Katarzyna Kucharska, Ewelina Wilkos, Roman Stefanski, Grzegorz Makowicz, Danuta Ryglewicz, Ksenia Slawinska and Ewa Piatkowska-Janko
Aim: The aim of the study was to assess psychological and physiological changes in cognitive functioning of a thalamic-damaged patient who underwent a stroke rehabilitation program which involved treatment as usual (TAU) combined with a computer-based Neurocognitive Training (NT). Additionally, the healthy control (HC) group (n=13) was recruited to assess neural circuitry including thalamic involvement in comparison to a patient in acute thalamic stroke who underwent the same scanning procedure before implementation of NT.
Methods: The patient (initials B.D.) was examined at three weeks after the ischemic stroke localized in left tuberothalamic territory. HCs and B.D. were evaluated using various cognitive measures and clinical scales. The computer-based NT was delivered individually once weekly for 60 minutes in a 12-week program. B.D. twice underwent a fMRI scanning session using a block-designed Stroop task: 1) after three weeks from lesion onset, and 2) after therapy.
Results: Compared with HCs, B.D. before therapy demonstrated marked deficits in learning and remembering both verbal and visual material, long-term information storing, problem solving, attentional switching and working memory. After therapy, B.D. showed clinically significant improvement in memory, attention, and executive functions. B.D. showed a post-therapy decreased activation pattern and, by contrasting the congruent versus the incongruent condition, after treatment increased activations remained only in the left parietal lobule and right middle frontal gyrus. In HCs increased activation was detected in right anterior cingulate, frontal regions and striatal region during Stroop interference, which remains in line with other studies.
Conclusions: Marked improvement was described in the patient after therapy. Further research is needed to increase knowledge about the involvement of the thalamus in key cognitive processes in the context of efficacy and effectiveness of neurocognitive training.