Cognitive deficits after stroke
Despite considerable research efforts, several clinical and theoretical issues in the understanding of apraxia and related cognitive deficits following a stroke remain controversial. For example, the contribution of lesions to the subcortical grey matter – that is, in the basal ganglia or thalamus – to apraxic deficits continues to be debated. Using a region-wise statistical lesion comparison in stroke patients with left-hemispheric lesions confined to subcortical regions, we identified a specific role of the caudate nucleus in apraxic deficits, thereby providing new insights into the subcortical anatomy of apraxia after stroke (Schmidt et al., 2023).
Besides, little is still known about the impact of apraxia and related visuospatial neglect on stroke patients’ cognitive and functional outcomes in the early rehabilitation period. A large longitudinal study found that apraxia severity had a significant adverse effect on the cognitive outcome of stroke patients approximately two weeks after the stroke, while the severity of visuospatial neglect affected their functional outcome early after the stroke. These findings emphasise the need to develop appropriate therapeutic approaches for the cognitive sequelae of a stroke to ameliorate the harmful effects of apraxia and neglect on early stroke rehabilitation (Latarnik et al., 2022).
A neuropsychological test battery that is particularly well suited to assessing cognitive deficits in the early phase following a stroke is the Cologne Neuropsychological Screening for Stroke Patients (KöpSS). It comprises the assessment of cognitive functions in eight domains, including language, praxis, visuospatial functions, and attention. Based on a large sample of healthy control subjects, a recent study developed age- and education-adjusted norms for the total score of the KöpSS (Latarnik et al., 2025). This has high clinical importance, as the development of age- and education-specific norms can lead to improved early diagnosis of cognitive deficits in stroke patients.
From a theoretical perspective, the precise cognitive mechanisms underlying spatial neglect following a stroke are not fully understood. Computational modelling revealed that neglect symptoms were associated with deficient predictive processing, which provides novel insights into the role of altered prediction-dependent processing for neglect. Modern lesion-based disconnection analysis further related the impaired predictive processing to disconnection within fronto-parietal, fronto-occipital, and temporo-parietal pathways (Vossel et al., 2025).
Selected publications:
- Latarnik S, Kessler J, Fink GR, Grefkes C, Weiss PH (2025). Alters- und Bildungsnormen für das Kölner Neuropsychologische Screening für Schlaganfallpatienten (KöpSS). Zeitschrift für Neuropsychologie, 36(2), 93-99. doi.org/10.1024/1016-264X/a000414
- Latarnik S, Stahl J, Vossel S, Grefkes C, Fink GR, Weiss PH (2022). The impact of apraxia and neglect on early rehabilitation outcome after stroke. Neurological Research and Practice, 4(1), 46. doi: 10.1186/s42466-022-00211-x
- Schmidt CC, Achilles EIS, Bolte K, Kleineberg NN, Richter MK, Schloss N, Fink GR, Weiss PH (2023). Association of circumscribed subcortical gray and white matter lesions with apraxic deficits in patients with left hemisphere stroke. Neurology, 101(11), e1137-e1144. doi: 10.1212/WNL.0000000000207598
- Vossel S, Käsbauer A-S, Mengotti P, Schmidt CC, Saliger J, Karbe H, Fink GR (2025). Neglect symptoms are related to a prediction-hypersensitivity in ipsilesional space. Cortex, 184, 1-18. doi: 10.1016/j.cortex.2024.12.007