Impact of Left Hemisphere Stroke on Cognitive Functioning and Implications for Driving

左半球中风对认知功能的影响及其对驾驶的影响

• 批准号: 10041706
• 负责人: Juliana V. Baldo
• 金额: --
• 依托单位: VA NORTHERN CALIFORNIA HEALTH CARE SYS
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-10-01 至 2024-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10041706
• 关键词: Address; Adult; Affect; Age; American; Area; Automobile Driving; Awareness; Behavioral; Biological Markers; Brain; Brain Injuries; Brain imaging; Brain region; Chronic; Clinical; Clinical Treatment; Clinical assessments; Cognitive deficits; Complex; Computer software; Control Groups; Data; Data Analyses; Dorsal; Education; Environment; Evaluation; Exhibits; Future; Goals; Impairment; Individual; Inferior; Inferior frontal gyrus; Language; Lead; Least-Squares Analysis; Left; Lesion; Literature; Location; MRI Scans; Magnetic Resonance Imaging; Measurement; Measures; Medical Records; Neurologic; Neuropsychological Tests; Neuropsychology; Parietal; Parietal Lobe; Participant; Patients; Pattern; Performance; Prefrontal Cortex; Reaction Time; Recording of previous events; Research; Resolution; Risk; Sampling; Short-Term Memory; Site; Speed; Standardization; Stroke; Structure; Symptoms; Techniques; Training; Training Programs; Veterans; Vision; Visuospatial; Work; automobile accident; base; clinical care; cognitive function; cohort; daily functioning; disability; driving safety; education evaluation; executive function; fitness; impaired driving performance; improved; inattention; military veteran; neural correlate; performance tests; portability; post stroke; stroke patient; stroke survivor; treatment planning; visual search

Chronic disability following stroke is a significant problem for Veterans that can affect a variety of daily activities. One area of importance in clinical assessment and treatment planning is the impact of stroke on driving safety. Unfortunately, formal assessments of driving fitness and related cognitive deficits (e.g., visuospatial changes) are often not conducted in left hemisphere stroke patients. The current project will address this gap by evaluating left hemisphere stroke patients on a state-of-the-art driving simulator, comparing their performance to that of both right hemisphere stroke patients and healthy controls. Driving variables assessed by the simulator include the number of collisions, unsafe lane crossings, speed exceedances, and reaction time to stop. Different types of driving errors will then be related to performance on a neuropsychological battery, which includes standardized and experimental measures of visuospatial ability, executive functioning, and language. Last, we will investigate the neural correlates of distinct types of driving errors using voxel-based lesion symptom mapping, which relates structural lesions to behavioral performance on a voxel-by-voxel basis. Participants for the current study include 40 left and 40 right hemisphere Veteran stroke patients with no prior neurologic or severe psychiatric history. A control group of 20 age- and education-matched Veterans with no neurologic or psychiatric history will provide additional context for interpretation of the data. Driving performance will be examined with a state-of-the-art driving simulator that has been demonstrated to have strong ecological validity and predictive validity with respect to on-road driving fitness. It is predicted that 60-70% of left hemisphere patients will exhibit impaired driving performance (“failed” or “needs training” rating), significantly higher than healthy controls but not significantly different from right hemisphere patients. It is expected, however, that left hemisphere patients will show a distinct pattern of performance from right hemisphere patients. For example, it is expected that LH patients will exhibit disproportionately more errors under complex driving scenarios (e.g., in a construction zone), whereas both stroke groups will exhibit significant visuospatial driving errors (unsafe lane changes and collisions) relative to controls. Partial least squares regression will then be used to identify which neuropsychological measures are most closely related to driving performance variables measured in the simulator. It is predicted that driving errors in left hemisphere patients will correlate with both visuospatial measures (e.g., Useful Field of View/Visual Search) and executive functioning measures (e.g., Trails B). We also propose to relate structural lesion data from high-resolution 3T MRI scans to different types of driving errors. This aspect of the project will utilize voxel-based lesion symptom mapping (VLSM) software that our group helped develop. It is predicted that driving errors related to visuospatial inattention will be associated with lesions to a dorsal fronto-parietal network, whereas driving errors in complex driving scenarios will be additionally associated with lesions to a more ventral network that includes left inferior parietal and prefrontal cortex. In summary, the findings from our study will provide critical information as to the importance of driving safety referrals and evaluations following stroke, particularly in left hemisphere stroke patients. This study will advance the field by identifying neuropsychological test performance and lesion locations that should be flags for additional concern about driving safety following stroke, as well as identifying differences among left and right hemisphere stroke patients. It is our hope that the findings from this study will not only inform clinicians and patients of potential driving risks, but will ultimately provide the type of data needed to support individualized training programs in simulated driving environments for Veterans who wish to return to driving.

中风后的慢性残疾对退伍军人来说是一个严重的问题，可能会影响到各种日常活动。 临床评估和治疗计划的一个重要方面是中风对驾驶安全的影响。 不幸的是，驾驶健康和相关认知缺陷的正式评估(例如，视觉空间变化) 在左半球中风患者中通常不进行。当前项目将通过评估以下内容来解决这一差距 在最先进的驾驶模拟器上测试左半球中风患者的表现，并与 右半球卒中患者和健康对照组。模拟器评估的驾驶变量包括 碰撞次数、不安全车道穿越、超速和停车反应时间。不同类型 驾驶失误的发生率将与神经心理测试的表现相关，其中包括标准化的 以及视觉空间能力、执行功能和语言的实验测量。最后，我们将调查 使用基于体素的病变症状映射，不同类型的驾驶错误的神经关联，这与 以体素为基础的结构损伤到行为表现。 目前研究的参与者包括40名左半球和40名右半球中风老兵，他们以前没有 神经学或严重精神病史。20名年龄和教育程度匹配的退伍军人作为对照组，没有 神经学或精神病史将为数据的解释提供额外的背景。驾驶性能 将通过一种最先进的驾驶模拟器进行测试，该模拟器已被证明具有很强的生态 关于道路驾驶健康的效度和预测效度。据预测，60%-70%的左半球 患者将表现出驾驶能力受损(“失败”或“需要训练”评级)，显著高于 健康对照组，但与右半球患者无显著差异。然而，预计会留下 大脑半球患者将表现出与右半球患者截然不同的表现模式。例如，它 预计车祸患者在复杂的驾驶场景下会出现不成比例的错误(例如，在 施工区)，而两个中风组都将表现出严重的视觉空间驾驶错误(不安全车道 更改和冲突)相对于控件。然后将使用偏最小二乘回归来识别 神经心理测量与驾驶性能变量的关系最为密切， 模拟器。据预测，左半球患者的驾驶错误将与视觉空间 措施(例如，有用视野/视觉搜索)和执行功能措施(例如，线索B)。我们也 建议将来自高分辨率3T MRI扫描的结构性损伤数据与不同类型的驾驶错误相关联。 该项目的这一方面将利用我们小组帮助的基于体素的病变症状映射(VLSM)软件 发展。据预测，与视觉空间注意力不集中有关的驾驶错误将与 额顶背侧网络，而复杂驾驶场景中的驾驶错误将额外关联 病变累及更腹侧的网络，包括左下顶叶和前额叶皮质。 总而言之，我们的研究结果将为驾驶安全的重要性提供关键信息 中风后的转诊和评估，特别是在左半球中风患者中。这项研究将会取得进展 通过确定神经心理测试的表现和损伤位置来确定应该是 对中风后驾驶安全的其他关注，以及识别左侧和右侧的差异 半球中风患者。我们希望这项研究的发现不仅能让临床医生和 潜在驾驶风险的患者，但最终将提供支持个性化所需的数据类型 为希望重新开始驾驶的退伍军人提供模拟驾驶环境中的培训计划。