This study aims to evaluate the potential effects of premorbid personality on the short- and long-term global cognitive recovery in patients with severe acquired brain injury (sABI) or stroke. The secondary aims are to assess the effects of premorbid personality on the sort- and long-term recovery in autonomy (disability), cognitive functions, psycho-behavioral functioning, motor skills, and social participation. Evaluate the incidence of premorbid personality alterations. Investigate personality changes 12-18 months after the neurological event.
Participants included in the study will undergo cognitive, motor, psychological, behavioral, personality, and disability assessments at different time points following the neurological event: T0: Initial assessment upon admission to the rehabilitation facility; within 90 days of the event for patients with severe acquired brain injury (sABI), as soon as cognitive evaluation becomes feasible (LCF ≥ 6); within 30 days of the event for stroke patients, as soon as cognitive assessment is possible. T1: At discharge from the inpatient rehabilitation program, provided that at least 30 days have passed since the initial assessment (T0). T2: At 12 months post-event for stroke patients and at 18 months post-event for patients with ABI.
Study Type
OBSERVATIONAL
Enrollment
250
Participants evaluated at T0 (Initial assessment upon admission to the rehabilitation facility), T1 (at discharge from the inpatient rehabilitation program, as long as at least 30 days have passed since the initial assessment (T0), T2 (at 12 months from the event for patients with stroke, and at 18 months from the event for patients with sABI).
Sezione medicina fisica e riabilitativa dipartimento di neuroscienze, verona
Verona, VR, Italy
RECRUITINGMontreal Cognitive Assessment (MoCA)
MoCA is a brief, standardized screening tool designed to detect the global cognitive status of patients. It assesses multiple cognitive domains, including: Attention and concentration, Executive functions, Memory, Language, Visuoconstructional skills, Conceptual thinking, Calculations, Orientation. The test takes approximately 10 to 15 minutes to administer and yields a total score out of 30 points. Higher scores indicates a better performance. In the study it is used to evaluate the potential effects of premorbid personality on the degree of global cognitive rocovery in the short and long term.
Time frame: The test is administered (both stroke and sABI) at baseline-T0 (between 3-30 days from onset - ictus; 7-90 days from onset - sABI), at discharge (at least 30 days from T0) and at followup-T2 (12 moths from onset - ictus; 18 months from onset - sABI).
Oxford Cognitive Screen (OCS)
Neuropsychological assessment tool that measures a person's global cognitive status, providing an analysis of key cognitive functions such as memory, executive functions, praxis, attention, language, and visuospatial exploration. Composed of various sub-tests, the OCS allows for the rapid and systematic identification of potential cognitive deficits and is particularly useful in patients with brain damage, such as those with stroke. Higher scores meaning a better performance.
Time frame: The test is administered (both stroke and sABI) at baseline-T0 (between 3-30 days from onset - ictus; 7-90 days from onset - sABI), at discharge (at least 30 days from T0) and at followup-T2 (12 moths from onset - ictus; 18 months from onset - sABI).
Trial Making Test (TMT)
Consists of two parts: TMT-A, used as a measure of psychomotor speed and visual search/attention skills; TMT-B used as a measure of attentional set-shifting and mental flexibility. Time needed to complete the tasks is recorded.
Time frame: The test is administered (both stroke and sABI) at baseline -T0 (between 3-30 days from onset - ictus; 7-90 days from onset - sABI), at discharge (at least 30 days from T0) and at followup-T2 (12 moths from onset - ictus; 18 months from onset - sABI).
Digit Span Forward
Digit Span Forward is a brief, standardized subtest used to assess attention and short-term verbal memory. It requires the patient to repeat a sequence of numbers in the same order as presented by the examiner, with increasing length. The task evaluates auditory attention, immediate recall, and working memory span. Higher scores indicate better performance. In the study, it is used to investigate the relationship between premorbid personality traits and specific cognitive functions, particularly attentional capacity.
Time frame: The test is administered (both stroke and sABI at baseline-T0 (between 3-30 days from onset - stroke; 7-90 days from onset - sABI), at discharge (at least 30 days from T0), and at follow-up T2 (12 months from onset - stroke; 18 months from onset - sABI).
Corsi Span Forward
Corsi Span Forward is a brief, standardized visuospatial memory task used to assess short-term visuospatial memory and attention. During the task, the examiner taps a sequence of blocks on a board, and the patient is required to reproduce the same sequence in the same order. The length of the sequence increases progressively. Higher scores indicate better visuospatial short-term memory performance. In the study, it is used to explore the association between premorbid personality traits and the recovery of visuospatial attention and memory functions.
Time frame: The test is administered (both stroke and sABI)at baseline-T0 (between 3-30 days from onset - stroke; 7-90 days from onset - sABI), at discharge (at least 30 days from T0), and at follow-up T2 (12 months from onset - stroke; 18 months from onset - sABI).
Digit Span Backward
Digit Span Backward is a standardized neuropsychological task that assesses working memory and attention. In this task, the examiner reads aloud a sequence of digits, and the patient is required to repeat them in reverse order. The sequence length increases progressively until the patient can no longer recall the digits correctly. Higher scores reflect better working memory performance. In the study, it is used to investigate the relationship between premorbid personality traits and recovery of working memory and attentional control.
Time frame: The test is administered both stroke and sABI, at baseline-T0 (between 3-30 days from onset - stroke; 7-90 days from onset - sABI), at discharge (at least 30 days from T0), and at follow-up T2 (12 months from onset - stroke; 18 months from onset - sABI).
Corsi span backward
Corsi Span Backward is a standardized visuospatial memory task used to assess working memory and executive functions. In this task, the examiner taps a sequence of blocks on a board, and the patient is required to reproduce the sequence in reverse order. The sequences increase in length until the patient can no longer reproduce them correctly. Higher scores indicate better visuospatial working memory and manipulation abilities. In the study, it is used to examine how premorbid personality traits may influence the recovery of executive and visuospatial memory functions.
Time frame: The test is administered both stroke and sABI, at baseline-T0 (between 3-30 days from onset - stroke; 7-90 days from onset - sABI), at discharge (at least 30 days from T0), and at follow-up T2 (12 months from onset - stroke; 18 months from onset - sABI).
Rey Auditory Verbal Learning Test (RAVLT)
The Rey Auditory Verbal Learning Test (RAVLT) is a standardized neuropsychological assessment of verbal learning and memory. The test involves the oral presentation of a list of 15 unrelated words over five learning trials, followed by immediate recall after each trial, an interference list, immediate recall of the original list, and delayed recall after a 20-30-minute interval. A recognition trial is also included. RAVLT. Higher scores indicate better verbal learning and memory abilities. In the study, it is used to assess how premorbid personality may influence short- and long-term verbal memory recovery.
Time frame: The test is administered both stroke and sABI, at baseline-T0 (between 3-30 days from onset - stroke; 7-90 days from onset - sABI), at discharge (at least 30 days from T0), and at follow-up T2 (12 months from onset - stroke; 18 months from onset - sABI).
Test della Figura di Rey - Test della Figura di Taylor
The Rey-Osterrieth Complex Figure Test (ROCFT) and the Taylor Complex Figure Test (TCFT) are standardized neuropsychological tools used to assess visuospatial constructional abilities and non-verbal memory. Participants are asked to copy a complex figure (Rey or Taylor) and then reproduce it from memory after a short delay and again after a longer delay. The TCFT is used as an alternative version to minimize learning effects during repeated assessments. These tests evaluate multiple cognitive processes, including visuoperception, planning, attention, working memory, and long-term visuospatial memory. Higher scores reflect better performance. In the study, they are used to evaluate the influence of premorbid personality traits on visuospatial memory and planning skills in the short and long term.
Time frame: The test is administered both stroke and sABI, at baseline-T0 (between 3-30 days from onset - stroke; 7-90 days from onset - sABI), at discharge (at least 30 days from T0), and at follow-up T2 (12 months from onset - stroke; 18 months from onset - sABI).
Stroop Test (ST)
Evaluates attention and the ability to inhibit automatic responses. The Stroop effect is evaluated by computing a time interference effect (based on execution time) and an error interference effect (based on number of errors).
Time frame: The test is administered both stroke and sABI, at baseline-T0 (between 3-30 days from onset - ictus; 7-90 days from onset - sABI), at discharge (at least 30 days from T0) and at followup-T2 (12 moths from onset - ictus; 18 months from onset - sABI).
Modified Five Point Test (MFPT)
It measures figural fluency by assessing the ability to initiate mental productivity and self-monitoring during a visual-spatial task. Performance is assessed by scoring the total number of correct and unique designs generated in 3 min (UDs), and the total number of UDs produced into strategies (CSs).
Time frame: The test is administered (both stroke and sABI) at baseline-T0 (between 3-30 days from onset - ictus; 7-90 days from onset - sABI), at discharge (at least 30 days from T0) and at followup-T2 (12 moths from onset - ictus; 18 months from onset - sABI).
Phonemic fluency
Phonemic Fluency is a brief verbal task assessing executive functions, especially lexical retrieval and cognitive flexibility. Participants must say as many words as possible beginning with a given letter in 60 seconds. Higher scores reflect better executive functioning. In the study, it assesses the potential impact of premorbid personality on verbal recovery.
Time frame: The test is administered (only sABI) at baseline-T0 (between 7-90 days from onset - sABI), at discharge (at least 30 days from T0), and at follow-up T2 ( 18 months from onset - sABI).
Semantic fluency
Semantic Fluency assesses verbal memory and executive functioning. Participants list as many words as possible from a semantic category (e.g., animals) in 60 seconds. Higher scores indicate better cognitive performance. In the study, it evaluates the influence of premorbid personality on language and executive recovery.
Time frame: The test is administered (only sABI) at baseline-T0 (between 7-90 days from onset - sABI), at discharge (at least 30 days from T0), and at follow-up T2 ( 18 months from onset - sABI).
Verbal Reasoning Test (VRT)
The Verbal Reasoning Test evaluates verbal reasoning skills through tasks such as identifying absurdities, intruders, relationships, differences, idiomatic expressions, familiarity, and classifications. Higher scores indicate stronger verbal reasoning. In the study, it assesses how premorbid personality influences verbal reasoning recovery.
Time frame: Administered at baseline-T0 (3-30 days post-stroke; 7-90 days post-sABI), at discharge (≥30 days from T0), and at follow-up T2 (12 months post-stroke; 18 months post-sABI).
Brain Injury Rehabilitation Trust questionnaire (BIRT)
Both versions (for patient, for relatives). Self-report tools used to assess psycho-behavioral functioning in individuals with brain injury. It evaluates emotional, behavioral, and social aspects relevant to rehabilitation outcomes. Higher scores indicate greater difficulties. In the study, it is used to explore the impact of premorbid personality on psycho-behavioral recovery.
Time frame: Administered (both sABI and stroke) at at follow-up T2 (12 months post-stroke; 18 months post-sABI).
Hospital Anxiety and Depression Scale (HADS)
Is a self-administered questionnaire designed to assess anxiety and depression symptoms in medically ill patients. It consists of 14 items divided equally between anxiety and depression subscales. Higher scores indicate greater symptom severity. In the study, it is used to evaluate the influence of premorbid personality on psychological well-being during recovery.
Time frame: Administered (both stroke and sABI) at baseline-T0 (3-30 days post-stroke; 7-90 days post-sABI), at discharge (≥30 days from T0), and at follow-up T2 (12 months post-stroke; 18 months post-sABI).
HEXACO Adjective Scale (HAS)
Is a self-report personality questionnaire assessing six major personality dimensions: Honesty-Humility, Emotionality, Extraversion, Agreeableness, Conscientiousness, and Openness to Experience. It uses adjective-based items to capture trait levels. Higher scores reflect stronger expression of each trait. In the study, it is used to investigate the role of premorbid personality in cognitive and functional recovery.
Time frame: Administered (both stroke an sABI) at baseline-T0 (3-30 days post-stroke; 7-90 days post-sABI) and at follow-up T2 (12 months post-stroke; 18 months post-sABI).
Disability Rating Scale (DRS)
Is a standardized tool used to assess the level of disability and functional changes in individuals with brain injury. It evaluates areas such as consciousness, cognitive ability for self-care, dependence on others, and employability. Scores range from no disability to extreme vegetative state, with higher scores indicating greater disability. In the study, it is used to measure functional recovery and independence over time.
Time frame: Administered at baseline-T0 (3-30 days post-stroke; 7-90 days post-sABI), at discharge (≥30 days from T0), and at follow-up T2 (12 months post-stroke; 18 months post-sABI).
Frenchay Activities Index (FAI)
Is a questionnaire designed to assess the level of participation in instrumental activities of daily living (IADLs) following brain injury or stroke. It evaluates domestic chores, leisure, social activities, and work-related tasks. Higher scores indicate greater independence and activity participation. In the study, it is used to monitor social participation and functional recovery.
Time frame: Administered (both stroke and sABI) at follow-up T2 (12 months post-stroke; 18 months post-sABI).
Fugl Mayer (FM)
Is a standardized scale used to evaluate motor functioning, balance, sensation, and joint functioning in post-stroke patients. It is widely used to assess recovery of motor impairment, particularly in the upper and lower extremities. Higher scores indicate better motor function. In the study, it is used to measure motor recovery over time.
Time frame: The test is administered both stroke and sABI, at baseline-T0 (between 3-30 days from onset - stroke; 7-90 days from onset - sABI), at discharge (at least 30 days from T0), and at follow-up T2 (12 months from onset - stroke; 18 months from onset - sABI).
Motricity Index (MI)
Is a clinical scale used to assess motor strength in patients with neurological impairments, especially after stroke. It evaluates muscle power in the upper and lower limbs through specific movements. Higher scores indicate greater muscle strength and motor function. In the study, it is used to monitor motor recovery and functional status.
Time frame: Administered (both stroke and sABI) at baseline-T0 (3-30 days post-stroke; 7-90 days post-sABI), at discharge (≥30 days from T0), and at follow-up T2 (12 months post-stroke; 18 months post-sABI).
Modified Ashworth Scale (MAS)
Is a clinical tool used to measure muscle spasticity in patients with neurological conditions such as stroke or brain injury. It assesses resistance during passive soft-tissue stretching and grades spasticity on a scale from 0 (no increase in muscle tone) to 4 (affected part rigid). Higher scores indicate greater spasticity. In the study, it is used to evaluate changes in muscle tone during motor recovery.
Time frame: Administered (both stroke and sABI) at baseline-T0 (3-30 days post-stroke; 7-90 days post-sABI), at discharge (≥30 days from T0), and at follow-up T2 (12 months post-stroke; 18 months post-sABI).
Modified barthel Index (MBI)
Is a clinical scale used to measure a patient's level of independence in performing basic activities of daily living (ADLs), such as feeding, bathing, grooming, dressing, bowel and bladder control, mobility, and stair climbing. Higher scores indicating greater functional independence. In the study, it is used to assess disability levels and functional outcomes during rehabilitation.
Time frame: Administered (only stroke) at baseline-T0 (3-30 days post-stroke), at discharge (≥30 days from T0), and at follow-up T2 (12 months post-stroke; ).
Disability Rating Scale (DRS)
Is a clinical tool used to assess the overall level of disability in individuals recovering from severe brain injury, including traumatic and non-traumatic causes. It evaluates a range of functional areas, including consciousness, cognitive ability for self-care, level of dependence, and psychosocial adaptability. Scores range from 0 (no disability) to 29 (extreme vegetative state), with higher scores indicating greater disability. In the study, it is used to monitor functional recovery and global disability over time.
Time frame: Administered (only sABI) at baseline-T0 (7-90 days post-sABI), at discharge (≥30 days from T0), and at follow-up T2 (18 months post-sABI).
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