background and Purpose: Research suggests comparable long-term psychosocial outcomes following mild traumatic brain injury (mTBI) and minor stroke, but no direct comparison has been made. This study aimed to directly compare psychosocial outcome over time in persons with mTBI and minor stroke., Methods: In this multicenter, prospective longitudinal cohort study, community-dwelling persons with mTBI (n = 182) and minor stroke (n = 48) were assessed at 6 weeks, 3, 6 and 12 months post-injury. Outcome measures included anxiety and depression symptoms (Hospital Anxiety and Depression Scale-HADS), cognitive problems in daily life (Checklist for Cognitive and Emotional Consequences of Stroke-CLCE-24) and quality of life (EuroQol-5D-5L-EQ-5D-5L). Multilevel growth curve modeling, controlled for demographic variables, was used to determine outcomes over time between groups. Proportions of persons reporting persistent psychosocial symptoms at 6 months post-injury were compared using Pearson's Chi-squared tests., Results: Improvements in outcomes were observed in the first 6 months and effects stabilized to 12 months post-injury in both groups. Minor stroke cases reported significantly higher levels of HADS anxiety and a significantly reduced increase in EQ-5D-5L utility scores than mTBI cases, but differences were small in absolute numbers. No significant differences were observed between groups regarding HADS depression and CLCE-24 cognition scores. Proportions of persons reporting persistent psychosocial symptoms were equal between groups., Conclusions: Psychosocial outcome is largely comparable following mTBI and minor stroke. Specific attention should be paid to anxiety symptoms and cognitive problems in daily life for which uniform aftercare seems appropriate.
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- 2021
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49. ZMILE, a multicomponent self-management intervention for adults with epilepsy: Rationale and description of the intervention.
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Chan HY, Leenen LA, Wijnen BF, van der Putten IM, Evers SM, Hjm Majoie M, and van Heugten CM
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- Adaptation, Psychological, Adult, Epilepsy psychology, Family, Female, Health Behavior, Humans, Male, Motivation, Netherlands, Epilepsy therapy, Self-Management
- Abstract
Objective: In this paper, we aim to provide a comprehensive description of the multicomponent self-management intervention for adults with epilepsy, ZMILE., Rationale or Theory: Acquiring self-management skills has been shown to play a vital role in enabling patients with epilepsy overcoming (health-related) struggles in daily life and coping with limitations their condition poses on them. ZMILE is a course consisting of education (to increase concordance to treatment), goal-setting (proactive coping), and self-monitoring., Resources Needed: The course is guided by two nurse practitioners and each patient is allowed to bring one family member or friend. Self-monitoring plays an important role and can be done through e-Health tools or written diaries., Processes Involved: During and after the course, patients are required to work toward a personally defined goal using a five-step approach by means of pro-active coping. Moreover, patients are expected to use self-monitoring tools to reflect on their own behavior and identify ways to optimize medication intake when required., Quantification: ZMILE is provided in an outpatient setting over five weekly group sessions and one booster session. From the start, patients are encouraged to set individual goals. Each group session will have a different theme but part of every session is reflecting on personal goals and to learn from eachother., Conclusions: The ZMILE-intervention has been evaluated and may be a promising intervention in terms of effectiveness and feasibility for adults with epilepsy, relatives, and professionals. We present the adapted version which can be implemented in clinical practice.
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- 2021
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50. The relationship between social cognition and participation in the long term after stroke.
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Stiekema APM, Nijsse B, de Kort PLM, Spikman JM, Visser-Meily JMA, and van Heugten CM
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- Cognition, Cross-Sectional Studies, Humans, Prospective Studies, Social Cognition, Stroke complications, Stroke Rehabilitation
- Abstract
Social cognitive impairments may play a role in participation restrictions after stroke. Understanding their relationship could inform treatment approaches to improve participation. We investigated the relationship between social cognition and participation in the long term after stroke. Of 395 patients participating in a large prospective cohort study, cross-sectional data were available at 3-4 years post-stroke of 118 patients on tests for emotion recognition, theory of mind, empathy, and behaviour regulation. Participation was assessed with the Utrecht Scale for Evaluation of Rehabilitation - Participation (USER-P). Bivariate and multivariate regression analysis were used to examine the relationship between social cognitive domains and participation. The majority suffered from minor stroke (83.1% scored NIHSS 0-4). Only behaviour regulation was related to participation restrictions in bivariate analysis, but social cognitive impairments did not predict participation restrictions in multivariate regression in this group. To conclude, in a sample of minor stroke patients with mild impairments in theory of mind, emotion recognition and behavioural control, there were no associations with restrictions in participation. Research should examine whether a relationship is present in patients with more severe stroke. In addition, measuring social aspects of participation is necessary to further unravel this relationship, to determine treatment targets for improving participation.
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- 2021
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