Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan.
Neurosurg Rev. 2021 Apr;44(2):977-985. doi: 10.1007/s10143-020-01272-9. Epub 2020 Mar 11.
Considering quality of life (QOL) after stroke, car driving is one of the most important abilities for returning to the community. In this study, directed attention and sustained attention, which are thought to be crucial for driving, were examined. Identification of specific brain structure abnormalities associated with post-stroke cognitive dysfunction related to driving ability would help in determining fitness for car driving after stroke. Magnetic resonance imaging was performed in 57 post-stroke patients (51 men; mean age, 63 ± 11 years) who were assessed for attention deficit using a standardized test (the Clinical Assessment for Attention, CAT), which includes a Continuous Performance Test (CPT)-simple version (CPT-SRT), the Behavioral Inattention Test (BIT), and a driving simulator (handle task for dividing attention, and simple and selective reaction times for sustained attention). A statistical non-parametric map (SnPM) that displayed the association between lesion location and cognitive function for car driving was created. From the SnPM analysis, the overlay plots were localized to the right hemisphere during handling the hit task for bilateral sides (left hemisphere damage related to right-side neglect and right hemisphere damage related to left-side neglect) and during simple and selective reaction times (false recognition was related to damage of both hemispheres). A stepwise multiple linear regression analysis confirmed the importance of both hemispheres, especially the right hemisphere, for cognitive function and car driving ability. The present study demonstrated that the right hemisphere has a crucial role for maintaining directed attention and sustained attention, which maintain car driving ability, improving QOL for stroke survivors.
考虑到中风后的生活质量（QOL），驾驶汽车是重返社区的最重要能力之一。在这项研究中，我们检查了定向注意力和持续注意力，这被认为是驾驶的关键。确定与驾驶能力相关的中风后认知功能障碍相关的特定大脑结构异常，将有助于确定中风后是否适合驾驶汽车。对 57 名中风后患者（51 名男性；平均年龄 63±11 岁）进行了磁共振成像检查，这些患者使用标准化测试（注意力临床评估，CAT）评估了注意力缺陷，该测试包括连续性能测试（CPT-简单版）（CPT-SRT）、行为性疏忽测试（BIT）和驾驶模拟器（处理任务以分散注意力，以及简单和选择性反应时间以保持注意力）。创建了一个显示病变位置与驾驶认知功能之间关联的统计非参数图（SnPM）。从 SnPM 分析中，叠加图被定位在处理双边碰撞任务期间的右半球（与右侧忽略相关的左半球损伤和与左侧忽略相关的右半球损伤）以及在简单和选择性反应时间期间（错误识别与两个半球的损伤有关）。逐步多元线性回归分析证实了两个半球，尤其是右半球，对认知功能和驾驶能力的重要性。本研究表明，右半球在维持驾驶能力所需的定向注意力和持续注意力中起着至关重要的作用，从而提高了中风幸存者的生活质量。
