Name: dual-task stroop paradigm for detecting cognitive deficits in high-functioning stroke patients
Uploaded: 2022-12-16T12:50:00
Description: Watch this Scientific Journal Video about Dual-Task Stroop Paradigm for Detecting Cognitive Deficits in High-Functioning Stroke Patients at JoVE.com

This study was supported by grants from the National Natural Science Foundation of China (No. 81804004, 81902281), China Postdoctoral Science Foundation (No. 2018M643207), Shenzhen Municipal Health Commission Project (No. SZBC2018005), Shenzhen Science and Technology Project (No. JCYJ20160428174825490), the General Guidance Program of Guangzhou Municipal Health and Family Planning (No. 20211A010079, 20211A011106), Guangzhou and University Foundation (No. 202102010100), Guangzhou Medical University Foundation (No. PX-66221494), Key Laboratory of Guangdong Higher Education Institutes&#160; [Grant Number: 2021KSYS009] and Guangdong Province Department of Education [Grant Number: 2021ZDZX2063].

This project was approved by the Medical Ethics Association of the Fifth Affiliated Hospital of Guangzhou Medical University (No. KY01-2020-08-06) and has been registered at the China Clinical Trial Registration Center (No. ChiCTR2000036514). Informed consent was obtained from patients for using their data in this study.
1. Recruitment
<ol>
	<li>Recruit stroke patients with stable conditions as confirmed by imaging examination-diagnosis conforms to the diagnostic criteria of...

<ol>
	<li>Dichgans, M., Pulit, S. L., Rosand, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Stroke+genetics:+Discovery,+biology,+and+clinical+applications.">Stroke genetics: Discovery, biology, and clinical applications.</a> The Lancet. Neurology. 18 (6), 587-599 (2019).</li><li>Chen, G., Leak, R. K., Sun, Q., Zhang, J. H., Chen, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Neurobiology+of+stroke:+Research+progress+and+perspectives.">Neurobiology of stroke: Research progress and perspectives.</a> Progress In Neurobiology. 163-164, 1-4 (2018).</li><li>Maratos, M., Huynh, L., Tan, J., Lui, J., Jarus, T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Picture+this:+Exploring+the+lived+experience+of+high-functioning+stroke+survivors+using+photovoice.">Picture this: Exploring the lived experience of high-functioning stroke survivors using photovoice.</a> Qualitative Health Research. 26 (8), 1055-1066 (2016).</li><li>Platz, T., Prass, K., Denzler, P., Bock, S., Mauritz, K. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Testing+a+motor+performance+series+and+a+kinematic+motion+analysis+as+measures+of+performance+in+high-functioning+stroke+patients:+reliability,+validity,+and+responsiveness+to+therapeutic+intervention.">Testing a motor performance series and a kinematic motion analysis as measures of performance in high-functioning stroke patients: reliability, validity, and responsiveness to therapeutic intervention.</a> Archives of Physical Medicine and Rehabilitation. 80 (3), 270-277 (1999).</li><li>Trzepacz, P. T., Hochstetler, H., Wang, S., Walker, B., Saykin, A. 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A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Relationship+between+dual-task+gait+speed+and+walking+activity+poststroke.">Relationship between dual-task gait speed and walking activity poststroke.</a> Stroke. 49 (5), 1296-1298 (2018).</li><li>Liu, Y. -. C., Yang, Y. -. R., Tsai, Y. -. A., Wang, R. -. Y. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cognitive+and+motor+dual+task+gait+training+improve+dual+task+gait+performance+after+stroke+-+A+randomized+controlled+pilot+trial.">Cognitive and motor dual task gait training improve dual task gait performance after stroke - A randomized controlled pilot trial.</a> Scientific Reports. 7 (1), 4070 (2017).</li><li>Manaf, H., Justine, M., Ting, G. H., Latiff, L. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comparison+of+gait+parameters+across+three+attentional+loading+conditions+during+timed+up+and+go+test+in+stroke+survivors.">Comparison of gait parameters across three attentional loading conditions during timed up and go test in stroke survivors.</a> Topics In Stroke Rehabilitation. 21 (2), 128-136 (2014).</li><li>Ou, H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Motor+dual-tasks+for+gait+analysis+and+evaluation+in+post-stroke+patients.">Motor dual-tasks for gait analysis and evaluation in post-stroke patients.</a> Journal of Visualized Experiments. (169), e62302 (2021).</li><li>Hirano, D., Goto, Y., Jinnai, D., Taniguchi, T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effects+of+a+dual+task+and+different+levels+of+divided+attention+on+motor-related+cortical+potential.">Effects of a dual task and different levels of divided attention on motor-related cortical potential.</a> Journal of Physical Therapy Science. 32 (11), 710-716 (2020).</li><li>Loetscher, T., Potter, K. -. J., Wong, D., das Nair, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cognitive+rehabilitation+for+attention+deficits+following+stroke.">Cognitive rehabilitation for attention deficits following stroke.</a> The Cochrane Database of Systematic Reviews. 2019 (11), (2019).</li><li>Chen, C., Leys, D., Esquenazi, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+interaction+between+neuropsychological+and+motor+deficits+in+patients+after+stroke.">The interaction between neuropsychological and motor deficits in patients after stroke.</a> Neurology. 80, 27-34 (2013).</li><li>Puglisi, G., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Frontal+pathways+in+cognitive+control:+Direct+evidence+from+intraoperative+stimulation+and+diffusion+tractography.">Frontal pathways in cognitive control: Direct evidence from intraoperative stimulation and diffusion tractography.</a> Brain. 142 (8), 2451-2465 (2019).</li><li>MacLeod, C. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Half+a+century+of+research+on+the+Stroop+effect:+An+integrative+review.">Half a century of research on the Stroop effect: An integrative review.</a> Psychological Bulletin. 109 (2), 163-203 (1991).</li><li>Su, M., Wang, R., Dong, Z., Zhao, D., Yu, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Decline+in+attentional+inhibition+among+migraine+patients:+An+event-related+potential+study+using+the+Stroop+task.">Decline in attentional inhibition among migraine patients: An event-related potential study using the Stroop task.</a> The Journal of Headache and Pain. 22 (1), 34 (2021).</li><li>Tsang, C. S. L., Chong, D. Y. K., Pang, M. Y. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cognitive-motor+interference+in+walking+after+stroke:+test-retest+reliability+and+validity+of+dual-task+walking+assessments.">Cognitive-motor interference in walking after stroke: test-retest reliability and validity of dual-task walking assessments.</a> Clinical Rehabilitation. 33 (6), 1066-1078 (2019).</li><li>Bai, Q., Hu, J., Zhang, L. J., Chen, Y., Zhang, Y. H., Wang, X. C., Chi, L. Y. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Application+value+of+Stroop+test+in+the+evaluation+of+cognitive+function+in+asymptomatic+cerebral+infarction.">Application value of Stroop test in the evaluation of cognitive function in asymptomatic cerebral infarction.</a> China Journal of Alzheimer's Disease and Related Disorders. 4 (4), 269-274 (2021).</li><li>Pandian, S., Arya, K. N. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Stroke-related+motor+outcome+measures:+Do+they+quantify+the+neurophysiological+aspects+of+upper+extremity+recovery.">Stroke-related motor outcome measures: Do they quantify the neurophysiological aspects of upper extremity recovery.</a> Journal of Bodywork and Movement Therapies. 18 (3), 412-423 (2014).</li><li>Albert, M. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+simple+test+of+visual+neglect.">A simple test of visual neglect.</a> Neurology. 23 (6), 658-664 (1973).</li><li>Nasreddine, Z. S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+Montreal+Cognitive+Assessment,+MoCA:+A+brief+screening+tool+for+mild+cognitive+impairment.">The Montreal Cognitive Assessment, MoCA: A brief screening tool for mild cognitive impairment.</a> Journal of the American Geriatrics Society. 53 (4), 695-699 (2005).</li><li>Morris, J. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+Clinical+Dementia+Rating+(CDR):+Current+version+and+scoring+rules.">The Clinical Dementia Rating (CDR): Current version and scoring rules.</a> Neurology. 43 (11), 2412-2414 (1993).</li><li>Sullivan, K. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Fugl-Meyer+assessment+of+sensorimotor+function+after+stroke:+Standardized+training+procedure+for+clinical+practice+and+clinical+trials.">Fugl-Meyer assessment of sensorimotor function after stroke: Standardized training procedure for clinical practice and clinical trials.</a> Stroke. 42 (2), 427-432 (2011).</li><li>Sanford, J., Moreland, J., Swanson, L. R., Stratford, P. W., Gowland, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reliability+of+the+Fugl-Meyer+assessment+for+testing+motor+performance+in+patients+following+stroke.">Reliability of the Fugl-Meyer assessment for testing motor performance in patients following stroke.</a> Physical Therapy. 73 (7), 447-454 (1993).</li><li>Downs, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+Berg+Balance+Scale.">The Berg Balance Scale.</a> Journal of Physiotherapy. 61 (1), 46 (2015).</li><li>Blum, L., Korner-Bitensky, N. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Usefulness+of+the+Berg+Balance+Scale+in+stroke+rehabilitation:+A+systematic+review.">Usefulness of the Berg Balance Scale in stroke rehabilitation: A systematic review.</a> Physical Therapy. 88 (5), 559-566 (2008).</li><li>El Said, S. M. S., Adly, N. N., Abdul-Rahman, S. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Executive+function+and+physical+function+among+community-dwelling+Egyptian+older+adults.">Executive function and physical function among community-dwelling Egyptian older adults.</a> Journal of Alzheimer's Disease. 80 (4), 1583-1589 (2021).</li><li>Al-Yahya, E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Prefrontal+cortex+activation+while+walking+under+dual-task+conditions+in+stroke:+A+multimodal+imaging+study.">Prefrontal cortex activation while walking under dual-task conditions in stroke: A multimodal imaging study.</a> Neurorehabilitation and Neural Repair. 30 (6), 591-599 (2016).</li><li>Matjacic, Z., Zadravec, M., Olensek, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Feasibility+of+robot-based+perturbed-balance+training+during+treadmill+walking+in+a+high-functioning+chronic+stroke+subject:+A+case-control+study.">Feasibility of robot-based perturbed-balance training during treadmill walking in a high-functioning chronic stroke subject: A case-control study.</a> Journal of Neuroengineering and Rehabilitation. 15 (1), 32 (2018).</li></ol>

In our study, the results of the routine clinical cognitive assessment scales for the high-functioning stroke patient did not show any significant cognitive deficits. However, these assessment scales might show a ceiling effect and be less sensitive for identifying the mild cognitive deficits of high-functioning stroke patients. Hence, this protocol further selected ACC and RT in dual-task assessment based on the Stroop paradigm as major indicators to identify the cognitive deficits of high-functioning stroke patients. T...

Stroke is the leading cause of disability in humans1 and can cause varying degrees of motor, cognitive, emotional, and other functional deficits2. Some stroke patients with better prognosis and only slight functional defects show greater functional autonomy in daily activities, but the functional state of their disability may not be sufficient to support their return to work or previous activities. These patients are referred to as high-functioning stroke patients3,4. Due to their minor functional deficits, it is hard to identify their dysfunctions, especially in terms of cognitive functions, through the general assessment of function scales, such as the Montreal cognitive assessment (MoCA)5 and clinical dementia rating (CDR)6, which have a ceiling effect and poor sensitivity for identifying mild functional defects in high-functioning stroke patients. Therefore, it is necessary to develop objective and simple methods to identify cognitive dysfunction in high-functioning stroke patients.
In recent years, the advantages of the dual-task paradigm in assessment and training have gradually become valued7,8. For example, patients may perform normally on simple cognitive single tasks (e.g., calculation) but show varying degrees of cognitive decline when additional tasks are added9,10 (e.g., walking while counting). Manaf et al. found that stroke patients often use compensatory strategies when performing cognitive-motor dual tasks, such as maintaining stability by sacrificing cognitive task performance11. Therefore, the dual-task assessment may have advantages in identifying cognitive deficits in patients with high-functioning stroke. On the one hand, the content of the dual-task assessment is closer to daily life than a single task, such as walking while observing the surrounding environment or talking and calling. In previous studies, the walking + naming task and walking + crossing obstacles task were designed to simulate walking in real environments12.
On the other hand, the executive ability in dual tasks has a close relationship with divided attention (belonging to the category of advanced cognitive function)13. Divided attention is the ability to handle multiple tasks simultaneously and allocate attention to two or more tasks14. This cognitive skill is of great significance to improve the efficiency of daily activities. Therefore, the results of the dual-task assessment can be used for reflecting the individual&#39;s divided attention. Normally, people can deal with two or more simple tasks simultaneously in their daily lives and are not disturbed. However, when brain function is impaired, there may be more dual-task interference when faced with simple dual tasks; that is, when performing dual tasks, the reduced divided attention may be likely to cause the performance of one or two tasks to be impaired15. It is concluded that dual-task execution is more likely to be able to detect advanced cognitive function impairment in patients with high-functioning stroke.
The Stroop paradigm is a classical experimental paradigm to study the Stroop effect (also known as the conflict effect)16, which has been widely used in attention assessment in cognitive function tests, especially in the field of attention inhibition17. The classical Stroop effect refers to the fact that it is difficult for individuals to respond quickly and accurately to non-dominant stimuli due to the interference of the dominant response. This results in a longer response time and lower response accuracy for non-dominant stimuli. The difference in reaction time or accuracy rate between dominant and non-dominant reactions is the Stroop effect18. Therefore, the Stroop requires high levels of attention19. Smaller Stroop effects represent higher attentional inhibition, while larger Stroop effects represent a decline in attentional inhibition18.
The Stroop paradigm may be more suitable for assessing cognitive dysfunction in patients with high-functioning stroke and has higher sensitivity and specificity for attention assessment than the traditional clinical assessment scale20. Therefore, this study designed a dual-task assessment based on the Stroop paradigm to identify cognitive deficits in high-functioning stroke patients. The protocol also includes clinical assessment of cognitive function, lower limb motor function, and balance function in stroke patients to ensure that patients can complete the dual-task assessment. Functional near-infrared spectroscopy (fNIRS) was used as an objective evaluation tool for brain function to detect the activation of brain function in high-functioning stroke patients under the dual task. The effectiveness and feasibility of the dual-task assessment scheme based on the Stroop paradigm were verified from the perspective of neuroimaging, which provides new aspects for clinical practice.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Balance Ball</td>
			<td>Shanghai Fanglian Industrial Co,&#160;China</td>
			<td>PVC-KXZ-EVA01-2015</td>
			<td>NA</td>
		</tr>
		<tr>
			<td>E-Prime 3.0</td>
			<td>Psychology softwares Tools</td>
			<td></td>
			<td>commercial stimulus presentation software</td>
		</tr>
		<tr>
			<td>fNIRS</td>
			<td>Hui Chuang, China</td>
			<td>NirSmart-500</td>
			<td>NA</td>
		</tr>
	</tbody>
</table>

dual-task stroop paradigm for detecting cognitive deficits in high-functioning stroke patients

General clinical cognitive assessment scales are not sensitive enough to cognitive impairment in high-functioning stroke patients. The dual-task assessment has advantages for identifying cognitive deficits in high-functioning stroke patients and has been gradually applied in clinical assessment and cognitive training. Moreover, the Stroop paradigm has higher sensitivity and specificity for attentional assessment than conventional clinical cognitive assessment scales. Therefore, this study presents the dual-task assessment based on the Stroop paradigm to identify cognitive deficits in high-functioning stroke patients. This study demonstrates a single- and dual-task evaluation based on the Stroop paradigm and confirms its feasibility through case experiments and synchronized functional near-infrared spectroscopy evaluation. The Stroop reaction time and correct rate are used as the main indicators to evaluate the cognitive level of the subjects. This study protocol aims to provide new ideas to figure out the ceiling effect in general clinical assessment failure for high-functioning stroke patients.

This study presents results from a high-functioning stroke patient, who was a 71-year-old male who suffered from ischemic stroke with left hemiplegia 2 years ago. The magnetic resonance imaging (MRI) presented bilateral chronic infarction from the basal ganglia to the radiating crown. He was able to walk and live independently in the community but was not satisfied with his cognitive recovery. However, the functional assessments were all within the normal range: FMA = 100, BBS = 56/56, TUGT = 6, MoCA = 26/30, CDR = 0.5, ...

Watch this Scientific Journal Video about Dual-Task Stroop Paradigm for Detecting Cognitive Deficits in High-Functioning Stroke Patients at JoVE.com

Dual-Task Stroop Paradigm for Detecting Cognitive Deficits in High-Functioning Stroke Patients

Clinical assessment scales are notsensitive enough to cognitive dysfunction in high-functioning stroke patients. The dual-task paradigm presents advantages and potential in the assessment and cognitive training of cognitive dysfunction. The study here proposes a dual-task Stroop paradigm to identify cognitive dysfunction in high-functioning stroke patients.

General clinical cognitive assessment scales are not sensitive enough to cognitive impairment in high-functioning stroke patients. The dual-task ...

Our study protocol could be used to identify cognitive deficit in high functioning stroke patients who are not easily detected by conventional assessment skills. This study protocol is to provide new ideas to figure out effect in general clinical assessment failure for high functioning stroke patients. This study protocol could be easily used in the clinical practice.For example, the clinician could modify the treatment strategy based on the Stroop reaction time and the correct rate. Demonstrating the procedure will be Siqi Huang, rehabilitation therapist;Siqing Wang, occupational therapist;Yajie Zhanga, physical therapist, Biyi Zhao, occupational therapist from our lab. Recruit stroke patients with stable conditions at Brunnstrom Stage 4 as confirmed by imaging examination.Ensure that the subjects participate in the test voluntarily and sign an informed consent form. Record the information of the participant, including name, gender, date of birth, education level, body mass index, medical history, and medication history. For cognitive assessment, perform MoCA on the participants by asking 11 questions addressing their attention and concentration, executive function, memory, language, visual structure skills, abstract thinking, computing, and orientation.Then perform CDR by collecting information during structured interviews with the participants and their families to assess the abilities of the participants in aspects such as memory, orientation, judgment and problem solving, work and social interaction, family life, personal hobby, and independent living. Perform Albert's Test to detect the presence of unilateral spatial neglect in patients with stroke. Ask the subject to cross out all the lines that are placed in random orientations on a piece of paper.Next, perform Fugl-Meyer Assessment on the participants to assess sensation, balance, joint range of motion, and joint pain in patients with post-stroke hemiplegia. The motor function includes items assessing movement, coordination, and the reflex actions of the shoulder, elbow, forearm, wrist, hand, hip, knee, and ankle. Also perform Berg Balance Scale on the stroke patient with a total of 14 items from easy to difficult including sitting balance, standing balance, body transfer, turning, and single leg standing.Perform the timed up and go test. Ask the subject to stand up from the chair, walk for three meters, turn their body, then return and sit in the chair. Concurrently, time the whole process from issuing the departure order to sitting in the chair.Prepare the participant by ensuring that the CZ site at the top of the test cap, which is the fourth point from the forehead to the occipital lobe, is on the midline of the full cap. Ensure that the midpoint of the connection lies between the nasal root to the lower edge of the occipital protuberance, the connection between the superior auricular fossa of both ears or the intersection point of the connection from the nasal root to the occipital protuberance. Then click the pre-acquisition button to start pre-acquisition and calibrate the test signal.Perform Stroop single task evaluation synchronized with fNIRS. Then perform Stroop dual task evaluation synchronized with fNIRS. First, ask the patient to sit in a stable chair.Run the commercial stimulus presentation software and select the congruence test trials. Make a new profile for the patient. Select the congruence test trials of the Stroop task and repeat three trials.In the resting stage, ask the patient to relax. When the experiment is in the stimulation stage, ask the patient to perform the attention related test and complete the task in six seconds. The patient should complete it 10 times in 60 seconds.Ask the patient to follow the instructions for the two test trials. Select the congruence test trials. Click the arrow button to the left when left is shown.Click the arrow button to the right when right is shown. Select the incongruence task trials. Click the arrow button to the left as soon as possible when right is shown on the left of the square.Click the arrow button to the right as soon as possible when left is shown on the right of the square. Finish the task, save the data and export the data to a self-built database. To perform the Stroop dual task evaluation, ask the patient to sit on a balance ball.Let the patient complete the Stroop experimental paradigm with the steps shown in the previous step. When the experiment is in a resting stage ask the patient to keep balance and relax on the balance ball. When the experiment is on stimulation, ask the patient to carry out the attention related test while maintaining balance on the balance ball as much as possible.This study presents cognitive assessment of a high functioning stroke patient compared to a healthy subject. In dual task congruence test trials, the reaction time of the stroke patient was higher than that of a healthy young subject and their accuracy was relatively lower. This difference was greater in the incongruence test trials.The results for brain function showed that the beta value of the regions of interest in the stroke patient was lower than that in the healthy young subject while performing dual task Stroop. Blood oxygen concentration in brain regions was shown. The beta values in the stroke patient were lower than that in the healthy young subject during dual task performance.During the dual task case, the evaluator should protect participant to avoid occurrence of accidental injuries such as falling. Our study protocol was mainly used to evaluate acuity function. The different types and difficult levels of dual tasks should be studied in the future.Dual task assessment in our study protocol could identify cognitive deficit in high functioning patients which will pave the way for the development of individualized treatment plans.

dual-task-stroop-paradigm-for-detecting-cognitive-deficits-high

Research

JoVE Journal

Neuroscience

Morris Water Maze Test for Learning and Memory Deficits in Alzheimer&#39;s Disease Model Mice

The Morris Water Maze (MWM) was first established by neuroscientist Richard G. Morris in 1981 in order to test hippocampal-dependent learning, including acquisition of spatial memoryand long-term spatial memory 1. The MWM is a relatively simple procedure typically consisting of six day trials, the main advantage being the differentiation between the spatial (hidden-platform) and non-spatial (visible platform) conditions 2-4. In addition, the MWM testing environment reduces odor trail interference 5. This has led the task to be used extensively in the study of the neurobiology and neuropharmacology of spatial learning and memory. The MWM plays an important role in the validation of rodent models for neurocognitive disorders such as Alzheimer&#x2019;s Disease 6, 7. In this protocol we discussed the typical procedure of MWM for testing learning and memory and data analysis commonly used in Alzheimer&#x2019;s disease transgenic model mice.

Morris Water Maze Test for Learning and Memory Deficits in Alzheimer's Disease Model Mice

The Morris Water Maze is a behavioral task to test hippocampal-dependent learning and memory. It has been widely used in the study of neurobiology, neuropharmacology and neurocognitive disorders in rodent models.

The Morris Water Maze (MWM) was first established by neuroscientist Richard G. Morris in 1981 in order to test hippocampal-dependent learning, including ...

A Novel Light Damage Paradigm for Use in Retinal Regeneration Studies in Adult Zebrafish

Light-induced retinal degeneration (LIRD) is commonly used in both rodents and zebrafish to damage rod and cone photoreceptors. In adult zebrafish, photoreceptor degeneration triggers M&#252;ller glial cells to re-enter the cell cycle and produce transient-amplifying progenitors. These progenitors continue to proliferate as they migrate to the damaged area, where they ultimately give rise to new photoreceptors. Currently, there are two widely-used LIRD paradigms, each of which results in varying degrees of photoreceptor loss and corresponding differences in the regeneration response. As more genetic and pharmacological tools are available to test the role of individual genes of interest during regeneration, there is a need to develop a robust LIRD paradigm. Here we describe a LIRD protocol that results in widespread and consistent loss of both rod and cone photoreceptors in which we have combined the use of two previously established LIRD techniques. Furthermore, this protocol can be extended for use in pigmented animals, which eliminates the need to maintain transgenic lines of interest on the albino background for LIRD studies.

Multiple light damage protocols have been described to damage photoreceptors and consequently induce a retinal regeneration response in adult zebrafish. This protocol describes an improved method that can be used in pigmented animals and that damages the vast majority of rod and cone photoreceptors across the entire retina.

Light-induced retinal degeneration (LIRD) is commonly used in both rodents and zebrafish to damage rod and cone photoreceptors. In adult zebrafish, ...

Intracerebroventricular Injection of Amyloid-&#946; Peptides in Normal Mice to Acutely Induce Alzheimer-like Cognitive Deficits

Amyloid-&#946; (A&#946;) is a major pathological mediator of both familial and sporadic Alzheimer's disease (AD). In the brains of AD patients, progressive accumulation of A&#946; oligomers and plaques is observed. Such A&#946; abnormalities are believed to block long-term potentiation, impair synaptic function, and induce cognitive deficits. Clinical and experimental evidences have revealed that the acute increase of A&#946; levels in the brain allows development of Alzheimer-like phenotypes. Hence, a detailed protocol describing how to acutely generate an AD mouse model via the intracerebroventricular (ICV) injection of A&#946; is necessary in many cases. In this protocol, the steps of the experiment with an A&#946;-injected mouse are included, from the preparation of peptides to the testing of behavioral abnormalities. The process of preparing the tools and animal subjects before the injection, of injecting the A&#946; into the mouse brain via ICV injection, and of assessing the degree of cognitive impairment are easily explained throughout the protocol, with an emphasis on tips for effective ICV injection of A&#946;. By mimicking certain aspects of AD with a designated injection of A&#946;, researchers can bypass the aging process and focus on the downstream pathology of A&#946; abnormalities.

The amyloid-&#946; (A&#946;)-injected animal model enables the administration of a defined quantity and species of A&#946; fragments and reduces individual differences within each study group. This protocol describes the intracerebroventricular (ICV) injection of A&#946; without stereotactic instruments, enabling the production of Alzheimer-like behavioral abnormalities in normal mice.

Amyloid-&#946; (A&#946;) is a major pathological mediator of both familial and sporadic Alzheimer's disease (AD). In the brains of AD patients, ...

High-resolution Quantification of Odor-guided Behavior in Drosophila melanogaster Using the Flywalk Paradigm

In their natural environment, insects such as the vinegar fly Drosophila melanogaster are bombarded with a huge amount of chemically distinct odorants. To complicate matters even further, the odors detected by the insect nervous system usually are not single compounds but mixtures whose composition and concentration ratios vary. This leads to an almost infinite amount of different olfactory stimuli which have to be evaluated by the nervous system.
To understand which aspects of an odor stimulus determine its evaluation by the fly, it is therefore desirable to efficiently examine odor-guided behavior towards many odorants and odor mixtures. To directly correlate behavior to neuronal activity, behavior should be quantified in a comparable time frame and under identical stimulus conditions as in neurophysiological experiments. However, many currently used olfactory bioassays in Drosophila neuroethology are rather specialized either towards efficiency or towards resolution.
Flywalk, an automated odor delivery and tracking system, bridges the gap between efficiency and resolution. It allows the determination of exactly when an odor packet stimulated a freely walking fly, and to determine the animal&#180;s dynamic behavioral reaction.

High-resolution Quantification of Odor-guided Behavior in Drosophila melanogaster Using the Flywalk Paradigm

The automated tracking system Flywalk is used for high-resolution quantification of odor-guided behavior in Drosophila melanogaster.

In their natural environment, insects such as the vinegar fly Drosophila melanogaster are bombarded with a huge amount of chemically distinct odorants. To ...

Lateral Chronic Cranial Window Preparation Enables In Vivo Observation Following Distal Middle Cerebral Artery Occlusion in Mice

Focal cerebral ischemia (i.e., ischemic stroke) may cause major brain injury, leading to a severe loss of neuronal function and consequently to a host of motor and cognitive disabilities. Its high prevalence poses a serious health burden, as stroke is among the principal causes of long-term disability and death worldwide1. Recovery of neuronal function is, in most cases, only partial. So far, treatment options are very limited, in particular due to the narrow time window for thrombolysis2,3. Determining methods to accelerate recovery from stroke remains a prime medical goal; however, this has been hampered by insufficient mechanistic insights into the recovery process. Experimental stroke researchers frequently employ rodent models of focal cerebral ischemia. Beyond the acute phase, stroke research is increasingly focused on the sub-acute and chronic phase following cerebral ischemia. Most stroke researchers apply permanent or transient occlusion of the MCA in mice or rats. In patients, occlusions of the MCA are among the most frequent causes of ischemic stroke4. Besides proximal occlusion of the MCA using the filament model, surgical occlusion of the distal MCA is probably the most frequently used model in experimental stroke research5. Occlusion of a distal (to the branching of the lenticulo-striate arteries) MCA branch typically spares the striatum and primarily affects the neocortex. Vessel occlusion can be permanent or transient. High reproducibility of lesion volume and very low mortality rates with respect to the long-term outcome are the main advantages of this model. Here, we demonstrate how to perform a chronic cranial window (CW) preparation lateral to the sagittal sinus, and afterwards how to surgically induce a distal stroke underneath the window using a craniotomy approach. This approach can be applied for sequential imaging of acute and chronic changes following ischemia via epi-illuminating, confocal laser scanning, and two-photon intravital microscopy.

Lateral Chronic Cranial Window Preparation Enables In Vivo Observation Following Distal Middle Cerebral Artery Occlusion in Mice

Surgical occlusion of a distal middle cerebral artery branch (MCAo) is a frequently used model in experimental stroke research. This manuscript describes the basic technique of permanent MCAo, combined with the insertion of a lateral cranial window, which offers the opportunity for longitudinal intravital microscopy in mice.

Focal cerebral ischemia (i.e., ischemic stroke) may cause major brain injury, leading to a severe loss of neuronal function and consequently to a host of ...

Utilizing 3D Printing Technology to Merge MRI with Histology: A Protocol for Brain Sectioning

Magnetic resonance imaging (MRI) allows for the delineation between normal and abnormal tissue on a macroscopic scale, sampling an entire tissue volume three-dimensionally. While MRI is an extremely sensitive tool for detecting tissue abnormalities, association of signal changes with an underlying pathological process is usually not straightforward. In the central nervous system, for example, inflammation, demyelination, axonal damage, gliosis, and neuronal death may all induce similar findings on MRI. As such, interpretation of MRI scans depends on the context, and radiological-histopathological correlation is therefore of the utmost importance. Unfortunately, traditional pathological sectioning of brain tissue is often imprecise and inconsistent, thus complicating the comparison between histology sections and MRI. This article presents novel methodology for accurately sectioning primate brain tissues and thus allowing precise matching between histology and MRI. The detailed protocol described in this article will assist investigators in applying this method, which relies on the creation of 3D printed brain slicers. Slightly modified, it can be easily implemented for brains of other species, including humans.

The overall goal of this protocol is to accurately align magnetic resonance imaging (MRI) image volumes with histology sections via the creation of customized 3D-printed brain holders and slicer boxes.

Magnetic resonance imaging (MRI) allows for the delineation between normal and abnormal tissue on a macroscopic scale, sampling an entire tissue volume ...

Evaluation of Bioenergetic Function in Cerebral Vascular Endothelial Cells

The integrity of the blood-brain-barrier (BBB) is critical to prevent brain injury. Cerebral vascular endothelial (CVE) cells are one of the cell types that comprise the BBB; these cells have a very high-energy demand, which requires optimal mitochondrial function. In the case of disease or injury, the mitochondrial function in these cells can be altered, resulting in disease or&#160;the opening of the BBB. In this manuscript, we introduce a method to measure mitochondrial function in CVE cells by using whole, intact cells and a bioanalyzer. A mito-stress assay is used to challenge the cells that have been perturbed, either physically or chemically, and evaluate their bioenergetic function. Additionally, this method also provides a useful way to screen new therapeutics that have direct effects on mitochondrial function. We have optimized the cell density necessary to yield oxygen consumption rates that allow for the calculation of a variety of mitochondrial parameters, including ATP production, maximal respiration, and spare capacity. We also show the sensitivity of the assay by demonstrating that the introduction of the&#160;microRNA, miR-34a, leads to a pronounced and detectable decrease in mitochondrial activity. While the data shown in this paper is optimized for the bEnd.3 cell line, we have also optimized the protocol for primary CVE cells, further suggesting the utility in preclinical and clinical models.

Endothelial cell mitochondria are critical to maintain blood-brain-barrier integrity. We introduce a protocol to measure bioenergetic function in cerebral vascular endothelial cells.

The integrity of the blood-brain-barrier (BBB) is critical to prevent brain injury. Cerebral vascular endothelial (CVE) cells are one of the cell types ...

Characterizing the Relationship Between Eye Movement Parameters and Cognitive Functions in Non-demented Parkinson's Disease Patients with Eye Tracking

Cognitive impairment is a common phenomenon in Parkinson&#8217;s disease that has implications on the prognosis. A simple, noninvasive and objective proxy measurement of cognitive function in Parkinson&#8217;s disease will be helpful in detecting early cognitive decline. As a physiological metric, eye movement parameter is not confounded by the subject&#39;s attributes and intelligence and can function as a proxy marker if it correlates with cognitive functions. To this end, this study explored the relationship between the eye movement parameters and performance in cognitive tests in multiple domains. In the experiment, a visual search task with eye tracking was set up, where subjects were asked to look for a number embedded in an array of alphabets scattered randomly on a computer screen. The differentiation between the number and the alphabet is an overlearned task such that the confounding effect of cognitive ability on the eye movement parameters is minimized. The average saccadic amplitude and fixation duration were captured and calculated during the visual search task. The cognitive assessment battery covered domains of frontal-executive functions, attention, verbal and visual memory. It was found that prolonged fixation duration was associated with poorer performance in verbal fluency, visual and verbal memory, allowing further exploration on the use of eye movement parameters as proxy markers for cognitive function in Parkinson&#8217;s disease patients. The experimental paradigm has been found to be highly tolerable in our group of Parkinson&#39;s disease patients and could be applied transdiagnostically to other disease entities for similar research questions.

Here, we present a protocol to study the relationship between the eye movement parameters and cognitive functions in non-demented Parkinson&#39;s disease patients. The experiment used an eye tracker to measure the saccadic amplitude and fixation duration in a visual search task. The correlation with performance in multi-domain cognitive tasks was subsequently measured.

Cognitive impairment is a common phenomenon in Parkinson&#8217;s disease that has implications on the prognosis. A simple, noninvasive and objective proxy ...

Detecting Pre-Stimulus Source-Level Effects on Object Perception with Magnetoencephalography

Pre-stimulus oscillatory brain activity influences upcoming perception. The characteristics of this pre-stimulus activity can predict whether a near-threshold stimulus will be perceived or not perceived, but can they also predict which one of two competing stimuli with different perceptual contents is perceived? Ambiguous visual stimuli, which can be seen in one of two possible ways at a time, are ideally suited to investigate this question. Magnetoencephalography (MEG) is a neurophysiological measurement technique that records magnetic signals emitted as a result of brain activity. The millisecond temporal resolution of MEG allows for a characterization of oscillatory brain states from as little as 1 second of recorded data. Presenting an empty screen around 1 second prior to the ambiguous stimulus onset therefore provides a time window in which one can investigate whether pre-stimulus oscillatory activity biases the content of upcoming perception, as indicated by participants&#39;&#160;reports. The spatial resolution of MEG is not excellent, but sufficient to localise sources of brain activity at the centimetre scale. Source reconstruction of MEG activity then allows for testing hypotheses about the oscillatory activity of specific regions of interest, as well as the time- and frequency-resolved connectivity between regions of interest. The described protocol enables a better understanding of the influence of spontaneous, ongoing brain activity on visual perception.

This article describes how to set up an experiment that allows detecting pre-stimulus source-level influences on object perception using magnetoencephalography (MEG). It covers stimulus material, experimental design, MEG recording, and data analysis.

Pre-stimulus oscillatory brain activity influences upcoming perception. The characteristics of this pre-stimulus activity can predict whether a ...

An Emerging Target Paradigm to Evoke Fast Visuomotor Responses on Human Upper Limb Muscles

To reach towards a seen object, visual information has to be transformed into motor commands. Visual information such as the object&#8217;s color, shape, and size are processed and integrated within numerous brain areas, then ultimately relayed to the motor periphery. In some instances, a reaction is needed as fast as possible. These fast visuomotor transformations, and their underlying neurological substrates, are poorly understood in humans as they have lacked a reliable biomarker. Stimulus-locked responses (SLRs) are short latency (&#60;100 ms) bursts of electromyographic (EMG) activity representing the first wave of muscle recruitment influenced by visual stimulus presentation. SLRs provide a quantifiable output of rapid visuomotor transformations, but SLRs have not been consistently observed in all subjects in past studies. Here we describe a new, behavioral paradigm featuring the sudden emergence of a moving target below an obstacle that consistently evokes robust SLRs. Human participants generated visually guided reaches toward or away from the emerging target using a robotic manipulandum while surface electrodes recorded EMG activity from the pectoralis major muscle. In comparison to previous studies that investigated SLRs using static stimuli, the SLRs evoked with this emerging target paradigm were larger, evolved earlier, and were present in all participants. Reach reaction times (RTs) were also expedited in the emerging target paradigm. This paradigm affords numerous opportunities for modification that could permit systematic study of the impact of various sensory, cognitive, and motor manipulations on fast visuomotor responses. Overall, our results demonstrate that an emerging target paradigm is capable of consistently and robustly evoking activity within a fast visuomotor system.

Presented here is a behavioral paradigm that elicits robust fast visuomotor responses on human upper limb muscles during visually guided reaches.

To reach towards a seen object, visual information has to be transformed into motor commands. Visual information such as the object&#8217;s color, shape, ...