1
|
Huber SK, Knols RH, Held JPO, Betschart M, de Bruin ED. PEMOCS: Evaluating the effects of a concept-guided, PErsonalised, MOtor-Cognitive exergame training on cognitive functions and gait in chronic Stroke-study protocol for a randomised controlled trial. Trials 2024; 25:451. [PMID: 38965612 PMCID: PMC11223407 DOI: 10.1186/s13063-024-08283-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 06/21/2024] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND Many stroke survivors remain with residual cognitive and motor impairments despite receiving timely acute and sub-acute rehabilitation. This indicates that rehabilitation following stroke should be continuous to meet the needs of individual stroke patients. Both cognitive and motor functions are essential for mastering daily life and, therefore, should be aimed at with rehabilitation. Exergames, motor-cognitive exercises performed using video games, are an auspicious method to train both motor and cognitive functions and at the same time may foster the long-term motivation for training. This study aims to assess the effect of concept-guided, personalised, motor-cognitive exergame training on cognitive and motor functions in chronic stroke survivors. METHODS This study is a single-blinded, randomised controlled trial. Assessments are performed at baseline, after a 12-week intervention, and at a 24-weeks follow-up. Chronic stroke patients (≥ 18 years old, ≥ 6 months post-stroke) able to stand for 3 min, independently walk 10 m, follow a two-stage command, and without other neurological diseases apart from cognitive deficits or dementia are included. Participants in the intervention group perform the exergame training twice per week for 30 (beginning) up to 40 (end) minutes additionally to their usual care programme. Participants in the control group receive usual care without additional intervention(s). Global cognitive functioning (total Montreal Cognitive Assessment (MoCA) score) is the primary outcome. Secondary outcomes include health-related quality of life, specific cognitive functions, single- and dual-task mobility, and spatiotemporal gait parameters. The target sample size for this trial is 38 participants. Linear mixed models with the post-outcome scores as dependent variables and group and time as fixed effects will be performed for analysis. DISCUSSION Superior improvements in global cognitive functioning and in the abovementioned secondary outcomes in the intervention group compared to the control group are hypothesised. The results of this study may guide future design of long-term rehabilitation interventions after stroke. TRIAL REGISTRATION ClinicalTrials.gov (NCT05524727). Registered on September 1, 2022.
Collapse
Affiliation(s)
- S K Huber
- Physiotherapy Occupational Therapy Research Center, Directorate of Research and Education, University Hospital Zurich, Zurich, Switzerland.
- Motor Control and Learning Group, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland.
| | - R H Knols
- Physiotherapy Occupational Therapy Research Center, Directorate of Research and Education, University Hospital Zurich, Zurich, Switzerland
- Motor Control and Learning Group, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - J P O Held
- Rehabilitation Center Triemli Zurich, Valens Clinics, Zurich, Switzerland
| | - M Betschart
- Department of Health, OST - Eastern Swiss University of Applied Sciences, St. Gallen, Switzerland
- Institute of Therapy and Rehabilitation, Kantonsspital Winterthur, Winterthur, Switzerland
| | - E D de Bruin
- Motor Control and Learning Group, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
- Department of Health, OST - Eastern Swiss University of Applied Sciences, St. Gallen, Switzerland
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
2
|
Han K, Liu G, Liu N, Li J, Li J, Cui L, Cheng M, Long J, Liao X, Tang Z, Liu Y, Liu J, Chen J, Lu H, Zhang H. Effects of Mobile Intelligent Cognitive Training for Patients with Post-Stroke Cognitive Impairment: A 12-Week, Multicenter, Randomized Controlled Study. J Alzheimers Dis 2024:JAD240356. [PMID: 38968051 DOI: 10.3233/jad-240356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2024]
Abstract
Background The current application effects of computerized cognitive intervention are inconsistent and limited to hospital rehabilitation settings. Objective To investigate the effect of mobile intelligent cognitive training (MICT) on patients with post-stroke cognitive impairment (PSCI). Methods This study was a multicenter, prospective, open-label, blinded endpoint, cluster-randomized controlled trial (RCT). 518 PSCI patients were stratified and assigned to four rehabilitation settings, and then patients were randomized into experimental and control groups in each rehabilitation setting through cluster randomization. All patients received comprehensive management for PSCI, while the experimental group additionally received MICT intervention. Treatment was 30 minutes daily, 5 days per week, for 12 weeks. Cognitive function, activities of daily living (ADL), and quality of life (QOL) were assessed before the treatment, at weeks 6 and 12 post-treatment, and a 16-week follow-up. Results Linear Mixed Effects Models showed patients with PSCI were better off than pre-treatment patients on each outcome measure (p < 0.05). Additionally, the improvement of these outcomes in the experimental group was significantly better than in the control group at week 6 post-treatment and 16-week follow-up (p < 0.05). The rehabilitation setting also affected the cognitive efficacy of MICT intervention in improving PSCI patients, and the degree of improvement in each outcome was found to be highest in hospital, followed by community, nursing home, and home settings. Conclusions Long-term MICT intervention can improve cognition, ADL, and QOL in patients with PSCI, with sustained effects for at least one month. Notably, different rehabilitation settings affect the cognitive intervention efficacy of MICT on PSCI patients. However, this still needs to be further determined in future studies.
Collapse
Affiliation(s)
- Kaiyue Han
- School of Rehabilitation, Capital Medical University, Fengtai District, Beijing, China
- Beijing Bo'ai Hospital, China Rehabilitation Research Center, Fengtai District, Beijing, China
| | - Guangliang Liu
- Beijing Fangshan Liangxiang Hospital, Fangshan District, Beijing, China
| | - Nan Liu
- Beijing Puren Hospital, Dongcheng District, Beijing, China
| | - Jiangyi Li
- Beijing Dongcheng District Kangfu One Two Three Health Training Center, Dongcheng District, Beijing, China
| | - Jianfeng Li
- Beijing Yangfangdian Hospital, Haidian District, Beijing, China
| | - Lihua Cui
- Beijing Fengtai District Jiaxiang Nursing-Home for the Elderly, Fengtai District, Beijing, China
- Beijing Fengtai You Anmen Hospital, Fengtai District, Beijing, China
| | - Ming Cheng
- Beijing Haidian District Guolilai Elderly Care Center, Haidian District, Beijing, China
| | - Junzi Long
- School of Rehabilitation, Capital Medical University, Fengtai District, Beijing, China
- Beijing Bo'ai Hospital, China Rehabilitation Research Center, Fengtai District, Beijing, China
- Changping Laboratory, Changping District, Beijing, China
| | - Xingxing Liao
- School of Rehabilitation, Capital Medical University, Fengtai District, Beijing, China
- Beijing Bo'ai Hospital, China Rehabilitation Research Center, Fengtai District, Beijing, China
- Changping Laboratory, Changping District, Beijing, China
| | - Zhiqing Tang
- School of Rehabilitation, Capital Medical University, Fengtai District, Beijing, China
- Beijing Bo'ai Hospital, China Rehabilitation Research Center, Fengtai District, Beijing, China
| | - Ying Liu
- School of Rehabilitation, Capital Medical University, Fengtai District, Beijing, China
- Beijing Bo'ai Hospital, China Rehabilitation Research Center, Fengtai District, Beijing, China
| | - Jiajie Liu
- School of Rehabilitation, Capital Medical University, Fengtai District, Beijing, China
- Beijing Bo'ai Hospital, China Rehabilitation Research Center, Fengtai District, Beijing, China
| | - Jiarou Chen
- Beijing Bo'ai Hospital, China Rehabilitation Research Center, Fengtai District, Beijing, China
- The second school of medicine, Wenzhou Medical University, Longwan District, Wenzhou, China
| | - Haitao Lu
- School of Rehabilitation, Capital Medical University, Fengtai District, Beijing, China
- Beijing Bo'ai Hospital, China Rehabilitation Research Center, Fengtai District, Beijing, China
| | - Hao Zhang
- School of Rehabilitation, Capital Medical University, Fengtai District, Beijing, China
- Beijing Bo'ai Hospital, China Rehabilitation Research Center, Fengtai District, Beijing, China
- University of Health and Rehabilitation Sciences, Gaoxin District, Qingdao, China
- Cheeloo College of Medicine, Shandong University, Lixia District, Jinan, China
| |
Collapse
|
3
|
Egger M, Bergmann J, Krewer C, Jahn K, Müller F. Sensory Stimulation and Robot-Assisted Arm Training after Stroke: A Randomized Controlled Trial. J Neurol Phys Ther 2024:01253086-990000000-00068. [PMID: 38912852 DOI: 10.1097/npt.0000000000000486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2024]
Abstract
BACKGROUND AND PURPOSE Functional recovery after stroke is often limited, despite various treatment methods such as robot-assisted therapy. Repetitive sensory stimulation (RSS) might be a promising add-on therapy that is thought to directly drive plasticity processes. First positive effects on sensorimotor function have been shown. However, clinical studies are scarce, and the effect of RSS combined with robot-assisted training has not been evaluated yet. Therefore, our objective was to investigate the feasibility and sensorimotor effects of RSS (compared to a control group receiving sham stimulation) followed by robot-assisted arm therapy. METHODS Forty participants in the subacute phase (4.4-23.9 weeks) after stroke with a moderate to severe arm paresis were randomized to RSS or control group. Participants received 12 sessions of (sham-) stimulation within 3 weeks. Stimulation of the fingertips and the robot-assisted therapy were each applied in 45-min sessions. Motor and sensory outcome assessments (e.g. Fugl-Meyer-Assessment, grip strength) were measured at baseline, post intervention and at a 3-week follow-up. RESULTS Participants in both groups improved their sensorimotor function from baseline to post and follow-up measurements, as illustrated by most motor and sensory outcome assessments. However, no significant group effects were found for any measures at any time (P > 0.058). Stimulations were well accepted, no safety issues arose. DISCUSSION AND CONCLUSIONS Feasibility of robot-assisted therapy with preceding RSS in persons with moderate to severe paresis was demonstrated. However, RSS preceding robot-assisted training failed to show a preliminary effect compared to the control intervention. Participants might have been too severely affected to identify changes driven by the RSS, or these might have been diluted or more difficult to identify because of the additional robotic training and neurorehabilitation. VIDEO ABSTRACT AVAILABLE for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A478).
Collapse
Affiliation(s)
- Marion Egger
- Department of Neurology, Research Group, Schoen Clinic Bad Aibling, Bad Aibling, Germany (M.E., J.B., C.K., K.J., F.M.)
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Faculty of Medicine, LMU Munich, Pettenkofer School of Public Health, Munich, Germany (M.E.); German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians-Universität in Munich, Munich, Germany (J.B., K.J.); and Chair of Human Movement Science, Department of Sports and Health Sciences, Technical University of Munich, Munich, Germany (C.K.)
| | - Jeannine Bergmann
- Department of Neurology, Research Group, Schoen Clinic Bad Aibling, Bad Aibling, Germany (M.E., J.B., C.K., K.J., F.M.)
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Faculty of Medicine, LMU Munich, Pettenkofer School of Public Health, Munich, Germany (M.E.); German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians-Universität in Munich, Munich, Germany (J.B., K.J.); and Chair of Human Movement Science, Department of Sports and Health Sciences, Technical University of Munich, Munich, Germany (C.K.)
| | - Carmen Krewer
- Department of Neurology, Research Group, Schoen Clinic Bad Aibling, Bad Aibling, Germany (M.E., J.B., C.K., K.J., F.M.)
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Faculty of Medicine, LMU Munich, Pettenkofer School of Public Health, Munich, Germany (M.E.); German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians-Universität in Munich, Munich, Germany (J.B., K.J.); and Chair of Human Movement Science, Department of Sports and Health Sciences, Technical University of Munich, Munich, Germany (C.K.)
| | - Klaus Jahn
- Department of Neurology, Research Group, Schoen Clinic Bad Aibling, Bad Aibling, Germany (M.E., J.B., C.K., K.J., F.M.)
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Faculty of Medicine, LMU Munich, Pettenkofer School of Public Health, Munich, Germany (M.E.); German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians-Universität in Munich, Munich, Germany (J.B., K.J.); and Chair of Human Movement Science, Department of Sports and Health Sciences, Technical University of Munich, Munich, Germany (C.K.)
| | - Friedemann Müller
- Department of Neurology, Research Group, Schoen Clinic Bad Aibling, Bad Aibling, Germany (M.E., J.B., C.K., K.J., F.M.)
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Faculty of Medicine, LMU Munich, Pettenkofer School of Public Health, Munich, Germany (M.E.); German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians-Universität in Munich, Munich, Germany (J.B., K.J.); and Chair of Human Movement Science, Department of Sports and Health Sciences, Technical University of Munich, Munich, Germany (C.K.)
| |
Collapse
|
4
|
Sánchez-Sánchez ML, Ruescas-Nicolau MA, Arnal-Gómez A, Iosa M, Pérez-Alenda S, Cortés-Amador S. Validity of an android device for assessing mobility in people with chronic stroke and hemiparesis: a cross-sectional study. J Neuroeng Rehabil 2024; 21:54. [PMID: 38616288 PMCID: PMC11017601 DOI: 10.1186/s12984-024-01346-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 03/22/2024] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Incorporating instrument measurements into clinical assessments can improve the accuracy of results when assessing mobility related to activities of daily living. This can assist clinicians in making evidence-based decisions. In this context, kinematic measures are considered essential for the assessment of sensorimotor recovery after stroke. The aim of this study was to assess the validity of using an Android device to evaluate kinematic data during the performance of a standardized mobility test in people with chronic stroke and hemiparesis. METHODS This is a cross-sectional study including 36 individuals with chronic stroke and hemiparesis and 33 age-matched healthy subjects. A simple smartphone attached to the lumbar spine with an elastic band was used to measure participants' kinematics during a standardized mobility test by using the inertial sensor embedded in it. This test includes postural control, walking, turning and sitting down, and standing up. Differences between stroke and non-stroke participants in the kinematic parameters obtained after data sensor processing were studied, as well as in the total execution and reaction times. Also, the relationship between the kinematic parameters and the community ambulation ability, degree of disability and functional mobility of individuals with stroke was studied. RESULTS Compared to controls, participants with chronic stroke showed a larger medial-lateral displacement (p = 0.022) in bipedal stance, a higher medial-lateral range (p < 0.001) and a lower cranio-caudal range (p = 0.024) when walking, and lower turn-to-sit power (p = 0.001), turn-to-sit jerk (p = 0.026) and sit-to-stand jerk (p = 0.001) when assessing turn-to-sit-to-stand. Medial-lateral range and total execution time significantly correlated with all the clinical tests (p < 0.005), and resulted significantly different between independent and limited community ambulation patients (p = 0.042 and p = 0.006, respectively) as well as stroke participants with significant disability or slight/moderate disability (p = 0.024 and p = 0.041, respectively). CONCLUSION This study reports a valid, single, quick and easy-to-use test for assessing kinematic parameters in chronic stroke survivors by using a standardized mobility test with a smartphone. This measurement could provide valid clinical information on reaction time and kinematic parameters of postural control and gait, which can help in planning better intervention approaches.
Collapse
Affiliation(s)
- M Luz Sánchez-Sánchez
- Physiotherapy in Motion. Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Gascó Oliag n 5, 46010, Valencia, Spain
| | - Maria-Arantzazu Ruescas-Nicolau
- Physiotherapy in Motion. Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Gascó Oliag n 5, 46010, Valencia, Spain.
| | - Anna Arnal-Gómez
- Physiotherapy in Motion. Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Gascó Oliag n 5, 46010, Valencia, Spain
| | - Marco Iosa
- Department of Psychology, Sapienza University of Rome, Via dei Marsi 78, 00185, Rome, Italy
- Smart Lab, Santa Lucia Foundation IRCCS, Via Ardeatina 306, 00179, Rome, Italy
| | - Sofía Pérez-Alenda
- Physiotherapy in Motion. Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Gascó Oliag n 5, 46010, Valencia, Spain
| | - Sara Cortés-Amador
- Physiotherapy in Motion. Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Gascó Oliag n 5, 46010, Valencia, Spain
| |
Collapse
|
5
|
Gangaram-Panday SG, Zhou Y, Gillebert CR. Screening for post-stroke neurocognitive disorders in diverse populations: A systematic review. Clin Neuropsychol 2024; 38:588-611. [PMID: 37480233 DOI: 10.1080/13854046.2023.2237676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 07/12/2023] [Indexed: 07/23/2023]
Abstract
Objective: Although neurocognitive disorders (NCD) are common post-stroke, many populations do not have adapted cognitive screens and cut-offs. We therefore reviewed the appropriateness of the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA) and Oxford Cognitive Screen (OCS) for diagnosing NCD in culturally diverse stroke populations. Method: Using an extensive search string, diagnostic accuracy studies for MMSE, MoCA and OCS in the stroke population were retrieved from four databases. We compared translations and adaptations, adjustments in scores and cut-offs, and their diagnostic accuracy. Results: The search resulted in 28 MMSE, 39 MoCA and 5 OCS-studies in 13 western, educated, industrialized, rich and democratic (WEIRD) and 4 other countries. There was a lack of studies on South-American, African, and non-Chinese-Asian populations. All three tests needed adaptation for less WEIRD populations and populations with languages with non-Latin features. Optimal MMSE and OCS subtest cut-offs were similar across WEIRD and less WEIRD populations, whereas optimal MoCA cut-offs appeared lower for less WEIRD populations. The use of adjusted scores resulted in different optimal cut-offs or similar cut-offs with better accuracy. Conclusions: MoCA, MMSE and OCS are promising tools for diagnosing post-stroke-NCD. For culturally diverse populations, translation, adaptation and adjusted scores or cut-offs are necessary for diagnostic accuracy. Available studies report scarcely about their sample's cultural background and there is a lack of diagnostic accuracy studies in less WEIRD or culturally diverse populations. Future studies should report more cultural characteristics of their sample to provide better insight into the tests' accuracy in culturally diverse populations.
Collapse
Affiliation(s)
- Shonimá G Gangaram-Panday
- Brain and Cognition, Leuven Brain Institute, KU Leuven, Leuven, Belgium
- Psychology, Anton de Kom University of Suriname, Paramaribo, Suriname
| | - Yanyao Zhou
- Psychology, University of Hong Kong, Hong Kong
| | - Céline R Gillebert
- Brain and Cognition, Leuven Brain Institute, KU Leuven, Leuven, Belgium
- TRACE Center for Translational Health Research, KU Leuven, Leuven, Belgium
| |
Collapse
|
6
|
Basagni B, Malloggi S, Polito C, Pellicciari L, Campagnini S, Pancani S, Mannini A, Gemignani P, Salvadori E, Marignani S, Giovannelli F, Viggiano MP, Hakiki B, Grippo A, Macchi C, Cecchi F. MoCA Domain-Specific Pattern of Cognitive Impairment in Stroke Patients Attending Intensive Inpatient Rehabilitation: A Prospective Study. Behav Sci (Basel) 2024; 14:42. [PMID: 38247694 PMCID: PMC10813017 DOI: 10.3390/bs14010042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/18/2023] [Accepted: 12/24/2023] [Indexed: 01/23/2024] Open
Abstract
A domain-specific perspective to cognitive functioning in stroke patients may predict their cognitive recovery over time and target stroke rehabilitation intervention. However, data about domain-specific cognitive impairment after stroke are still scarce. This study prospectively investigated the domain-specific pattern of cognitive impairments, using the classification proposed by the Montreal Cognitive Assessment (MoCA), in a cohort of 49 stroke patients at admission (T0), discharge (T1), and six-month follow-up (T2) from subacute intensive rehabilitation. The predictive value of T0 cognitive domains cognitive impairment at T1 and T2 was also investigated. Patients' cognitive functioning at T0, T1, and T2 was assessed through the MoCA domains for executive functioning, attention, language, visuospatial, orientation, and memory. Different evolutionary trends of cognitive domain impairments emerged across time-points. Patients' impairments in all domains decreased from T0 to T1. Attention and executive impairments decreased from T0 to T2 (42.9% and 26.5% to 10.2% and 18.4%, respectively). Conversely, altered visuospatial, language, and orientation increased between T1 and T2 (16.3%, 36.7%, and 40.8%, respectively). Additionally, patients' global cognitive functioning at T1 was predicted by the language and executive domains in a subacute phase (p = 0.031 and p = 0.001, respectively), while in the long term, only attention (p = 0.043) and executive (p = 0.019) domains intervened. Overall, these results confirm the importance of a domain-specific approach to target cognitive recovery across time in stroke patients.
Collapse
Affiliation(s)
- Benedetta Basagni
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Firenze, Italy; (B.B.); (S.M.); (C.P.); (L.P.); (S.P.); (A.M.); (P.G.); (E.S.); (S.M.); (B.H.); (A.G.); (C.M.); (F.C.)
| | - Serena Malloggi
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Firenze, Italy; (B.B.); (S.M.); (C.P.); (L.P.); (S.P.); (A.M.); (P.G.); (E.S.); (S.M.); (B.H.); (A.G.); (C.M.); (F.C.)
| | - Cristina Polito
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Firenze, Italy; (B.B.); (S.M.); (C.P.); (L.P.); (S.P.); (A.M.); (P.G.); (E.S.); (S.M.); (B.H.); (A.G.); (C.M.); (F.C.)
| | - Leonardo Pellicciari
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Firenze, Italy; (B.B.); (S.M.); (C.P.); (L.P.); (S.P.); (A.M.); (P.G.); (E.S.); (S.M.); (B.H.); (A.G.); (C.M.); (F.C.)
| | - Silvia Campagnini
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Firenze, Italy; (B.B.); (S.M.); (C.P.); (L.P.); (S.P.); (A.M.); (P.G.); (E.S.); (S.M.); (B.H.); (A.G.); (C.M.); (F.C.)
| | - Silvia Pancani
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Firenze, Italy; (B.B.); (S.M.); (C.P.); (L.P.); (S.P.); (A.M.); (P.G.); (E.S.); (S.M.); (B.H.); (A.G.); (C.M.); (F.C.)
| | - Andrea Mannini
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Firenze, Italy; (B.B.); (S.M.); (C.P.); (L.P.); (S.P.); (A.M.); (P.G.); (E.S.); (S.M.); (B.H.); (A.G.); (C.M.); (F.C.)
| | - Paola Gemignani
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Firenze, Italy; (B.B.); (S.M.); (C.P.); (L.P.); (S.P.); (A.M.); (P.G.); (E.S.); (S.M.); (B.H.); (A.G.); (C.M.); (F.C.)
| | - Emilia Salvadori
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Firenze, Italy; (B.B.); (S.M.); (C.P.); (L.P.); (S.P.); (A.M.); (P.G.); (E.S.); (S.M.); (B.H.); (A.G.); (C.M.); (F.C.)
| | - Sara Marignani
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Firenze, Italy; (B.B.); (S.M.); (C.P.); (L.P.); (S.P.); (A.M.); (P.G.); (E.S.); (S.M.); (B.H.); (A.G.); (C.M.); (F.C.)
| | - Fabio Giovannelli
- Department of NEUROFARBA, University of Florence, 50143 Firenze, Italy; (F.G.); (M.P.V.)
| | - Maria Pia Viggiano
- Department of NEUROFARBA, University of Florence, 50143 Firenze, Italy; (F.G.); (M.P.V.)
| | - Bahia Hakiki
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Firenze, Italy; (B.B.); (S.M.); (C.P.); (L.P.); (S.P.); (A.M.); (P.G.); (E.S.); (S.M.); (B.H.); (A.G.); (C.M.); (F.C.)
| | - Antonello Grippo
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Firenze, Italy; (B.B.); (S.M.); (C.P.); (L.P.); (S.P.); (A.M.); (P.G.); (E.S.); (S.M.); (B.H.); (A.G.); (C.M.); (F.C.)
| | - Claudio Macchi
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Firenze, Italy; (B.B.); (S.M.); (C.P.); (L.P.); (S.P.); (A.M.); (P.G.); (E.S.); (S.M.); (B.H.); (A.G.); (C.M.); (F.C.)
- Department of Experimental and Clinical Medicine, University of Florence, 50143 Firenze, Italy
| | - Francesca Cecchi
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Firenze, Italy; (B.B.); (S.M.); (C.P.); (L.P.); (S.P.); (A.M.); (P.G.); (E.S.); (S.M.); (B.H.); (A.G.); (C.M.); (F.C.)
- Department of Experimental and Clinical Medicine, University of Florence, 50143 Firenze, Italy
| |
Collapse
|
7
|
Boone AE, Noe J, Wolf TJ. Feasibility of Augmenting Cognitive Strategy Training With Non-Invasive Brain Stimulation. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2024; 44:98-105. [PMID: 37264631 DOI: 10.1177/15394492231176214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Many individuals post-stroke have difficulty identifying if or how they can continue performing meaningful daily life tasks. The objective of this study was to evaluate the feasibility of metacognitive strategy training (MCST) and transcranial direct current stimulation (tDCS) in chronic stroke. A case series design was used. Participants completed 12 intervention sessions over 4 weeks consisting of 20 min of tDCS and 45 min of MCST to address occupational performance goals. Feasibility outcomes of acceptability and safety/tolerability were evaluated and measures of occupational performance were administered pre- and post-intervention. Participants perceived the intervention to be highly acceptable and relevant to their needs. Large improvements were observed for performance and satisfaction with goals trained (Hedge's g = 2.07 and 2.11, respectively) and untrained (Hedge's g = 1.25 and 1.43, respectively) within the intervention. An intervention combining MCST with tDCS was feasible to administer and positively received by stakeholders; further research is warranted.
Collapse
Affiliation(s)
| | - Jenna Noe
- University of Missouri, Columbia, USA
| | | |
Collapse
|
8
|
Kusec A, Milosevich E, Williams OA, Chiu EG, Watson P, Carrick C, Drozdowska BA, Dillon A, Jennings T, Anderson B, Dawes H, Thomas S, Kuppuswamy A, Pendlebury ST, Quinn TJ, Demeyere N. Long-term psychological outcomes following stroke: the OX-CHRONIC study. BMC Neurol 2023; 23:426. [PMID: 38036966 PMCID: PMC10688008 DOI: 10.1186/s12883-023-03463-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 11/10/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Stroke survivors rate longer-term (> 2 years) psychological recovery as their top priority, but data on how frequently psychological consequences occur is lacking. Prevalence of cognitive impairment, depression/anxiety, fatigue, apathy and related psychological outcomes, and whether rates are stable in long-term stroke, is unknown. METHODS N = 105 long-term stroke survivors (M [SD] age = 72.92 [13.01]; M [SD] acute NIH Stroke Severity Score = 7.39 [6.25]; 59.0% Male; M [SD] years post-stroke = 4.57 [2.12]) were recruited (potential N = 208). Participants completed 3 remote assessments, including a comprehensive set of standardized cognitive neuropsychological tests comprising domains of memory, attention, language, and executive function, and questionnaires on emotional distress, fatigue, apathy and other psychological outcomes. Ninety participants were re-assessed one year later. Stability of outcomes was assessed by Cohen's d effect size estimates and percent Minimal Clinically Important Difference changes between time points. RESULTS On the Montreal Cognitive Assessment 65.3% scored < 26. On the Oxford Cognitive Screen 45.9% had at least one cognitive impairment. Attention (27.1%) and executive function (40%) were most frequently impaired. 23.5% and 22.5% had elevated depression/anxiety respectively. Fatigue (51.4%) and apathy (40.5%) rates remained high, comparable to estimates in the first-year post-stroke. Attention (d = -0.12; 85.8% stable) and depression (d = 0.09, 77.1% stable) were the most stable outcomes. Following alpha-adjustments, only perceptuomotor abilities (d = 0.69; 40.4% decline) and fatigue (d = -0.33; 45.3% decline) worsened over one year. Cognitive impairment, depression/anxiety, fatigue and apathy all correlated with worse quality of life. CONCLUSION Nearly half of participants > 2 years post-event exhibited psychological difficulties including domains of cognition, mood, and fatigue, which impact long-term quality of life. Stroke is a chronic condition with highly prevalent psychological needs, which require monitoring and intervention development.
Collapse
Affiliation(s)
- Andrea Kusec
- Department of Experimental Psychology, University of Oxford, Anna Watts Building, Radcliffe Observatory Quarter, Oxford, UK
| | - Elise Milosevich
- Department of Experimental Psychology, University of Oxford, Anna Watts Building, Radcliffe Observatory Quarter, Oxford, UK
| | - Owen A Williams
- Department of Experimental Psychology, University of Oxford, Anna Watts Building, Radcliffe Observatory Quarter, Oxford, UK
| | - Evangeline G Chiu
- Department of Experimental Psychology, University of Oxford, Anna Watts Building, Radcliffe Observatory Quarter, Oxford, UK
| | - Pippa Watson
- Department of Experimental Psychology, University of Oxford, Anna Watts Building, Radcliffe Observatory Quarter, Oxford, UK
| | - Chloe Carrick
- Department of Experimental Psychology, University of Oxford, Anna Watts Building, Radcliffe Observatory Quarter, Oxford, UK
| | - Bogna A Drozdowska
- School of Cardiovascular & Metabolic Health, University of Glasgow, Glasgow, UK
| | - Avril Dillon
- Department of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | | | - Bloo Anderson
- Patient and Public Involvement Representative, Oxford, UK
| | - Helen Dawes
- NIHR Exeter Biomedical Research Centre, University of Exeter, Medical School Building, St Luke's Campus, Magdalen Road, Exeter, UK
| | - Shirley Thomas
- School of Medicine, Queen's Medical Centre, University of Nottingham, Nottingham, UK
| | - Annapoorna Kuppuswamy
- Institute of Neurology Department of Clinical and Movement Neurosciences, University College London, 33 Queen Square, London, UK
- Department of Biomedical Sciences, University of Leeds, Leeds, UK
| | - Sarah T Pendlebury
- Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Terence J Quinn
- School of Cardiovascular & Metabolic Health, University of Glasgow, Glasgow, UK
| | - Nele Demeyere
- Department of Experimental Psychology, University of Oxford, Anna Watts Building, Radcliffe Observatory Quarter, Oxford, UK.
- Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK.
| |
Collapse
|
9
|
Xie W, Chen X, Ma X, Song S, Ma H, You J, Huang C. Effect of hyperbaric oxygen therapy combined with repetitive transcranial magnetic stimulation on vascular cognitive impairment: a randomised controlled trial protocol. BMJ Open 2023; 13:e073532. [PMID: 37963686 PMCID: PMC10649391 DOI: 10.1136/bmjopen-2023-073532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 10/27/2023] [Indexed: 11/16/2023] Open
Abstract
INTRODUCTION Vascular cognitive impairment (VCI) has an increasing prevalence worldwide, accounting for at least 20%-40% of all diagnoses of dementia. The decline in cognitive function seriously impairs patients' activities of daily living and social participation and reduces their quality of life. However, there is still a lack of advanced, definitive rehabilitation programmes for VCI. Hyperbaric oxygen therapy (HBOT) and repetitive transcranial magnetic stimulation (rTMS) are recognised treatments for improving cognitive impairment. The former can restore oxygen supply in the brain by increasing oxygen partial pressure in brain tissue, while the latter can enhance neuronal excitability and promote synaptic plasticity. However, no studies have explored the effect of HBO combined with rTMS on VCI. METHODS AND ANALYSIS This study is designed as a single-centre, assessor-blind, randomised controlled clinical trial with four parallel arms. A total of 72 participants will be recruited and randomly assigned to the control group, HBOT group, rTMS group and HBOT combined with rTMS group at a ratio of 1:1:1:1. All enrolled participants will receive conventional treatment. The entire intervention period is 4 weeks, with a 3-week follow-up. Outcomes will be measured at baseline (T0), after a 4-week intervention (T1) and after an additional 3-week follow-up period (T2). The primary endpoint is the Montreal Cognitive Assessment score. The secondary endpoints are Mini-Mental State Examination score, Modified Barthel Index score, latency and amplitude of P300, cerebral cortical oxygenated haemoglobin (HbO2) and deoxygenated haemoglobin (HbR) concentrations as measured by task-state functional near-infrared spectroscopy. ETHICS AND DISSEMINATION Ethics approval was obtained from the West China Hospital Clinical Trials and Biomedical Ethics Committee of Sichuan University (ethics reference: 2022 (1972)). The findings will be published in peer-reviewed journals and disseminated through scientific conferences and seminars. TRIAL REGISTRATION NUMBER ChiCTR2300068242.
Collapse
Affiliation(s)
- Wei Xie
- Department of Rehabilitation Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Xinxin Chen
- Department of Rehabilitation Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Xichao Ma
- Department of Rehabilitation Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Sihui Song
- Department of Rehabilitation Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Hui Ma
- Department of Rehabilitation Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Jiuhong You
- Department of Rehabilitation Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Cheng Huang
- Department of Rehabilitation Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| |
Collapse
|
10
|
Nicotra A, Maestri G, Salvadori E, Pantoni L. Brain health assessment. An exploratory review of tools related to its cognitive dimension. CEREBRAL CIRCULATION - COGNITION AND BEHAVIOR 2023; 6:100188. [PMID: 38292014 PMCID: PMC10826206 DOI: 10.1016/j.cccb.2023.100188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 08/16/2023] [Accepted: 10/01/2023] [Indexed: 02/01/2024]
Abstract
Background Brain health is an evolving concept and relates to physical and mental health, social well-being, productivity, creativity. Brain health has several dimensions (cognitive, motor, functional, social, and emotional), and should be recognized as one top global priorities of health policies. The purpose of this paper is to provide a summary of tools developed for assessing the cognitive dimension of brain health in the out-patient services. Methods A literature search on PubMed was performed (from inception to May 31, 2023). We identified cognitive tests, functional and psychological scales, and focused on screening tools specifically proposed to characterize cognition within the construct of brain health, comparing them with common global screening tests. Results Among 1947 records, we identified 17 cognitive screening tools used in the context of brain health assessment, of which four were ad hoc developed: Brain Health Assessment (BHA), Brain Health Test (BHT), Brain Health Test-7 (BHT-7), and The Cogniciti Brain Health Assessment. The four tests have administration time ranging from 4 to 30 min, and different administration methods (paper-and-pencil or tablet-based). All four tools assess memory and other cognitive domains. Specific cut-offs have been identified for BHT and BHT-7, while the other tools have automated scoring systems. All but one test also assess other dimensions. Compared to commonly used cognitive screening tests, the brain health tools are less widely used, translated, and validated. Conclusions The concept of brain health is new and requires further validation of tools for its assessment, especially for the cognition dimension.
Collapse
Affiliation(s)
- Alessia Nicotra
- Neurology Unit, Luigi Sacco University Hospital, Milan, Italy
| | - Giorgia Maestri
- Neurology Unit, Luigi Sacco University Hospital, Milan, Italy
| | - Emilia Salvadori
- Neuroscience Research Center, Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Leonardo Pantoni
- Neurology Unit, Luigi Sacco University Hospital, Milan, Italy
- Neuroscience Research Center, Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| |
Collapse
|
11
|
Carmona C, Sullivan JE, Arceo R, Drogos J, Besser S, Gutierrez S, Jeteric Z, Wyman J, Yao J. Development and Preliminary Validity Study of a Modified Version of the Upper Extremity Fugl-Meyer Assessment for Use in Telerehabilitation. J Neurol Phys Ther 2023; 47:208-216. [PMID: 37314323 PMCID: PMC10487354 DOI: 10.1097/npt.0000000000000447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND/PURPOSE The Upper Extremity Fugl-Meyer Assessment (UEFMA, maximum 66) is widely used in clinics and research studies to examine poststroke upper extremity (UE) impairment. This study aimed to develop and provide pilot data to support the validity of a remote version of the UEFMA to examine UE impairment after stroke through telerehabilitation. METHODS Team members developed a remote version of the UEFMA for telerehabilitation (tUEFMA, maximum 44) using subscales II to IV and VII of the UEFMA. Twenty-two participants with moderate to severe arm impairment (UEFMA, median = 19) and chronic stroke (>1 year post) were evaluated using the UEFMA (face-to-face) and the tUEFMA (remotely). A prediction equation was used to identify the function to predict the UEFMA based on the tUEFMA. Intraclass correlation (ICC) was used to test the absolute agreement between the subscales included in the UEFMA and the tUEFMA, and between their 2 normalized total scores. RESULTS A strong and significant agreement was found between the total scores of the UEFMA and the projected value based on the tUEFMA (ICC = 0.79, P < 0.05). The ICC test also reported a good agreement in subscales II to IV and a poor agreement in subscale VII between the UEFMA and the tUEFMA using a real-time video link. DISCUSSION AND CONCLUSIONS The study findings suggest that the tUEFMA is a promising tool to remotely examine UE impairment in individuals with chronic stroke and moderate to severe arm impairment. Future research should evaluate additional psychometric properties and clinical utility of the tUEFMA across stroke participants with a broad range of arm impairments.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A441 ).
Collapse
Affiliation(s)
- Carolina Carmona
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, Illinois (C.C,. J.E.S., R.A., J.D., S.B., S.G., Z.J., J.W., J.Y.); and Northwestern University Interdepartmental Neuroscience, Northwestern University, and Department of Biomedical Engineering, Northwestern University, Chicago, Illinois (J.Y.)
| | - Jane E. Sullivan
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, Illinois (C.C,. J.E.S., R.A., J.D., S.B., S.G., Z.J., J.W., J.Y.); and Northwestern University Interdepartmental Neuroscience, Northwestern University, and Department of Biomedical Engineering, Northwestern University, Chicago, Illinois (J.Y.)
| | - Riegele Arceo
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, Illinois (C.C,. J.E.S., R.A., J.D., S.B., S.G., Z.J., J.W., J.Y.); and Northwestern University Interdepartmental Neuroscience, Northwestern University, and Department of Biomedical Engineering, Northwestern University, Chicago, Illinois (J.Y.)
| | - Justin Drogos
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, Illinois (C.C,. J.E.S., R.A., J.D., S.B., S.G., Z.J., J.W., J.Y.); and Northwestern University Interdepartmental Neuroscience, Northwestern University, and Department of Biomedical Engineering, Northwestern University, Chicago, Illinois (J.Y.)
| | - Sofie Besser
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, Illinois (C.C,. J.E.S., R.A., J.D., S.B., S.G., Z.J., J.W., J.Y.); and Northwestern University Interdepartmental Neuroscience, Northwestern University, and Department of Biomedical Engineering, Northwestern University, Chicago, Illinois (J.Y.)
| | - Susana Gutierrez
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, Illinois (C.C,. J.E.S., R.A., J.D., S.B., S.G., Z.J., J.W., J.Y.); and Northwestern University Interdepartmental Neuroscience, Northwestern University, and Department of Biomedical Engineering, Northwestern University, Chicago, Illinois (J.Y.)
| | - Zineyra Jeteric
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, Illinois (C.C,. J.E.S., R.A., J.D., S.B., S.G., Z.J., J.W., J.Y.); and Northwestern University Interdepartmental Neuroscience, Northwestern University, and Department of Biomedical Engineering, Northwestern University, Chicago, Illinois (J.Y.)
| | - James Wyman
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, Illinois (C.C,. J.E.S., R.A., J.D., S.B., S.G., Z.J., J.W., J.Y.); and Northwestern University Interdepartmental Neuroscience, Northwestern University, and Department of Biomedical Engineering, Northwestern University, Chicago, Illinois (J.Y.)
| | - Jun Yao
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, Illinois (C.C,. J.E.S., R.A., J.D., S.B., S.G., Z.J., J.W., J.Y.); and Northwestern University Interdepartmental Neuroscience, Northwestern University, and Department of Biomedical Engineering, Northwestern University, Chicago, Illinois (J.Y.)
| |
Collapse
|
12
|
Wei X, Ma Y, Wu T, Yang Y, Yuan Y, Qin J, Bu Z, Yan F, Zhang Z, Han L. Which cutoff value of the Montreal Cognitive Assessment should be used for post-stroke cognitive impairment? A systematic review and meta-analysis on diagnostic test accuracy. Int J Stroke 2023; 18:908-916. [PMID: 37190789 DOI: 10.1177/17474930231178660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
BACKGROUND Post-stroke cognitive impairment (PSCI) is one of the serious complications of stroke. The Montreal Cognitive Assessment (MoCA), as a brief cognitive impairment screening tool, is widely used in stroke survivors. However, some studies have suggested that the use of the universal cutoff value of 26 may be inappropriate for detecting cognitive impairments in stroke settings. AIM We conducted this study to identify the optimal cutoff value of the MoCA in screening for PSCI. METHODS PubMed, CINAHL, Embase, the Cochrane Library, and Web of Science were searched for eligible studies until March 23, 2023. All studies were screened by two independent researchers. The quality of each article was evaluated by the Quality Assessment of Diagnostic Accuracy Studies-2 tool. A bivariate mixed-effects model was used to pool sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and the summary receiver operating characteristic curve. RESULTS Twenty-four studies with a total of 4231 patients were included in this review. Despite the lack of evidence of publication bias, a high degree of heterogeneity was observed. A meta-analysis revealed that a cutoff value of 21/22 yielded the best diagnostic accuracy. The optimal cutoff varied in different regions, stroke types, and stroke phases as well. CONCLUSION The optimal cutoff of MoCA was 21/22 for stroke populations rather than the initially recommended cutoff of 26. A revised (lower) cutoff should be considered for stroke survivors.
Collapse
Affiliation(s)
- Xiaoqin Wei
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China
| | - Yuxia Ma
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China
| | - Tingting Wu
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China
| | - Yiyi Yang
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China
| | - Yue Yuan
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China
| | - Jiangxia Qin
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China
| | - Zhaowen Bu
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China
- Nursing Department, Gansu Provincial Hospital, Lanzhou, China
| | - Fanghong Yan
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China
| | - Ziyao Zhang
- Lanzhou University of Arts and Science, Lanzhou, China
| | - Lin Han
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China
- Nursing Department, Gansu Provincial Hospital, Lanzhou, China
| |
Collapse
|
13
|
Li X, Chen Z, Jiao H, Wang B, Yin H, Chen L, Shi H, Yin Y, Qin D. Machine learning in the prediction of post-stroke cognitive impairment: a systematic review and meta-analysis. Front Neurol 2023; 14:1211733. [PMID: 37602236 PMCID: PMC10434510 DOI: 10.3389/fneur.2023.1211733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 07/20/2023] [Indexed: 08/22/2023] Open
Abstract
Objective Cognitive impairment is a detrimental complication of stroke that compromises the quality of life of the patients and poses a huge burden on society. Due to the lack of effective early prediction tools in clinical practice, many researchers have introduced machine learning (ML) into the prediction of post-stroke cognitive impairment (PSCI). However, the mathematical models for ML are diverse, and their accuracy remains highly contentious. Therefore, this study aimed to examine the efficiency of ML in the prediction of PSCI. Methods Relevant articles were retrieved from Cochrane, Embase, PubMed, and Web of Science from the inception of each database to 5 December 2022. Study quality was evaluated by PROBAST, and c-index, sensitivity, specificity, and overall accuracy of the prediction models were meta-analyzed. Results A total of 21 articles involving 7,822 stroke patients (2,876 with PSCI) were included. The main modeling variables comprised age, gender, education level, stroke history, stroke severity, lesion volume, lesion site, stroke subtype, white matter hyperintensity (WMH), and vascular risk factors. The prediction models used were prediction nomograms constructed based on logistic regression. The pooled c-index, sensitivity, and specificity were 0.82 (95% CI 0.77-0.87), 0.77 (95% CI 0.72-0.80), and 0.80 (95% CI 0.71-0.86) in the training set, and 0.82 (95% CI 0.77-0.87), 0.82 (95% CI 0.70-0.90), and 0.80 (95% CI 0.68-0.82) in the validation set, respectively. Conclusion ML is a potential tool for predicting PSCI and may be used to develop simple clinical scoring scales for subsequent clinical use. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=383476.
Collapse
Affiliation(s)
- XiaoSheng Li
- Department of Rehabilitation Medicine, The Affiliated Hospital of Yunnan University, Kunming, China
| | - Zongning Chen
- Department of Research and Teaching, Lijiang People’s Hospital, Lijiang, China
| | - Hexian Jiao
- Department of Research and Teaching, Lijiang People’s Hospital, Lijiang, China
| | - BinYang Wang
- Department of Rehabilitation Medicine, The Affiliated Hospital of Yunnan University, Kunming, China
| | - Hui Yin
- Department of Rehabilitation Medicine, The Affiliated Hospital of Yunnan University, Kunming, China
| | - LuJia Chen
- Department of Rehabilitation Medicine, The Affiliated Hospital of Yunnan University, Kunming, China
| | - Hongling Shi
- Department of Rehabilitation Medicine, The Third People’s Hospital of Yunnan Province, Kunming, China
| | - Yong Yin
- Department of Rehabilitation Medicine, The Affiliated Hospital of Yunnan University, Kunming, China
| | - Dongdong Qin
- Department of Research and Teaching, Lijiang People’s Hospital, Lijiang, China
| |
Collapse
|
14
|
Tap L, Vernooij MW, Wolters F, van den Berg E, Mattace-Raso FUS. New horizons in cognitive and functional impairment as a consequence of cerebral small vessel disease. Age Ageing 2023; 52:afad148. [PMID: 37585592 PMCID: PMC10431695 DOI: 10.1093/ageing/afad148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 06/06/2023] [Indexed: 08/18/2023] Open
Abstract
Cerebral small vessel disease (cSVD) is a frequent finding in imaging of the brain in older adults, especially in the concomitance of cardiovascular disease risk factors. Despite the well-established link between cSVD and (vascular) cognitive impairment (VCI), it remains uncertain how and when these vascular alterations lead to cognitive decline. The extent of acknowledged markers of cSVD is at best modestly associated with the severity of clinical symptoms, but technological advances increasingly allow to identify and quantify the extent and perhaps also the functional impact of cSVD more accurately. This will facilitate a more accurate diagnosis of VCI, against the backdrop of concomitant other neurodegenerative pathology, and help to identify persons with the greatest risk of cognitive and functional deterioration. In this study, we discuss how better assessment of cSVD using refined neuropsychological and comprehensive geriatric assessment as well as modern image analysis techniques may improve diagnosis and possibly the prognosis of VCI. Finally, we discuss new avenues in the treatment of cSVD and outline how these contemporary insights into cSVD can contribute to optimise screening and treatment strategies in older adults with cognitive impairment and multimorbidity.
Collapse
Affiliation(s)
- Lisanne Tap
- Department of Internal Medicine, Section of Geriatric Medicine and Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Meike W Vernooij
- Department of Radiology and Nuclear Medicine and Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Frank Wolters
- Department of Epidemiology and Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Esther van den Berg
- Department of Neurology and Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Francesco U S Mattace-Raso
- Department of Internal Medicine, Section of Geriatric Medicine and Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
15
|
Wang L, Yang L, Liu H, Pu J, Li Y, Tang L, Chen Q, Pu F, Bai D. C-Reactive Protein Levels and Cognitive Decline following Acute Ischemic Stroke: A Systematic Review and Meta-Analysis. Brain Sci 2023; 13:1082. [PMID: 37509012 PMCID: PMC10377587 DOI: 10.3390/brainsci13071082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 07/12/2023] [Accepted: 07/13/2023] [Indexed: 07/30/2023] Open
Abstract
Cognitive decline (CD) is devastating with a high incidence in patients after stroke. Although some studies have explored underlying associations between C-reactive protein (CRP) levels and cognitive decline after stroke, consistent results have not been obtained. Therefore, this meta-analysis aimed to explore whether or not higher levels of C-reactive proteins were associated with an increased risk of cognitive decline after stroke. To this end, PubMed, Embase, the Cochrane Library, and Web of Science were searched for eligible studies, and pooled effect sizes from eligible studies were calculated using random effect models. Furthermore, subgroups were established and meta-regression analyses were performed to explain the causes of heterogeneity. Eventually, nine studies with 3893 participants were included. Our statistical results suggested that the concentrations of peripheral CRP may be significantly increased for CD patients after stroke, compared to those of non-CD patients. Subgroup analyses showed that CRP was higher in CD than that in non-CD patients when the mini-mental state examination was used. A higher level of CRP in the acute phase of ischemic stroke may suggest an increased risk of CD after stroke. However, these results should be cautiously interpreted because of the limited sample sizes and the diversity of potential confounders in the studies included in this meta-analysis.
Collapse
Affiliation(s)
- Likun Wang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Lining Yang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Haiyan Liu
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Juncai Pu
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Yi Li
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Lu Tang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Qing Chen
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Fang Pu
- Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing 100191, China
| | - Dingqun Bai
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| |
Collapse
|
16
|
Qiu X, Lei YP, Zhou RX. SIRS, SOFA, qSOFA, and NEWS in the diagnosis of sepsis and prediction of adverse outcomes: a systematic review and meta-analysis. Expert Rev Anti Infect Ther 2023; 21:891-900. [PMID: 37450490 DOI: 10.1080/14787210.2023.2237192] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 06/20/2023] [Accepted: 06/27/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND We compared Systemic Inflammatory Response Syndrome (SIRS), Sequential Organ Failure Assessment (SOFA), Quick Sepsis-related Organ Failure Assessment (qSOFA), and National Early Warning Score (NEWS) for sepsis diagnosis and adverse outcomes prediction. METHODS Clinical studies that used SIRS, SOFA, qSOFA, and NEWS for sepsis diagnosis and prognosis assessment were included. Data were extracted, and meta-analysis was performed for outcome measures, including sepsis diagnosis, in-hospital mortality, 7/10/14-day mortality, 28/30-day mortality, and ICU admission. RESULTS Fifty-seven included studies showed good overall quality. Regarding sepsis prediction, SIRS demonstrated high sensitivity (0.85) but low specificity (0.41), qSOFA showed low sensitivity (0.42) but high specificity (0.98), and NEWS exhibited high sensitivity (0.71) and specificity (0.85). For predicting in-hospital mortality, SOFA demonstrated the highest sensitivity (0.89) and specificity (0.69). In terms of predicting 7/10/14-day mortality, SIRS exhibited high sensitivity (0.87), while qSOFA had high specificity (0.75). For predicting 28/30-day mortality, SOFA showed high sensitivity (0.97) but low specificity (0.14), whereas qSOFA displayed low sensitivity (0.41) but high specificity (0.88). CONCLUSIONS NEWS independently demonstrates good diagnostic capability for sepsis, especially in high-income countries. SOFA emerges as the optimal choice for predicting in-hospital mortality and can be employed as a screening tool for 28/30-day mortality in low-income countries.
Collapse
Affiliation(s)
- Xia Qiu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yu-Peng Lei
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Rui-Xi Zhou
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Chengdu, Sichuan, China
| |
Collapse
|
17
|
Zhang C, Zhang X, Meng P, Gao H, Bai B, Li D. The association between serum uric acid and cognitive performance in patients with ischemic stroke is modified by estimated glomerular filtration rate. Sci Rep 2023; 13:7097. [PMID: 37130897 PMCID: PMC10154290 DOI: 10.1038/s41598-023-34352-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/27/2023] [Indexed: 05/04/2023] Open
Abstract
The relationship between serum uric acid (SUA) and poor cognitive performance in patients with ischemic stroke is unclear. We hypothesized that the severity of renal function mediates the association between SUA and cognitive dysfunction.A retrospective analysis of 608 patients with ischemic stroke was conducted between 2016 and 2020. SUA was obtained from inpatient medical records. Global cognitive function via mini-mental state exam (MMSE) and Montreal Cognitive Assessment (MoCA) was determined one month after hospital discharge. The relationship between SUA and cognitive function was assessed by multiple linear and logistic regression analyses. Patients had a mean age of 66.6 years (SD: 4.1 years), and 52% were male. The mean SUA level was 298.6 ± 75.4 μmol/L. SUA increases were significantly positively associated with lower MMSE and MoCA scores and increased risk of moderate-severe cognitive impairment one month after stroke (p < 0.01), even after adjusting for factors including age, gender, BMI, diabetes and hypertension history. Adding a term for estimated glomerular filtration rate (eGFR) attenuated these associations such that SUA was no longer associated with cognitive performance. A fully adjusted stronger negative association between SUA and cognitive performance was found in those who had lower eGFR, with a significant eGFR interaction for MMSE (p-interaction = 0.016) and MoCA (p-interaction = 0.005). In patients with ischemic stroke, SUA showed an inverse association with cognitive function among those who have lower eGFR. The renal function might mediate the association between SUA and cognitive dysfunction.
Collapse
Affiliation(s)
- Chunyan Zhang
- Department of Neurology, Second Hospital, Shanxi Medical University, 382 Wuyi Road, Taiyuan, 030001, Shanxi, China
| | - Xiuping Zhang
- Department of Neurology, Second Hospital, Shanxi Medical University, 382 Wuyi Road, Taiyuan, 030001, Shanxi, China
| | - Pengfei Meng
- Department of Neurology, Second Hospital, Shanxi Medical University, 382 Wuyi Road, Taiyuan, 030001, Shanxi, China
| | - Huizhong Gao
- Department of Neurology, Second Hospital, Shanxi Medical University, 382 Wuyi Road, Taiyuan, 030001, Shanxi, China
| | - Bo Bai
- Department of Neurology, Second Hospital, Shanxi Medical University, 382 Wuyi Road, Taiyuan, 030001, Shanxi, China
| | - Dongfang Li
- Department of Neurology, Second Hospital, Shanxi Medical University, 382 Wuyi Road, Taiyuan, 030001, Shanxi, China.
| |
Collapse
|
18
|
Salvadori E, Brambilla M, Maestri G, Nicotra A, Cova I, Pomati S, Pantoni L. The clinical profile of cerebral small vessel disease: Toward an evidence-based identification of cognitive markers. Alzheimers Dement 2023; 19:244-260. [PMID: 35362229 PMCID: PMC10084195 DOI: 10.1002/alz.12650] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 01/21/2022] [Accepted: 02/14/2022] [Indexed: 01/18/2023]
Abstract
There is no consensus on which test is more suited to outline the cognitive deficits of cerebral small vessel disease (cSVD) patients. We explored the ability of eight cognitive tests, selected in a previous systematic review as the most commonly used in this population, to differentiate among cSVD patients, controls, and other dementing conditions performing a meta-analysis of 86 studies. We found that cSVD patients performed worse than healthy controls in all tests while data on the comparison to neurodegenerative diseases were limited. We outlined a lack of data on these tests' accuracy on the diagnosis. Cognitive tests measuring processing speed were those mostly associated with neuroimaging cSVD markers. There is currently incomplete evidence that a single test could differentiate cSVD patients with cognitive decline from other dementing diseases. We make preliminary proposals on possible strategies to gain information about the clinical definition of cSVD that currently remains a neuroimaging-based one.
Collapse
Affiliation(s)
| | | | - Giorgia Maestri
- Neurology Unit, Luigi Sacco University Hospital, Milan, Italy
| | - Alessia Nicotra
- Neurology Unit, Luigi Sacco University Hospital, Milan, Italy
| | - Ilaria Cova
- Neurology Unit, Luigi Sacco University Hospital, Milan, Italy
| | - Simone Pomati
- Neurology Unit, Luigi Sacco University Hospital, Milan, Italy
| | - Leonardo Pantoni
- "Luigi Sacco" Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy.,Stroke and Dementia Lab, 'Luigi Sacco' Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| |
Collapse
|
19
|
Kotov SV, Kiselev AV, Isakova EV, Kotov AS, Stovbun SV, Borisova VA. [The effect of the start date of cognitive rehabilitation after ischemic stroke on the level of recovery]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:77-83. [PMID: 37682099 DOI: 10.17116/jnevro202312308277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
OBJECTIVE The dependence of result of cognitive training in patients who have suffered an ischemic stroke (IS) on the timing of their onset continues to be discussed. The aim was to study the results of cognitive rehabilitation of patients after IS during various periods after it. MATERIAL AND METHODS 140 patients were examined during complex rehabilitation in terms up to 1, 2-3, 4-6 and 7-12 months after IS, 78 of them received drug support (DS) of rehabilitation with intravenous injections of ampasse. The Montreal Cognitive Assessment (MoCA) and Hospital Anxiety and Depression Scale (HADS) were used to monitor the effectiveness of rehabilitation. RESULTS In all subgroups, there was a statistically significant increase in the MoCA score after the course, but number of people with an increase in the score by 1 or more points was highest among those who started the course 3 or more months after the development of IS (p=0.015). Among those who received DS, an increase in the MoCA was noted in 87.2%, in those who did not receive it - 38.7% (p<0.001). There was no statistically significant increase in the severity of anxiety and depression after the course of treatment in any of the subgroups. CONCLUSION The used approach of a combination of cognitive, physical rehabilitation and DS proved to be justified for achieving results during a two-week course of inpatient rehabilitation of patients both in the early and late recovery period after IS.
Collapse
Affiliation(s)
- S V Kotov
- Vladimirsky Moscow Regional Research and Clinical Institute, Moscow, Russia
| | - A V Kiselev
- Semenov Federal Research Center for Chemical Physics, Moscow, Russia
| | - E V Isakova
- Vladimirsky Moscow Regional Research and Clinical Institute, Moscow, Russia
| | - A S Kotov
- Vladimirsky Moscow Regional Research and Clinical Institute, Moscow, Russia
| | - S V Stovbun
- Semenov Federal Research Center for Chemical Physics, Moscow, Russia
| | - V A Borisova
- Vladimirsky Moscow Regional Research and Clinical Institute, Moscow, Russia
| |
Collapse
|
20
|
Cherkos K, Jember G, Mihret T, Fentanew M. Prevalence and Associated Factors of Cognitive Impairment Among Stroke Survivors at Comprehensive Specialized Hospitals in Northwest Ethiopia: Multi-Centered Cross-Sectional Study. Vasc Health Risk Manag 2023; 19:265-277. [PMID: 37138791 PMCID: PMC10150733 DOI: 10.2147/vhrm.s405357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 04/22/2023] [Indexed: 05/05/2023] Open
Abstract
Background Deficit in cognitive impairment is the most serious of the stroke sequelae. Post-stroke cognitive impairment is associated with impaired daily living activities and decreased capacity for independent living and functional performance. As a result, the purpose of this study was to determine the prevalence and associated factors of cognitive impairment among stroke survivors at comprehensive specialized hospitals in Ethiopia's Amhara region by 2022. Methods A multi-centered cross-sectional study was designed at an institution. During the study period. Data was gathered by conducting structured questionnaire interviews with participants and reviewing medical charts with trained data collectors. The participants were chosen using a systematic random sampling technique. The Montreal cognitive assessment basic was used to assess cognitive impairment. Descriptive statistics, binary and multivariate logistic regression methods were used to analyze the data. The Hosmer-Lemeshow goodness-of-fit test was used to assess the fitness of the model. The AOR with a P value of 0.05 at 95% CI was reported, and variables were considered statistically significant. Results This study enrolled 422 stroke survivors. Overall, 58.3% of stroke survivors had cognitive impairment (95% CI 53.4-63.0%). The study participants' age with AOR; 7.12 (4.40-11.45), being hypertensive with AOR; 7.52 (3.46-16.35), arriving at the hospital after 24 hours with AOR; 4.33 (1.49-12.05), less than three months after stroke with AOR; 4.83 (3.95-12.19), dominant hemisphere lesion with AOR; 4.83 (3.95-12.19) and being illiterate with AOR; 5.26 (4.43-18.64) were found significant factors. Conclusion Cognitive impairment was discovered to be relatively common among stroke survivors in this study. More than half of stroke survivors who attended comprehensive specialized hospitals during the study period were found to have cognitive impairment. Age, hypertension, arriving at the hospital after 24 hours, less than three months after stroke, dominant hemisphere lesion, and illiterate educational status were all significant factors in cognitive impairment.
Collapse
Affiliation(s)
- Kassahun Cherkos
- Department of Physiotherapy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Gashaw Jember
- Department of Physiotherapy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tewodros Mihret
- Department of Physiotherapy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Molla Fentanew
- Department of Physiotherapy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Correspondence: Molla Fentanew, University of Gondar, P.O. Box. 196, Gondar, Ethiopia, Tel +251935686860, Email
| |
Collapse
|
21
|
Chiavilli M, Campagnini S, Baretta T, Castagnoli C, Paperini A, Politi AM, Pellicciari L, Baccini M, Basagni B, Marignani S, Bardi D, Sodero A, Lombardi G, Guolo E, Navarro JS, Galeri S, Montesano A, Falco L, Rovaris MG, Carrozza MC, Macchi C, Mannini A, Cecchi F. Design and implementation of a Stroke Rehabilitation Registry for the systematic assessment of processes and outcomes and the development of data-driven prediction models: The STRATEGY study protocol. Front Neurol 2022; 13:919353. [PMID: 36299268 PMCID: PMC9588928 DOI: 10.3389/fneur.2022.919353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 08/09/2022] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Stroke represents the second preventable cause of death after cardiovascular disease and the third global cause of disability. In countries where national registries of the clinical quality of stroke care have been established, the publication and sharing of the collected data have led to an improvement in the quality of care and survival of patients. However, information on rehabilitation processes and outcomes is often lacking, and predictors of functional outcomes remain poorly explored. This paper describes a multicenter study protocol to implement a Stroke rehabilitation Registry, mainly based on a multidimensional assessment proposed by the Italian Society of Physical and Rehabilitation Medicine (PMIC2020), in a pilot Italian cohort of stroke survivors undergoing post-acute inpatient rehabilitation, to provide a systematic assessment of processes and outcomes and develop data-driven prediction models of functional outcomes. METHODS All patients with a diagnosis of ischemic or haemorrhagic stroke confirmed by clinical assessment, admitted to intensive rehabilitation units within 30 days from the acute event, aged 18+, and providing informed consent will be enrolled. Measures will be taken at admission (T0), at discharge (T1), and at follow-up, 3 months (T2) and 6 months (T3) after the stroke. Assessment variables include anamnestic data, clinical and nursing complexity information and measures of body structures and function, activity and participation (PMIC2020), rehabilitation interventions, adverse events and discharge data. The modified Barthel Index will be our primary outcome. In addition to classical biostatistical analysis, learning algorithms will be cross-validated to achieve data-driven prognosis prediction models. CONCLUSIONS This study will test the feasibility of a stroke rehabilitation registry in the Italian health context and provide a systematic assessment of processes and outcomes for quality assessment and benchmarking. By the development of data-driven prediction models in stroke rehabilitation, this study will pave the way for the development of decision support tools for patient-oriented therapy planning and rehabilitation outcomes maximization. CLINICAL TIAL REGISTRATION The registration on ClinicalTrials.gov is ongoing and under review. The identification number will be provided when the review process will be completed.
Collapse
Affiliation(s)
| | - Silvia Campagnini
- IRCCS Fondazione Don Carlo Gnocchi onlus, Firenze, Italy
- The Biorobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Teresa Baretta
- IRCCS Fondazione Don Carlo Gnocchi onlus, Firenze, Italy
| | | | - Anita Paperini
- IRCCS Fondazione Don Carlo Gnocchi onlus, Firenze, Italy
| | | | | | - Marco Baccini
- IRCCS Fondazione Don Carlo Gnocchi onlus, Firenze, Italy
| | | | - Sara Marignani
- IRCCS Fondazione Don Carlo Gnocchi onlus, Firenze, Italy
| | - Donata Bardi
- IRCCS Fondazione Don Carlo Gnocchi onlus, Firenze, Italy
| | - Alessandro Sodero
- IRCCS Fondazione Don Carlo Gnocchi onlus, Firenze, Italy
- NEUROFARBA Department, Neuroscience Section, University of Florence, Florence, Italy
| | - Gemma Lombardi
- IRCCS Fondazione Don Carlo Gnocchi onlus, Firenze, Italy
| | - Erika Guolo
- IRCCS Fondazione Don Carlo Gnocchi onlus, Firenze, Italy
| | | | - Silvia Galeri
- IRCCS Fondazione Don Carlo Gnocchi Onlus, Milan, Italy
| | | | - Lucia Falco
- IRCCS Fondazione Don Carlo Gnocchi Onlus, Milan, Italy
| | | | | | - Claudio Macchi
- IRCCS Fondazione Don Carlo Gnocchi onlus, Firenze, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Andrea Mannini
- IRCCS Fondazione Don Carlo Gnocchi onlus, Firenze, Italy
| | - Francesca Cecchi
- IRCCS Fondazione Don Carlo Gnocchi onlus, Firenze, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| |
Collapse
|
22
|
Pu M, You Y, Wang X. Predictive value of serum matrix metalloproteinase 9 combined with tissue inhibitor of metalloproteinase 1 for post-stroke cognitive impairment. J Clin Neurosci 2022; 105:103-108. [PMID: 36148726 DOI: 10.1016/j.jocn.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/14/2022] [Accepted: 09/02/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Post-stroke cognitive impairment (PSCI) seriously affects the quality of life of patients. Identifying early predictors of PSCI to realize timely intervention of PSCI can provide effective information for patient rehabilitation and follow-up treatment, and has important clinical significance for delaying its progression to dementia. METHODS Montreal Cognitive Assessment (MoCA) and National Institutes of Health Stroke Scale (NIHSS) were used to assess patients' cognitive and neurological function separately. ELISA was used to analyze serum tissue inhibitor of metalloproteinase 1 (TIMP 1) and matrix metalloproteinase 9 (MMP 9) levels of patients on admission. RESULTS 180 patients with first-ever acute ischemic stroke (AIS) were included in the study. After three months of follow-up, 78 patients were diagnosed with PSCI, and 102 patients did not have PSCI. MMP 9 and TIMP 1 were elevated in PSCI patients on admission relative to non-PSCI groups, and they were positively correlated with patients' NIHSS scores on admission (p < 0.001). Serum levels of MMP 9 and TIMP 1 in PSCI patients were negatively correlated with MoCA scores at the end of the 3-month follow-up (p < 0.001). Serum MMP 9 (p < 0.001), TIMP 1 (p = 0.02) and combined detection (p < 0.001) of AIS patients at admission appear to have predictive value for the diagnosis of PSCI three months later. CONCLUSION Serum MMP 9 and TIMP 1 levels in stroke patients were statistically predictive of PSCI.
Collapse
Affiliation(s)
- Mengjia Pu
- Department of Neurology, the Affiliated Wuxi People's Hospital of Nanjing Medical University, No.299 Qingyang Road, Wuxi 214023, Jiangsu, China
| | - Yiping You
- Department of Neurology, the Affiliated Wuxi People's Hospital of Nanjing Medical University, No.299 Qingyang Road, Wuxi 214023, Jiangsu, China
| | - Xuehui Wang
- Department of Neurology, the Affiliated Wuxi People's Hospital of Nanjing Medical University, No.299 Qingyang Road, Wuxi 214023, Jiangsu, China.
| |
Collapse
|
23
|
Xiao P, Hua K, Chen F, Yin Y, Wang J, Fu X, Yang J, Liu Q, Chan Q, Jiang G. Abnormal Cerebral Blood Flow and Volumetric Brain Morphometry in Patients With Obstructive Sleep Apnea. Front Neurosci 2022; 16:934166. [PMID: 35873812 PMCID: PMC9298748 DOI: 10.3389/fnins.2022.934166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 05/30/2022] [Indexed: 11/13/2022] Open
Abstract
Obstructive sleep apnea (OSA) is a serious breathing disorder, leading to myocardial infarction, high blood pressure, and stroke. Brain morphological changes have been widely reported in patients with OSA. The pathophysiological mechanisms of cerebral blood flow (CBF) changes associated with OSA are not clear. In this study, 20 patients with OSA and 36 healthy controls (HCs) were recruited, and then pseudo-continuous arterial spin labeling (pCASL) and voxel-based morphometry (VBM) methods were utilized to explore blood perfusion and morphological changes in the patients with OSA. Compared with the HC group, the OSA group showed increased CBF values in the right medial prefrontal cortex (mPFC), left precentral gyrus, and right insula and showed decreased CBF values in the right temporal pole (TP) and the right cerebellum_Crus2. Compared with the HC group, the patients with OSA showed decreased gray matter volume (GMV) in the right dorsal lateral prefrontal cortex (DLPFC), the right occipital pole, and the vermis. There were no significantly increased GMV brain regions found in patients with OSA. Pearson correlation analysis showed that the reduced GMV in the right DLPFC and the right occipital pole was both positively correlated with Mini-Mental State Examination (MMSE) (r = 0.755, p < 0.001; r = 0.686, p = 0.002) and Montreal Cognitive Assessment (MoCA) scores (r = 0.716, p = 0.001; r = 0.601, p = 0.008), and the reduced GMV in the right occipital pole was negatively correlated with duration of illness (r = -0.497, p = 0.036). Patients with OSA have abnormal blood perfusion metabolism and morphological changes in brain regions including the frontal lobe and the cerebellum and were closely related to abnormal behavior, psychology, and cognitive function, which play an important role in the pathophysiological mechanism of OSA.
Collapse
Affiliation(s)
- Ping Xiao
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Department of Otolaryngology-Head & Neck Surgery, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Kelei Hua
- Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Feng Chen
- Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Yi Yin
- Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Jurong Wang
- Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Xiangjun Fu
- Department of Otolaryngology-Head & Neck Surgery, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Jiasheng Yang
- Department of Respiratory and Critical Care Medicine, Center for Sleep Medicine, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Qingfeng Liu
- Department of Respiratory and Critical Care Medicine, Center for Sleep Medicine, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Queenie Chan
- Philips Healthcare, Hong Kong, Hong Kong SAR, China
| | - Guihua Jiang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, China
| |
Collapse
|
24
|
Valério D, Almeida J, Demeyere N, Lima M, Nogueira J, Santana I. The European Portuguese version of the Oxford Cognitive Screening (OCS-Pt): a screening test for acute stroke patients. Neurol Sci 2022; 43:3717-3728. [DOI: 10.1007/s10072-022-05880-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 01/05/2022] [Indexed: 11/24/2022]
|
25
|
Tran L, Alvarez XA, Le HA, Nguyen DA, Le T, Nguyen N, Nguyen T, Nguyen T, Vo T, Tran T, Duong C, Nguyen H, Nguyen S, Nguyen H, Le T, Nguyen M, Nguyen T. Clinical Efficacy of Cerebrolysin and Cerebrolysin plus Nootropics in the Treatment of Patients with Acute Ischemic Stroke in Vietnam. CNS & NEUROLOGICAL DISORDERS DRUG TARGETS 2022; 21:621-630. [PMID: 34414874 DOI: 10.2174/1871527320666210820091655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 06/29/2021] [Accepted: 07/11/2021] [Indexed: 01/13/2023]
Abstract
AIMS To investigate the efficacy and safety of Cerebrolysin and Cerebrolysin plus nootropics in the routine treatment of patients with acute ischemic stroke (AIS). BACKGROUND Acute ischemic stroke (AIS) is a leading cause of disability with unmet treatment needs lacking effective drug therapy. Multimodal drugs modulating stroke pathophysiology as Cerebrolysin constitute a good therapeutic option. OBJECTIVE In this study, we assessed the effects of Cerebrolysin and Cerebrolysin plus nootropics, in comparison with other nootropic drugs alone, on functional, neurological and cognitive recovery of patients with AIS in Vietnam. METHODS This non-interventional, controlled, open-label, prospective and multicenter study included 398 AIS patients (234 males) treated with Cerebrolysin (n=190; 20 i.v. infusions of 10 ml), other nootropics (comparator group; n=86), or a combination of both (n=122). The study primary endpoint was the modified Ranking Scale (mRS) score on day 90. Secondary endpoints included study-period change in NIHSS score; percentage of well-recovered (mRS 0-2) patients, the proportion of good NIHSS response (≥6 points) cases, and MoCA scores at day 90; and safety indicators. RESULTS Compared with other nootropics, both Cerebrolysin and combined therapy induced significant improvements (p<0.001) in: Functional recovery (mRS scores); percentage of well-recovered patients (Cerebrolysin: 81.6%; combination: 93.4%; comparator: 43.0%); neurological recovery (study- period NIHSS change); proportion of good NIHSS responders (Cerebrolysin: 77.5%; combination: 92.5%; comparator: 47.6%); and MoCA scores (Cerebrolysin: 23.3±4.8; combination: 23.7±4.1; comparator: 15.9±7.7). Compared to Cerebrolysin, combined therapy improved (p<0.01) mRS outcomes and NIHSS change, but not MoCA scores, in moderate-severe stroke (NIHSS>11) cases only. No drug-related adverse events were reported. CONCLUSION Cerebrolysin alone or combined with other nootropics was effective and safe in routine AIS treatment, during both acute and recovery phases, which supports its use in daily clinical practice. Others: According to the results of this multicenter study, the importance of reducing differences in the treatment regimens of AIS in Vietnam should be further emphasized.
Collapse
Affiliation(s)
- Luc Tran
- Outpatient Department, National Geriatric Hospital, Hanoi, Vietnam
| | - X Anton Alvarez
- Medinova Institute of Neurosciences, Clinica RehaSalud, A Coruña, Spain.,Clinical Research Department, QPS Holdings, A Coruña, Spain
| | | | | | - Thinh Le
- Neurology Department, Bach Mai Hospital, Hanoi, Vietnam
| | - Ngoc Nguyen
- Stroke centre, 108 Military Hospital, Hanoi, Vietnam
| | - Thang Nguyen
- Department of Cerebrovascular Disease, 115 People's Hospital, Hochiminh City, Vietnam
| | - Tai Nguyen
- Neurology Department, Cho Ray Hospital, Hochiminh City, Vietnam
| | - Tan Vo
- Neurology Department, Gia Dinh People's Hospital, Hochiminh City, Vietnam
| | - Tuan Tran
- Neurology Department, Thai Nguyen Central General Hosp, Thainguyen, Vietnam
| | - Chinh Duong
- Neurology Department, Nghe An General Hospital, Nghean, Vietnam
| | - Huyen Nguyen
- Neurology Department, Viet Tiep General Hospital, Haiphong, Vietnam
| | - Sam Nguyen
- Neurology Department, Thanh Hoa General Hospital, Thanhhoa, Vietnam
| | - Hien Nguyen
- Stroke unit, 103 Military Hospital, Hanoi, Vietnam
| | - Thanh Le
- Neurology Department, Thong Nhat Hospital, Hochiminh City, Vietnam
| | - Minh Nguyen
- Neurology Department, Trung Vuong Hospital, Hochiminh City, Vietnam
| | - Thang Nguyen
- Neurology Department, Hochiminh City Medicine and Pharmacy University Hospital, Hochiminh City, Vietnam
| |
Collapse
|
26
|
YANG JH, ZHU YL, HAN B, YANG L. Clinical observation of taking acupuncture at the acupoints based on "four seas theory" for post-stroke cognitive impairment 基于“四海理论”组穴针刺治疗脑卒中后认知障碍的临床观察. WORLD JOURNAL OF ACUPUNCTURE-MOXIBUSTION 2022. [DOI: 10.1016/j.wjam.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
27
|
Rosenstein I, Andersen O, Victor D, Englund E, Granberg T, Hedberg‐Oldfors C, Jood K, Fitrah YA, Ikeuchi T, Danylaité Karrenbauer V. Four Swedish cases of CSF1R-related leukoencephalopathy: Visualization of clinical phenotypes. Acta Neurol Scand 2022; 145:599-609. [PMID: 35119108 PMCID: PMC9304267 DOI: 10.1111/ane.13589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/04/2022] [Accepted: 01/18/2022] [Indexed: 11/28/2022]
Abstract
Colony stimulating factor 1 receptor (CSF1R)‐related leukoencephalopathy is a rare, genetic disease caused by heterozygous mutations in the CSF1R gene with rapidly progressive neurodegeneration, behavioral, cognitive, motor disturbances.
Collapse
Affiliation(s)
- Igal Rosenstein
- Department of Clinical Neuroscience Institute of Neuroscience and Physiology Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Department of neurology Region Västra Götaland Södra Älvsborgs Hospital Borås Sweden
- Department of Neurology Region Västra Götaland Sahlgrenska University Hospital Gothenburg Sweden
| | - Oluf Andersen
- Department of Clinical Neuroscience Institute of Neuroscience and Physiology Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Department of Neurology Region Västra Götaland Sahlgrenska University Hospital Gothenburg Sweden
| | - Daniel Victor
- Department of Neurology Halmstad Hospital Halmstad Sweden
| | - Elisabet Englund
- Neuropathology, Department of Genetics and Pathology Laboratory Medicine Lund Sweden
| | - Tobias Granberg
- Department of Neuroradiology Karolinska University Hospital Stockholm Sweden
- Department of Clinical Neuroscience Karolinska Institute Stockholm Sweden
| | - Carola Hedberg‐Oldfors
- Department of Laboratory Medicine Institute of Biomedicine University of Gothenburg Gothenburg Sweden
| | - Katarina Jood
- Department of Clinical Neuroscience Institute of Neuroscience and Physiology Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Department of Neurology Region Västra Götaland Sahlgrenska University Hospital Gothenburg Sweden
| | | | | | - Virginija Danylaité Karrenbauer
- Department of Clinical Neuroscience Karolinska Institute Stockholm Sweden
- Medical Unit Neuro R52 Karolinska University Hospital Stockholm Sweden
| |
Collapse
|
28
|
Yan X, Ren Z, Wen Q, Jin X, Wang Y, Zhang W. Uric Acid and Cognitive Impairment in Patients with Acute Ischemic Stroke: A Meta-Analysis. Horm Metab Res 2022; 54:316-324. [PMID: 35533675 DOI: 10.1055/a-1798-0387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Serum uric acid (UA) has been suggested to be correlated with outcomes after stroke. We performed a meta-analysis to evaluate the association between serum UA and post-stroke cognitive impairment (PSCI) in patients with acute ischemic stroke (AIS). Relevant observational studies were identified by search of electronic databases including PubMed, Embase, and Web of Science. A randomized-effect model incorporating the possible between-study heterogeneity was used to pool the results. Overall, eleven studies with 4246 patients of AIS were included, 2073 (48.8%) of them had PSCI. Pooled results showed that patients with PSCI had significantly higher level of serum UA as compared to those without PSCI (mean difference: 35.70 μmol/l, 95% confidence interval (CI): 8.36 to 63.01, p=0.01; I2=95%). Subgroup analysis showed significant higher level of serum UA in patients with PSCI evaluated during follow-up of 3 months to 3 years, but not for those evaluated during hospitalization (p for subgroup difference=0.01). In addition, results of meta-analysis also showed that compared to patients with lower serum UA, AIS patients with higher serum UA had increased risk of PSCI (odds ratio: 1.33, 95% CI: 1.02 to 1.73, p=0.04; I2=72%). Higher level of serum UA after disease onset may be a marker of increased risk of PSCI in patients with AIS. Although these findings need to be validated in large-scale prospective studies, the possible mechanisms underlying the association between UA and PSCI should be also investigated.
Collapse
Affiliation(s)
- Xue Yan
- Center of Cerebral Diseases, the Third Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, China
| | - Zhong Ren
- Center of Cerebral Diseases, the Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, China
| | - Quan Wen
- Center of Cerebral Diseases, the Third Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, China
| | - Xi Jin
- Center of Cerebral Diseases, the Third Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, China
| | - Ying Wang
- Center of Cerebral Diseases, the Third Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, China
| | - Weimin Zhang
- Center of Cerebral Diseases, the Third Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, China
| |
Collapse
|
29
|
Prediction of post-stroke cognitive impairment by Montreal Cognitive Assessment (MoCA) performances in acute stroke: comparison of three normative datasets. Aging Clin Exp Res 2022; 34:1855-1863. [PMID: 35441928 PMCID: PMC9283135 DOI: 10.1007/s40520-022-02133-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 03/29/2022] [Indexed: 11/30/2022]
Abstract
Background Cognitive assessment in acute stroke is relevant for identifying patients at risk of persistent post-stroke cognitive impairment (PSCI). Despite preliminary evidence on MoCA accuracy, there is no consensus on its optimal score in the acute stroke setting to predict PSCI. Aims (1) To explore whether the application of different normative datasets to MoCA scores obtained in the acute stroke setting results in variable frequency of patients defined as cognitively impaired; (2) to assess whether the normality cut-offs provided by three normative datasets predict PSCI at 6–9 months; (3) to calculate alternative MoCA cut-offs able to predict PSCI. Methods Consecutive stroke patients were reassessed at 6–9 months with extensive neuropsychological and functional batteries for PSCI determination. Results Out of 207 enrolled patients, 118 (57%) were followed-up (mean 7.4 ± 1.7 months), and 77 of them (65%) received a PSCI diagnosis. The application of the normality thresholds provided by the 3 normative datasets yielded to variable (from 28.5% to 41%) rates of patients having an impaired MoCA performance, and to an inadequate accuracy in predicting PSCI, maximizing specificity instead of sensitivity. In ROC analyses, a MoCA score of 22.82, adjusted according to the most recent normative dataset, achieved a good diagnostic accuracy in predicting PSCI. Conclusions The classification of acute stroke patients as normal/impaired based on MoCA thresholds proposed by general population normative datasets underestimated patients at risk of persistent PSCI. We calculated a new adjusted MoCA score predictive of PSCI in acute stroke patients to be further tested in larger studies.
Collapse
|
30
|
Rost NS, Brodtmann A, Pase MP, van Veluw SJ, Biffi A, Duering M, Hinman JD, Dichgans M. Post-Stroke Cognitive Impairment and Dementia. Circ Res 2022; 130:1252-1271. [PMID: 35420911 DOI: 10.1161/circresaha.122.319951] [Citation(s) in RCA: 202] [Impact Index Per Article: 101.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Poststroke cognitive impairment and dementia (PSCID) is a major source of morbidity and mortality after stroke worldwide. PSCID occurs as a consequence of ischemic stroke, intracerebral hemorrhage, or subarachnoid hemorrhage. Cognitive impairment and dementia manifesting after a clinical stroke is categorized as vascular even in people with comorbid neurodegenerative pathology, which is common in elderly individuals and can contribute to the clinical expression of PSCID. Manifestations of cerebral small vessel disease, such as covert brain infarcts, white matter lesions, microbleeds, and cortical microinfarcts, are also common in patients with stroke and likewise contribute to cognitive outcomes. Although studies of PSCID historically varied in the approach to timing and methods of diagnosis, most of them demonstrate that older age, lower educational status, socioeconomic disparities, premorbid cognitive or functional decline, life-course exposure to vascular risk factors, and a history of prior stroke increase risk of PSCID. Stroke characteristics, in particular stroke severity, lesion volume, lesion location, multiplicity and recurrence, also influence PSCID risk. Understanding the complex interaction between an acute stroke event and preexisting brain pathology remains a priority and will be critical for developing strategies for personalized prediction, prevention, targeted interventions, and rehabilitation. Current challenges in the field relate to a lack of harmonization of definition and classification of PSCID, timing of diagnosis, approaches to neurocognitive assessment, and duration of follow-up after stroke. However, evolving knowledge on pathophysiology, neuroimaging, and biomarkers offers potential for clinical applications and may inform clinical trials. Preventing stroke and PSCID remains a cornerstone of any strategy to achieve optimal brain health. We summarize recent developments in the field and discuss future directions closing with a call for action to systematically include cognitive outcome assessment into any clinical studies of poststroke outcome.
Collapse
Affiliation(s)
- Natalia S Rost
- J. Philip Kistler Stroke Research Center (N.S.R., S.J.v.V., A. Biffi), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Amy Brodtmann
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Australia (A. Brodtmann).,Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia (A. Brodtmann. M.P.P.)
| | - Matthew P Pase
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia (A. Brodtmann. M.P.P.).,Harvard T.H. Chan School of Public Health, Boston (M.P.P.)
| | - Susanne J van Veluw
- MassGeneral Institute for Neurodegenerative Disease, Massachusetts General Hospital, Charlestown (S.J.v.V.)
| | - Alessandro Biffi
- J. Philip Kistler Stroke Research Center (N.S.R., S.J.v.V., A. Biffi), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston.,Divisions of Memory Disorders and Behavioral Neurology (A. Biffi), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Marco Duering
- J. Philip Kistler Stroke Research Center (N.S.R., S.J.v.V., A. Biffi), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston.,Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Germany (M. Duering, M. Dichgans).,Medical Image Analysis Center and Department of Biomedical Engineering, University of Basel, Switzerland (M. Duering)
| | - Jason D Hinman
- Department of Neurology, David Geffen School of Medicine, University of California Los Angeles (J.D.H.).,Department of Neurology, West Los Angeles VA Medical Center, CA (J.D.H.)
| | - Martin Dichgans
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Germany (M. Duering, M. Dichgans).,German Center for Neurodegenerative Diseases (DZNE), Munich, Germany (M. Dichgans).,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany (M. Dichgans)
| |
Collapse
|
31
|
Shen W, Fan X, Wang L, Zhang Y. Traditional Chinese Medicine for Post-Stroke Cognitive Impairment: A Systematic Review and Meta-Analysis. Front Pharmacol 2022; 13:816333. [PMID: 35237166 PMCID: PMC8883343 DOI: 10.3389/fphar.2022.816333] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/18/2022] [Indexed: 12/29/2022] Open
Abstract
Background: Post-stroke cognitive impairment (PSCI) affects more than one-third of stroke patients, and causes much greater harm to long-term function than the initial brain damage. No conventional Western medications have shown convincing clinical effectiveness for treating PSCI. Research shows that Traditional Chinese medicine (TCM) can improve cognitive function in patients. However, the clinical efficacy and safety remain controversial. The aim of this study was to examine the effectiveness and harmful effects of TCMs in the treatment of PSCI. Method: We searched seven databases and two clinical registration websites for randomized controlled trials (RCTs). The revised Cochrane risk of bias tool (RoB 2.0) was used to evaluate the methodological quality and RevMan 5.4 was used for data analysis. This study has been submitted to PROSPERO with registration number is CRD42020149299. Results: We included 34 studies in this review. The results of this study showed that TCM adjuvant therapy improved scores on the MoCA [MD = 2.55, 95% CI (1.56, 3.53), p < 0.00001; MD = 3.07, 95% CI (1.98, 4.17), p < 0.00001 at treatment duration of <3 and 3 months, respectively], MMSE [MD = 2.55, 95% CI (1.99, 3.10), p < 0.00001; MD = 2.53, 95% CI (1.59, 3.47), p < 0.00001; MD = 2.91, 95% CI (1.26, 4.56), p = 0.0006; MD = 3.11, 95% CI (-0.04, 6.27), p = 0.05 at treatment duration of <3, 3, 4, and 6 months, respectively], and BI [MD = 7.34, 95% CI (3.83, 10.85), p < 0.0001; MD = 8.98, 95% CI (4.76, 13.21), p < 0.0001 at treatment duration of <3 and 3 months, respectively] and reduced scores on the ADL (MD = -8.64, 95% CI (-9.83, -7.45), p < 0.00001; MD = -2.00, 95% CI (-2.94, -1.06), p < 0.0001 at treatment duration of 3 and 4 months, respectively], NIHSS [MD = -2.48, 95% CI (-4.97, 0.00), p = 0.05; MD = -3.81, 95% CI (-6.21, -1.40), p = 0.002 at treatment duration of <3 and 3 months, respectively], and CSS [MD = -2.47, 95% CI (-3.49, -1.45), p < 0.00001 at a treatment duration of 3 months]. No serious adverse reactions were observed. Conclusion: Despite the significant positive results, the present evidence supports, to a limited extent because of the methodological flaws and herbal heterogeneity, that TCM adjuvant therapy can be used for patients with PSCI. While, further rigorous RCTs are warranted to confirm the efficacy and safety of TCM. Systematic Review Registration: https://www.crd.york.ac.uk/prospero, identifier CRD42020149299.
Collapse
Affiliation(s)
- Wei Shen
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xueming Fan
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Liuding Wang
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yunling Zhang
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| |
Collapse
|
32
|
Fan X, Shen W, Wang L, Zhang Y. Efficacy and Safety of DL-3-n-Butylphthalide in the Treatment of Poststroke Cognitive Impairment: A Systematic Review and Meta-Analysis. Front Pharmacol 2022; 12:810297. [PMID: 35145408 PMCID: PMC8823901 DOI: 10.3389/fphar.2021.810297] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 12/08/2021] [Indexed: 01/02/2023] Open
Abstract
Background: Poststroke cognitive impairment (PSCI) is a common complication observed after stroke. Current pharmacologic therapies have no definitive evidence for cognitive recovery or disease progression. Recent studies have verified the positive effect of DL-3-n-butylphthalide (NBP). However, the clinical efficacy and safety are still unclear. The aim of this study was to assess the efficacy of NBP and its harmful effect in the treatment of PSCI. Method: Eligible randomized controlled trials (RCTs) were retrieved from inception to June 2021 from seven medical databases and two clinical registries. The revised Cochrane risk of bias tool (RoB 2.0) was used for methodological quality. RevMan v5.4.1 from Cochrane Collaboration was used for statistical analysis, and Hartung-Knapp-Sidik-Jonkman (HKSJ) method was used for post hoc testing depend on the number of studies. This study has been submitted to PROSPERO with registration number is CRD42021274123. Result: We identified 26 studies with a total sample size of 2,571 patients. The results of this study showed that NBP as monotherapy or combination therapy had better performance in increasing the MoCA (monotherapy: SMDN = 1.05, 95% CI [0.69, 1.42], p < 0.00001; SMDP = 1.06, 95% CI [0.59, 1.52], p < 0.00001. combination: SMDO = 0.81, 95% CI [0.62, 1.01], p < 0.00001; SMDN = 0.90, 95% CI [0.46, 1.33], p < 0.0001; SMDD = 1.04, 95% CI [0.71, 1.38], p < 0.00001), MMSE (monotherapy: MDN = 4.89, 95% CI [4.14, 5.63]), p < 0.00001). combination: SMDO = 1.26, 95% CI [0.97, 1.56], p < 0.00001; SMDC = 1.63, 95% CI [1.28, 1.98], p < 0.00001; SMDN = 2.13, 95% CI [1.52, 2.75], p < 0.00001) and BI (monotherapy: MDN = 13.53, HKSJ 95% CI [9.84, 17.22], p = 0.014. combination: SMDO = 2.24, HKSJ 95%CI [0.37, 4.11], p = 0.032; SMDC = 3.36, 95%CI [2.80, 3.93], p < 0.00001; SMDD = 1.48, 95%CI [1.13, 1.83], p < 0.00001); and decreasing the NIHSS (monotherapy: MDN = −3.86, 95% CI [−5.22, −2.50], p < 0.00001. combination: SMDO = −1.15, 95% CI [−1.31, −0.98], p < 0.00001; SMDC = −1.82, 95% CI [−2.25, −1.40], p < 0.00001) and CSS (combination: MDO = −7.11, 95% CI [−8.42, −5.80], p < 0.00001), with no serious adverse reactions observed. The funnel plot verified the possibility of publication bias. Conclusion: NBP maintains a stable pattern in promoting the recovery of cognitive function and abilities of daily living, as well as reducing the symptoms of neurological deficits. However, there is still a need for more high-quality RCTs to verify its efficacy and safety.
Collapse
Affiliation(s)
| | - Wei Shen
- *Correspondence: Wei Shen, ; Yunling Zhang,
| | | | | |
Collapse
|
33
|
Ramírez-Moreno J, Bartolomé Alberca S, Muñoz Vega P, Guerrero Barona E. Screening for cognitive impairment with the Montreal Cognitive Assessment in Spanish patients with minor stroke or transient ischaemic attack. NEUROLOGÍA (ENGLISH EDITION) 2022; 37:38-44. [DOI: 10.1016/j.nrleng.2018.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 11/17/2018] [Indexed: 10/23/2022] Open
|
34
|
Lan C, Huang Z, Luo X, Zhang Y. The Correlations Between Serum Hcy Level and Seizures and Cognitive Function in Patients After Stroke. Am J Alzheimers Dis Other Demen 2022; 37:15333175221146738. [PMID: 36541875 PMCID: PMC10581107 DOI: 10.1177/15333175221146738] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUNDS Post-stroke cognitive dysfunction (PSCI), a set of illnesses ranging from moderate cognitive impairment to dementia, which is one of the most prevalent consequences following a stroke. Homocysteine (Hcy) has been related to a number of neurological and systemic diseases. It's also a known risk factor for cardiovascular disease and systemic atherosclerosis (CVD). The link between Hcy and PSCI, on the other hand, is unknown. METHODS Our hospital evaluated 325 patients with acute cerebral infarction between January 1, 2018 and December 1, 2021. There are biological markers and baseline data available. Patients were divided into two groups based on the results of the Montreal Cognitive Assessment (MoCA). The researchers performed logistic regression analysis to find variables that may be linked to PSCI. RESULTS HCY levels were significantly higher in PSCI patients than in non-PSCI patients. Age, education, seizure manifestation, and income level were all shown to be independent risk variables for PSCI in a multivariate logistic analysis. Hcy levels in PSCI patients differed considerably between the high and low groups. The high and low Hcy levels groups had significantly varied hypertension histories and urine levels. Hcy levels in PSCI patients differed considerably between the high and low groups. The high and low Hcy levels groups had significantly varied hypertension histories and urine levels. CONCLUSION Serum Hcy levels have been linked to PSCI in post-stroke patients, and researchers believe that serum Hcy levels will diminish PSCI.
Collapse
Affiliation(s)
- Chen Lan
- Jinggangshan University, Ji’an, China
- Neurology Department, Affiliated Hospital of Jinggangshan University, Ji’an, China
| | - Zhiqiang Huang
- Neurology Department, Affiliated Hospital of Jinggangshan University, Ji’an, China
| | - Xinxin Luo
- Neurology Department, Affiliated Hospital of Jinggangshan University, Ji’an, China
| | - Yongcheng Zhang
- Neurology Department, Affiliated Hospital of Jinggangshan University, Ji’an, China
| |
Collapse
|
35
|
Kotov SV, Borisova VA, Slyunkova EV, Isakova EV, Kiselev AV, Kotov AS. [Dynamics of recovery of cognitive deficit in patients in the early recovery period of ischemic stroke]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:26-32. [PMID: 34932282 DOI: 10.17116/jnevro202112111126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Study of the effectiveness of the use of the drug Ampasse in the process of complex rehabilitation in patients in the early recovery period of ischemic stroke at the second (stationary) stage. MATERIAL AND METHODS The study included 60 patients, 28 women and 32 men, aged 43 to 76 years (mean - 58.4±9.1 years), in the recovery period after suffering a stroke in the period from 1 to 12 months (on average - 4.7±3.5 months). All patients received complex rehabilitation, patients of the 1st group received additional intravenous injections of the drug Ampasse 25 mg (5.0 ml), 15 injections. Patients of the 2nd group (n 0) did not receive Ampasse. To assess cognitive functions, the following tests were used: the Montreal Cognitive Assessment Scale (MoCA), Stroop's test, subtest 9 of the Wechsler test, Koos cubes (CC), the severity of anxiety and depression was assessed, and motor recovery was assessed by the hand motor activity test (ARAT). The assessment was carried out before the start of treatment and on the 21st day. RESULTS There was a statistically significant increase in the score on the MoCA scale, in patients of the 1st group by an average of 2 points, in the 2nd group there was no significant dynamics, a statistically significant difference was found in the proportion of patients who had an increase in the MoCA index after the course of treatment in the 1st group. compared with the 2nd (χ2 - 22.528, p<0.001). Decreased the level of rigidity according to the Stroop test in patients of the 1st group compared with the 2nd (χ2 - 8.297, p=0.004). The number of patients who showed positive dynamics in the Koos cubes test in the 1st group was statistically significantly higher (χ2- 4.344, p=0.038). A statistically significant decrease in the level of depression was revealed in patients of the 1st group. The number of patients with improved motor function of the hand was greater in the 1st group of MG (χ2 - 4.286, p<0.039). CONCLUSION In patients in complex therapy receiving intravenous administration of the drug Ampasse at a dose of 25 mg (5.0 ml) 15 administrations, a statistically significant improvement in cognitive functions was revealed according to MoCA tests, Stroop test, Koos Cubes, when compared with the comparison group. The use of Ampasse increased the effectiveness of cognitive and motor rehabilitation in patients with post-stroke disorders.
Collapse
Affiliation(s)
- S V Kotov
- Vladimirsky Moscow Regional Research Clinical Institute, Moscow, Russia
| | - V A Borisova
- Vladimirsky Moscow Regional Research Clinical Institute, Moscow, Russia
| | - E V Slyunkova
- Vladimirsky Moscow Regional Research Clinical Institute, Moscow, Russia
| | - E V Isakova
- Vladimirsky Moscow Regional Research Clinical Institute, Moscow, Russia
| | - A V Kiselev
- Vladimirsky Moscow Regional Research Clinical Institute, Moscow, Russia
| | - A S Kotov
- Vladimirsky Moscow Regional Research Clinical Institute, Moscow, Russia
| |
Collapse
|
36
|
Qin Y, Ai D, Jordan AE, Guo X, Li T, Diao S, Zhao H, Liu Y, Xue Q, Wang Y, Fang Q. Better Screening Value of Sylvian Fissure Ratio on Cognitive Decline Among Female Compared to Male: An Observational Study in Elderly Patients With Cerebral Small Vessel Disease in Soochow. Front Neurosci 2021; 15:729782. [PMID: 34675766 PMCID: PMC8524438 DOI: 10.3389/fnins.2021.729782] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 09/03/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Cognitive decline (CD) occurs frequently in elderly patients with cerebral small vessel disease (CSVD). In China, elderly patients are more likely to enter healthcare in community hospitals where no magnetic resonance imaging (MRI) is available. This study aimed to explore the screening value of Sylvian fissure ratio (SFR) on CD and compare its gender difference from community-transferred patients. Methods: We performed a single-center, observational study (collected between April 1, 2016, and March 1, 2019) to evaluate the association between Montreal Cognitive Assessment (MoCA) and SFR in 203 eligible community-transferred patients. Baseline characteristics of patients were collected during hospitalization. Multiple linear regression analyses were used to estimate the effect of variables on MoCA, and interactions between select variables were analyzed in different models. Receiver operating characteristic (ROC) curve analysis was used to evaluate the discriminative effect of SFR to severe CD. Results: We identified that a meaningful SFR cutoff of 0.05 had important screening value (likelihood ratio test, p = 0.067) on CD. The ratio had a lower screen value in males when compared to females (adjusted β, −5.54; 95% CI, −8.78 to −2.30 vs. adjusted β, −1.01; 95% CI, −2.84 to 0.82). The gender difference was further verified by ROC curve analysis, in which this discriminative effect was more potent in females (from 0.878 to 0.948) compared to males (from 0.838 to 0.837). Conclusion: An SFR of 0.05 may be more useful to distinguish CD in female patients with CSVD than male patients in whom the syndrome is suspected clinically.
Collapse
Affiliation(s)
- Yiren Qin
- The Stroke Center, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Dannan Ai
- The Stroke Center, The First Affiliated Hospital of Soochow University, Suzhou, China
| | | | - Xiaoning Guo
- The Stroke Center, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Tan Li
- The Stroke Center, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Shanshan Diao
- The Stroke Center, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Hongru Zhao
- The Stroke Center, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yang Liu
- Department of Neurology, Saarland University, Homburg, Germany
| | - Qun Xue
- The Stroke Center, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yueju Wang
- The Stroke Center, The First Affiliated Hospital of Soochow University, Suzhou, China.,Department of Geriatrics, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Qi Fang
- The Stroke Center, The First Affiliated Hospital of Soochow University, Suzhou, China
| |
Collapse
|
37
|
Neuromuscular Electric Stimulation in Addition to Exercise Therapy in Patients with Lower Extremity Paresis Due to Acute Ischemic Stroke. A proof-of-concept randomised controlled trial. J Stroke Cerebrovasc Dis 2021; 30:106050. [PMID: 34418670 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/03/2021] [Accepted: 08/04/2021] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Exercise therapy and neuromuscular electrical stimulation (NMES) during the initial 14 days after stroke may benefit recovery of gait. We aimed to determine whether poststroke NMES of vastus medial and tibial muscles during exercise therapy is more effective than exercise therapy alone. MATERIALS AND METHODS In this proof-of-concept randomised trial patients with first-ever acute ischemic stroke and a leg paresis (40-85 years of age) were randomised (1:1) to 10 min of daily NMES + exercise therapy or exercise therapy alone. Primary outcome was the between-group difference in change in 6 min Walk Test (6MWT) at 90 days post stroke estimated with a mixed regression model. Secondary outcomes included 10 m Walk Test, Fugl-Meyer Motor Assessment, Guralnik Timed Standing Balance, Sit to Stand, Timed Up and Go, EQ-5D-5L, Montreal Cognitive Assessment and Becks Depression Inventory. RESULTS 50 stroke survivors (25 in each group) with a mean age of 67 years (range 43-83) were included. An insignificant between-group difference in change of 28.3 m (95%CI -16.0 to 72.6, p = 0.23, adjusted for baseline) in 6MWT at 90-days follow-up was found, in favour of the NMES group. All secondary outcomes showed no statistically significant between-group difference. The conclusion was that adding NMES to exercise therapy had no effect on poststroke walking distance measured by the 6 MWT or any of the secondary outcomes. CONCLUSIONS In this proof-of-concept RCT, we demonstrated that NMES in addition to exercise therapy during the first 14 days after onset of ischemic stroke did not improve walking distance or any of the secondary outcomes. Future studies with a longer trial period, stratifying patients into subgroups with comparable patterns of expected spontaneous recovery - if possible within 48 h post stroke, and greater sample size, than in this study are suggestions of how rehabilitation research could go on exploring the potential for NMES as an amplifier in stroke recovery.
Collapse
|
38
|
Affiliation(s)
- Bruno S Subbarao
- Physical Medicine and Rehabilitation Department, Phoenix Veterans Healthcare System, Building 34, 650 E Indian School Rd, Phoenix, AZ 85012, USA.
| | - Jesse Stokke
- HonorHealth Rehabilitation Hospital, 8850 E Pima Center Pkwy, Scottsdale, AZ 85258, USA
| | - Samuel J Martin
- HonorHealth Rehabilitation Hospital, 8850 E Pima Center Pkwy, Scottsdale, AZ 85258, USA
| |
Collapse
|
39
|
Einstad MS, Saltvedt I, Lydersen S, Ursin MH, Munthe-Kaas R, Ihle-Hansen H, Knapskog AB, Askim T, Beyer MK, Næss H, Seljeseth YM, Ellekjær H, Thingstad P. Associations between post-stroke motor and cognitive function: a cross-sectional study. BMC Geriatr 2021; 21:103. [PMID: 33546620 PMCID: PMC7863272 DOI: 10.1186/s12877-021-02055-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 01/15/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Motor and cognitive impairments are frequently observed following stroke, but are often managed as distinct entities, and there is little evidence regarding how they are related. The aim of this study was to describe the prevalence of concurrent motor and cognitive impairments 3 months after stroke and to examine how motor performance was associated with memory, executive function and global cognition. METHODS The Norwegian Cognitive Impairment After Stroke (Nor-COAST) study is a prospective multicentre cohort study including patients hospitalized with acute stroke between May 2015 and March 2017. The National Institutes of Health Stroke Scale (NIHSS) was used to measure stroke severity at admission. Level of disability was assessed by the Modified Rankin Scale (mRS). Motor and cognitive functions were assessed 3 months post-stroke using the Montreal Cognitive Assessment (MoCA), Trail Making Test Part B (TMT-B), 10-Word List Recall (10WLR), Short Physical Performance Battery (SPPB), dual-task cost (DTC) and grip strength (Jamar®). Cut-offs were set according to current recommendations. Associations were examined using linear regression with cognitive tests as dependent variables and motor domains as covariates, adjusted for age, sex, education and stroke severity. RESULTS Of 567 participants included, 242 (43%) were women, mean (SD) age was 72.2 (11.7) years, 416 (75%) had an NIHSS score ≤ 4 and 475 (84%) had an mRS score of ≤2. Prevalence of concurrent motor and cognitive impairment ranged from 9.5% for DTC and 10WLR to 22.9% for grip strength and TMT-B. SPPB was associated with MoCA (regression coefficient B = 0.465, 95%CI [0.352, 0.578]), TMT-B (B = -9.494, 95%CI [- 11.726, - 7.925]) and 10WLR (B = 0.132, 95%CI [0.054, 0.211]). Grip strength was associated with MoCA (B = 0.075, 95%CI [0.039, 0.112]), TMT-B (B = -1.972, 95%CI [- 2.672, - 1.272]) and 10WLR (B = 0.041, 95%CI [0.016, 0.066]). Higher DTC was associated with more time needed to complete TMT-B (B = 0.475, 95%CI [0.075, 0.875]) but not with MoCA or 10WLR. CONCLUSION Three months after suffering mainly minor strokes, 30-40% of participants had motor or cognitive impairments, while 20% had concurrent impairments. Motor performance was associated with memory, executive function and global cognition. The identification of concurrent impairments could be relevant for preventing functional decline. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02650531 .
Collapse
Affiliation(s)
- Marte Stine Einstad
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, Trondheim, Norway.
| | - Ingvild Saltvedt
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
- Department of Geriatric Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Stian Lydersen
- Department of Mental Health, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
| | - Marie H Ursin
- Department of Medicine, Bærum Hospital, Vestre Viken Hospital Trust, Drammen, Norway
| | - Ragnhild Munthe-Kaas
- Department of Medicine, Bærum Hospital, Vestre Viken Hospital Trust, Drammen, Norway
| | - Hege Ihle-Hansen
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | | | - Torunn Askim
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
| | - Mona K Beyer
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Halvor Næss
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
- Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
- Institute of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Yngve M Seljeseth
- Medical Department, Ålesund Hospital, Møre and Romsdal Health Trust, Ålesund, Norway
| | - Hanne Ellekjær
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
- Stroke Unit, Department of Internal Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Pernille Thingstad
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
| |
Collapse
|
40
|
Diagnostic test accuracy of new generation tympanic thermometry in children under different cutoffs: a systematic review and meta-analysis. BMC Pediatr 2020; 20:210. [PMID: 32398036 PMCID: PMC7216633 DOI: 10.1186/s12887-020-02097-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 04/20/2020] [Indexed: 02/01/2023] Open
Abstract
Background The infrared tympanic thermometer (IRTT) is a popular method for temperature screening in children, but it has been debated for the low accuracy and reproducibility compared with other measurements. This study was aimed to identify and quantify studies reporting the diagnostic accuracy of the new generation IRTT in children and to compare the sensitivity and specificity of IRTT under different cutoffs and give the optimal cutoff. Methods Articles were derived from a systematic search in PubMed, Web of Science Core Collection, and Embase, and were assessed for internal validity by the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). The figure of risk of bias was created by Review Manager 5.3 and data were synthesized by MetaDisc 1.4. Results Twelve diagnostic studies, involving 4639 pediatric patients, were included. The cut-offs varied from 37.0 °C to 38.0 °C among these studies. The cut-off 37.8 °C was with the highest sROC AUC (0.97) and Youden Index (0.83) and was deemed to be the optimal cutoff. Conclusion The optimal cutoff for infrared tympanic thermometers is 37.8 °C. New Generation Tympanic Thermometry is with high diagnostic accuracy in pediatric patients and can be an alternative for fever screening in children.
Collapse
|
41
|
Droś J, Kowalska K, Pasińska P, Szyper-Maciejowska A, Gorzkowska A, Klimkowicz-Mrowiec A. Delirium Post-Stroke-Influence on Post-Stroke Dementia (Research Study-Part of the PROPOLIS Study). J Clin Med 2020; 9:jcm9072165. [PMID: 32659885 PMCID: PMC7408906 DOI: 10.3390/jcm9072165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/23/2020] [Accepted: 07/07/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Previous research confirmed association between delirium and subsequent dementia in different clinical settings, but the impact of post-stroke delirium on cognitive functioning is still under-investigated. Therefore, we aimed to assess the risk of dementia among patients with stroke and in-hospital delirium. METHODS A total of 750 consecutive patients admitted to the stroke unit with acute stroke or transient ischemic attacks were screened for delirium, during the first seven days after admission. At the three- and twelve-month follow-up, patients underwent cognitive evaluation. The DSM-5 definition for dementia was used. Cases with pre-stroke dementia were excluded from the analysis. RESULTS Out of 691 included cases, 423 (61.22%) and 451 (65.27%) underwent cognitive evaluation, three and twelve months after stroke; 121 (28.61%) and 151 (33.48%) patients were diagnosed with dementia, respectively. Six (4.96%) patients with dementia, three months post-stroke did not meet the diagnostic criteria for dementia nine months later. After twelve months, 37 (24.50%) patients were diagnosed with dementia, first time after stroke. Delirium in hospital was an independent risk factor for dementia after three months (OR = 7.267, 95%CI 2.182-24.207, p = 0.001) but not twelve months after the stroke. CONCLUSIONS Patients with stroke complicated by in-hospital delirium are at a higher risk for dementia at three but not twelve months post-stroke.
Collapse
Affiliation(s)
- Jakub Droś
- Doctoral School in Medical and Health Sciences, Jagiellonian University Medical College, 31-008 Kraków, Poland;
| | - Katarzyna Kowalska
- Department of Neurology, Faculty of Medicine, Jagiellonian University Medical College, 31-008 Kraków, Poland; (K.K.); (P.P.)
| | - Paulina Pasińska
- Department of Neurology, Faculty of Medicine, Jagiellonian University Medical College, 31-008 Kraków, Poland; (K.K.); (P.P.)
| | | | - Agnieszka Gorzkowska
- Department of Neurorehabilitation, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland;
| | - Aleksandra Klimkowicz-Mrowiec
- Department of Neurology, Faculty of Medicine, Jagiellonian University Medical College, 31-008 Kraków, Poland; (K.K.); (P.P.)
- Correspondence: ; Tel.: +48-12-424-86-35
| |
Collapse
|
42
|
Zhang T, Zhao J, Li X, Bai Y, Wang B, Qu Y, Li B, Zhao S. Chinese Stroke Association guidelines for clinical management of cerebrovascular disorders: executive summary and 2019 update of clinical management of stroke rehabilitation. Stroke Vasc Neurol 2020; 5:250-259. [PMID: 32595138 PMCID: PMC7548515 DOI: 10.1136/svn-2019-000321] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 05/19/2020] [Accepted: 05/27/2020] [Indexed: 02/05/2023] Open
Abstract
Stroke is the third leading cause of long-term disability. Effective stroke rehabilitation should be provided to patients with a moderate or severe stroke so as to achieve functional recovery. Also, stroke rehabilitation is moving towards more intense therapy models that incorporate technologies such as robotics and computer games. Evidence-based guidelines are useful for promoting the best possible clinical practices. This guideline summarises the modes of stroke rehabilitation in China—three-stage rehabilitation network, rehabilitation of stroke dysfunction, training for activities of daily living, stroke complications and rehabilitation care. The aim of this guideline was to provide a synopsis of best clinical practices in the stroke rehabilitation of adult patients in China.
Collapse
Affiliation(s)
- Tong Zhang
- Department of Neurorehabilitation, China Rehabilitation Research Center, Beijing, China
| | - Jun Zhao
- Department of Neurorehabilitation, China Rehabilitation Research Center, Beijing, China
| | - Xueping Li
- Department of Rehabilitation, Nanjing First Hospital, Nanjing, Jiangsu, China
| | - Yulong Bai
- Department of Rehabilitation, Huashan Hospital Fudan University, Shanghai, China
| | - Baojun Wang
- Department of Neurorehabilitation, Inner Mongolia Baotou City Central Hospital, Baotou, Inner Mongolia, China
| | - Yun Qu
- Department of Neurorehabilitation, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Bingjie Li
- Department of Neurorehabilitation, China Rehabilitation Research Center, Beijing, China
| | - Shengjie Zhao
- Department of Neurorehabilitation, China Rehabilitation Research Center, Beijing, China
| | | |
Collapse
|
43
|
Geraghty JR, Lara-Angulo MN, Spegar M, Reeh J, Testai FD. Severe cognitive impairment in aneurysmal subarachnoid hemorrhage: Predictors and relationship to functional outcome. J Stroke Cerebrovasc Dis 2020; 29:105027. [PMID: 32807442 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105027] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 05/18/2020] [Accepted: 06/03/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Cognitive impairment is common after aneurysmal subarachnoid hemorrhage (SAH). However, compared to predictors of functional outcome, meaningful predictors of cognitive impairment are lacking. OBJECTIVE Our goal was to assess which factors during hospitalization can predict severe cognitive impairment in SAH patients, especially those who might otherwise be expected to have good functional outcomes. We hypothesized that the degree of early brain injury (EBI), vasospasm, and delayed neurological deterioration (DND) would predict worse cognitive outcomes. METHODS We retrospectively reviewed SAH patient records from 2013 to 2019 to collect baseline information, clinical markers of EBI (Fisher, Hunt-Hess, and Glasgow Coma scores), vasospasm, and DND. Cognitive outcome was assessed by Montreal Cognitive Assessment (MoCA) and functional outcomes by modified Rankin Scale (mRS) at hospital discharge. SAH patients were compared to non-neurologic hospitalized controls. Among SAH patients, logistic regression analysis was used to identify predictors of severe cognitive impairment defined as a MoCA score <22. RESULTS We screened 288 SAH and 80 control patients. Cognitive outcomes assessed via MoCA at discharge were available in 105 SAH patients. Most of these patients had good functional outcome at discharge with a mean mRS of 1.8±1.3. Approximately 56.2% of SAH patients had MoCA scores <22 compared to 28.7% of controls. Among SAH patients, modified Fisher scale was an independent predictor of cognitive impairment after adjustment for baseline differences (OR 1.638, p=0.043). MoCA score correlated inversely with mRS (r=-0.3299, p=0.0006); however, among those with good functional outcome (mRS 0-2), 48.7% still exhibited cognitive impairment. CONCLUSIONS Severe cognitive impairment is highly prevalent after SAH, even among patients with good functional outcome. Higher modified Fisher scale on admission is an independent risk factor for severe cognitive impairment. Cognitive screening is warranted in all SAH patients, regardless of functional outcome.
Collapse
Affiliation(s)
- Joseph R Geraghty
- Department of Neurology and Rehabilitation, College of Medicine, University of Illinois at Chicago, 912 S. Wood St. Suite 174N, Chicago, IL 60612, United States; Medical Scientist Training Program, University of Illinois at Chicago, Chicago, IL, United States.
| | - Melissa N Lara-Angulo
- Department of Neurology and Rehabilitation, College of Medicine, University of Illinois at Chicago, 912 S. Wood St. Suite 174N, Chicago, IL 60612, United States.
| | - Milen Spegar
- Department of Neurology and Rehabilitation, College of Medicine, University of Illinois at Chicago, 912 S. Wood St. Suite 174N, Chicago, IL 60612, United States.
| | - Jenna Reeh
- Department of Neurology and Rehabilitation, College of Medicine, University of Illinois at Chicago, 912 S. Wood St. Suite 174N, Chicago, IL 60612, United States.
| | - Fernando D Testai
- Department of Neurology and Rehabilitation, College of Medicine, University of Illinois at Chicago, 912 S. Wood St. Suite 174N, Chicago, IL 60612, United States.
| |
Collapse
|
44
|
Pertz M, Popkirov S, Schlegel U, Thoma P. Research on cognitive and sociocognitive functions in patients with brain tumours: a bibliometric analysis and visualization of the scientific landscape. Neurol Sci 2020; 41:1437-1449. [PMID: 32052308 PMCID: PMC8266703 DOI: 10.1007/s10072-020-04276-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 02/02/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Many patients with brain tumours exhibit mild to severe (neuro)cognitive impairments at some point during the course of the disease. Social cognition, as an instance of higher-order cognitive functioning, specifically enables initiation and maintenance of appropriate social interactions. For individuals being confronted with the diagnosis of a brain tumour, impairment of social function represents an additional burden, since those patients deeply depend on support and empathy provided by family, friends and caregivers. METHODS The present study explores the scientific landscape on (socio)cognitive functioning in brain tumour patients by conducting a comprehensive bibliometric analysis using VOSviewer. The Web of Science Core Collection database was examined to identify relevant documents published between 1945 and 2019. RESULTS A total of 664 English titles on (socio)cognitive functions in patients with brain tumours was retrieved. Automated textual analysis revealed that the data available so far focus on three major topics in brain tumour patients: cognitive functions in general and in paediatric cases, as well as psychological factors and their influence on quality of life. The focus of research has gradually moved from clinical studies with cognitive functions as one of the outcome measures to investigations of interactions between cognitive functions and psychological constructs such as anxiety, depression or fatigue. Medical, neurological and neuropsychological journals, in particular neuro-oncological journals published most of the relevant articles authored by a relatively small network of well interconnected researchers in the field. CONCLUSION The bibliometric analysis highlights the necessity of more research on social cognition in brain tumour patients.
Collapse
Affiliation(s)
- Milena Pertz
- Department of Neurology, University Hospital Knappschaftskrankenhaus, Ruhr-University Bochum, In der Schornau 23-25, D-44892, Bochum, Germany.
| | - Stoyan Popkirov
- Department of Neurology, University Hospital Knappschaftskrankenhaus, Ruhr-University Bochum, In der Schornau 23-25, D-44892, Bochum, Germany
| | - Uwe Schlegel
- Department of Neurology, University Hospital Knappschaftskrankenhaus, Ruhr-University Bochum, In der Schornau 23-25, D-44892, Bochum, Germany
| | - Patrizia Thoma
- Neuropsychological Therapy Centre (NTC)/Clinical Neuropsychology, Faculty of Psychology, Ruhr-University Bochum, Universitätsstraße 150, D-44780, Bochum, Germany
| |
Collapse
|
45
|
Yuan M, Bi X. Therapeutic and Diagnostic Potential of microRNAs in Vascular Cognitive Impairment. J Mol Neurosci 2020; 70:1619-1628. [DOI: 10.1007/s12031-020-01597-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 05/14/2020] [Indexed: 12/19/2022]
|
46
|
Sun J, Lv X, Gao X, Chen Z, Wei D, Ling Y, Zhang J, Gu Q, Liu J, Chen W, Liu S. The association between serum uric acid level and the risk of cognitive impairment after ischemic stroke. Neurosci Lett 2020; 734:135098. [PMID: 32485287 DOI: 10.1016/j.neulet.2020.135098] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 05/20/2020] [Accepted: 05/24/2020] [Indexed: 01/07/2023]
Abstract
Post-stroke cognitive impairment (PSCI) is a severe complication of stroke. Predicting PSCI is difficult because some risk factors for stroke, such as blood glucose level and blood pressure, are affected by many other elements. Although recent studies have shown that high serum uric acid (UA) levels are associated with cognitive dysfunction and may be a risk factor for PSCI, its impact remains unclear. Accordingly, the present study aimed to explore the association between serum UA level and PSCI. In total, 274 patients who experienced acute cerebral infarction, confirmed between January 2016 and December 2018, were enrolled. Baseline data and biological indicators were recorded. According to the Montreal Cognitive Assessment (MoCA) scores, patients were divided into two groups: PSCI and non-PSCI. Logistic regression analysis was used to determine possible risk factors for PSCI. Results demonstrated that serum UA levels were significantly higher in the PSCI group than in the non-PSCI group. Multivariable logistic analysis revealed that age, years of education, and UA level were independent risk factors for PSCI. PSCI patients were subdivided according to serum UA level: high and low. Hypertension history and homocysteine (Hcy) levels differed significantly between the high and low UA level groups. Further analysis revealed that a history of hypertension and Hcy demonstrated a certain correlation (r = 0.163, 0.162; P < 0.05), suggesting that serum UA level was an independent risk factor for PSCI. These findings indicate that serum UA level was correlated with PSCI in post-stroke patients and is anticipated to be used in clinical practice to reduce the incidence of PSCI.
Collapse
Affiliation(s)
- Jing Sun
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325027, China
| | - Xinhuang Lv
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325027, China
| | - Xinxin Gao
- Department of Preventive Medicine, School of Public Health and Management, Wenzhou Medical University, Wenzhou, Zhejiang, 325035, China
| | - Zewei Chen
- Department of Preventive Medicine, School of Public Health and Management, Wenzhou Medical University, Wenzhou, Zhejiang, 325035, China
| | - Dianhui Wei
- Department of Preventive Medicine, School of Public Health and Management, Wenzhou Medical University, Wenzhou, Zhejiang, 325035, China
| | - Yi Ling
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325027, China
| | - Junmei Zhang
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325027, China
| | - Qilu Gu
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325027, China
| | - Jiaming Liu
- Department of Preventive Medicine, School of Public Health and Management, Wenzhou Medical University, Wenzhou, Zhejiang, 325035, China.
| | - Weian Chen
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325027, China.
| | - Suzhi Liu
- Department of Neurology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, 150 Ximen Street, Linhai, Zhejiang, 317000, China.
| |
Collapse
|
47
|
Effect of DPP-4 inhibitor on elderly patients with T2DM combined with MCI. Exp Ther Med 2020; 19:1356-1362. [PMID: 32010309 PMCID: PMC6966108 DOI: 10.3892/etm.2019.8339] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 11/08/2019] [Indexed: 12/23/2022] Open
Abstract
The aim of this study was to investigate the effect of dipeptidyl peptidase-4 (DPP-4) inhibitor on blood sugar level and cognitive ability in elderly patients with type 2 diabetes mellitus (T2DM) combined with post-stroke mild cognitive impairment (MCI). Thirty patients received DPP-4 inhibitor (study group), while another thirty received sulfonylurea (control group). Six months after treatment, markers regarding blood sugar were improved in both groups (all P<0.05) without intergroup differences (all P>0.05); scores regarding cognitive ability improved in the study group (both P<0.05) and were higher versus the control group (both P<0.01); the study group had higher Aβ1-42/Aβ1-40 value versus the pretreatment value (P<0.001), which differed from the control group (P<0.05); tumor necrosis factor-α and interleukin-6 concentrations decreased in both groups, while the study group had greater reductions; C-reactive protein value decreased after treatment in the study group (all P<0.05). Using DPP-4 inhibitor in elderly patients with T2DM combined with post-stroke MCI can lower blood sugar and improve cognitive ability. The mechanism may be associated with the improvement of Aβ gathering and reduction in inflammatory response.
Collapse
|
48
|
NIHSS is not enough for cognitive screening in acute stroke: A cross-sectional, retrospective study. Sci Rep 2020; 10:534. [PMID: 31953508 PMCID: PMC6969160 DOI: 10.1038/s41598-019-57316-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 12/27/2019] [Indexed: 11/11/2022] Open
Abstract
The aim of this study was to investigate whether the cognitive subscale of the National Institute of Health Stroke Scale (NIHSS), the Cog-4, can detect cognitive deficits in acute stroke. This was a cross-sectional, retrospective study. The study sample consisted of people with stroke enrolled in an acute stroke unit. The index test Cog-4 was calculated based on admission NIHSS score. The reference standard instrument, the Montreal Cognitive Assessment (MoCA), was performed within 36–48 h of admission. Non-parametric statistics were used for data analyses. The study included 531 participants with a mean age of 69 years. The Cog-4 failed to identify cognitive deficits in 65%, 58%, and 53% of patients when the MoCA thresholds for impaired cognition were set at ≤25 p, ≤23 p, and ≤19 p, respectively, were chosen for impaired cognition. The agreement between the Cog-4 and the MoCA was poor; Cohen’s kappa was from −0.210 to −0.109, depending on the MoCA cut-offs. The sensitivity of the Cog-4 was 35%, 42% and 48% for the MoCA thresholds for impaired cognition ≤25, ≤23 and ≤19 points, respectively. The Cog-4 has a limited ability to identify cognitive deficits in acute stroke. More structured and comprehensive tests should be employed as diagnostic tools.
Collapse
|
49
|
Liu Y, Chen H, Zhao K, He W, Lin S, He J. High levels of plasma fibrinogen are related to post-stroke cognitive impairment. Brain Behav 2019; 9:e01391. [PMID: 31475471 PMCID: PMC6790326 DOI: 10.1002/brb3.1391] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 06/30/2019] [Accepted: 07/28/2019] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Studies have shown that high levels of the fibrinogen (FIB) are related to cognitive deficits. However, the relationship between fibrinogen and cognitive deficit after stroke remains unclear. Therefore, we explored the relationship between plasma fibrinogen and post-stroke cognitive impairment (PSCI). METHODS This study is carried out in the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China. A total of 210 patients with acute ischemic stroke were enrolled in this study. Ultimately, 134 patients completed 3-month follow-up. Blood samples were collected at hospital admission. Cognitive function was evaluated 3 months after stroke. All patients underwent the Mini-Mental State Examination (MMSE) after 3 months. RESULTS Higher levels of fibrinogen were observed in patients with post-stroke cognitive impairment compared with the non-PSCI group (p < .001). Additionally, elevated plasma fibrinogen levels were independently associated with PSCI (odds ratio [OR] = 2.000, 95% CI 1.062-3.770 p = .032). The plasma fibrinogen levels were negatively correlated with the 3-month MMSE scores (r = -.171, p = .048). In a multivariate linear regression, FIB was negatively associated with the 3-month MMSE scores after adjustment for the other variables (β = -0.782, p = .035). CONCLUSION High levels of plasma fibrinogen were associated with the presence and severity of PSCI.
Collapse
Affiliation(s)
- Yuntao Liu
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Huijun Chen
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Kai Zhao
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Weilei He
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Shasha Lin
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jincai He
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| |
Collapse
|
50
|
Ghafar MZAA, Miptah HN, O'Caoimh R. Cognitive screening instruments to identify vascular cognitive impairment: A systematic review. Int J Geriatr Psychiatry 2019; 34:1114-1127. [PMID: 31050033 DOI: 10.1002/gps.5136] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 04/19/2019] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Vascular cognitive impairment (VCI) is common and important to detect as controlling risk factors, particularly hypertension, may slow onset and progression. There is no consensus as to which cognitive screening instrument (CSI) is most suitable for VCI. We systematically reviewed the psychometric properties of brief CSIs for vascular mild cognitive impairment (VMCI) and vascular dementia (VaD). METHODS Literature searches were performed using scholarly databases from inception until 31 May 2018. Studies were eligible if participants were aged 18 or older, interviewed face-to-face, and standard diagnostic criteria for VCI were applied, excluding those specifically identifying post-stroke dementia. Risk of bias was assessed using the Quality in Prognosis Studies (QUIPS) tool. RESULTS Fifteen studies were identified including eight types of CSIs (27 subtests/variants) and 4575 participants (1015 with VCI), mean age range: 51.6 to 75.5 years. Most studies compared more than one instrument. Five papers examined clock-drawing; four, the Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE); and three used the Brief Memory and Executive Test (BMET). The MoCA (AUC > 0.90) and MMSE (AUC: 0.86-0.99) had excellent accuracy in differentiating VaD from controls; the MoCA had good internal consistency (Cronbach's α: .83-.88). The MoCA (AUC: 0.87-0.93) and BMET (AUC: 0.94) had the greatest accuracy in separating VMCI from controls. Most studies had low to moderate risk of bias in all domains of the QUIPS. Data were heterogeneous, precluding a meta-analysis. CONCLUSIONS Although few studies were available and further research is required, data suggests that the MoCA is accurate and reliable for differentiating VaD and VMCI from controls.
Collapse
Affiliation(s)
- Mohd Zaquan Arif Abd Ghafar
- Clinical Sciences Institute, National University of Ireland, Galway, Galway City, Ireland.,Department of Geriatric and Stroke Medicine, University Hospital Galway, Galway City, Ireland
| | - Hayatul Nawwar Miptah
- Clinical Sciences Institute, National University of Ireland, Galway, Galway City, Ireland
| | - Rónán O'Caoimh
- Clinical Sciences Institute, National University of Ireland, Galway, Galway City, Ireland.,Department of Geriatric and Stroke Medicine, University Hospital Galway, Galway City, Ireland.,Centre for Gerontology and Rehabilitation, University College Cork, Cork City, Ireland.,Department of Geriatric Medicine, Mercy University Hospital, Cork City, Ireland
| |
Collapse
|