Exploring the use of dopaminergic medication to treat hemispatial inattention during in-patient post-stroke neurorehabilitation.
cognition
dopamine
hemispatial inattention
neurorehabilitation
spatial neglect
stroke
Journal
Journal of neuropsychology
ISSN: 1748-6653
Titre abrégé: J Neuropsychol
Pays: England
ID NLM: 101468753
Informations de publication
Date de publication:
09 2022
09 2022
Historique:
revised:
08
03
2022
received:
28
10
2021
accepted:
16
03
2022
pubmed:
7
4
2022
medline:
9
9
2022
entrez:
6
4
2022
Statut:
ppublish
Résumé
Hemispatial inattention (HSI), a lateralised impairment of spatial processing, is a common consequence of stroke. It is a poor prognostic indicator for functional recovery and interferes with the progress during in-patient neurorehabilitation. Dopaminergic medication has shown promise in improving HSI in the chronic post-stroke period but is untested in more acute settings, e.g. during in-patient neurorehabilitation. We audited the use of dopaminergic medication in ten sequential patients with post-stroke HSI, on an open-label exploratory basis. Patients' response to medication was assessed individually, using a three-week Off-On-Off protocol. We employed a mixture of bedside and functional measures, and made a multidisciplinary judgement of efficacy in individual patients. In six out of 10 patients, there was a convincing improvement of HSI while on medication, which reversed when it was paused. There was a mean 57% relative increase in target detection in the star cancellation test on the most affected side (on vs. off medication). In the six responders, medication was therefore continued throughout their admission without adverse effects. The star cancellation test was sensitive to HSI in most patients but in two cases failed to detect changes that were picked up by a functional assessment (Kessler Functional Neglect Assessment Protocol). We found this multidisciplinary approach to be feasible in an in-patient neurorehabilitation setting. We suggest further research to explore the efficacy of dopaminergic medication in improving neurorehabilitation outcomes for patients with post-stroke HSI. We suggest that more detailed N-of-1 assessments of treatment response, with internal blinding, may be a productive approach.
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
518-536Informations de copyright
© 2022 The British Psychological Society.
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