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Determinants of cognitive outcomes of perinatal and childhood stroke: A review
Amanda Fuentes1, Angela Deotto1, Mary Desrocher1
1a Department of Psychology , York University , Toronto , ON , Canada.
Insights
Pediatric stroke outcomes are complex due to many factors interacting. Understanding these interactions, like age and lesion location, is key for better prognosis and interventions in childhood stroke.
Area of Science:
- Neuroscience
- Pediatric Neurology
- Developmental Psychology
Background:
- Cognitive and behavioral outcomes after pediatric stroke are not fully understood.
- Heterogeneity in the pediatric stroke population complicates generalizations about outcomes.
- Understanding these outcomes is crucial for prognosis, intervention, and brain plasticity research.
Purpose of the Study:
- To review the literature on factors influencing cognitive outcomes in pediatric stroke.
- To examine the impact of age, time since stroke, sex, etiology, lesion characteristics, neurologic impairment, and seizures.
- To identify key interactions between these variables affecting cognitive development post-stroke.
Main Methods:
- Systematic literature review of published studies on pediatric stroke.
- Analysis of demographic, neurological, etiological, and psychosocial variables.
- Focus on interactive effects of variables on cognitive outcomes.
Main Results:
- Significant interactive effects were found between variables influencing cognitive outcomes.
- Key interactions include age x lesion location, lesion characteristics x neurologic impairment, lesion volume x time since stroke, sex x lesion laterality, and seizures x time since stroke.
- These interactions are often domain-specific, affecting different cognitive abilities uniquely.
Conclusions:
- Cognitive outcomes in pediatric stroke are shaped by complex interactions among multiple factors.
- Future research should focus on these interactive effects to refine prognostic models.
- Tailored interventions based on individual patient profiles are essential for optimizing recovery.
Abstract:
Our understanding of cognitive and behavioral outcomes of perinatal and childhood stroke is rapidly evolving. A current understanding of cognitive outcomes following pediatric stroke can inform prognosis and direct interventions and our understanding of plasticity in the developing brain. However, our understanding of these outcomes has been hampered by the notable heterogeneity that exists amongst the pediatric stroke population, as the influences of various demographic, cognitive, neurological, etiological, and psychosocial variables preclude broad generalizations about outcomes in any one cognitive domain. We therefore aimed to conduct a detailed overview of the published literature regarding the effects of age at stroke, time since stroke, sex, etiology, lesion characteristics (i.e., location, laterality, volume), neurologic impairment, and seizures on cognitive outcomes following pediatric stroke. A key theme arising from this review is the importance of interactive effects among variables on cognitive outcomes following pediatric stroke. Interactions particularly of note include the following: (a) age at Stroke x Lesion Location; (b) Lesion Characteristics (i.e., volume, location) x Neurologic Impairment; (c) Lesion Volume x Time Since Stroke; (d) Sex x Lesion Laterality; and (e) Seizures x Time Since Stroke. Further, it appears that these relationships do not always apply uniformly across cognitive domains but, rather, are contingent upon the cognitive ability in question. Implications for future research directions are discussed.
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