EXAMINATION OF EXECUTIVE DYSFUNCTIONS AMONG STROKE SURVIVORS VIA 64- WISCONSIN CARD SORTING TEST.

SUMMARY: Objective: The objective of our study was to examine executive dysfunctions in stroke survivors (three months after stroke) via Wisconsin Card Scoring Test (WCST) and to assess the influence of stroke severity and lesion location. Contingent and methods: We examined 20 stroke survivors with the following neuropsychological battery: MMSE, 21 – Hamilton test and WCST. Results: We found executive dysfunctions in 90% of our patients. Stroke severity measured by NIHSS influenced MMSE scoring and some of the WCST results (percent conceptual level, trials to complete first category, failure to maintain set and learning abilities). Patients with left hemispheric lesions had statistically significant higher level of total errors than patients with right hemispheric and brainstem lesions. Conclusion: Sub-acute stroke stage is strongly associated with executive dysfunctions.

Procedure: All the patient underwent assessment that included clinical evaluation by neurologist, CT scan, blood testing at the time of admission to the clinic and neuropsychological examination three months after the stroke onset.We used the following neuropsychological battery: Mini Mental State Examination (MMSE), 21 Hamilton Questionnaire, WCST, Luria Aphasia test, Simple apraxia battery.The level of stroke disability was assessed by the NIHSS.The Location of the lesion was verified by CT scan (left hemispheric lesions in 30%; right hemispheric lesions in 45%, and brainstem lesions in 25%).MMSE was used for assessment of global cognitive functioning.21-Hamilton Depression Scale was used as a screening test for depression.WCST was used as a test for assessment of the executive functions.Standard score and T -score of the number of total errors, perseverations, perseverative errors, nonperseverative errors, conceptual levels were used as independent measures, as well as number of completed categories, trials to complete first category, failure to maintain set, learning to learn assessed with percentiles.DOI: 10.5272/jimab.2011171.178Statistical analysis: STATGRAPHICS 5.0 Plus free version was used for statistical analysis.For our purposes we used One -Way and Multifactor ANOVA and simple and multiple regression analyses.All statistical tests were interpreted at the 5% significance level.

RESULTS:
The MMSE scores were within 17-30 (average 23.45; SD 3.25), the distribution of the patients according to MMSE is shown on figure 1. Hamilton scoring s within the 4 to 18 range (average 12.6, SD 3.66, figure 2).
Assessments of patients' attitude, cooperation and effort are shown on Figures 3, 4 and 5.As it is shown on Table 1a &, 1b we failure to find influence of attitude, cooperation and effort on test scoring.
No statistically significant association was found between MMSE and Hamilton score and WCST results (table 2a, 2b) Statistically significant difference of number of total errors was found between the left hemispheric lesion group and the other two groups (Kruskall -Wallis Test p=0.0268).The influence of lesion location on WCST results is shown on Table 3.
Main WCST results are summarized on Table 4.
As it is shown on Table 5a, no severe or moderate to severe impairment was found.20% of our patients had abnormal results on number of total errors, 15 % -on number of perseverative errors, 60% -on number nonperseverative errors and 40 % on conceptual level scoring.Borderline results (below average compared with normal population) had about 25% of them.
The influence of stroke severity on examined cognitive parameters is shown on Table 6.Relationships between NIHSS and respectively MMSE -scoring, standard score of percent conceptual level, trials to complete first category, failure to maintain set and learning to learn abilities were been found.

Table 1a :
Influence of attitude, cooperation and effort on WCST results.

Table 1b :
Influence of attitude, cooperation and effort on WCST results.

Table 2a :
Association between MMSE/Hamilton and WCST results.

Table 2b :
Association between MMSE/Hamilton and WCST results

Table 3 :
Association between lesion location and WCST results.

Table 4 :
Main results on WCST

Table 6 .
Influence of NIHSS on