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Stroke researchers link ability to self administer medication after stroke with memory loss

2014-08-15 10:21:35 FOR IMMEDIATE RELEASE

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Screening stroke survivors for medication self-administration ability may be a useful approach to identifying memory deficits that contribute to poor outcomes

West Orange, NJ. August 15, 2014.  Kessler stroke researchers and colleagues have identified an association between over-optimistic estimation of one’s own ability to take medications accurately, and memory loss among stroke survivors. Results indicate that assessing patients for their ability to estimate medication skills accurately may predict memory disorder. The article, “Stroke survivors over-estimate their medication self-administration ability (MSA), predicting memory loss,” was epublished ahead of print on May 28 by Brain Injury (doi:10.3109/02699052.2014.915984). The authors are AM Barrett, MD, and J Masmela of Kessler Foundation, Elizabeth E Galletta of Hunter College, Jun Zhang of St. Charles Hospital, Port Jefferson, NY, and Uri Adler, MD, of Kessler Institute for Rehabilitation.

Researchers compared 24 stroke survivors with 17 controls, using the Hopkins Medication Schedule to assess MSA, the Geriatric Depression Scale to assess mood, and the Hopkins Verbal Test and Mini-Mental State Examination to assess memory. Results showed that stroke survivors over-estimated their MSA in comparison to controls. Over-estimation of MSA correlated strongly with verbal memory deficit.

Strategies that enhance adherence to medication are a public health priority. “Few studies, however, have looked at cognitive factors that may interfere with MSA,” commented Dr. Barrett. “While some stroke survivors have obvious cognitive deficits, many people are not aware that stroke survivors can be intelligent and high functioning, but still have trouble with thinking that can cause errors in medication self-management.  These individuals may not realize their own deficits, a condition called cognitive anosognosia. Screening stroke survivors for MSA may be a useful approach to identifying memory deficits that hinder rehabilitation and community participation and contribute to poor outcomes.”

Larger studies of left and right stroke survivors need to be conducted in the community and rehabilitation settings in order to determine the underlying mechanisms for both over-estimation and under-estimation of self-performance.

Funded by National Institutes of Health (Barrett, PI: K24HD062647), and Kessler Foundation.

About Stroke Rehabilitation Research at Kessler Foundation

Research studies span all domains of post-stroke cognitive dysfunction, but emphasize hidden disabilities after stroke, including hidden disabilities of functional vision (spatial bias and spatial neglect). Students, resident physicians, and post-doctoral trainees are mentored in translational neuroscience of rehabilitation.  Dr. Barrett and her colleagues work closely with the clinical staff at Kessler Institute for Rehabilitation.  Among their collaborative efforts are the founding of the Network for Spatial Neglect and development of the Kessler Foundation Neglect Assessment Process (KF-NAPTM). Stroke Research receives funding from the Department of Education/NIDRR; the National Institutes of Health/NICHD/NCMRR; Kessler Foundation; the Healthcare Foundation of New Jersey; and the Wallerstein Foundation for Geriatric Improvement. Scientists have faculty appointments at Rutgers New Jersey Medical School.

About AM Barrett, MD

AM Barrett, MD, a cognitive neurologist and clinical researcher, studies brain-behavior relationships from the perspectives of cognitive neurology, cognitive neuroscience, and cognitive neurorehabilitation. Dr. Barrett is an expert in hidden cognitive disabilities after stroke, which contribute to safety problems & rehospitalization, increased caregiver burden, & poor hospital-to-home transition.  She is director of Stroke Rehabilitation Research at Kessler Foundation and chief of Neurorehabilitation Program Innovation at Kessler Institute for Rehabilitation. She is a founder of the Network for Spatial Neglect, which promotes multidisciplinary research for this underdiagnosed hidden disability. Dr. Barrett is also professor of physical medicine & rehabilitation at Rutgers New Jersey Medical School and adjunct professor of neurology at Columbia University School of Medicine. She is a former president of the American Society for Neurorehabilitation.

Dr. Barrett is author of the reference article Spatial Neglect on emedicine.com. 

Recent publications by Stroke Rehabilitation Research:

• Oh-Park M, Hung C, Chen P, Barrett AM. Severity of spatial neglect during acute inpatient rehabilitation predicts community mobility post stroke. Physical Medicine & Rehabilitation 2014 Jan 9 (DOI: 10.1016/j.pmrj.2014.01.002)

• Barrett AM. Picturing the body in spatial neglect: descending a staircase. Neurology. 2013 Oct 8;81(15):1280-1.

• Goedert KM, Chen P, Boston RC, Foundas AL, Barrett AM. Presence of motor-intentional aiming deficit predicts functional improvement of spatial neglect with prism adaptation. Neurorehabilitation and Neural Repair epub Dec 27 2013. DOI: 10.1177/1545968313516872

• Barrett AM, Oh-Park M, Chen P, Ifejika NL. Five new things in neurorehabilitation. Neurology Clinical Practice. Epub Nov 13 2014. doi: 10.1212/01.CPJ.0000437088.98407.fa.

About Kessler Foundation
Kessler Foundation, a major nonprofit organization in the field of disability, is a global leader in rehabilitation research that seeks to improve cognition, mobility and long-term outcomes, including employment, for people with neurological disabilities caused by diseases and injuries of the brain and spinal cord. Kessler Foundation leads the nation in funding innovative programs that expand opportunities for employment for people with disabilities. For more information, visit KesslerFoundation.org; Tweet us @KesslerFdn

About Kessler Institute for Rehabilitation
Kessler Institute for Rehabilitation is nationally recognized for the treatment and research of both spinal cord and brain injuries and leads the field in the care and treatment for stroke, neurological diseases, amputation, orthopedic and musculoskeletal conditions and cardiac recovery. Ranked as one of the top two rehabilitation hospitals in the nation and best in the greater New York/New Jersey metropolitan area by U.S. News & World Report, Kessler has three hospital campuses in West Orange, Saddle Brook and Chester, N.J., and more than 85 outpatient centers throughout the state. For more information, visit www.kessler-rehab.com/

Contacts:
Carolann Murphy, 973.324.8382, CMurphy@KesslerFoundation.org
Lauren Scrivo, 973.324.8384, 973.768.6583 - c, LScrivo@KesslerFoundation.org