Stroke Symptoms as a Predictor of Future Hospitalization

Ludic Table: a comparative study between playful rehabilitation and kinesiotherapy in restricting upper limb movements in individuals with stroke

Stroke is a neurological syndrome resulting from the sudden interruption of blood flow. Among the symptoms/consequences of the stroke are muscle weakness in the lower and/or upper limbs, decreased sensitivity, altered fine motor skills, proprioception, and reflections. The treatment for the motor consequences is orthopedic management, in which the physiotherapist assists the individual in repetitive range of motion exercises, which can be demotivating during the treatment. The Ludic Table (LT), on the other hand, incorporates playfulness into therapy, making it a motivating tool. This research describes the comparative study between kinesiotherapy techniques and exercises using the LT, applied to the development of upper limb movements. For this, fourteen volunteers were divided into groups, submitted to interventions according to the techniques, and evaluated using systems such as goniometry, HAQ-DI, GMFM-88, and neurofunctional assessment. In general, it can be stated that regardless of the intervention, the individuals obtained gain in movements (minimum average of 7 degrees) and that the use of the LT allows the development of the angular amplitude and the reduction of the effects of spasticity. The individuals submitted to the intervention through the LT obtained the development of a greater number of articular movements of the shoulder and elbow.

Biomarkers as MEDiators of racial disparities in risk factors (BioMedioR): Rationale, study design, and statistical considerations

PURPOSE

Relative to White adults, Black adults have a substantially higher prevalence of hypertension and diabetes, both key risk factors for stroke, cardiovascular disease, cognitive impairment, and dementia. Blood biomarkers have shown promise in identifying contributors to racial disparities in many chronic diseases.

METHODS

We outline the study design and related statistical considerations for a nested cohort study, the Biomarker Mediators of Racial Disparities in Risk Factors (BioMedioR) study, within the 30,239-person biracial REasons for Geographic And Racial Differences in Stroke (REGARDS) study (2003-present). Selected biomarkers will be assessed for contributions to racial disparities in risk factor development over median 9.4 years of follow-up, with initial focus on hypertension, and diabetes. Here we outline study design decisions and statistical considerations for the sampling of 4,400 BioMedioR participants.

RESULTS

The population for biomarker assessment was selected using a random sample study design balanced across race and sex to provide the optimal opportunity to describe association of biomarkers with the development of hypertension and diabetes. Descriptive characteristics of the BioMedioR sample and analytic plans are provided for this nested cohort study.

CONCLUSIONS

This nested biomarker study will examine pathways with the target to help explain racial differences in hypertension and diabetes incidence.

Atrial Fibrillation and Stroke Symptoms in the REGARDS Study

Background

It is unknown if stroke symptoms in the absence of a stroke diagnosis are a sign of subtle cardioembolic phenomena. The objective of this study was to examine associations between atrial fibrillation (AF) and stroke symptoms among adults with no clinical history of stroke or transient ischemic attack (TIA).

Methods and Results

We evaluated associations between AF and self‐reported stroke symptoms in the national, prospective REGARDS (Reasons for Geographic and Racial Differences in Stroke) cohort. We conducted cross‐sectional (n=27 135) and longitudinal (n=21 932) analyses over 8 years of follow‐up of REGARDS participants without stroke/transient ischemic attack and stratified by anticoagulant or antiplatelet agent use. The mean age was 64.4 (SD±9.4) years, 55.3% were women, and 40.8% were Black participants; 28.6% of participants with AF reported stroke symptoms. In the cross‐sectional analysis, comparing participants with and without AF, the risk of stroke symptoms was elevated for adults with AF taking neither anticoagulants nor antiplatelet agents (odds ratio [OR], 2.22; 95% CI, 1.89–2.59) or antiplatelet agents only (OR, 1.92; 95% CI, 1.61–2.29) but not for adults with AF taking anticoagulants (OR, 1.08; 95% CI, 0.71–1.65). In the longitudinal analysis, the risk of stroke symptoms was also elevated for adults with AF taking neither anticoagulants nor antiplatelet agents (hazard ratio [HR], 1.41; 95% CI, 1.21–1.66) or antiplatelet agents only (HR, 1.23; 95% CI, 1.04–1.46) but not for adults with AF taking anticoagulants (HR, 0.86; 95% CI, 0.62–1.18).

Conclusions

Stroke symptoms in the absence of a stroke diagnosis may represent subclinical cardioembolic phenomena or “whispering strokes.” Future studies examining the benefit of stroke symptom screening may be warranted.

Family History of Stroke is Associated with Greater Prevalence of Certain Risk Factors and Self-Reported Stroke Symptoms

OBJECTIVES

Family history of stroke increases stroke risk, however mechanisms underlying this association remain unclear. We investigated whether family history of stroke is related to increased prevalence of stroke risk factors, unhealthy behaviors and self-reported stroke symptoms in middle-aged adults.

MATERIALS AND METHODS

In a cross-sectional study conducted from November 2018 to January 2021 in 100 primary care facilities in Poland we evaluated adults aged 40-65 years (n = 2207, women 57.4%, median age 55 years) for stroke risk factors, healthy behaviors, family history of stroke, self-reported stroke symptoms and stroke knowledge using structured questionnaires. Patients were categorized based on family history of stroke defined as ≥1 first-degree relative with documented stroke.

RESULTS

Family history of stroke was reported by 571 (25.9%) individuals who were older (median age 56 vs. 54 years, p = 0.00001) and after adjustment for age more frequently suffered from hypertension (61.5% vs. 53.7%, p = 0.024) and prior transient ischemic attack (2.1% vs. 0.9%, p = 0.019), but not other risk factors. However, they were less obese (34.5% vs. 39.1%, p = 0.03). Women, but not men, with family history of stroke (n = 339, 26.8%) had greater prevalence of atrial fibrillation (7.4% vs. 3.9%, p = 0.037). Family history of stroke was associated with higher prevalence of any self-reported stroke symptom (32.9% vs. 23.2%, p < 0.00001), but not with unhealthy dietary behaviors or low level of knowledge about stroke.

CONCLUSIONS

Family history of stroke is associated with greater prevalence of certain risk factors and self-reported stroke symptoms, which indicates the need for closer surveillance of middle-aged individuals at risk.

Research progress on the pharmacological effect and clinical application of Tongqiao Huoxue Decoction in the treatment of ischaemic stroke

Ischaemic stroke (IS) is a common type of stroke characterised by sudden fainting and communication disorders, alongside a number of other symptoms. It is characterised by high morbidity, disability, and mortality rates. Tongqiao Huoxue Decoction (THD) is effective in the treatment of stroke. As a representative prescription for promoting blood circulation and removing blood stasis, THD has been widely used clinically. This paper systematically introduces clinical and experimental studies of THD in the treatment of IS, summarising its clinical application, pharmacological mechanisms, and active components in the treatment of IS. It also explores its key pathways in the treatment of IS through network pharmacology analyses, thereby speculating on its underlying mechanisms. It is of great significance for the secondary development of this classic prescription as well as for the research and development of new drugs.

Stroke symptoms impact on mental and physical health: A Lebanese population based study

BACKGROUND/OBJECTIVE

Stroke symptoms in the absence of diagnosed stroke are common worldwide and associated with stroke risk factors and great impact on the physical and mental health functioning. The aim of this study was to assess, at the national level, the association of stroke symptoms with mental and physical health.

METHODS

Quality of life was assessed using physical and mental component summary scores (PCS and MCS) of the Short Form 12v2 Health Survey in the Lebanese population. We assessed the differences in the mean PCS and MCS scores among asymptomatic individuals with no stroke/transient ischemic attack (TIA) history (n=1167), symptomatic individuals with no stroke/TIA history (n=125) and those with stroke/TIA history (n=46). Psychometric properties of the Lebanese version of the SF- 12v2 were evaluated using principal component analysis.

RESULTS

Symptomatic individuals had an average PCS scores of 2.31 (95%CI: 0.75-3.88) points lower and those with stroke/TIA history had 3.26 (95%CI: 1.01-5.51) points lower when compared with asymptomatic individuals with no stroke/TIA history. Similarly, MCS scores for symptomatic individuals were 2.58 (95%CI: 1.02-4.13) points lower and those with stroke/TIA history had 3.28 (95%CI: 1.06-5.50) points lower than asymptomatic individuals.

CONCLUSION

Physical and mental health functioning declined among symptomatic individuals and those with stroke/TIA history. Thus, frequent monitoring for the early detection of stroke symptoms may be recommended.