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Huang H, Zhan Y, Yu L, Li S, Cai X. Association between Blood Pressure and Post-Stroke Cognitive Impairment: A Meta-Analysis. Rev Cardiovasc Med 2024; 25:174. [PMID: 39076476 PMCID: PMC11267189 DOI: 10.31083/j.rcm2505174] [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: 09/25/2023] [Revised: 11/15/2023] [Accepted: 11/29/2023] [Indexed: 07/31/2024] Open
Abstract
Background Post-stroke cognitive impairment (PSCI) represents a serious post-stroke complication with poor cognitive consequences. A vascular consequence after a stroke is that the occurrence and progression of PSCI may be closely related to blood pressure (BP). Thus, we systematically reviewed and performed a meta-analysis of the literature to examine the correlations between BP and PSCI. Methods We systematically queried databases, including PubMed, the Cochrane Library, Embase, and Scopus, and conducted meta-analyses on studies reporting odds ratios (ORs) related to the association between BP and PSCI. Two authors autonomously assessed all titles, abstracts, and full texts and extracted data following the Meta-Analysis of Observational Studies in Epidemiology guidelines. The quality of the studies was evaluated using the modified Newcastle-Ottawa scale. Results Meta-analyses incorporated 12 articles comprising a cumulative participant cohort of 21,732 individuals. The quality assessment indicated good in five studies, fair in one study, and poor in six. Through meta-analyses, we found that hypertension, systolic or diastolic BP (SBP or DBP) was significantly associated with PSCI (OR 1.53, 95% confidence interval (CI), 1.18-1.99; p = 0.001, I 2 = 66%; OR 1.13, 95% CI, 1.05-1.23; p = 0.002, I 2 = 52%; OR 1.38, 95% CI, 1.11-1.72; p = 0.004, I 2 = 90%, respectively). In the subgroup analysis, SBP < 120 mmHg, 120-139 mmHg, 140-159 mmHg, 160-179 mmHg, and DBP ≥ 100 mmHg highly predicted the occurrence of PSCI (OR 1.15, p = 0.0003; OR 1.26, p = 0.010; OR 1.15, p = 0.05; OR 1.02, p = 0.009; OR 1.96, p < 0.00001, respectively). However, the predictive effect of BP for PSCI declines when SBP ≥ 180 mmHg and DBP ≤ 99 mmHg (p > 0.05). Statistical heterogeneity was moderate to high, and publication bias was detected in SBP for PSCI. Conclusions Considering the multifactorial etiology of PSCI, it is difficult to conclude that BP is an independent risk factor for PSCI. Given the restricted inclusion of studies, caution is advised when interpreting the findings from this meta-analysis. Subsequent investigations with substantial sample sizes are essential to exploring BP as a prospective target for addressing PSCI. Trial Registration Number CRD42023437783 from PROSPERO.
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Affiliation(s)
- Huifen Huang
- Neurology Department of Lishui Municipal Central Hospital, 323000 Lishui, Zhejiang, China
| | - Yanli Zhan
- Lishui Cardio-Cerebrovascular Disease Prevention Center, 323000 Lishui, Zhejiang, China
| | - Linling Yu
- Neurology Department of Lishui Municipal Central Hospital, 323000 Lishui, Zhejiang, China
| | - Shan Li
- Lishui Cardio-Cerebrovascular Disease Prevention Center, 323000 Lishui, Zhejiang, China
| | - Xueli Cai
- Neurology Department of Lishui Municipal Central Hospital, 323000 Lishui, Zhejiang, China
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Tsiakiri A, Christidi F, Tsiptsios D, Vlotinou P, Kitmeridou S, Bebeletsi P, Kokkotis C, Serdari A, Tsamakis K, Aggelousis N, Vadikolias K. Processing Speed and Attentional Shift/Mental Flexibility in Patients with Stroke: A Comprehensive Review on the Trail Making Test in Stroke Studies. Neurol Int 2024; 16:210-225. [PMID: 38392955 PMCID: PMC10893544 DOI: 10.3390/neurolint16010014] [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: 12/30/2023] [Revised: 01/17/2024] [Accepted: 01/19/2024] [Indexed: 02/25/2024] Open
Abstract
The Trail Making Test (TMT) is one of the most commonly administered tests in clinical and research neuropsychological settings. The two parts of the test (part A (TMT-A) and part B (TMT-B)) enable the evaluation of visuoperceptual tracking and processing speed (TMT-A), as well as divided attention, set-shifting and cognitive flexibility (TMT-B). The main cognitive processes that are assessed using TMT, i.e., processing speed, divided attention, and cognitive flexibility, are often affected in patients with stroke. Considering the wide use of TMT in research and clinical settings since its introduction in neuropsychological practice, the purpose of our review was to provide a comprehensive overview of the use of TMT in stroke patients. We present the most representative studies assessing processing speed and attentional shift/mental flexibility in stroke settings using TMT and applying scoring methods relying on conventional TMT scores (e.g., time-to-complete part A and part B), as well as derived measures (e.g., TMT-(B-A) difference score, TMT-(B/A) ratio score, errors in part A and part B). We summarize the cognitive processes commonly associated with TMT performance in stroke patients (e.g., executive functions), lesion characteristics and neuroanatomical underpinning of TMT performance post-stroke, the association between TMT performance and patients' instrumental activities of daily living, motor difficulties, speech difficulties, and mood statue, as well as their driving ability. We also highlight how TMT can serve as an objective marker of post-stroke cognitive recovery following the implementation of interventions. Our comprehensive review underscores that the TMT stands as an invaluable asset in the stroke assessment toolkit, contributing nuanced insights into diverse cognitive, functional, and emotional dimensions. As research progresses, continued exploration of the TMT potential across these domains is encouraged, fostering a deeper comprehension of post-stroke dynamics and enhancing patient-centered care across hospitals, rehabilitation centers, research institutions, and community health settings. Its integration into both research and clinical practice reaffirms TMT status as an indispensable instrument in stroke-related evaluations, enabling holistic insights that extend beyond traditional neurological assessments.
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Affiliation(s)
- Anna Tsiakiri
- Neurology Department, School of Medicine, Democritus University of Thrace, 681 00 Alexandroupolis, Greece; (A.T.); (F.C.); (P.V.); (S.K.); (P.B.); (K.V.)
| | - Foteini Christidi
- Neurology Department, School of Medicine, Democritus University of Thrace, 681 00 Alexandroupolis, Greece; (A.T.); (F.C.); (P.V.); (S.K.); (P.B.); (K.V.)
| | - Dimitrios Tsiptsios
- Neurology Department, School of Medicine, Democritus University of Thrace, 681 00 Alexandroupolis, Greece; (A.T.); (F.C.); (P.V.); (S.K.); (P.B.); (K.V.)
| | - Pinelopi Vlotinou
- Neurology Department, School of Medicine, Democritus University of Thrace, 681 00 Alexandroupolis, Greece; (A.T.); (F.C.); (P.V.); (S.K.); (P.B.); (K.V.)
| | - Sofia Kitmeridou
- Neurology Department, School of Medicine, Democritus University of Thrace, 681 00 Alexandroupolis, Greece; (A.T.); (F.C.); (P.V.); (S.K.); (P.B.); (K.V.)
| | - Paschalina Bebeletsi
- Neurology Department, School of Medicine, Democritus University of Thrace, 681 00 Alexandroupolis, Greece; (A.T.); (F.C.); (P.V.); (S.K.); (P.B.); (K.V.)
| | - Christos Kokkotis
- Department of Physical Education and Sport Science, Democritus University of Thrace, 691 00 Komotini, Greece; (C.K.); (N.A.)
| | - Aspasia Serdari
- Department of Child and Adolescent Psychiatry, School of Medicine, Democritus University of Thrace, 681 00 Alexandroupolis, Greece;
| | - Konstantinos Tsamakis
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, London SE5 8AB, UK;
| | - Nikolaos Aggelousis
- Department of Physical Education and Sport Science, Democritus University of Thrace, 691 00 Komotini, Greece; (C.K.); (N.A.)
| | - Konstantinos Vadikolias
- Neurology Department, School of Medicine, Democritus University of Thrace, 681 00 Alexandroupolis, Greece; (A.T.); (F.C.); (P.V.); (S.K.); (P.B.); (K.V.)
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Levine DA, Morgenstern LB, Kwicklis M, Shi X, Case E, Lisabeth LD. Blood Pressure Control From 2011 to 2019 in Patients 90 Days After Stroke. Stroke 2023; 54:e389-e390. [PMID: 37313739 PMCID: PMC10524965 DOI: 10.1161/strokeaha.123.043162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Deborah A Levine
- Department of Internal Medicine and Cognitive Health Services Research Program (D.A.L.), University of Michigan, Ann Arbor
- Department of Neurology and Stroke Program (D.A.L., L.B.M., M.K., E.C., L.D.L.), University of Michigan, Ann Arbor
| | - Lewis B Morgenstern
- Department of Neurology and Stroke Program (D.A.L., L.B.M., M.K., E.C., L.D.L.), University of Michigan, Ann Arbor
- Department of Epidemiology (L.B.M., M.K., E.C., L.D.L.), University of Michigan, Ann Arbor
| | - Madeline Kwicklis
- Department of Neurology and Stroke Program (D.A.L., L.B.M., M.K., E.C., L.D.L.), University of Michigan, Ann Arbor
- Department of Epidemiology (L.B.M., M.K., E.C., L.D.L.), University of Michigan, Ann Arbor
| | - Xu Shi
- Department of Biostatistics (X.S.), University of Michigan, Ann Arbor
| | - Erin Case
- Department of Neurology and Stroke Program (D.A.L., L.B.M., M.K., E.C., L.D.L.), University of Michigan, Ann Arbor
- Department of Epidemiology (L.B.M., M.K., E.C., L.D.L.), University of Michigan, Ann Arbor
| | - Lynda D Lisabeth
- Department of Neurology and Stroke Program (D.A.L., L.B.M., M.K., E.C., L.D.L.), University of Michigan, Ann Arbor
- Department of Epidemiology (L.B.M., M.K., E.C., L.D.L.), University of Michigan, Ann Arbor
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Ayehu GW, Admasu FT, Yitbarek GY, Agegnehu Teshome A, Amare AT, Atlaw D, Sharma S. Early post-stroke cognitive impairment and in-hospital predicting factors among stroke survivors in Ethiopia. Front Neurol 2023; 14:1163812. [PMID: 37284182 PMCID: PMC10239813 DOI: 10.3389/fneur.2023.1163812] [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: 02/11/2023] [Accepted: 04/24/2023] [Indexed: 06/08/2023] Open
Abstract
Background In low-and middle-income countries, post-stroke cognitive impairment (PSCI) is the least investigated stroke complication that clinically is given little attention. Finding patients who are at high risk of having cognitive problems after a stroke could allow targeted follow-up and help with prognosis discussions, which would then contribute to improved treatment outcomes. The main aim of this study was to determine the incidence and predictors of PSCI among stroke survivors in Northwest Ethiopia. Methods The study was a multicenter prospective cohort study. The study participants were 403 stroke survivors who were alive on follow-up after 3 months of stroke onset at the neurology department of three hospitals in Northwest Ethiopia. To investigate the link between the outcome and the explanatory variables, analyses of bivariable and logistic multivariable regression were performed. A value of p of 0.05 or less was regarded as statistically significant, and data were presented as odds ratios and 95% confidence intervals. Results The mean age of the participants was 61.3 years (SD = 0.7), 56% were females, the mean time from symptom onset to hospital arrival was 46 h (SD = 3.32), and the mean National Institute of Health Stroke Scale (NIHSS) score at admission was 14.79 (SD = 0.25). PSCI was observed in 122 patients (30.3%) after 90 days of stroke onset, that is, 83 (20.6%) of female and 39 (9.7%) of male stroke survivors. The result of multivariable logistic regression analysis revealed PSCI was independently associated with age (adjusted OR = 1.04, 95% CI = 1.061-1.981), women (AOR = 1.390, 95% CI = 1.221-2.690), admission modified Rankin scale (mRS) (AOR = 1.629, 95% CI = 1.381-2.037), moderate Glasgow coma scale (GCS) score (AOR = 1.149, 95% CI = 1.402-3.281), and poor GCS score (AOR = 1.632, 95% CI = 1.610-4.361) and stage one (AOR = 1.428, 95% CI = 1.198-2.922) and stage two hypertension (AOR = 1.255, 95% CI = 1.107-2.609). Conclusion Nearly one-third of stroke survivors developed PSCI. Moreover, further research is needed with a larger sample size, showing a time trend and longer follow-up duration.
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Affiliation(s)
- Gashaw Walle Ayehu
- Department of Biomedical Sciences, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Fitalew Tadele Admasu
- Department of Biomedical Sciences, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Getachew Yideg Yitbarek
- Department of Biomedical Sciences, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Assefa Agegnehu Teshome
- Department of Biomedical Sciences, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Abraham Tsedalu Amare
- Department of Adult Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Daniel Atlaw
- Department of Biomedical Sciences, Goba Referral Hospital, Madda Walabu University, Goba, Oromia, Ethiopia
| | - Saurab Sharma
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia (NeuRA), Sydney, NSW, Australia
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Farron MR, Kabeto MU, Levine DA, Wixom CR, Langa KM. Blood pressure and cognitive function among older adults in India. J Int Med Res 2022. [PMCID: PMC8733366 DOI: 10.1177/03000605211068720] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Objective We aimed to investigate the relationship between blood pressure and cognitive function among older adults in India. Methods In this study, we analyzed cross-sectional data of systolic and diastolic blood pressure (SBP and DBP, respectively) and cognitive testing from 3690 adults aged 60 years and older participating in the Longitudinal Aging Study in India—Diagnostic Assessment of Dementia from 14 states in India. Results After controlling for key sociodemographic, health, and geographic factors, higher SBP and lower DBP were each independently associated with worse cognitive function. Older age, female sex, lower education level, being widowed, residing in a rural area, being a member of a Scheduled Caste or Scheduled Tribe, having a low level of economic consumption, being underweight, and a history of stroke were all independently associated with worse cognitive function scores. Conclusions Both SBP and DBP were independently associated with cognitive function among older adults in India in diverging directions. Clinical interventions targeting high SBP and low DBP may benefit both cognitive health and cardiovascular health.
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Affiliation(s)
- Madeline R. Farron
- General Medicine, Department of Internal Medicine, University of Michigan, University of Michigan, Ann Arbor, MI, USA
| | - Mohammed U. Kabeto
- General Medicine, Department of Internal Medicine, University of Michigan, University of Michigan, Ann Arbor, MI, USA
| | - Deborah A. Levine
- General Medicine, Department of Internal Medicine, University of Michigan, University of Michigan, Ann Arbor, MI, USA
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, University of Michigan, Ann Arbor, MI, USA
| | - Caroline R. Wixom
- General Medicine, Department of Internal Medicine, University of Michigan, University of Michigan, Ann Arbor, MI, USA
| | - Kenneth M. Langa
- General Medicine, Department of Internal Medicine, University of Michigan, University of Michigan, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, University of Michigan, Ann Arbor, MI, USA
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
- Institute of Gerontology, University of Michigan, Ann Arbor, MI, USA
- Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI, USA
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Kunt R, Çınar BP, Yüksel B, Güllüoğlu H, Sayılır İ, Çeliker Uslu S, Özaydın Göksu E, Bülbül NG, Yıldız B, Öz D, Keskin AO, Korucu O, Akpınar ÇK, Solmaz V, Akpınar M, Altunç FZ, Elmas Z, Büyükuysal Ç, Ekici M, Güvendi G. Clinical-epidemiological and radiological characteristics of stroke patients: A multicentre study. Int J Clin Pract 2021; 75:e14963. [PMID: 34626055 DOI: 10.1111/ijcp.14963] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 10/06/2021] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION AND AIM Stroke is the leading cause of disability in adults and the second most common cause of death, at a rate of 11.8% worldwide. The purpose of this study was to examine the aetiological, demographic, and clinical characteristics of patients admitted to hospital because of acute strokes. MATERIALS AND METHODS This multicentre study retrieved information for all patients admitted to hospital because of an acute cerebrovascular event over a six-month period, and sociodemographic, aetiological, and clinical characteristics were recorded. RESULTS A total of 1136 patients, 520 of whom were women (45.7%), with a mean age of 70.3 ± 12.8 years, were included in the study. Of these, 967 were diagnosed with ischaemic stroke (IS) (85.1%), 99 with haemorrhagic stroke (HS) (8.7%), and 70 with transient ischaemic attack (6.1%). The most common risk factor for stroke was hypertension (73%). Carotid disease and hyperlipidaemia rates were higher in patients with HS. Numbers of functionally dependent patients with severe neurological status according to the National Institutes of Health Stroke Scale and modified Rankin scale were significantly higher in the HS group (P < .001). When IS was classified according to the Trial of Org 10172 in Acute Stroke Treatment, small vessel disease emerged as the most common cause (41%). The most common lesion localisations were the parietal lobe (23%) in the IS group and the thalamus (35.3%) in the HS group. Eighty-eight patients (7.7%), 62 (6.4%) in the ischaemic subgroup, and 26 (26.3%) in the haemorrhagic subgroup, died within the first month. CONCLUSION Current and accurate evaluations of stroke aetiology are essential for stroke prevention and treatment planning. This study, shows that no change occurred in the aetiology of stroke and epidemiological characteristics and that accurate identification of modifiable stroke risk factors is still a major goal.
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Affiliation(s)
- Refik Kunt
- Department of Neurology, School of Medicine, İzmir Demokrasi University, İzmir, Turkey
| | - Bilge Piri Çınar
- Department of Neurology, School of Medicine, Zonguldak Bülent Ecevit University, Zonguldak, Turkey
| | - Burcu Yüksel
- Neurology Clinic, Antalya Training and Research Hospital, Antalya, Turkey
| | | | - İdris Sayılır
- Neurology Clinic, Samsun Training and Research Hospital, Samsun, Turkey
| | | | | | | | - Baykal Yıldız
- Neurology Clinic, Dr. Ersin Arslan Training and Research Hospital, Gaziantep, Turkey
| | - Didem Öz
- Neurology Clinic, Dokuz Eylül University, İzmir, Turkey
| | - Ahmet Onur Keskin
- Neurology Clinic, Eskişehir Yunus Emre State Hospital, Eskişehir, Turkey
| | - Osman Korucu
- Neurology Clinic, Keçiören Training and Research Hospital, Ankara, Turkey
| | | | - Volkan Solmaz
- Department of Neurology, Faculty of Medicine, Trakya University, Edirne, Turkey
| | - Meliha Akpınar
- Department of Neurology, Faculty of Medicine, Trakya University, Edirne, Turkey
| | - Fatma Zehra Altunç
- Neurology Clinic, Antalya Training and Research Hospital, Antalya, Turkey
| | - Zeynep Elmas
- Neurology Clinic, Medicalpark İzmir Hospital, İzmir, Turkey
| | - Çağatay Büyükuysal
- Department of Statistics, Faculty of Medicine, Bülent Ecevit University, Zonguldak, Turkey
| | - Mustafa Ekici
- Emergency Medicine Clinic, Atatürk State Hospital, Aydın, Turkey
| | - Güven Güvendi
- Department of Physiology, School of Medicine, İzmir Demokrasi University, İzmir, Turkey
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Aam S, Gynnild MN, Munthe-Kaas R, Saltvedt I, Lydersen S, Knapskog AB, Ihle-Hansen H, Ellekjær H, Eldholm RS, Fure B. The Impact of Vascular Risk Factors on Post-stroke Cognitive Impairment: The Nor-COAST Study. Front Neurol 2021; 12:678794. [PMID: 34421786 PMCID: PMC8374055 DOI: 10.3389/fneur.2021.678794] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 06/07/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Post-stroke cognitive impairment (PSCI) is common, but evidence on the impact of vascular risk factors is lacking. We explored the association between pre-stroke vascular risk factors and PSCI and studied the course of PSCI. Materials and Methods: Vascular risk factors were collected at baseline in stroke survivors (n = 635). Cognitive assessments of attention, executive function, memory, language, and the Montreal Cognitive Assessment (MoCA) were performed at 3 and/or 18 months post-stroke. Stroke severity was assessed with the National Institutes of Health Stroke Scale (NIHSS). PSCI was measured with global z; MoCA z-score; and z-score of the four assessed cognitive domains. Mixed-effect linear regression was applied with global z, MoCA z-score, and z-scores of the cognitive domains as dependent variables. Independent variables were the vascular risk factors (hypertension, hypercholesterolemia, smoking, diabetes mellitus, atrial fibrillation, coronary heart disease, previous stroke), time, and the interaction between these. The analyses were adjusted for age, education, and sex. There were between 5 and 25% missing data for the variables for PSCI. Results: Mean age was 71.6 years (SD 11.7); 42% were females; and the mean NIHSS score at admittance was 3.8 (SD 4.8). Regardless of vascular risk factors, global z, MoCA, and all the assessed cognitive domains were impaired at 3 and 18 months, with MoCA being the most severely impaired. Atrial fibrillation (AF) was associated with poorer language at 18 months and coronary heart disease (CHD) with poorer MoCA at 18 months (LR = 12.80, p = 0.002, and LR = 8.32, p = 0.004, respectively). Previous stroke was associated with poorer global z and attention at 3 and 18 months (LR = 15.46, p < 0.001, and LR = 16.20, p < 0.001). In patients without AF, attention improved from 3 to 18 months, and in patients without CHD, executive function improved from 3 to 18 months (LR = 10.42, p < 0.001, and LR = 9.33, p = 0.009, respectively). Discussion: Our findings indicate that a focal stroke lesion might be related to pathophysiological processes leading to global cognitive impairment. The poorer prognosis of PSCI in patients with vascular risk factors emphasizes the need for further research on complex vascular risk factor interventions to prevent PSCI.
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Affiliation(s)
- Stina Aam
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU-Norwegian University of Science and Technology, Trondheim, Norway.,Department of Geriatric Medicine, Clinic of Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Mari Nordbø Gynnild
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU-Norwegian University of Science and Technology, Trondheim, Norway.,Stroke Unit, Clinic of Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Ragnhild Munthe-Kaas
- Department of Medicine, Vestre Viken Hospital Trust, Bærum Hospital, Drammen, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ingvild Saltvedt
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU-Norwegian University of Science and Technology, Trondheim, Norway.,Department of Geriatric Medicine, Clinic of Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Stian Lydersen
- Department of Mental Health, Faculty of Medicine and Health Science, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
| | | | - Hege Ihle-Hansen
- Department of Medicine, Vestre Viken Hospital Trust, Bærum Hospital, Drammen, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Hanne Ellekjær
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU-Norwegian University of Science and Technology, Trondheim, Norway.,Stroke Unit, Clinic of Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Rannveig Sakshaug Eldholm
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU-Norwegian University of Science and Technology, Trondheim, Norway.,Department of Geriatric Medicine, Clinic of Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Brynjar Fure
- Department of Internal Medicine, Central Hospital, Karlstad, Sweden.,School of Medical Sciences, Örebro University, Örebro, Sweden
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Lee KP, Chang AYW, Sung PS. Association between Blood Pressure, Blood Pressure Variability, and Post-Stroke Cognitive Impairment. Biomedicines 2021; 9:773. [PMID: 34356837 PMCID: PMC8301473 DOI: 10.3390/biomedicines9070773] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/23/2021] [Accepted: 06/29/2021] [Indexed: 12/18/2022] Open
Abstract
After stroke, dynamic changes take place from necrotic-apoptotic continuum, inflammatory response to poststroke neurogenesis, and remodeling of the network. These changes and baseline brain pathology such as small vessel disease (SVD) and amyloid burden may be associated with the occurrence of early or late poststroke cognitive impairment (PSCI) or dementia (PSD), which affect not only stroke victims but also their families and even society. We reviewed the current concepts and understanding of the pathophysiology for PSCI/PSD and identified useful tools for the diagnosis and the prediction of PSCI in serological, CSF, and image characteristics. Then, we untangled their relationships with blood pressure (BP) and blood pressure variability (BPV), important but often overlooked risk factors for PSCI/PSD. Finally, we provided evidence for the modifying effects of BP and BPV on PSCI as well as pharmacological and non-pharmacological interventions and life style modification for PSCI/PSD prevention and treatment.
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Affiliation(s)
- Kang-Po Lee
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan;
- Department of Neurology, E-DA Hospital, Kaohsiung 824, Taiwan
| | - Alice Y. W. Chang
- Department of Physiology, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan;
- Institute of Basic Medical Sciences, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
| | - Pi-Shan Sung
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan;
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
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