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Deng Y, Sun S. Runx1 promotes neuronal injury in ischemic stroke through mediating miR-203-3p/Pde4d axis. Brain Inj 2024; 38:1035-1045. [PMID: 38994671 DOI: 10.1080/02699052.2024.2373914] [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: 03/08/2024] [Revised: 05/27/2024] [Accepted: 06/24/2024] [Indexed: 07/13/2024]
Abstract
BACKGROUND It has been reported that Runx1 engaged in IS progression, but the detailed mechanism of Runx1 in IS is still unclear. METHODS Mice and HT22 cells were subjected to the process of middle cerebral artery occlusion and reperfusion (MCAO/R) and oxygen-glucose deprivation/reoxygenation (OGD/R), respectively. Infract volume was tested using TTC staining. The levels of inflammatory cytokines were investigated using ELISA assay. Cell viability was examined utilizing MTS. Apoptosis rate was evaluated using flow cytometry and TUNEL. The productions of SOD and MDA were monitored by means of commercial kits. The correlations among Runx1, miR-203-3p and Pde4d were ascertained using dual luciferase reporter gene, ChIP and RNA-RNA pull-down assays. RESULTS Runx1 and Pde4d were abnormally elevated, while miR-203-3p was notably declined in MCAO/R mice and OGD/R-induced HT22 cells. OGD/R treatment suppressed cell viability and facilitated cell apoptosis, inflammation and oxidative stress, which were compromised by Runx1 knockdown or miR-203-3p upregulation. Runx1 bound to miR-203-3p promoter, thus decreasing miR-203-3p expression. MiR-203-3p inhibited Pde4d expression via targeting Pde4d mRNA. Runx1 deficiency-induced protection effects on OGD/R-treated HT22 cells were offset by miR-203-3p downregulation. CONCLUSION Runx1 aggravated neuronal injury caused by IS through mediating miR-203-3p/Pde4d axis.
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Affiliation(s)
- Yongwen Deng
- Department of Neurosurgery, Hunan Provincial People's Hospital (The first affiliated hospital of Hunan normal university), Changsha, Hunan, P.R. China
| | - Shengli Sun
- Department of Neurosurgery, Hunan Provincial People's Hospital (The first affiliated hospital of Hunan normal university), Changsha, Hunan, P.R. China
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Gallucci L, Sperber C, Guggisberg AG, Kaller CP, Heldner MR, Monsch AU, Hakim A, Silimon N, Fischer U, Arnold M, Umarova RM. Post-stroke cognitive impairment remains highly prevalent and disabling despite state-of-the-art stroke treatment. Int J Stroke 2024; 19:888-897. [PMID: 38425239 DOI: 10.1177/17474930241238637] [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: 03/02/2024]
Abstract
BACKGROUND State-of-the-art stroke treatment significantly reduces lesion size and stroke severity, but it remains unclear whether these therapeutic advances have diminished the burden of post-stroke cognitive impairment (PSCI). AIMS In a cohort of patients receiving modern state-of-the-art stroke care including endovascular therapy, we assessed the frequency of PSCI and the pattern of domain-specific cognitive deficits, identified risk factors for PSCI, and determined the impact of acute PSCI on stroke outcome. METHODS In this prospective monocentric cohort study, we examined patients with first-ever anterior circulation ischemic stroke without pre-stroke cognitive decline, using a comprehensive neuropsychological assessment ⩽10 days after symptom onset. Normative data were stratified by demographic variables. We defined PSCI as at least moderate (<1.5 standard deviation) deficits in ⩾2 cognitive domains. Multivariable regression analysis was applied to define risk factors for PSCI. RESULTS We analyzed 329 non-aphasic patients admitted from December 2020 to July 2023 (67.2 ± 14.4 years old, 41.3% female, 13.1 ± 2.7 years of education). Although most patients had mild stroke (median National Institutes of Health Stroke Scale (NIHSS) 24 h = 1.00 (0.00; 3.00); 87.5% with NIHSS ⩽ 5), 69.3% of them presented with PSCI 2.7 ± 2.0 days post-stroke. The most severely and often affected cognitive domains were verbal learning, episodic memory, executive functions, selective attention, and constructive abilities (39.1%-51.2% of patients), whereas spatial neglect was less frequent (18.5%). The risk of PSCI was reduced with more years of education (odds ratio (OR) = 0.47, 95% confidence interval (CI) = 0.23-0.99) and right hemisphere lesions (OR = 0.47, 95% CI = 0.26-0.84), and increased with stroke severity (NIHSS 24 h, OR = 4.19, 95% CI = 2.72-6.45), presence of hyperlipidemia (OR = 1.93, 95% CI = 1.01-3.68), but was not influenced by age. After adjusting for stroke severity and depressive symptoms, acute PSCI was associated with poor functional outcome (modified Rankin Scale > 2, F = 13.695, p < 0.001) and worse global cognition (Montreal Cognitive Assessment (MoCA) score, F = 20.069, p < 0.001) at 3 months post-stroke. CONCLUSION Despite modern stroke therapy and many strokes having mild severity, PSCI in the acute stroke phase remains frequent and associated with worse outcome. The most prevalent were learning and memory deficits. Cognitive reserve operationalized as years of education independently protects post-stroke cognition.
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Affiliation(s)
- Laura Gallucci
- Department of Neurology, University Hospital, Inselspital, University of Bern, Bern, Switzerland
- Graduate School of Health Sciences, University of Bern, Bern, Switzerland
| | - Christoph Sperber
- Department of Neurology, University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Adrian G Guggisberg
- Department of Neurology, University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Christoph P Kaller
- Department of Neuroradiology, University Medical Center Freiburg, Freiburg, Germany
| | - Mirjam R Heldner
- Department of Neurology, University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | | | - Arsany Hakim
- University Institute of Diagnostic and Interventional Neuroradiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Norbert Silimon
- Department of Neurology, University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Urs Fischer
- Department of Neurology, University Hospital, Inselspital, University of Bern, Bern, Switzerland
- Department of Neurology, University Hospital and University of Basel, Basel, Switzerland
| | - Marcel Arnold
- Department of Neurology, University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Roza M Umarova
- Department of Neurology, University Hospital, Inselspital, University of Bern, Bern, Switzerland
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Guo C, Yin Y, Ma Z, Xu F, Wang S. Astilbin exerts a neuroprotective effect by upregulating the signaling of nuclear NF-E2-related factor 2 in vitro. Heliyon 2024; 10:e37276. [PMID: 39296123 PMCID: PMC11409207 DOI: 10.1016/j.heliyon.2024.e37276] [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: 04/03/2024] [Revised: 08/29/2024] [Accepted: 08/30/2024] [Indexed: 09/21/2024] Open
Abstract
Objective The present study aims to evaluate the impact of Astilbin (AST) on cortical neuron survival in vitro under conditions of oxygen-glucose deprivation and reoxygenation (OGD/R) and determine the role of NF-E2-related factor 2 (Nrf2) in this process. Methods Primary neurons were pre-treated with various concentrations of AST for 8 h before OGD induction. Cell viability and lactate dehydrogenase (LDH) leakage were assessed to determine the optimal concentration. Biomarkers related to oxidative stress, antioxidant enzyme activities, and apoptosis were evaluated at 24 h post-OGD/R. To investigate the involvement of Nrf2 in AST-mediated neuroprotection, we conducted molecular docking and microscale thermophoresis analyses, as well as examined the expression levels of Nrf2 and its regulatory genes including heme oxygenase-1(HO-1), (NAD(P)H: quinone oxidoreductase 1 (NQO-1), and peroxiredoxin 1 (Prdx1). Additionally, lentivirus-mediated knockdown of Nrf2 and overexpression of Nrf2 with L-sulforaphane (SFN) were performed, followed by an assessment of cell viability, oxidative stress, antioxidant enzyme activities and apoptosis. Results Pre-treatment with AST reduced oxidative stress levels while increasing antioxidant enzyme activities and mitigating neuronal apoptosis. After OGD/R exposure, AST upregulated nuclear Nrf2 expression and increased the expression of HO-1, NQO-1 and Prdx1 in the cytoplasm. However, the knockdown of Nrf2 abolished the antioxidative and protective effects exerted by AST treatment. Conversely, combining AST with the Nrf2 agonist SFN demonstrated an enhancement in the protective effects provided by AST. These results demonstrate that Nrf2-dependent antioxidant responses contribute to AST-induced tolerance against neuronal injury caused by OGD/R injury. Conclusions Overall findings support the ability of AST to protect primary neurons from OGD/R-induced damage through activation of Nrf2-dependent antioxidant responses.
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Affiliation(s)
- Chao Guo
- Xi'an People's Hospital (Xi'an Fourth Hospital), Xi'an, China
- Department of Pharmacy, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Ying Yin
- Department of Pharmacy, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Zhongying Ma
- Department of Pharmacy, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Fangqin Xu
- Department of Pharmacy, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Shiquan Wang
- Department of Anesthesiology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
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Filchenko I, Duss SB, Salzmann S, Brill AK, Korostovtseva L, Amelina V, Baillieul S, Bernasconi C, Schmidt MH, Bassetti CLA. Early sleep apnea treatment in stroke (eSATIS) - a multicentre, randomised controlled, rater-blinded, clinical trial: The association of post-stroke cognition with sleep-disordered breathing and its treatment. J Sleep Res 2024:e14296. [PMID: 39251407 DOI: 10.1111/jsr.14296] [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: 04/13/2024] [Revised: 06/22/2024] [Accepted: 07/13/2024] [Indexed: 09/11/2024]
Abstract
Sleep-disordered breathing (SDB) is linked to cognitive dysfunction. Although SDB is common in stroke patients, the impact of SDB and its early treatment on cognitive functioning after stroke remains poorly investigated. Therefore, we explored the association between SDB and post-stroke cognitive functioning, including the impact of early SDB treatment with adaptive servo-ventilation (ASV) on cognitive recovery from acute event to 3 months post-stroke. We used data from two studies, which included ischaemic stroke patients (n = 131) and no-stroke controls (n = 37) without SDB (apnea-hypopnea index, AHI <5/h) and with SDB (AHI≥20/h). Cognitive functioning was assessed within 7 days and 3 months post-stroke in stroke patients, or at study inclusion in no-stroke control group, respectively. Stroke patients with SDB were randomized to ASV treatment (ASV+) or usual care (ASV-). Linear regression adjusted for main confounders assessed the impact of SDB and its treatment on cognitive recovery. The intention-to-treat analysis did not show significant associations of SDB ASV+ (n = 30) versus SDB ASV- (n = 29) with cognitive recovery. In an exploratory subanalysis, compliant SDB ASV+ (n = 14) versus SDB ASV- showed improvements with ASV in visual memory and cognitive flexibility. Combining the stroke and non-stroke datasets, SDB (n = 85) versus no-SDB (n = 83) was associated with deficits in visual memory and response inhibition independently of stroke. SDB ASV- versus no-SDB (n = 51) was associated with less improvement in visual memory. There was no substantial evidence for benefits of intention-to-treat ASV on cognitive recovery. Exploratory analysis indicated that compliant ASV treatment could benefit visual memory and cognitive flexibility, whereas untreated SDB could contribute to a poor recovery of visual memory.
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Affiliation(s)
- Irina Filchenko
- Department of Neurology, Bern University Hospital (Inselspital) and University of Bern, Bern, Switzerland
- Interdisciplinary Sleep-Wake-Epilepsy Centre, Bern University Hospital (Inselspital) and University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Simone B Duss
- Department of Neurology, Bern University Hospital (Inselspital) and University of Bern, Bern, Switzerland
- Interdisciplinary Sleep-Wake-Epilepsy Centre, Bern University Hospital (Inselspital) and University of Bern, Bern, Switzerland
| | - Saskia Salzmann
- Department of Neurology, Bern University Hospital (Inselspital) and University of Bern, Bern, Switzerland
- Interdisciplinary Sleep-Wake-Epilepsy Centre, Bern University Hospital (Inselspital) and University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
- Division of Neuropaediatrics, Development and Rehabilitation, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Anne-Kathrin Brill
- Interdisciplinary Sleep-Wake-Epilepsy Centre, Bern University Hospital (Inselspital) and University of Bern, Bern, Switzerland
- Department for Pulmonary Medicine, Allergology and Clinical Immunology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lyudmila Korostovtseva
- Laboratory of Somnology, Almazov National Medical Research Centre, Sankt-Peterburg, Russia
| | - Valeria Amelina
- Laboratory of Somnology, Almazov National Medical Research Centre, Sankt-Peterburg, Russia
| | - Sébastien Baillieul
- Univ. Grenoble Alpes, Inserm, U1300, CHU Grenoble Alpes, Service Universitaire de Pneumologie Physiologie, Grenoble, France
| | - Corrado Bernasconi
- Department of Neurology, Bern University Hospital (Inselspital) and University of Bern, Bern, Switzerland
- Interdisciplinary Sleep-Wake-Epilepsy Centre, Bern University Hospital (Inselspital) and University of Bern, Bern, Switzerland
| | - Markus H Schmidt
- Department of Neurology, Bern University Hospital (Inselspital) and University of Bern, Bern, Switzerland
- Interdisciplinary Sleep-Wake-Epilepsy Centre, Bern University Hospital (Inselspital) and University of Bern, Bern, Switzerland
| | - Claudio L A Bassetti
- Department of Neurology, Bern University Hospital (Inselspital) and University of Bern, Bern, Switzerland
- Interdisciplinary Sleep-Wake-Epilepsy Centre, Bern University Hospital (Inselspital) and University of Bern, Bern, Switzerland
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Aytenew TM, Kefale D, Birhane BM, Kebede SD, Asferie WN, Kassaw A, Tiruneh YM, Legas G, Getie A, Bantie B, Asnakew S. Poststroke cognitive impairment among stroke survivors in Sub-Saharan Africa: a systematic review and meta-analysis. BMC Public Health 2024; 24:2143. [PMID: 39112982 PMCID: PMC11308218 DOI: 10.1186/s12889-024-19684-3] [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: 02/15/2024] [Accepted: 08/02/2024] [Indexed: 08/10/2024] Open
Abstract
INTRODUCTION Stroke is the leading cause of death and disability among adults and elderly individuals worldwide. Although several primary studies have been conducted to determine the prevalence of poststroke cognitive impairment among stroke survivors in sub-Saharan Africa, these studies have presented inconsistent findings. Therefore, this study aimed to determine the pooled prevalence of poststroke cognitive impairment and identify its associated factors among stroke survivors in sub-Saharan Africa. METHODS The studies were retrieved from the Google Scholar, Scopus, PubMed, and Web of Science databases. A manual search of the reference lists of the included studies was performed. A random-effects DerSimonian-Laird model was used to compute the pooled prevalence of poststroke cognitive impairment among stroke survivors in sub-Saharan Africa. RESULTS A total of 10 primary studies with a sample size of 1,709 stroke survivors were included in the final meta-analysis. The pooled prevalence of PSCI was obtained from the 9 included studies with a sample size of 1,566. In contrast, the data regarding the associated factors were obtained from all the 10 included studies with a sample size of 1,709. The pooled prevalence of poststroke cognitive impairment among stroke survivors was 59.61% (95% CI: 46.87, 72.35); I2 = 96.47%; P < 0.001). Increased age (≥ 45 years) [AOR = 1.23, 95% CI: 1.09, 1.40], lower educational level [AOR = 4.35, 95% CI: 2.87, 6.61], poor functional recovery [AOR = 1.75, 95% CI: 1.42, 2.15], and left hemisphere stroke [AOR = 4.88, 95% CI: 2.98, 7.99] were significantly associated with poststroke cognitive impairment. CONCLUSIONS The pooled prevalence of poststroke cognitive impairment was considerably high among stroke survivors in sub-Saharan Africa. Increased age, lower educational level, poor functional recovery, and left hemisphere stroke were the pooled independent predictors of poststroke cognitive impairment in sub-Saharan Africa. Stakeholders should focus on empowering education and lifestyle modifications, keeping their minds engaged, staying connected with social activities and introducing rehabilitative services for stroke survivors with these identified factors to reduce the risk of developing poststroke cognitive impairment.
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Affiliation(s)
- Tigabu Munye Aytenew
- Department of Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia.
| | - Demewoz Kefale
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Binyam Minuye Birhane
- School of Public Health, University of Technology Sydney, Sydney, NSW, Australia
- Department of Maternity and Neonatal Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Solomon Demis Kebede
- Department of Maternity and Neonatal Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Worku Necho Asferie
- Department of Maternity and Neonatal Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Amare Kassaw
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | | | - Getasew Legas
- Department of Psychiatry, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Addisu Getie
- Department of Nursing, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Berihun Bantie
- Department of Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Sintayehu Asnakew
- Department of Psychiatry, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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Sloane KL, Hamilton RH. Transcranial Direct Current Stimulation to Ameliorate Post-Stroke Cognitive Impairment. Brain Sci 2024; 14:614. [PMID: 38928614 PMCID: PMC11202055 DOI: 10.3390/brainsci14060614] [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: 04/22/2024] [Revised: 06/04/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024] Open
Abstract
Post-stroke cognitive impairment is a common and disabling condition with few effective therapeutic options. After stroke, neural reorganization and other neuroplastic processes occur in response to ischemic injury, which can result in clinical improvement through spontaneous recovery. Neuromodulation through transcranial direct current stimulation (tDCS) is a promising intervention to augment underlying neuroplasticity in order to improve cognitive function. This form of neuromodulation leverages mechanisms of neuroplasticity post-stroke to optimize neural reorganization and improve function. In this review, we summarize the current state of cognitive neurorehabilitation post-stroke, the practical features of tDCS, its uses in stroke-related cognitive impairment across cognitive domains, and special considerations for the use of tDCS in the post-stroke patient population.
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Affiliation(s)
- Kelly L. Sloane
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Physical Medicine and Rehabilitation, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Roy H. Hamilton
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Physical Medicine and Rehabilitation, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
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Munye Aytenew T, Demis Kebede S, Necho Asferie W, Asnakew S. Predictors of Poststroke Cognitive Decline among Stroke Survivors in Sub-Saharan Africa: A Systematic Review and Meta-Analysis. Dement Geriatr Cogn Disord 2024; 53:265-273. [PMID: 38870910 DOI: 10.1159/000539449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 05/19/2024] [Indexed: 06/15/2024] Open
Abstract
INTRODUCTION Stroke is a devastating medical disorder associated with significant morbidity and mortality among adults and the elderly worldwide. Although numerous primary studies have been conducted to determine the pooled predictors of poststroke cognitive decline among stroke survivors in Sub-Saharan Africa, these studies presented inconsistent findings. Hence, the review aimed to determine the pooled predictors of poststroke cognitive decline among stroke survivors in Sub-Saharan Africa. METHODS The eligible studies were accessed through Google Scholar, Scopus, PubMed, and Web of Science databases. A manual search of the reference lists of included studies was performed. A weighted inverse-variance random-effects model was used to determine the pooled predictors of poststroke cognitive decline among stroke survivors in Sub-Saharan Africa. RESULTS A total of 1,710 stroke survivors from 10 primary studies were included in the final meta-analysis. Increased age (≥45 years) (adjusted odds ratio [AOR] = 1.32, 95% CI: 1.13, 1.54), lower educational level (AOR = 4.58, 95% CI: 2.98, 7.03), poor functional recovery (AOR = 1.75, 95% CI: 1.42, 2.15), and left hemisphere stroke (AOR = 4.88, 95% CI: 2.98, 7.99) were significantly associated with poststroke cognitive decline. CONCLUSIONS Increased age, lower educational level, poor functional recovery, and left hemisphere stroke were the pooled independent predictors of poststroke cognitive decline in Sub-Saharan Africa Healthcare providers, and other concerned bodies should give attention to these risk factors as the early identification may help to improve the cognitive profile of stroke survivors.
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Affiliation(s)
- Tigabu Munye Aytenew
- Department of Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Solomon Demis Kebede
- Department of Maternity and Neonatal Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Worku Necho Asferie
- Department of Maternity and Neonatal Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Sintayehu Asnakew
- Department of Psychiatry, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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Oestreich LKL, Wright P, O'Sullivan MJ. Cardiovascular risk factors are associated with cognitive trajectory in the first year after stroke. CEREBRAL CIRCULATION - COGNITION AND BEHAVIOR 2024; 7:100230. [PMID: 38988670 PMCID: PMC11231527 DOI: 10.1016/j.cccb.2024.100230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 05/05/2024] [Accepted: 06/07/2024] [Indexed: 07/12/2024]
Abstract
Introduction Stroke often leads to cognitive impairment, but its progression and influencing factors over time remain poorly understood. This study evaluates immediate post-stroke cognitive impacts and investigates the influence of concurrent factors on cognitive evolution over the first year. Patients and methods In the STRATEGIC study, 179 patients with first symptomatic ischemic stroke underwent neuropsychological assessments within three months post-stroke, and 141 were re-evaluated at 12 months. Risk factors tested for associations with cognitive outcome included demographic variables, cardiovascular and other medical factors, and lesion characteristics. Cognitive performance was primarily measured via the Montreal Cognitive Assessment (MoCA), with domain-specific assessments for episodic memory (Free and Cued Selective Reminding Task), short-term memory (Digit Span forward), and working memory (Digit Span backward). Results At the time of stroke, participants ranged in age from 46 to 89 years (M = 70, SD = 9.5) and 36.9% were female. Ischemic heart disease predicted cognitive non-improvement between 3 and 12 months. Atrial fibrillation and carotid stenosis were linked to changes in episodic and working memory, respectively. Moreover, female sex and lower education correlated with stagnant global cognition and episodic memory. Discussion and conclusion Our findings underscore the important influence of cardiovascular risk factors on cognitive functional recovery after stroke. Interventions targeting these risk factors may improve cognitive prognosis and affect traditional outcome measures such as recurrent vascular events. Future trials should include cognitive measures to fully capture the potential benefits of intensive risk factor intervention.
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Affiliation(s)
- Lena KL Oestreich
- School of Psychology, The University of Queensland, Brisbane, Australia
- Australian Institute for Bioengineering and Nanotechnology, The University of Queensland, Brisbane, Australia
- Centre for Advanced Imaging, The University of Queensland, Brisbane, Australia
- National Imaging Facility, University of Queensland, Brisbane, Australia
| | - Paul Wright
- Department of Biomedical Engineering and Imaging Sciences, King's College London, United Kingdom
| | - Michael J O'Sullivan
- Department of Neurology, Royal Brisbane and Women's Hospital, Herston, Australia
- Institute for Molecular Bioscience, University of Queensland, Brisbane, Australia
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Ja’afar NL, Mustapha M, Mohamed M, Hashim S. A Review of Post-Stroke Cognitive Impairment and the Potential Benefits of Stingless Bee Honey Supplementation. Malays J Med Sci 2024; 31:75-91. [PMID: 38984252 PMCID: PMC11229577 DOI: 10.21315/mjms2024.31.3.5] [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: 11/26/2023] [Accepted: 02/02/2023] [Indexed: 07/11/2024] Open
Abstract
Post-stroke cognitive impairment (PSCI) is a common decline in cognitive abilities that occurs within 3 months after a stroke. During recovery, stroke survivors often experience varying degrees of cognitive decline, with some patients experiencing permanent cognitive deficits. Thus, it is crucial to prioritise recovery and rehabilitation after a stroke to promote optimal protection of and improvement in cognitive function. Honey derived from stingless bees has been linked to various therapeutic properties, including neuroprotective effects. However, scientific evidence for the mechanisms through which these honey supplements enhance cognitive function remains limited. This narrative review aims to provide an overview of the causes of PSCI, current treatments, the biomarkers influencing cognition in post-stroke patients and the potential of stingless bee honey (SBH) as a neuroprotective agent against the progression of PSCI.
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Affiliation(s)
- Nor Liyana Ja’afar
- Department of Physiology, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
| | - Muzaimi Mustapha
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
| | - Mahaneem Mohamed
- Department of Physiology, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
| | - Sabarisah Hashim
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
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Dangayach NS, Kreitzer N, Foreman B, Tosto-Mancuso J. Post-Intensive Care Syndrome in Neurocritical Care Patients. Semin Neurol 2024; 44:398-411. [PMID: 38897212 DOI: 10.1055/s-0044-1787011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
Post-intensive care syndrome (PICS) refers to unintended consequences of critical care that manifest as new or worsening impairments in physical functioning, cognitive ability, or mental health. As intensive care unit (ICU) survival continues to improve, PICS is becoming increasingly recognized as a public health problem. Studies that focus on PICS have typically excluded patients with acute brain injuries and chronic neurodegenerative problems. However, patients who require neurocritical care undoubtedly suffer from impairments that overlap substantially with those encompassed by PICS. A major challenge is to distinguish between impairments related to brain injury and those that occur as a consequence of critical care. The general principles for the prevention and management of PICS and multidomain impairments in patients with moderate and severe neurological injuries are similar including the ICU liberation bundle, multidisciplinary team-based care throughout the continuum of care, and increasing awareness regarding the challenges of critical care survivorship among patients, families, and multidisciplinary team members. An extension of this concept, PICS-Family (PICS-F) refers to the mental health consequences of the intensive care experience for families and loved ones of ICU survivors. A dyadic approach to ICU survivorship with an emphasis on recognizing families and caregivers that may be at risk of developing PICS-F after neurocritical care illness can help improve outcomes for ICU survivors. In this review, we will summarize our current understanding of PICS and PICS-F, emerging literature on PICS in severe acute brain injury, strategies for preventing and treating PICS, and share our recommendations for future directions.
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Affiliation(s)
- Neha S Dangayach
- Department of Neurology and Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Natalie Kreitzer
- Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Brandon Foreman
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Jenna Tosto-Mancuso
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY
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Shi Y, Fang Q, Hu Y, Mi Z, Luo S, Gan Y, Yuan S. Melatonin Ameliorates Post-Stroke Cognitive Impairment in Mice by Inhibiting Excessive Mitophagy. Cells 2024; 13:872. [PMID: 38786094 PMCID: PMC11119717 DOI: 10.3390/cells13100872] [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: 04/06/2024] [Revised: 05/09/2024] [Accepted: 05/14/2024] [Indexed: 05/25/2024] Open
Abstract
Post-stroke cognitive impairment (PSCI) remains the most common consequence of ischemic stroke. In this study, we aimed to investigate the role and mechanisms of melatonin (MT) in improving cognitive dysfunction in stroke mice. We used CoCl2-induced hypoxia-injured SH-SY5Y cells as a cellular model of stroke and photothrombotic-induced ischemic stroke mice as an animal model. We found that the stroke-induced upregulation of mitophagy, apoptosis, and neuronal synaptic plasticity was impaired both in vivo and in vitro. The results of the novel object recognition test and Y-maze showed significant cognitive deficits in the stroke mice, and Nissl staining showed a loss of neurons in the stroke mice. In contrast, MT inhibited excessive mitophagy both in vivo and in vitro and decreased the levels of mitophagy proteins PINK1 and Parkin, and immunofluorescence staining showed reduced co-localization of Tom20 and LC3. A significant inhibition of mitophagy levels could be directly observed under transmission electron microscopy. Furthermore, behavioral experiments and Nissl staining showed that MT ameliorated cognitive deficits and reduced neuronal loss in mice following a stroke. Our results demonstrated that MT inhibits excessive mitophagy and improves PSCI. These findings highlight the potential of MT as a preventive drug for PSCI, offering promising therapeutic implications.
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Affiliation(s)
- Yan Shi
- Key Laboratory of Study and Discovery of Small Targeted Molecules of Hunan Province, School of Medicine, Hunan Normal University, Changsha 410006, China; (Y.S.); (S.L.)
- Department of Medical Laboratory, School of Medicine, Hunan Normal University, Changsha 410006, China; (Q.F.); (Y.H.); (Z.M.); (Y.G.)
- Engineering Research Center of Reproduction and Translational Medicine of Hunan Province, School of Medicine, Hunan Normal University, Changsha 410013, China
| | - Qian Fang
- Department of Medical Laboratory, School of Medicine, Hunan Normal University, Changsha 410006, China; (Q.F.); (Y.H.); (Z.M.); (Y.G.)
| | - Yue Hu
- Department of Medical Laboratory, School of Medicine, Hunan Normal University, Changsha 410006, China; (Q.F.); (Y.H.); (Z.M.); (Y.G.)
| | - Zhaoyu Mi
- Department of Medical Laboratory, School of Medicine, Hunan Normal University, Changsha 410006, China; (Q.F.); (Y.H.); (Z.M.); (Y.G.)
| | - Shuting Luo
- Key Laboratory of Study and Discovery of Small Targeted Molecules of Hunan Province, School of Medicine, Hunan Normal University, Changsha 410006, China; (Y.S.); (S.L.)
| | - Yaoxue Gan
- Department of Medical Laboratory, School of Medicine, Hunan Normal University, Changsha 410006, China; (Q.F.); (Y.H.); (Z.M.); (Y.G.)
| | - Shishan Yuan
- Key Laboratory of Study and Discovery of Small Targeted Molecules of Hunan Province, School of Medicine, Hunan Normal University, Changsha 410006, China; (Y.S.); (S.L.)
- Department of Medical Laboratory, School of Medicine, Hunan Normal University, Changsha 410006, China; (Q.F.); (Y.H.); (Z.M.); (Y.G.)
- Engineering Research Center of Reproduction and Translational Medicine of Hunan Province, School of Medicine, Hunan Normal University, Changsha 410013, China
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Alphonce B, Meda J, Nyundo A. Incidence and predictors of post-stroke cognitive impairment among patients admitted with first stroke at tertiary hospitals in Dodoma, Tanzania: A prospective cohort study. PLoS One 2024; 19:e0287952. [PMID: 38598466 PMCID: PMC11006170 DOI: 10.1371/journal.pone.0287952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 02/01/2024] [Indexed: 04/12/2024] Open
Abstract
INTRODUCTION Stroke survivors develop cognitive impairment, which significantly impacts their quality of life, their families, and the community as a whole but not given attention. This study aims to determine the incidence and predictors of post-stroke cognitive impairment (PSCI) among adult stroke patients admitted to a tertiary hospital in Dodoma, Tanzania. METHODOLOGY A prospective cohort study was conducted at tertiary hospitals in the Dodoma region, central Tanzania. A sample size of 158 participants with the first stroke confirmed by CT/MRI brain aged ≥ 18 years met the criteria. At baseline, social-demographic, cardiovascular risks and stroke characteristics were acquired, and then at 30 days, participants were evaluated for cognitive functioning using Montreal Cognitive Assessment (MoCA). Key confounders for cognitive impairment, such as depression and apathy, were evaluated using the Personal Health Questionnaire (PHQ-9) and Apathy Evaluation Scale (AES), respectively. Descriptive statistics were used to summarise data; continuous data were reported as Mean (SD) or Median (IQR), and categorical data were summarised using proportions and frequencies. Univariate and multivariable logistic regression analysis was used to determine predictors of PSCI. RESULTS The median age of the 158 participants was 58.7 years; 57.6% of them were female, and 80.4% of them met the required criteria for post-stroke cognitive impairment. After multivariable logistic regression, left hemisphere stroke (AOR: 5.798, CI: 1.030-32.623, p = 0.046), a unit cm3 increase in infarct volume (AOR: 1.064, 95% CI: 1.018-1.113, p = 0.007), and apathy symptoms (AOR: 12.259, CI: 1.112-89.173, p = 0.041) had a significant association with PSCI. CONCLUSION The study revealed a significant prevalence of PSCI; early intervention targeting stroke survivors at risk may improve their outcomes. Future research in the field will serve to dictate policies and initiatives.
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Affiliation(s)
- Baraka Alphonce
- Department of Internal Medicine, School of Medicine & Dentistry, The University Dodoma, Dodoma, Tanzania
- Department of Internal Medicine, The Benjamin Mkapa Hospital, Dodoma, Tanzania
| | - John Meda
- Department of Internal Medicine, School of Medicine & Dentistry, The University Dodoma, Dodoma, Tanzania
- Department of Cardiology, The Benjamin Mkapa Hospital, Dodoma, Tanzania
| | - Azan Nyundo
- Department of Internal Medicine, The Benjamin Mkapa Hospital, Dodoma, Tanzania
- Department of Psychiatry and Mental Health, School of Medicine, The University Dodoma, Dodoma, Tanzania
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Camenzind M, Göbel N, Eberhard-Moscicka A, Knobel S, Hegi H, Single M, Kaufmann B, Schumacher R, Nyffeler T, Nef T, Müri R. The phenomenology of pareidolia in healthy subjects and patients with left- or right-hemispheric stroke. Heliyon 2024; 10:e27414. [PMID: 38468958 PMCID: PMC10926141 DOI: 10.1016/j.heliyon.2024.e27414] [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: 08/25/2023] [Revised: 02/21/2024] [Accepted: 02/28/2024] [Indexed: 03/13/2024] Open
Abstract
Pareidolia are perceptions of recognizable images or meaningful patterns where none exist. In recent years, this phenomenon has been increasingly studied in healthy subjects and patients with neurological or psychiatric diseases. The current study examined pareidolia production in a group of 53 stroke patients and 82 neurologically healthy controls who performed a natural images task. We found a significant reduction of absolute pareidolia production in left- and right-hemispheric stroke patients, with right-hemispheric patients producing overall fewest pareidolic output. Responses were categorized into 28 distinct categories, with 'Animal', 'Human', 'Face', and 'Body parts' being the most common, accounting for 72% of all pareidolia. Regarding the percentages of the different categories of pareidolia, we found a significant reduction for the percentage of "Body parts" pareidolia in the left-hemispheric patient group as compared to the control group, while the percentage of this pareidolia type was not significantly reduced in right-hemispheric patients compared to healthy controls. These results support the hypothesis that pareidolia production may be influenced by local-global visual processing with the left hemisphere being involved in local and detailed analytical visual processing to a greater extent. As such, a lesion to the right hemisphere, that is believed to be critical for global visual processing, might explain the overall fewest pareidolic output produced by the right-hemispheric patients.
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Affiliation(s)
- M. Camenzind
- Perception and Eye Movement Laboratory, Departments of Neurology and BioMedical Research, Inselspital, Bern University Hospital and University of Bern, Switzerland
| | - N. Göbel
- Perception and Eye Movement Laboratory, Departments of Neurology and BioMedical Research, Inselspital, Bern University Hospital and University of Bern, Switzerland
- Research and Analysis Services, University Hospital Basel and University of Basel, Basel, Switzerland
| | - A.K. Eberhard-Moscicka
- Perception and Eye Movement Laboratory, Departments of Neurology and BioMedical Research, Inselspital, Bern University Hospital and University of Bern, Switzerland
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Switzerland
- Department of Psychology, University of Bern, Bern, Switzerland
| | - S.E.J. Knobel
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - H. Hegi
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - M. Single
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - B.C. Kaufmann
- Neurocenter, Luzerner Kantonsspital, Lucerne, Switzerland
| | - R. Schumacher
- Perception and Eye Movement Laboratory, Departments of Neurology and BioMedical Research, Inselspital, Bern University Hospital and University of Bern, Switzerland
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - T. Nyffeler
- Neurocenter, Luzerner Kantonsspital, Lucerne, Switzerland
| | - T. Nef
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Switzerland
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - R.M. Müri
- Perception and Eye Movement Laboratory, Departments of Neurology and BioMedical Research, Inselspital, Bern University Hospital and University of Bern, Switzerland
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Switzerland
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
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Srinivas S, Vignesh Rk B, Ayinapudi VN, Govindarajan A, Sundaram SS, Priyathersini N. Neurological Consequences of Cardiac Arrhythmias: Relationship Between Stroke, Cognitive Decline, and Heart Rhythm Disorders. Cureus 2024; 16:e57159. [PMID: 38681361 PMCID: PMC11056008 DOI: 10.7759/cureus.57159] [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] [Accepted: 03/29/2024] [Indexed: 05/01/2024] Open
Abstract
Cardiac arrhythmias are one of the most common disorders with high morbidity and mortality. The effect of cardiac arrhythmias on the brain is very pronounced due to the high sensitivity of the brain to oxygen and blood supply. This mortality is preventable by early diagnosis and treatment which improves the patient's quality of life. Intervening at the right time, post arrhythmia is significant in preventing deaths and improving patient outcomes. Multiple pathophysiological mechanisms are studied for the brain-axis implications, that have the potential to be targeted by novel therapies. In this review, we describe the pathophysiological mechanisms and recent advances in detail to understand the functional aspects of the brain-heart axis and neurological implications post-stroke, caused by cardiac disorders. This paper aims to discuss the current literature on the neurological consequences of cardiac arrhythmias and delve into a deeper understanding of the brain-heart axis, imbalances, and decline, with the aim of summarizing everything and all about the neurological consequences of cardiac arrhythmias.
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Affiliation(s)
- Swathi Srinivas
- Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
| | - Bharath Vignesh Rk
- Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
| | | | | | | | - N Priyathersini
- Pathology, Sri Ramachandra Medical College and Research Institute, Chennai, IND
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15
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Kalchev E, Georgiev R, Ivanova D. A novel 5-stage visual rating scale for global arterial spin labeling perfusion assessment in the brain: Simplifying evaluation for clinical implementation. CEREBRAL CIRCULATION - COGNITION AND BEHAVIOR 2024; 6:100200. [PMID: 38235314 PMCID: PMC10791566 DOI: 10.1016/j.cccb.2024.100200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 12/27/2023] [Accepted: 01/01/2024] [Indexed: 01/19/2024]
Abstract
Objectives The aim of this study was to develop and validate a visual rating scale for evaluating global arterial spin labeling (ASL) perfusion changes in the brain, with potential applications in a variety of conditions that impact general brain blood supply and perfusion. Methods We employed a five-stage scale (0 being normal and 4 indicating the most severe perfusion decline) to assess 156 patients using a 3D pulsed ASL technique. Three radiologists independently reviewed the images, and inter-rater reliability of the visual rating scale was evaluated. Results The ASL stages showed a consistent distribution among the patients. The inter-rater reliability among the three radiologists, as measured by the Intraclass Correlation Coefficient (ICC), was 0.982. Conclusion Our findings suggest that this visual rating scale can be effectively implemented in everyday practice to evaluate global perfusion changes in the context of cardiovascular diseases, cerebrovascular diseases, cerebral small vessel disease, and other conditions that alter brain vascularization and perfusion. Further research is needed to explore the full range of clinical applications and to refine the scale for optimal utility.
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Affiliation(s)
- Emilian Kalchev
- Department of Diagnostic Imaging, St Marina University Hospital, Varna, Bulgaria
- Department of Diagnostic Imaging, Interventional Radiology and Radiotherapy, Medical University of Varna, Bulgaria
| | - Radoslav Georgiev
- Department of Diagnostic Imaging, St Marina University Hospital, Varna, Bulgaria
- Department of Diagnostic Imaging, Interventional Radiology and Radiotherapy, Medical University of Varna, Bulgaria
| | - Darina Ivanova
- Department of Diagnostic Imaging, St Marina University Hospital, Varna, Bulgaria
- Department of Diagnostic Imaging, Interventional Radiology and Radiotherapy, Medical University of Varna, Bulgaria
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Vadinova V, Sihvonen AJ, Wee F, Garden KL, Ziraldo L, Roxbury T, O'Brien K, Copland DA, McMahon KL, Brownsett SLE. The volume and the distribution of premorbid white matter hyperintensities: Impact on post-stroke aphasia. Hum Brain Mapp 2024; 45:e26568. [PMID: 38224539 PMCID: PMC10789210 DOI: 10.1002/hbm.26568] [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: 01/18/2023] [Revised: 11/29/2023] [Accepted: 12/04/2023] [Indexed: 01/17/2024] Open
Abstract
White matter hyperintensities (WMH) are a radiological manifestation of progressive white matter integrity loss. The total volume and distribution of WMH within the corpus callosum have been associated with pathological cognitive ageing processes but have not been considered in relation to post-stroke aphasia outcomes. We investigated the contribution of both the total volume of WMH, and the extent of WMH lesion load in the corpus callosum to the recovery of language after first-ever stroke. Behavioural and neuroimaging data from individuals (N = 37) with a left-hemisphere stroke were included at the early subacute stage of recovery. Spoken language comprehension and production abilities were assessed using word and sentence-level tasks. Neuroimaging data was used to derive stroke lesion variables (volume and lesion load to language critical regions) and WMH variables (WMH volume and lesion load to three callosal segments). WMH volume did not predict variance in language measures, when considered together with stroke lesion and demographic variables. However, WMH lesion load in the forceps minor segment of the corpus callosum explained variance in early subacute comprehension abilities (t = -2.59, p = .01) together with corrected stroke lesion volume and socio-demographic variables. Premorbid WMH lesions in the forceps minor were negatively associated with early subacute language comprehension after aphasic stroke. This negative impact of callosal WMH on language is consistent with converging evidence from pathological ageing suggesting that callosal WMH disrupt the neural networks supporting a range of cognitive functions.
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Affiliation(s)
- Veronika Vadinova
- Queensland Aphasia Research CentreUniversity of QueenslandBrisbaneAustralia
- School of Health and Rehabilitation SciencesUniversity of QueenslandBrisbaneAustralia
- Centre of Research Excellence in Aphasia Recovery and RehabilitationLa Trobe UniversityMelbourneAustralia
| | - A. J. Sihvonen
- Queensland Aphasia Research CentreUniversity of QueenslandBrisbaneAustralia
- School of Health and Rehabilitation SciencesUniversity of QueenslandBrisbaneAustralia
- Centre of Research Excellence in Aphasia Recovery and RehabilitationLa Trobe UniversityMelbourneAustralia
- Cognitive Brain Research Unit (CBRU)University of HelsinkiHelsinkiFinland
- Centre of Excellence in Music, Mind, Body and BrainUniversity of HelsinkiHelsinkiFinland
| | - F. Wee
- Queensland Aphasia Research CentreUniversity of QueenslandBrisbaneAustralia
| | - K. L. Garden
- Queensland Aphasia Research CentreUniversity of QueenslandBrisbaneAustralia
- School of Health and Rehabilitation SciencesUniversity of QueenslandBrisbaneAustralia
- Centre of Research Excellence in Aphasia Recovery and RehabilitationLa Trobe UniversityMelbourneAustralia
| | - L. Ziraldo
- Queensland Aphasia Research CentreUniversity of QueenslandBrisbaneAustralia
| | - T. Roxbury
- Queensland Aphasia Research CentreUniversity of QueenslandBrisbaneAustralia
| | - K. O'Brien
- Queensland Aphasia Research CentreUniversity of QueenslandBrisbaneAustralia
| | - D. A. Copland
- Queensland Aphasia Research CentreUniversity of QueenslandBrisbaneAustralia
- School of Health and Rehabilitation SciencesUniversity of QueenslandBrisbaneAustralia
- Centre of Research Excellence in Aphasia Recovery and RehabilitationLa Trobe UniversityMelbourneAustralia
| | - K. L. McMahon
- School of Clinical Sciences, Centre for Biomedical TechnologiesQueensland University of TechnologyBrisbaneAustralia
| | - S. L. E. Brownsett
- Queensland Aphasia Research CentreUniversity of QueenslandBrisbaneAustralia
- School of Health and Rehabilitation SciencesUniversity of QueenslandBrisbaneAustralia
- Centre of Research Excellence in Aphasia Recovery and RehabilitationLa Trobe UniversityMelbourneAustralia
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Deijle IA, Jonkers IM, Hooghiemstra AM, Engels G, Twisk JWR, Weinstein HC, Van Schaik SM, Van den Berg-Vos RM. Effects of a 1 year aerobic and strength training on cognitive functioning after transient ischemic attack or minor stroke: A randomized controlled trial. J Stroke Cerebrovasc Dis 2024; 33:107441. [PMID: 37966094 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107441] [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: 05/04/2023] [Revised: 10/18/2023] [Accepted: 10/20/2023] [Indexed: 11/16/2023] Open
Abstract
OBJECTIVES Patients who have recently suffered a transient ischemic attack (TIA) or minor ischemic stroke are at increased risk of cognitive impairment. In the present study, we aimed to investigate the effect of a 1-year exercise intervention on cognitive functioning up to 2 years post intervention. MATERIAL AND METHODS We conducted a single-blind randomized controlled trial to investigate the effect of an exercise intervention on cognitive functioning, compared with usual care, for up to 2 years. Patients with a TIA or minor stroke were randomly allocated to an intervention group receiving the 1-year exercise intervention (n = 60) or to usual care (n = 59). Outcome measures were assessed at baseline and after 1 and 2 years. We measured cognition with neuropsychological tests on three domains: (1) executive functioning, (2) attention-psychomotor speed, and (3) memory. Linear mixed models were used for longitudinal data to determine the effect of the exercise intervention on cognitive functioning. Statistical analyses were performed using IBM SPSS software 24.0. RESULTS We found that over the two years study period -and corrected for age, sex, and educational level- the intervention group on average improved significantly more in executive functioning than the control group (β = 0.13; 95 % CI [0.02 to 0.25]; p = 0.03). No significant intervention effects were found on either memory or attention-psychomotor speed. CONCLUSIONS Our data show that a 1-year exercise intervention significantly improved executive functioning over time, compared to usual care. We recommend that health care professionals consider broadening standard secondary stroke prevention treatment in patients with TIA/minor stroke by adding exercise and physical activity.
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Affiliation(s)
- Inger A Deijle
- Department of Neurology, OLVG, Amsterdam, the Netherlands; Department of Quality and Improvement, OLVG, Amsterdam, the Netherlands.
| | - Ilse M Jonkers
- Department of Psychology, Woonzorggroep Samen, Schagen, the Netherlands
| | - Astrid M Hooghiemstra
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Gwenda Engels
- Department of Neurology, OLVG, Amsterdam, the Netherlands
| | - Jos W R Twisk
- Department of Epidemiology and Data Science, Amsterdam UMC, Amsterdam, the Netherlands
| | | | | | - Renske M Van den Berg-Vos
- Department of Neurology, OLVG, Amsterdam, the Netherlands; Department of Neurology, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands
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18
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Campbell A, Gustafsson L, Grimley R, Gullo H, Rosbergen I, Summers M. Mapping the trajectory of acute mild-stroke cognitive recovery using serial computerised cognitive assessment. BRAIN IMPAIR 2023; 24:629-648. [PMID: 38167363 DOI: 10.1017/brimp.2022.24] [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: 11/07/2022]
Abstract
INTRODUCTION Cognitive impairment is common post-stroke. There is a need to understand patterns of early cognitive recovery post-stroke to guide both clinical and research practice. The aim of the study was to map the trajectory of cognitive recovery during the first week to 90-days post-stroke using serial computerised assessment. METHOD An observational cohort study recruited consecutive stroke patients admitted to a stroke unit within 48 hours of onset. Cognitive function was assessed using the computerised Cambridge Neuropsychological Test Automated Battery (CANTAB) daily for seven days, then 14, 30 and 90 days post-stroke. The CANTAB measured visual episodic memory and learning, information processing speed, visuo-spatial working memory, complex sustained attention and mental flexibility. Repeated measures MANOVA/ANOVA with Least Squares Difference post-hoc analyses were performed to ascertain significant change over time. RESULT Forty-eight participants, mean age 73, primarily mild, ischaemic stroke, completed all assessment timepoints. There was a trajectory of early, global cognitive improvement, indicative of a post-stroke delirium, that largely stabilised between 6 and 14-days post-stroke. Change over time was examined within each cognitive test, with one measure stabilising by day 6 (Reaction Time) and others detecting improving performances up to 14 days post-stroke. CONCLUSIONS Serial, computerised cognitive assessment can effectively map post-stroke cognitive recovery and revealed an early phase of global improvement over 14 days that is evidence for an acute post-stroke delirium. Resolution of post-stroke delirium in the second week following mild stroke indicates more extensive neuropsychological testing may be undertaken earlier than previously thought.
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Affiliation(s)
- Alana Campbell
- The University of Queensland (School of Health and Rehabilitation Sciences), Brisbane, Queensland, Australia
- Queensland Health (Sunshine Coast Hospital and Health Service), Sunshine Coast, Queensland, Australia
| | - Louise Gustafsson
- Griffith University (School of Health Sciences and Social Work), Brisbane, Queensland, Australia
| | - Rohan Grimley
- Queensland Health (Sunshine Coast Hospital and Health Service), Sunshine Coast, Queensland, Australia
- Griffith University (School of Medicine), Sunshine Coast, Queensland, Australia
| | - Hannah Gullo
- The University of Queensland (School of Health and Rehabilitation Sciences), Brisbane, Queensland, Australia
| | - Ingrid Rosbergen
- Queensland Health (Sunshine Coast Hospital and Health Service), Sunshine Coast, Queensland, Australia
- University of Applied Sciences, UAS, Leiden, The Netherlands
| | - Mathew Summers
- University of the Sunshine Coast (School of Health and Behavioural Sciences), Sunshine Coast, Queensland, Australia
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Zhou J, Fangma Y, Chen Z, Zheng Y. Post-Stroke Neuropsychiatric Complications: Types, Pathogenesis, and Therapeutic Intervention. Aging Dis 2023; 14:2127-2152. [PMID: 37199575 PMCID: PMC10676799 DOI: 10.14336/ad.2023.0310-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 03/10/2023] [Indexed: 05/19/2023] Open
Abstract
Almost all stroke survivors suffer physical disabilities and neuropsychiatric disturbances, which can be briefly divided into post-stroke neurological diseases and post-stroke psychiatric disorders. The former type mainly includes post-stroke pain, post-stroke epilepsy, and post-stroke dementia while the latter one includes post-stroke depression, post-stroke anxiety, post-stroke apathy and post-stroke fatigue. Multiple risk factors are related to these post-stroke neuropsychiatric complications, such as age, gender, lifestyle, stroke type, medication, lesion location, and comorbidities. Recent studies have revealed several critical mechanisms underlying these complications, namely inflammatory response, dysregulation of the hypothalamic pituitary adrenal axis, cholinergic dysfunction, reduced level of 5-hydroxytryptamine, glutamate-mediated excitotoxicity and mitochondrial dysfunction. Moreover, clinical efforts have successfully given birth to many practical pharmaceutic strategies, such as anti-inflammatory medications, acetylcholinesterase inhibitors, and selective serotonin reuptake inhibitors, as well as diverse rehabilitative modalities to help patients physically and mentally. However, the efficacy of these interventions is still under debate. Further investigations into these post-stroke neuropsychiatric complications, from both basic and clinical perspectives, are urgent for the development of effective treatment strategies.
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Affiliation(s)
| | | | - Zhong Chen
- Correspondence should be addressed to: Prof. Zhong Chen () and Dr. Yanrong Zheng (), Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Yanrong Zheng
- Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China.
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Ji W, Wang C, Chen H, Liang Y, Wang S. Predicting post-stroke cognitive impairment using machine learning: A prospective cohort study. J Stroke Cerebrovasc Dis 2023; 32:107354. [PMID: 37716104 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107354] [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: 06/30/2023] [Revised: 08/27/2023] [Accepted: 09/11/2023] [Indexed: 09/18/2023] Open
Abstract
BACKGROUND Post-stroke cognitive impairment (PSCI) is a serious complication of stroke that warrants prompt detection and management. Consequently, the development of a diagnostic prediction model holds clinical significance. OBJECTIVE Machine learning algorithms were employed to identify crucial variables and forecast PSCI occurrence within 3-6 months following acute ischemic stroke (AIS). METHODS A prospective study was conducted on a developed cohort (331 patients) utilizing data from the Affiliated Zhongda Hospital of Southeast University between January 2022 and August 2022, as well as an external validation cohort (66 patients) from December 2022 to January 2023. The optimal model was determined by integrating nine machine learning classification models, and personalized risk assessment was facilitated by a Shapley Additive exPlanations (SHAP) interpretation. RESULTS Age, education, baseline National Institutes of Health Scale (NIHSS), Cerebral white matter degeneration (CWMD), Homocysteine (Hcy), and C-reactive protein (CRP) were identified as predictors of PSCI occurrence. Gaussian Naïve Bayes (GNB) model was determined to be the optimal model, surpassing other classifier models in the validation set (area under the curve [AUC]: 0.925, 95 % confidence interval [CI]: 0.861 - 0.988) and achieving the lowest Brier score. The GNB model performed well in the test sets (AUC: 0.919, accuracy: 0.864, sensitivity: 0.818, and specificity: 0.932). CONCLUSIONS The present study involved the development of a GNB model and its elucidation through employment of the SHAP method. These findings provide compelling evidence for preventing PSCI, which could serve as a guide for high-risk patients to undertake appropriate preventive measures.
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Affiliation(s)
- Wencan Ji
- Nanjing Medical University, Nanjing, China; Jiangsu Research Center for Primary Health Development and General Practice Education, Jiangsu, China; Department of General Practice, Zhongda Hospital, Southeast University, Nanjing, China
| | - Canjun Wang
- Center of Clinical Laboratory Medicine, Zhongda Hospital, Southeast University, Nanjing, China
| | - Hanqing Chen
- Department of General Practice, Zhongda Hospital, Southeast University, Nanjing, China
| | - Yan Liang
- Department of General Practice, Zhongda Hospital, Southeast University, Nanjing, China
| | - Shaohua Wang
- Nanjing Medical University, Nanjing, China; Department of Endocrinology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China.
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21
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Yeh TT, Chang KC, Wang JJ, Lin WC, Wu CY. Neuroplastic Changes Associated With Hybrid Exercise-Cognitive Training in Stroke Survivors With Mild Cognitive Decline: A Randomized Controlled Trial. Neurorehabil Neural Repair 2023; 37:662-673. [PMID: 37750660 DOI: 10.1177/15459683231200220] [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: 09/27/2023]
Abstract
BACKGROUND Exercise and cognitive training have been shown to induce neuroplastic changes and modulate cognitive function following stroke. However, it remains unclear whether hybridized exercise-cognitive training facilitates cortical activity and further influences cognitive function after stroke. OBJECTIVE The study aimed to investigate the effects of 2 hybridized exercise-cognitive trainings on neuroplastic changes and behavioral outcomes in stroke survivors with mild cognitive decline. METHODS This study was a single-blind randomized controlled trial. Stroke survivors were randomly assigned to 1 of 3 groups: (1) sequential exercise-cognitive training (SEQ), (2) dual-task exercise-cognitive training (DUAL), or (3) control group (CON). All groups underwent training 60 min per day, 3 days per week, for a total of 12 weeks. The primary outcome was the resting-state (RS) functional connectivity (FC) in functional magnetic resonance imaging. Secondary behavioral outcomes included cognitive and physical functions. RESULTS After 12 weeks of training, patients in the SEQ group (n = 21) exhibited increased RS FC between the left occipital lobe and posterior cingulate gyrus with right parietal lobe, compared to the DUAL (n = 22) and CON (n = 20) groups. Additionally, patients in the DUAL group showed increased FC of the left temporal lobe. However, changes in behavioral outcome measures were non-significant among the 3 groups (all P's > .05). CONCLUSIONS This study highlights the distinct neuroplastic mechanisms associated with 2 types of exercise-cognitive hybridized trainings. The pre-post functional magnetic resonance imaging measurements illustrated the time course of neural mechanisms for cognitive recovery in stroke survivors following different exercise-cognitive training approaches. Trial registration. NCT03230253.
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Affiliation(s)
- Ting-Ting Yeh
- Master Degree Program in Health and Long-term Care Industry, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ku-Chou Chang
- Division of Cerebrovascular diseases, Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Taiwan
- Long-term care service center, Kaohsiung Chang Gung Memorial Hospital, Taiwan
- Department of Medicine, Chang Gung University College of Medicine, Taiwan
| | - Jiun-Jie Wang
- Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
- Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan, Taiwan
| | - Wei-Che Lin
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Department of Radiology, Jen Ai Chang Gung Health, Taichung, Taiwan
- School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Ching-Yi Wu
- Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
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Pearce G, O’Donnell J, Pimentel R, Blake E, Mackenzie L. Interventions to Facilitate Return to Work after Stroke: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6469. [PMID: 37569011 PMCID: PMC10418317 DOI: 10.3390/ijerph20156469] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 06/27/2023] [Accepted: 07/04/2023] [Indexed: 08/13/2023]
Abstract
PURPOSE To gather knowledge about effective return to work interventions for survivors of stroke. METHODS A database search was conducted in MEDLINE, CINAHL, PsycINFO, Scopus, and Web of Science using keywords and medical subject headings. Studies were included if they met the following criteria: (i) studies published in English since the year 2000; (ii) adult patients aged 18-65 with a primary diagnosis of stroke; (iii) working pre-stroke; and (iv) intervention in which one of the primary outcomes is return to work. The methodological quality of included studies was assessed and the evidence synthesised. RESULTS Twelve studies were included, of which three were randomised controlled trials, four were retrospective studies, one was a cohort study, one was an explorative longitudinal study, one was a pre-post treatment observation study and two were pilot studies. The employment rate at follow-up ranged from 7% to 75.6%. Overall, there was limited published evidence regarding the effectiveness of interventions to promote return to work for this population, and it was unclear if return to pre-stroke work was the goal. CONCLUSION A lack of large, controlled trials, variations in follow-up time and the definitions of return to work accounted for the large range of employment rates at follow-up. There is limited published high-quality evidence regarding the effectiveness of interventions to promote return to work in working-age survivors of stroke.
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Affiliation(s)
- Gemma Pearce
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
- Occupational Therapy Department, Concord Repatriation General Hospital, Concord, NSW 2139, Australia
| | - Joan O’Donnell
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
| | - Rebecca Pimentel
- Occupational Therapy Helping Children, Frenchs Forest, NSW 2086, Australia
| | - Elizabeth Blake
- Occupational Therapy Department, Royal North Shore Hospital, St Leonards, NSW 2065, Australia
| | - Lynette Mackenzie
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
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23
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Seyman EE, Sadeh-Gonik U, Berman P, Blum I, Shendler G, Nathan B, Rothschild O, Molad J, Ben Assayag E, Hallevi H. Association between intracranial vessel calcifications, structural brain damage, and cognitive impairment after minor strokes: a prospective study. Front Neurol 2023; 14:1218077. [PMID: 37533476 PMCID: PMC10393263 DOI: 10.3389/fneur.2023.1218077] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 06/30/2023] [Indexed: 08/04/2023] Open
Abstract
Background Vascular calcifications are a hallmark of atherosclerosis, and in the coronary arteries are routinely used as a prognostic marker. Calcifications of intracranial vessels (ICC) are frequently observed on non-contrast CT (NCCT) and their effect on post-stroke cognitive impairment (PSCI) remains unclear. Our aim was to explore the association of ICC with prospective long-term cognitive function and advanced MRI-measures in a large prospective cohort of cognitively intact mild stroke survivors. Methods Data from the Tel-Aviv brain acute stroke cohort (TABASCO) study [ClinicalTrials.gov #NCT01926691] were analyzed. This prospective cohort study (n = 575) aimed to identify predictors of PSCI, in cognitively intact mild stroke survivors. A quantitative assessment of the intracranial calcium content - The ICC score (ICCS) was calculated semi-automatically on NCCT using a validated calcium quantification application. Participants underwent a 3 T-MRI and prospective comprehensive cognitive clinical and laboratory assessments at enrollment, 6, 12, and 24-months. Results Data were available for 531 participants (67.4 years, 59.5% males). The incidence of PSCI at two-years doubled in the high ICCS group (26% vs. 13.7%, p < 0.001). The high ICCS group had significantly greater small-vessel-disease (SVD) tissue changes and reduced microstructural-integrity assessed by Diffusion-Tensor-Imaging (DTI) maps (p < 0.05 for all). In multivariate analysis, a higher ICCS was independently associated with brain atrophy manifested by lower normalized white and gray matter, hippocampal and thalamic volumes (β = -0.178, β = -0.2, β = -0.137, β = -0.157; p < 0.05) and independently predicted PSCI (OR 1.83, 95%CI 1.01-3.35). Conclusion Our findings suggest that the ICCS, which is a simple and readily available imaging marker on NCCT, is associated with brain atrophy, microstructural damage, the extent of SVD, and may predict PSCI. This finding has implications for identifying individuals at risk for PSCI and implementing targeted interventions to mitigate this risk.
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Affiliation(s)
- Estelle Emanuelle Seyman
- Stroke Department Division of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Udi Sadeh-Gonik
- Department of Radiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Phillip Berman
- Department of Radiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Itay Blum
- Department of Radiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Genady Shendler
- Department of Radiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Bornstein Nathan
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Brain Center, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Ofer Rothschild
- Stroke Department Division of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Jeremy Molad
- Stroke Department Division of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Einor Ben Assayag
- Stroke Department Division of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Hen Hallevi
- Stroke Department Division of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
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Zhao X, Dai S, Zhang R, Chen X, Zhao M, Bergeron MF, Zhou X, Zhang J, Zhong L, Ashford JW, Liu X. Using MemTrax memory test to screen for post-stroke cognitive impairment after ischemic stroke: a cross-sectional study. Front Hum Neurosci 2023; 17:1195220. [PMID: 37529406 PMCID: PMC10387538 DOI: 10.3389/fnhum.2023.1195220] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 06/28/2023] [Indexed: 08/03/2023] Open
Abstract
Background Whereas the Montreal Cognitive Assessment (MoCA) and Addenbrooke's cognitive examination-revised (ACE-R) are commonly used tests for the detection of post-stroke cognitive impairment (PSCI), these instruments take 10-30 min to administer and do not assess processing speed, which is a critical impairment in PSCI. MemTrax (MTx) is a continuous recognition test, which evaluates complex information processing, accuracy, speed, and attention, in 2 min. Aim To evaluate whether MTx is an effective and practical tool for PSCI assessment. Methods This study enrolled acute ischemic stroke (AIS) patients who have assessed the cognitive status including MTx, clinical dementia rating (CDR), MoCA, Neuropsychiatric Inventory (NPI), Hamilton depression scale (HAMD), Hamilton anxiety scale (HAMA), the National Institute of Health Stroke Scale (NIHSS), modified Rankin scale (mRS), and Barthel Index of activity of daily living (BI) combined with the physical examinations of the neurologic system at the 90-day (D90) after the AIS. The primary endpoint of this study was establishing MTx cut-offs for distinguishing PSCI from AIS. Results Of the 104 participants, 60 were classified to the PSCI group. The optimized cut-off value of MTx-%C (percent correct) was 78%, with a sensitivity and specificity for detecting PSCI from Non-PSCI of 90.0 and 84.1%, respectively, and an AUC of 0.919. Regarding the MTx-Cp (Composite score = MTx-%C/MTx-RT), using 46.3 as a cut-off value, the sensitivity and specificity for detecting PSCI from Non-PSCI were 80.0 and 93.2%, with an AUC of 0.925. Multivariate linear regression showed that PSCI reduced the MTx-%C (Coef. -14.18, 95% CI -18.41∼-9.95, p < 0.001) and prolonged the MTx-RT (response time) (Coef. 0.29, 95% CI 0.16∼0.43, p < 0.001) and reduced the MTx-CP (Coef. -19.11, 95% CI -24.29∼-13.93, p < 0.001). Conclusion MemTrax (MTx) is valid and effective for screening for PSCI among target patients and is a potentially valuable and practical tool in the clinical follow-up, monitoring, and case management of PSCI.
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Affiliation(s)
- Xiaoxiao Zhao
- Department of Neurology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
- Yunnan Province Clinical Research Center for Neurological Disease, Kunming, China
| | - Shujuan Dai
- Department of Neurology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
- Yunnan Province Clinical Research Center for Neurological Disease, Kunming, China
| | - Rong Zhang
- Department of Neurology, Kunming Second People’s Hospital, Kunming, Yunnan, China
| | - Xinjie Chen
- Department of Neurology, The First Affiliated Hospital of Dali University, Dali, China
| | - Mingjie Zhao
- Department of Neurology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
- Yunnan Province Clinical Research Center for Neurological Disease, Kunming, China
| | - Michael F. Bergeron
- Department of Health Sciences, University of Hartford, West Hartford, CT, United States
| | - Xianbo Zhou
- Zhongze Therapeutics, Shanghai, China
- Center for Alzheimer’s Research, Washington Institute of Clinical Research, Vienna, VA, United States
| | - Junyan Zhang
- Department of Clinical Epidemiology and Evidence-based Medicine, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Taiyuan, China
- Bothwin Clinical Study Consultant, Shanghai, China
| | - Lianmei Zhong
- Department of Neurology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
- Yunnan Province Clinical Research Center for Neurological Disease, Kunming, China
| | - J. Wesson Ashford
- War Related Illness and Injury Study Center, VA Palo Alto Health Care System (HCS), Palo Alto, CA, United States
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States
| | - Xiaolei Liu
- Department of Neurology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
- Yunnan Province Clinical Research Center for Neurological Disease, Kunming, China
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25
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Sobreiro MFM, Terroni L, Guajardo VD, Mattos PF, Leite CDC, Amaro E, Tinone G, Iosifescu DV, Fraguas R. The Impact of Post-Stroke Depressive Symptoms on Cognitive Performance in Women and in Men: A 4 Month Prospective Study. Life (Basel) 2023; 13:1554. [PMID: 37511929 PMCID: PMC10381498 DOI: 10.3390/life13071554] [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: 03/02/2023] [Revised: 06/21/2023] [Accepted: 07/08/2023] [Indexed: 07/30/2023] Open
Abstract
Background: Depressive symptoms have been associated with cognitive impairment after stroke, and women may be specifically affected. Objective: The aim of this study was to investigate gender-specific characteristics in the relationship between changes in depression severity and changes in cognitive performance after stroke. Methods: We prospectively evaluated 73 patients without a previous history of depression in the first and fourth months after a first ischemic stroke. The severity of depressive symptoms was assessed using the 31-item version of the Hamilton Rating Scale for Depression, and executive function, attention, working memory, and verbal fluency were assessed using a neuropsychological battery. Results: We included 46 (63.0%) men and 27 (36.9%) women, with mean ages of 55.2 (SD ± 15.1) and 46.8 (SD ± 14.7) years, respectively. We found significant improvement in the digit span forward and Stroop dots from month 1 to month 4 post stroke for both men and women. Women, but not men, presented a correlation between changes in phonemic verbal fluency and changes in the 31-item version of the Hamilton Rating Scale for Depression scores. Improvement in depression was correlated with improvement in verbal fluency, and worsening in depression was correlated with worsening in verbal fluency. Conclusions: Our results suggest that women might be more vulnerable to the relationship between depressive symptoms and cognitive performance, and improvement of depression may be necessary for women's improvement in phonemic verbal fluency from the first to the fourth month after a stroke. We did not adjust the results for multiple comparisons. Thus, our findings might be considered preliminary, and confirmatory studies, also focusing on specific characteristics of women that could explain these differences, are warranted.
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Affiliation(s)
- Matildes F M Sobreiro
- Grupo de Interconsultas, Departamento e Instituto de Psiquiatria do Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, Rua Dr. Ovídio Pires de Campos, 785, São Paulo CEP 05403-903, Brazil
| | - Luisa Terroni
- Grupo de Interconsultas, Departamento e Instituto de Psiquiatria do Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, Rua Dr. Ovídio Pires de Campos, 785, São Paulo CEP 05403-903, Brazil
| | - Valeri Delgado Guajardo
- Grupo de Interconsultas, Departamento e Instituto de Psiquiatria do Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, Rua Dr. Ovídio Pires de Campos, 785, São Paulo CEP 05403-903, Brazil
| | - Patricia Ferreira Mattos
- Grupo de Interconsultas, Departamento e Instituto de Psiquiatria do Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, Rua Dr. Ovídio Pires de Campos, 785, São Paulo CEP 05403-903, Brazil
| | - Claudia da Costa Leite
- Departamento de Radiologia do Hospital das Clinicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-000, Brazil
| | - Edson Amaro
- Departamento de Radiologia do Hospital das Clinicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-000, Brazil
| | - Gisela Tinone
- Departamento de Neurologia, Instituto Central do Hospital das Clinicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-000, Brazil
| | - Dan V Iosifescu
- New York University School of Medicine and Nathan Kline Institute, New York, NY 10003, USA
| | - Renerio Fraguas
- Grupo de Interconsultas, Departamento e Instituto de Psiquiatria do Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, Rua Dr. Ovídio Pires de Campos, 785, São Paulo CEP 05403-903, Brazil
- Laboratório de Investigações Médicas, LIM 21, Departamento e Instituto de Psiquiatria do Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, Rua Dr. Ovídio Pires de Campos, 785, São Paulo CEP 05403-903, Brazil
- Divisão de Psiquiatria e Psicologia, Hospital Universitário, Universidade de São Paulo, São Paulo 05403-903, Brazil
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26
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Xu M, Qian L, Wang S, Cai H, Sun Y, Thakor N, Qi X, Sun Y. Brain network analysis reveals convergent and divergent aberrations between mild stroke patients with cortical and subcortical infarcts during cognitive task performing. Front Aging Neurosci 2023; 15:1193292. [PMID: 37484690 PMCID: PMC10358837 DOI: 10.3389/fnagi.2023.1193292] [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: 03/24/2023] [Accepted: 06/09/2023] [Indexed: 07/25/2023] Open
Abstract
Although consistent evidence has revealed that cognitive impairment is a common sequela in patients with mild stroke, few studies have focused on it, nor the impact of lesion location on cognitive function. Evidence on the neural mechanisms underlying the effects of mild stroke and lesion location on cognitive function is limited. This prompted us to conduct a comprehensive and quantitative study of functional brain network properties in mild stroke patients with different lesion locations. Specifically, an empirical approach was introduced in the present work to explore the impact of mild stroke-induced cognitive alterations on functional brain network reorganization during cognitive tasks (i.e., visual and auditory oddball). Electroencephalogram functional connectivity was estimated from three groups (i.e., 40 patients with cortical infarctions, 48 patients with subcortical infarctions, and 50 healthy controls). Using graph theoretical analysis, we quantitatively investigated the topological reorganization of functional brain networks at both global and nodal levels. Results showed that both patient groups had significantly worse behavioral performance on both tasks, with significantly longer reaction times and reduced response accuracy. Furthermore, decreased global and local efficiency were found in both patient groups, indicating a mild stroke-related disruption in information processing efficiency that is independent of lesion location. Regarding the nodal level, both divergent and convergent node strength distribution patterns were revealed between both patient groups, implying that mild stroke with different lesion locations would lead to complex regional alterations during visual and auditory information processing, while certain robust cognitive processes were independent of lesion location. These findings provide some of the first quantitative insights into the complex neural mechanisms of mild stroke-induced cognitive impairment and extend our understanding of underlying alterations in cognition-related brain networks induced by different lesion locations, which may help to promote post-stroke management and rehabilitation.
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Affiliation(s)
- Mengru Xu
- Key Laboratory for Biomedical Engineering of Ministry of Education of China, Department of Biomedical Engineering, Zhejiang University, Hangzhou, China
| | - Linze Qian
- Key Laboratory for Biomedical Engineering of Ministry of Education of China, Department of Biomedical Engineering, Zhejiang University, Hangzhou, China
| | - Sujie Wang
- Key Laboratory for Biomedical Engineering of Ministry of Education of China, Department of Biomedical Engineering, Zhejiang University, Hangzhou, China
| | - Huaying Cai
- Department of Neurology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yi Sun
- Department of Neurology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Nitish Thakor
- Department of Biomedical Engineering, National University of Singapore, Singapore, Singapore
| | - Xuchen Qi
- Department of Neurosurgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Department of Neurosurgery, Shaoxing People's Hospital, Shaoxing, China
| | - Yu Sun
- Key Laboratory for Biomedical Engineering of Ministry of Education of China, Department of Biomedical Engineering, Zhejiang University, Hangzhou, China
- Department of Neurology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
- State Key Laboratory of Brain-Machine Intelligence, Zhejiang University, Hangzhou, China
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Namgung HG, Hong S, Choi YA. Association of Temporalis Muscle Mass with Early Cognitive Impairment in Older Patients with Acute Ischemic Stroke. J Clin Med 2023; 12:4071. [PMID: 37373767 DOI: 10.3390/jcm12124071] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/08/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
The prognostic value of temporal muscle mass has been studied in various neurological disorders. Herein, we investigated the association between temporal muscle mass and early cognitive function in patients with acute ischemic stroke. This study included 126 patients with acute cerebral infarction aged ≥65 years. Temporal muscle thickness (TMT) was measured using T2-weighted brain magnetic resonance imaging at admission for acute stroke. Within 2 weeks of stroke onset, skeletal mass index (SMI) and cognitive function were assessed using bioelectrical impedance analysis and the Korean version of the Montreal Cognitive Assessment (MoCA), respectively. Pearson's correlation analyzed the correlation between TMT and SMI, and multiple linear regression analyzed independent predictors of early post-stroke cognitive function. TMT and SMI were significantly positively correlated (R = 0.36, p < 0.001). After adjusting for covariates, TMT was an independent predictor of early post-stroke cognitive function, stratified by the MoCA score (β = 1.040, p = 0.017), age (β = -0.27, p = 0.006), stroke severity (β = -0.298, p = 0.007), and education level (β = 0.38, p = 0.008). TMT may be used as a surrogate marker for evaluating skeletal muscle mass because it is significantly associated with post-stroke cognitive function during the acute phase of ischemic stroke; therefore, TMT may help detect older patients at a high risk of early post-stroke cognitive impairment.
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Affiliation(s)
- Ho-Geon Namgung
- Department of Rehabilitation Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Seungho Hong
- Department of Rehabilitation Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Young-Ah Choi
- Department of Rehabilitation Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
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28
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Hua J, Dong J, Chen GC, Shen Y. Trends in cognitive function before and after stroke in China. BMC Med 2023; 21:204. [PMID: 37280632 DOI: 10.1186/s12916-023-02908-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 05/24/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND While cognitive impairment after stroke is common, cognitive trends before stroke are poorly understood, especially among the Chinese population who have a relatively high stroke burden. We aimed to model the trajectories of cognitive function before and after new-onset stroke among Chinese. METHODS A total of 13,311 Chinese participants aged ≥ 45 years and without a history of stroke were assessed at baseline between June 2011 and March 2012 and in at least one cognitive test between 2013 (wave 2) and 2018 (wave 4). Cognitive function was assessed using a global cognition score, which included episodic memory, visuospatial abilities, and a 10-item Telephone Interview of Cognitive Status (TICS-10) test to reflect calculation, attention, and orientation abilities. RESULTS During the 7-year follow-up, 610 (4.6%) participants experienced a first stroke. Both stroke and non-stroke groups showed declined cognitive function during follow-up. After adjustment for covariates, there was no significant difference in pre-stroke cognitive trajectories between stroke patients and stroke-free participants. The stroke group showed an acute decline in episodic memory (- 0.123 SD), visuospatial abilities (- 0.169 SD), and global cognition (- 0.135 SD) after stroke onset. In the years following stroke, the decline rate of the TICS-10 test was higher than the rate before stroke (- 0.045 SD/year). CONCLUSIONS Chinese stroke patients had not experienced steeper declines in cognition before stroke compared with stroke-free individuals. Incident stroke was associated with acute declines in global cognition, episodic memory, visuospatial abilities, and accelerated declines in calculation, attention, and orientation abilities.
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Affiliation(s)
- Jianian Hua
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Ren'ai Road, Suzhou, 215123, China
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Jianye Dong
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Ren'ai Road, Suzhou, 215123, China
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Guo-Chong Chen
- Department of Nutrition and Food Hygiene, Suzhou Medical College of Soochow University, 199 Ren'ai Road, Suzhou, 215123, China.
| | - Yueping Shen
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Ren'ai Road, Suzhou, 215123, China.
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Kaddumukasa MN, Kaddumukasa M, Katabira E, Sewankambo N, Namujju LD, Goldstein LB. Prevalence and predictors of post-stroke cognitive impairment among stroke survivors in Uganda. BMC Neurol 2023; 23:166. [PMID: 37098461 PMCID: PMC10127321 DOI: 10.1186/s12883-023-03212-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 04/15/2023] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND Little is known about the characteristics and determinants of post-stroke cognitive impairment in residents of low- and middle-income countries. The objective of this study was to determine the frequencies, patterns, and risk factors for cognitive impairment in a cross-sectional study of consecutive stroke patients cared for at Uganda's Mulago Hospital, located in sub-Saharan Africa. METHODS 131 patients were enrolled a minimum of 3-months after hospital admission for stroke. A questionnaire, clinical examination findings, and laboratory test results were used to collect demographic information and data on vascular risk factors and clinical characteristics. Independent predictor variables associated with cognitive impairment were ascertained. Stroke impairments, disability, and handicap were assessed using the National Institute of Health Stroke Scale (NIHSS), Barthel Index (BI), and modified Rankin scale (mRS), respectively. The Montreal Cognitive Assessment (MoCA) was used to assess participants' cognitive function. Stepwise multiple logistic regression was used to identify variables independently associated with cognitive impairment. RESULTS The overall mean MoCA score was 11.7-points (range 0.0-28.0-points) for 128 patients with available data of whom 66.4% were categorized as cognitively impaired (MoCA < 19-points). Increasing age (OR 1.04, 95% CI 1.00-1.07; p = 0.026), low level of education (OR 3.23, 95% CI 1.25-8.33; p = 0.016), functional handicap (mRS 3-5; OR 1.84, 95% CI 1.28-2.63; p < 0.001) and high LDL cholesterol (OR 2.74, 95% CI 1.14-6.56; p = 0.024) were independently associated with cognitive impairment. CONCLUSIONS Our findings highlight the high burden and need for awareness of cognitive impairment in post stroke populations in the sub-Saharan region and serve to emphasize the importance of detailed cognitive assessment as part of routine clinical evaluation of patients who have had a stroke.
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Affiliation(s)
- Martin N Kaddumukasa
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Mark Kaddumukasa
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Elly Katabira
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Nelson Sewankambo
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Lillian D Namujju
- Department of Electrical and Computer Engineering, College of Engineering, Design, Art and Technology, Makerere University, Kampala, Uganda
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Xie X, Hu P, Tian Y, Qiu B, Wang K, Bai T. Abnormal resting-state function within language network and its improvement among post-stroke aphasia. Behav Brain Res 2023; 443:114344. [PMID: 36781021 DOI: 10.1016/j.bbr.2023.114344] [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: 10/26/2022] [Revised: 01/30/2023] [Accepted: 02/10/2023] [Indexed: 02/13/2023]
Abstract
Several studies with resting-state magnetic resonance imaging (rs-fMRI) have examined functional impairments and plasticity within language network in patients with post-stroke aphasia (PSA). However, there is still ubiquitous inconsistency across these studies, partly due to restricted to very small sample size and the absence of validation with follow-up data. In the current study, we aimed at providing relatively strong evidence to support functional impairments and its reorganization in PSA. Here, the amplitude of low frequency fluctuations (ALFF) and functional connectivity were used to assess functional alterations of PSA with moderate sample size at baseline (thirty-five PSA patients and thirty-five healthy controls). Functional abnormalities at baseline were observed whether improved among sixteen follow-up patients. Compared with controls, PSA at baseline presented decreased ALFF in the left inferior frontal gyrus (IFG) and decreased functional connectivity of the left IFG with the bilateral supplementary motor area (SMA) and right superior temporal gyrus (STG). The decreased ALFF in IFG, decreased IFG-SMA and IFG-STG connectivity were enhanced among follow-up patients and was synchronized with language-performance improvement. Our results revealed reduced intrinsic neural activity and inter-connections within language network in PSA, which would be normalized synchronously as the improvement of language performance.
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Affiliation(s)
- Xiaohui Xie
- Department of Neurology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Panpan Hu
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yanghua Tian
- Department of Neurology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Psychology and Sleep Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China; Institute of Artificial Intelligence, Hefei Comprehensive National Science Center, Hefei, China
| | - Bensheng Qiu
- Center for Biomedical Engineering, University of Science and Technology of China, Hefei, China
| | - Kai Wang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China; Institute of Artificial Intelligence, Hefei Comprehensive National Science Center, Hefei, China; The School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China; Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China.
| | - Tongjian Bai
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
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Gao Y, Qiu Y, Yang Q, Tang S, Gong J, Fan H, Wu Y, Lu X. Repetitive Transcranial Magnetic Stimulation Combined with Cognitive Training for Cognitive Function and Activities of Daily Living in Patients with Post-Stroke Cognitive Impairment: A Systematic Review and Meta-Analysis. Ageing Res Rev 2023; 87:101919. [PMID: 37004840 DOI: 10.1016/j.arr.2023.101919] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 03/11/2023] [Accepted: 03/27/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND Despite the potential effect of repetitive transcranial magnetic stimulation (rTMS) combined with cognitive training for post-stroke cognitive impairment (PSCI), there is uncertainty regarding rTMS combined with cognitive training for PSCI. OBJECTIVE To determine the effectiveness of rTMS combined with cognitive training for improving global cognitive function, specific domains of cognitive function and activities of daily living (ADL) in patients with PSCI. METHODS Databases including Cochrane Central, EMBASE (Ovid SP), CHINAL, APA PsycINFO, EBSCO, Medline, Web of science and other sources were systematically searched on March 23, 2022, and updated on December 5, 2022. All randomized controlled trials (RCTs) applied rTMS + cognitive training for patients with PSCI were screened for inclusion. RESULTS A total of 8 trials was finally included and 336 participants provided data for meta-analyses. Large effects were found for rTMS + cognitive training on global cognition (g = 0.780, 95% CI = 0.477 to 1.083), executive function (g = 0.769, 95% CI = 0.291 to 1.247), working memory (g = 0.609, 95% CI = 0.158-1.061) and medium improvement on ADL (g = 0.418, 95% CI = 0.058 to 0.778) were seen. While, no effects were found on memory or attention. Subgroup analyses showed that combinations of phase of stroke onset, rTMS frequency, stimulation site and stimulation sessions were potent factors that modulate the effects of rTMS + cognitive training for cognitive function. CONCLUSIONS The pooled data showed more positive effects of rTMS + cognitive training for global cognition, executive function, working memory and ADL in patients with PSCI. While, robust evidence of rTMS + cognitive training for global cognition, executive function, working memory and ADL from the Grade recommendations is lacking. Further, rTMS + cognitive training did not show no better effects on memory. Future definitive trials are needed to determine the benefits of rTMS + cognitive training for cognitive function and ADL in the field of PSCI.
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Liu Y, Luo J, Fang J, Yin M, Cao J, Zhang S, Huang L, Cheng Q, Ai Y, Zheng H, Hu X. Screening diagnosis of executive dysfunction after ischemic stroke and the effects of transcranial magnetic stimulation: A prospective functional near-infrared spectroscopy study. CNS Neurosci Ther 2023; 29:1561-1570. [PMID: 36786133 PMCID: PMC10173709 DOI: 10.1111/cns.14118] [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: 08/12/2022] [Revised: 01/21/2023] [Accepted: 01/29/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Post-ischemic stroke executive impairment (PISEI) is a serious obstacle for patients to returning to their society and is currently difficult to screen early and clinically ineffective. AIM The aim of the study was to clarify whether functional near-infrared spectroscopy (fNIRS) can be used as a rapid screening tool for PISEI and to explore the efficacy of transcranial magnetic stimulation (TMS) in PISEI patients and the changes in brain function. METHODS A single-blind, randomized controlled study design was used to detect hemodynamic differences by fNIIRS in 16 PISEI patients and 16 healthy subjects during the resting state and Stroop task, respectively. After 3 days, all subjects received a single TMS intervention and underwent simultaneous fNIRS testing for the Stroop task before and 3 days after the TMS intervention. RESULTS PISEI patients had significantly higher HbO2 content in the left dorsolateral prefrontal cortex (DLPFC), the right pre-motor cortex (PMC) and the right primary sensorimotor cortex (SM1) during the Stroop task compared to the resting state (F = 141.966, p < 0.001), but significantly lower than healthy subjects (T = -3.413, p = 0.002). After TMS intervention, PISEI patients' time and error number scores on the Stroop test were significantly enhanced, and the functional activity of the above-mentioned brain regions was significantly more active than at baseline, while the strength of their functional connections with each other was markedly increased. CONCLUSIONS fNIRS helped screen and diagnose PISEI. A single TMS session benefited PISEI patients with effects lasting 3 days, which may be attributed to activation of the left DLPFC, right PMC and right SM1 brain regions.
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Affiliation(s)
- Yuanwen Liu
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jing Luo
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jie Fang
- Department of Rehabilitation Medicine, Xiamen Humanity Rehabilitation Hospital, Xiamen, China
| | - Mingyu Yin
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jie Cao
- Department of Education, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Shuxian Zhang
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Li Huang
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Qilin Cheng
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Yinan Ai
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Haiqing Zheng
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiquan Hu
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Yang J, Guo Q, Wang L, Yu S. POU Domain Class 2 Transcription Factor 2 Inhibits Ferroptosis in Cerebral Ischemia Reperfusion Injury by Activating Sestrin2. Neurochem Res 2023; 48:658-670. [PMID: 36306010 DOI: 10.1007/s11064-022-03791-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/12/2022] [Accepted: 10/12/2022] [Indexed: 02/07/2023]
Abstract
Cerebral ischemia reperfusion injury (CIRI) is the commonest cause of brain dysfunction. Up-regulation of POU domain class 2 transcription factor 2 (POU2F2) has been reported in patients with cerebral ischemia, while the role of POU2F2 in CIRI remains elusive. Middle cerebral artery occlusion/reperfusion (MCAO/R) in mice and oxygen and glucose deprivation/reperfusion (OGD/R) in mouse primary cortical neurons were used as models of CIRI injury in vivo and in vitro. Lentivirus-mediated POU2F2 knockdown further impaired CIRI induced by MCAO/R in mice, which was accompanied by increased-neurological deficits, cerebral infarct volume and neuronal loss. Our evidence suggested that POU2F2 deficiency deteriorated oxidative stress and ferroptosis according to the phenomenon such as the abatement of SOD, GSH, glutathione peroxidase 4 (GPX4) activity and accumulation of ROS, lipid ROS, 4-hydroxynonenal (4-HNE) and MDA. In vivo, primary cortical neurons with POU2F2 knockdown also showed worse neuronal damage, oxidative stress and ferroptosis. Sestrin2 (Sesn2) was reported as a neuroprotection gene and involved in ferroptosis mechanism. Up-regulation of Sesn2 was observed in the ischemic penumbra and OGD/R-induced neuronal cells. Further, we proved that POU2F2, as a transcription factor, could bind to Sesn2 promoter and positively regulate its expression. Sesn2 overexpression relieved oxidative stress and ferroptosis induced by POU2F2 knockdown in OGD/R-treated neurons. This research demonstrated that CIRI induced a compensatory increase of POU2F2 and Sesn2. Down-regulated POU2F2 exacerbated CIRI through the acceleration of oxidative stress and ferroptosis possibly by decreasing Sesn2 expression, which offers new sights into therapeutic mechanisms for CIRI.
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Affiliation(s)
- Jinghui Yang
- Department of Hepatobiliary and Pancreatic Surgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin Province, China
| | - Qian Guo
- Department of Neurology, China-Japan Union Hospital of Jilin University, No. 126, Xiantai Street, Changchun, Jilin Province, China
| | - Lu Wang
- Department of Neurology, China-Japan Union Hospital of Jilin University, No. 126, Xiantai Street, Changchun, Jilin Province, China
| | - Shan Yu
- Department of Neurology, China-Japan Union Hospital of Jilin University, No. 126, Xiantai Street, Changchun, Jilin Province, China.
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Tan HK, Narasimhalu K, Ting SKS, Hameed S, Chang HM, De Silva DA, Chen CLH, Tan EK. B-vitamin supplementation on mitigating post-stroke cognition and neuropsychiatric sequelae: A randomized controlled trial. Int J Stroke 2023; 18:163-172. [PMID: 35195052 DOI: 10.1177/17474930221085880] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND PURPOSE A third of stroke patients suffer from post-stroke cognitive decline, depressive symptoms, and anxiety symptoms. B-vitamin supplementation provides a possible safe and affordable treatment to mitigate post-stroke neuropsychiatric sequelae via reducing homocysteine levels. Our study aims to examine the effect of B-vitamin supplementation in the prevention of post-stroke cognitive decline, depressive symptoms, and anxiety symptoms. Our secondary aims were to investigate associations between baseline factors and the three outcomes. METHODS Patients were recruited as part of a Singaporean substudy of a randomized controlled trial that examined the effect of B-vitamin supplementation on recurrent cardiovascular events. Cognitive decline, depressive symptoms, and anxiety symptoms were assessed with neuropsychological assessments and Hospital Anxiety and Depression Scale 6 monthly. Cox regression analyses were performed to determine treatment efficacy. Logistic regression used to examine factors associated with cognitive decline, depressive symptoms, and anxiety symptoms. RESULTS A total of 707 were included in the analyses. Survival and hazards ratio analysis showed no treatment effect of B-vitamins on cognitive decline, depressive symptoms, and anxiety symptoms. Cognitive decline was only associated with age. Depressive symptoms were associated with large anterior cerebral infarcts and hyperlipidemia. CONCLUSIONS Our study showed no benefit of supplementation with B-vitamins for post-stroke cognitive decline, depressive symptoms, or anxiety symptoms. Depressive symptoms were associated with larger anterior cerebral infarcts, which may be reflective of the disability associated with larger infarcts.
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Affiliation(s)
| | - Kaavya Narasimhalu
- Department of Neurology, National Neuroscience Institute (Singapore General Hospital Campus), Singapore
| | - Simon Kang Seng Ting
- Department of Neurology, National Neuroscience Institute (Singapore General Hospital Campus), Singapore
| | - Shahul Hameed
- Department of Neurology, National Neuroscience Institute (Singapore General Hospital Campus), Singapore
| | - Hui Meng Chang
- Department of Neurology, National Neuroscience Institute (Singapore General Hospital Campus), Singapore
| | - Deidre Anne De Silva
- Department of Neurology, National Neuroscience Institute (Singapore General Hospital Campus), Singapore
| | | | - Eng King Tan
- Department of Neurology, National Neuroscience Institute (Singapore General Hospital Campus), Singapore
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Kaddumukasa MN, Kaddumukasa M, Katabira E, Sewankambo N, Namujju LD, Goldstein LB. Prevalence and Predictors of Post-stroke Cognitive Impairment among Stroke Survivors in Uganda. RESEARCH SQUARE 2023:rs.3.rs-2456615. [PMID: 36711491 PMCID: PMC9882649 DOI: 10.21203/rs.3.rs-2456615/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Background Little is known about the characteristics and determinants of post-stroke cognitive impairments in low- and middle-income countries. The objective of this study was to determine the frequencies, patterns, and risk factors for cognitive impairment in a cross-sectional study of consecutive stroke patients cared for at Uganda's Mulago Hospital, located in sub-Saharan Africa. Methods From August 2019 to July 2020, patients were enrolled a minimum of 3-months post-stroke hospital admission. We collected data on their demographics, vascular risk factors and clinical factors using a questionnaire, clinical examination findings, and test results. Independent predictor variables associated with cognitive impairment were ascertained. Stroke impairments, disability, and handicap were assessed using the National Institute of Health Stroke Scale (NIHSS), Barthel Index (BI), and modified Rankin scale (mRS), respectively. The Montreal Cognitive Assessment (MoCA) was used to assess participants' cognitive function. Stepwise multiple logistic regression was used to identify variables independently associated with cognitive impairment. Results The overall mean MoCA score was 11.7-points (range 0.0-28.0-points) for 128 patients with available data of whom 66.4% were categorized as cognitively impaired (MoCA < 19-points). Increasing age (OR 1.04, 95% CI 1.00-1.07; p = 0.026), low level of education (OR 3.23, 95% CI 1.25-8.33; p = 0.016), functional handicap (mRS 3-5; OR 1.84, 95% CI 1.28-2.63; p < 0.001) and high LDL cholesterol (OR 2.74, 95% CI 1.14-6.56; p = 0.024) were independently associated with cognitive impairment. Discussion Further longitudinal, prospective studies are required to confirm these findings and identify strategies for reducing the risk of post-stroke cognitive impairment in this population.
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You S, Bi Y, Miao M, Bao A, Du J, Xu T, Liu CF, Zhang Y, He J, Cao Y, Zhong C. Plasma sDPP4 (Soluble Dipeptidyl Peptidase-4) and Cognitive Impairment After Noncardioembolic Acute Ischemic Stroke. Stroke 2023; 54:113-121. [PMID: 36475470 DOI: 10.1161/strokeaha.122.040798] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND DPP4 (dipeptidyl peptidase-4) inhibitors have been proven to promote neuronal regeneration, reverse the development of cognitive deficits. However, the association of circulating soluble form (sDPP4 [soluble DPP4]) with poststroke cognitive impairment (PSCI) is unclear. We aimed to investigate the association between plasma sDPP4 levels and PSCI in patients with ischemic stroke. METHODS A total of 600 noncardioembolic stroke patients were included based on a preplanned ancillary study from the CATIS (China Antihypertensive Trial in Acute Ischemic Stroke). We used the Montreal Cognitive Assessment to evaluate cognitive function at 3 months follow-up after ischemic stroke. Binary logistic regression analyses were performed to investigate the association of plasma sDPP4 levels with subsequent PSCI. We further calculated integrated discrimination improvement and category-free net reclassification improvement to investigate the incremental prognostic effect of plasma sDPP4 beyond the basic model with conventional risk factors. RESULTS Plasma sDPP4 was inversely associated with PSCI after ischemic stroke, and the adjusted odds ratio (95% CI) for the highest versus lowest quartile of sDPP4 was 0.49 (0.29-0.81; P for trend=0.011). Each 1-SD increase of logarithm-transformed plasma sDPP4 concentration was associated with 17% (odds ratio, 0.83 [95% CI, 0.70-0.99]) lower risk of PSCI. Adding plasma sDPP4 to the basic model notably improved risk reclassification for PSCI, as shown by a category-free net reclassification improvement of 19.10% (95% CI, 2.52%-35.68%; P=0.03) and integrated discrimination improvement of 0.79% (95% CI, 0.13%-1.46%; P=0.02). CONCLUSIONS Higher plasma sDPP4 levels were associated with decreased risk of cognitive impairment after noncardioembolic ischemic stroke.
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Affiliation(s)
- Shoujiang You
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, China (S.Y., C.-F.L., Y.C.).,Department of Epidemiology, School of Public Health, Medical College of Soochow University, Suzhou, China (Y.B., M.M., A.B., J.D., T.X., Y.Z., C.Z.)
| | - Yucong Bi
- Department of Epidemiology, School of Public Health, Medical College of Soochow University, Suzhou, China (Y.B., M.M., A.B., J.D., T.X., Y.Z., C.Z.)
| | - Mengyuan Miao
- Department of Epidemiology, School of Public Health, Medical College of Soochow University, Suzhou, China (Y.B., M.M., A.B., J.D., T.X., Y.Z., C.Z.)
| | - Anran Bao
- Department of Epidemiology, School of Public Health, Medical College of Soochow University, Suzhou, China (Y.B., M.M., A.B., J.D., T.X., Y.Z., C.Z.)
| | - Jigang Du
- Department of Epidemiology, School of Public Health, Medical College of Soochow University, Suzhou, China (Y.B., M.M., A.B., J.D., T.X., Y.Z., C.Z.)
| | - Tan Xu
- Department of Epidemiology, School of Public Health, Medical College of Soochow University, Suzhou, China (Y.B., M.M., A.B., J.D., T.X., Y.Z., C.Z.)
| | - Chun-Feng Liu
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, China (S.Y., C.-F.L., Y.C.).,Institutes of Neuroscience, Soochow University, Suzhou, China (C.-F.L., Y.C.)
| | - Yonghong Zhang
- Department of Epidemiology, School of Public Health, Medical College of Soochow University, Suzhou, China (Y.B., M.M., A.B., J.D., T.X., Y.Z., C.Z.)
| | - Jiang He
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (J.H.)
| | - Yongjun Cao
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, China (S.Y., C.-F.L., Y.C.).,Institutes of Neuroscience, Soochow University, Suzhou, China (C.-F.L., Y.C.)
| | - Chongke Zhong
- Department of Epidemiology, School of Public Health, Medical College of Soochow University, Suzhou, China (Y.B., M.M., A.B., J.D., T.X., Y.Z., C.Z.)
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Zinman J, Kapoor A, Si K, Sujanthan S, Southwell A, Cayley ML, Sicard MN, Lien K, Murray BJ, Lanctôt K, Herrmann N, Dowlatshahi D, Sahlas DJ, Saposnik G, Mandzia JL, Casaubon LK, Hassan A, Perez Y, Swartz RH. Men Are at Higher Risk of Screening Positive for Vascular Cognitive Impairment Compared to Women after Stroke and Transient Ischemic Attack. J Alzheimers Dis 2023; 94:89-94. [PMID: 37212109 DOI: 10.3233/jad-230021] [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: 05/23/2023]
Abstract
While women have greater incidence of dementia, men have higher prevalence of vascular risk factors. This study examined sex differences in risk of screening positive for cognitive impairment after stroke. Ischemic stroke/TIA patients (N = 5969) participated in this prospective, multi-centered study, which screened for cognitive impairment using a validated brief screen. Men showed a higher risk of screening positive for cognitive impairment after adjusting for age, education, stroke severity, and vascular risk factors, suggesting that other factors may be contributing to increased risk among men (OR = 1.34, CI 95% [1.16, 1.55], p < 0.001). The effect of sex on cognitive impairment after stroke warrants further attention.
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Affiliation(s)
- Julia Zinman
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Arunima Kapoor
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Kevin Si
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - Sajeevan Sujanthan
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - Alisia Southwell
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Megan L Cayley
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Michelle N Sicard
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Karen Lien
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Brian J Murray
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Krista Lanctôt
- University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Nathan Herrmann
- University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Dar Dowlatshahi
- Department of Medicine, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Demetrios J Sahlas
- Department of Medicine (Neurology), McMaster University, Hamilton General Hospital, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Gustavo Saposnik
- Stroke Outcomes and Decision Neuroscience Unit, St. Michael's Hospital, Toronto, ON, Canada
| | - Jennifer L Mandzia
- London Health Sciences Centre, Division of Neurology, London, ON, Canada
| | - Leanne K Casaubon
- University Health Network/Toronto Western Hospital, Division of Neurology, Toronto, ON, Canada
| | - Ayman Hassan
- Thunder Bay Regional Health Sciences Centre, Division of Neurology, Thunder Bay, ON, Canada
| | - Yael Perez
- Trillium Health Partners, Department of Medicine (Neurology), Mississauga, ON, Canada
| | - Richard H Swartz
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
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Tahmi M, Kane VA, Pavol MA, Naqvi IA. Neuroimaging biomarkers of cognitive recovery after ischemic stroke. Front Neurol 2022; 13:923942. [PMID: 36588894 PMCID: PMC9796574 DOI: 10.3389/fneur.2022.923942] [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: 04/19/2022] [Accepted: 11/23/2022] [Indexed: 12/15/2022] Open
Abstract
Post-stroke cognitive impairment affects more than one-third of patients after an ischemic stroke (IS). Identifying markers of potential cognitive recovery after ischemic stroke can guide patients' selection for treatments, enrollment in clinical trials, and cognitive rehabilitation methods to restore cognitive abilities in post-stroke patients. Despite the burden of post-stroke cognitive impairment, biomarkers of cognitive recovery are an understudied area of research. This narrative review summarizes and critically reviews the current literature on the use and utility of neuroimaging as a predictive biomarker of cognitive recovery after IS. Most studies included in this review utilized structural Magnetic Resonance Imaging (MRI) to predict cognitive recovery after IS; these studies highlighted baseline markers of cerebral small vessel disease and cortical atrophy as predictors of cognitive recovery. Functional Magnetic Resonance Imaging (fMRI) using resting-state functional connectivity and Diffusion Imaging are potential biomarkers of cognitive recovery after IS, although more precise predictive tools are needed. Comparison of these studies is limited by heterogeneity in cognitive assessments. For all modalities, current findings need replication in larger samples. Although no neuroimaging tool is ready for use as a biomarker at this stage, these studies suggest a clinically meaningful role for neuroimaging in predicting post-stroke cognitive recovery.
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Affiliation(s)
- Mouna Tahmi
- Department of Neurology, State University of New York Downstate Health Sciences University, New York, NY, United States
| | - Veronica A. Kane
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, United States
| | - Marykay A. Pavol
- Department of Neurology and Rehabilitation and Regenerative Medicine, Columbia University, New York, NY, United States
| | - Imama A. Naqvi
- Division of Stroke and Cerebrovascular Diseases, Department of Neurology, Columbia University, New York, NY, United States,*Correspondence: Imama A. Naqvi
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Chen N, Cao J, Zhang W, Chen Y, Xu L. Gender differences in the correlation between body mass index and cognitive impairment among the community-dwelling oldest-old in China: a cross-sectional study. BMJ Open 2022; 12:e065125. [PMID: 36418136 PMCID: PMC9685246 DOI: 10.1136/bmjopen-2022-065125] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE This study investigates gender differences in the correlation between body mass index (BMI) and cognitive impairment among Chinese community-dwelling oldest-old. SETTING Twenty-three provinces in China. Participants' mini-mental state examination (MMSE) scores <24 were considered cognitive impairment. Furthermore, the assessment standards of BMI status were classified into four categories: obese (BMI >30), overweight (25≤BMI≤30), normal (18.5≤BMI<25) and underweight (BMI <18.5). PARTICIPANTS A total of 9218 older adults (age 80+) were included from the 2018 wave of Chinese Longitudinal Healthy Longevity Study. METHODS Cognitive impairment, BMI and other covariates consisted of the sociodemographic variables, health behaviours and health status were collected. Cognitive impairment was assessed by the MMSE. Inverse probability weighting procedure was adopted to deal with bias due to dropout.Logistic regression was conducted to examine the correlation between BMI and cognitive impairment. RESULTS Among 9218 respondents, 3837 were males. Overall, the percentage of participants with cognitive impairment was 44.7%, with 32.1% among males and 53.7% among females. After controlling for other variables, males who were either overweight or underweight and females who were underweight were found to have higher risk of cognitive impairment among the oldest-old. Age, education, economic status, physical activity, activities of daily living, hypertension as well as heart disease were the predicting factors of cognitive impairment. CONCLUSIONS The relationship between BMI and cognitive impairment differs between male and female oldest-old, suggesting that we should pay attention to different BMI groups and adopt precise prevention strategies based on gender.
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Affiliation(s)
- Na Chen
- School of Elderly Care Services and management, Nanjing University of Traditional Chinese Medicine, Nanjing, Jiangsu, China
| | - JiaWei Cao
- School of Elderly Care Services and management, Nanjing University of Traditional Chinese Medicine, Nanjing, Jiangsu, China
| | - Wei Zhang
- School of Elderly Care Services and management, Nanjing University of Traditional Chinese Medicine, Nanjing, Jiangsu, China
| | - Yanan Chen
- School of Elderly Care Services and management, Nanjing University of Traditional Chinese Medicine, Nanjing, Jiangsu, China
| | - Ling Xu
- School of Elderly Care Services and management, Nanjing University of Traditional Chinese Medicine, Nanjing, Jiangsu, China
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Li Y, Yu Z, Zhou X, Wu P, Chen J. Aberrant interhemispheric functional reciprocities of the default mode network and motor network in subcortical ischemic stroke patients with motor impairment: A longitudinal study. Front Neurol 2022; 13:996621. [PMID: 36267883 PMCID: PMC9577250 DOI: 10.3389/fneur.2022.996621] [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] [Received: 07/18/2022] [Accepted: 09/15/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose The purpose of the present study was to explore the longitudinal changes in functional homotopy in the default mode network (DMN) and motor network and its relationships with clinical characteristics in patients with stroke. Methods Resting-state functional magnetic resonance imaging was performed in stroke patients with subcortical ischemic lesions and healthy controls. The voxel-mirrored homotopic connectivity (VMHC) method was used to examine the differences in functional homotopy in patients with stroke between the two time points. Support vector machine (SVM) and correlation analyses were also applied to investigate whether the detected significant changes in VMHC were the specific feature in patients with stroke. Results The patients with stroke had significantly lower VMHC in the DMN and motor-related regions than the controls, including in the precuneus, parahippocampus, precentral gyrus, supplementary motor area, and middle frontal gyrus. Longitudinal analysis revealed that the impaired VMHC of the superior precuneus showed a significant increase at the second time point, which was no longer significantly different from the controls. Between the two time points, the changes in VMHC in the superior precuneus were significantly correlated with the changes in clinical scores. SVM analysis revealed that the VMHC of the superior precuneus could be used to correctly identify the patients with stroke from the controls with a statistically significant accuracy of 81.25% (P ≤ 0.003). Conclusions Our findings indicated that the increased VMHC in the superior precuneus could be regarded as the neuroimaging manifestation of functional recovery. The significant correlation and the discriminative power in classification results might provide novel evidence to understand the neural mechanisms responsible for brain reorganization after stroke.
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Affiliation(s)
- Yongxin Li
- School of Traditional Chinese Medicine, Formula-Pattern Research Center, Jinan University, Guangzhou, China
- *Correspondence: Yongxin Li
| | - Zeyun Yu
- Acupuncture and Tuina School/Tird Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xuan Zhou
- School of Traditional Chinese Medicine, Formula-Pattern Research Center, Jinan University, Guangzhou, China
| | - Ping Wu
- Acupuncture and Tuina School/Tird Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Ping Wu
| | - Jiaxu Chen
- School of Traditional Chinese Medicine, Formula-Pattern Research Center, Jinan University, Guangzhou, China
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Kern KC, Wright CB, Leigh R. Global changes in diffusion tensor imaging during acute ischemic stroke and post-stroke cognitive performance. J Cereb Blood Flow Metab 2022; 42:1854-1866. [PMID: 35579236 PMCID: PMC9536124 DOI: 10.1177/0271678x221101644] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Post-stroke cognitive impairment is related to the effects of the acute stroke and pre-stroke brain health. We tested whether diffusion tensor imaging (DTI) can detect acute, global effects of stroke and predict post-stroke cognitive performance. Patients with stroke or TIA enrolled in a prospective cohort study were included if they had 1) at least one DTI acquisition at acute presentation, 24 hours, 5 days, or 30 days, and 2) follow-up testing with the telephone Montreal Cognitive Assessment (T-MoCA) at 30 and/or 90 days. A whole brain, white-matter skeleton excluding the infarct was used to derive mean global DTI measures for mean diffusivity (MD), fractional anisotropy (FA), free water (FW), FW-corrected MD (MDtissue), and FW-corrected FA (FAtissue). In 74 patients with ischemic stroke or TIA, there was a transient 4.2% increase in mean global FW between acute presentation and 24 hours (p = 0.024) that returned to initial values by 30 days (p = 0.03). Each acute global DTI measure was associated with 30-day T-MoCA score (n = 61, p = 0.0011-0.0076). Acute global FW, MD, FA and FAtissue were also associated with 90-day T-MoCA (n = 56, p = 0.0034-0.049). Transient global FW elevation likely reflects stroke-related interstitial edema, whereas other global DTI measures are more representative of pre-stroke brain health.
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Affiliation(s)
- Kyle C Kern
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Clinton B Wright
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Richard Leigh
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA.,Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Hua J, Zhou Y, Chen L, Tang X, Diao S, Fang Q. How do cardiovascular risk factors correlate with post-stroke cognitive function: Directly or indirectly through stroke severity? Front Neurol 2022; 13:917295. [PMID: 35989927 PMCID: PMC9389173 DOI: 10.3389/fneur.2022.917295] [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: 04/11/2022] [Accepted: 07/07/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives Cognitive impairment may affect one-third of stroke survivors. Cardiovascular risk factors and stroke severity were known to be associated with cognitive function after stroke. However, it is unclear whether cardiovascular risk factors directly affect cognition after stroke, indirectly affect cognition by changing stroke severity, or both. Moreover, the effect of a combination of hypertension and diabetes mellitus was conflicting. We aimed to investigate the multiple direct and indirect associations and inspire potential intervention strategies. Materials and methods From February 2020 to January 2021, 350 individuals received cognitive tests within 7 days after incident stroke. Cognitive tests were performed using the Chinese version of the Mini-Mental State Examination (MMSE). A moderated mediation model was constructed to test the indirect associations between cardiovascular and demographic risk factors and cognition mediated through stroke severity, the direct associations between risk factors and cognition, and the moderating effects of hypertension and diabetes. Results Age (estimate, -0.112), atrial fibrillation (estimate, -4.092), and stroke severity (estimate, -1.994) were directly associated with lower cognitive function after stroke. Vascular disease (estimate, 1.951) and male sex (estimate, 2.502) were directly associated with better cognition after stroke. Higher education level was associated with better cognition directly (estimate, 1.341) and indirectly (estimate, 0.227) through stroke severity. The combination of hypertension decreased the magnitude of the negative association between atrial fibrillation and cognition (estimate, from -4.092 to -3.580). Conclusion This is the first Chinese study exploring the moderated and mediating associations between cardiovascular risk factors, stroke severity, and cognitive function after stroke. Age, female sex, and atrial fibrillation were directly associated with lower cognition after stroke. The combination of hypertension might have a positive effect on cognition.
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Affiliation(s)
- Jianian Hua
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yixiu Zhou
- Department of Emergency, Children's Hospital of Soochow University, Suzhou, China
| | - Licong Chen
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiang Tang
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Shanshan Diao
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Qi Fang
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China
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Deijle IA, Hemmes R, Boss HM, de Melker EC, van den Berg BTJ, Kwakkel G, van Wegen E, Bosboom WM, Weinstein HC, van Schaik SM, Van den Berg-Vos RM. Effect of an exercise intervention on global cognition after transient ischemic attack or minor stroke: the MoveIT randomized controlled trial. BMC Neurol 2022; 22:289. [PMID: 35927622 PMCID: PMC9351151 DOI: 10.1186/s12883-022-02805-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 07/14/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Patients with a transient ischemic attack (TIA) or ischemic stroke are at increased risk of developing cognitive impairment in the subacute phase. At present, the effects of exercise on cognitive functioning following a TIA or stroke are not fully known. The purpose of this trial was to investigate the effect of exercise on global cognition. METHODS The MoveIT trial is a single-centre, observer-blinded, randomized controlled trial involving a 1-year exercise intervention consisting of a 12-week group exercise program, combined with three counselling visits to the physiotherapists over a 9-month period. The control group received standard care. The primary outcome was global cognitive functioning, assessed at one year, using the Montreal Cognitive Assessment (MoCA). Secondary outcomes included cardiorespiratory fitness, the cardiovascular profile, and attainment of secondary prevention targets, anxiety, depression and fatigue at one and two years. RESULTS The experimental group consisted of 60 patients, while the control group consisted of 59 patients. The mean age was 64.3 years and 41% were female. No between-group differences were found on global cognitive functioning (MD, 0.7 out of 30, 95% CI, - 0.2 to 1.6) or on secondary outcome measures at 12 months. The only significant between-group difference was found for fatigue, in favour of the experimental group at 12 months (MD, 0.6 out of 63, 95% CI, 0.1 to 1.1). CONCLUSIONS No benefit of this exercise intervention was found regarding global cognition. Future studies need to focus on optimizing rehabilitation strategies for this vulnerable group of patients. TRIAL REGISTRATION http://www.trialregister.nl . Unique identifier: NL3721 . Date first registration: 06-03-2013.
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Affiliation(s)
- Inger A. Deijle
- Department of Neurology, OLVG, Amsterdam, The Netherlands
- Department of Physical Therapy, OLVG, Amsterdam, The Netherlands
| | | | - H. Myrthe Boss
- Department of Neurology, Gelderse Vallei Hospital, Ede, The Netherlands
| | | | | | - Gert Kwakkel
- Department of Rehabilitation Medicine, Amsterdam UMC, location Vrije Universiteit Amsterdam, De Boelelaan 1118, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, The Netherlands
- Amsterdam Neurosciences, Neurovascular Disorders, Amsterdam, The Netherlands
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL USA
- Department of Neurorehabilitation, Amsterdam Rehabilitation Research Centre Reade, Amsterdam, The Netherlands
| | - Erwin van Wegen
- Department of Rehabilitation Medicine, Amsterdam UMC, location Vrije Universiteit Amsterdam, De Boelelaan 1118, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, The Netherlands
- Amsterdam Neurosciences, Neurovascular Disorders, Amsterdam, The Netherlands
| | - Wendy M. Bosboom
- Board of directors, Rivierenland Hospital, Tiel, The Netherlands
| | - Henry C. Weinstein
- Department of Neurology, OLVG, Amsterdam, The Netherlands
- Amsterdam Neurosciences, Neurovascular Disorders, Amsterdam, The Netherlands
| | | | - Renske M. Van den Berg-Vos
- Department of Neurology, OLVG, Amsterdam, The Netherlands
- Amsterdam Neurosciences, Neurovascular Disorders, Amsterdam, The Netherlands
- Department of Neurology, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
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Zhang M, Wang K, Xie L, Pan X. Short-term Montreal Cognitive Assessment predicts functional outcome after endovascular therapy. Front Aging Neurosci 2022; 14:808415. [PMID: 35992595 PMCID: PMC9382115 DOI: 10.3389/fnagi.2022.808415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 07/01/2022] [Indexed: 11/24/2022] Open
Abstract
Background The previous studies have shown that cognition in patients 4–8 weeks after stroke can predict early functional outcomes after stroke. The analyses of data from the REVASCAT trial proved that stent thrombectomy improves post-morbid wiring test outcomes in patients with AIS compared with drug therapy. However, few studies focus on the relationship between cognitive impairment and functional outcomes in patients undergoing endovascular treatment. Methods A total of 647 participants registered from stroke centers. Stroke severity was evaluated by National Institutes of Health stroke scale (NIHSS). The functional status was estimated by modified Rankin scale (mRS). The cognitive impairment was assessed by trained neurologists at 14 (±4) and 90 (±7) days after stroke onset using the Montreal Cognitive Assessment (MoCA). A MoCA score of less than 26 was considered post-stroke cognitive impairment (PSCI). Results A total of 120 Patients who underwent endovascular therapy were included. The PSCI group had higher levels of age, men, educational status, atrial fibrillation, smoking, alcoholism, Alberta Stroke Program Early CT (ASPECT) score of the anterior circulation, and OTP time than the non-PSCI group (p < 0.05). In contrast, the 14-day MoCA score, 14-day NIHSS score, 3-month MoCA score, 3-month NIHSS score, 3-month mRS score, and 3-month EQ5D score were lower in those PSCI patients. The risk predictors of PSCI were age, sex, educational level, atrial fibrillation, smoking, alcoholism, ASPECT Score (anterior circulation), 14-day MoCA score, and 14-day NIHSS score. There were strong relationships between 3-month NIHSS and MoCA (r = –0.483, p < 0.001). Receiver operating characteristic (ROC) curve indicated that 14-day MoCA score, memory, abstraction, visuospatial/executive functions, attention, and language, played a significant role to predict PSCI [area under the curve (AUC) > 0.7]. It had predictive value for the 14-day visuospatial/executive functions to predict 3-month functional outcomes. Conclusion Early application of the MoCA in different cognitive regions could predict the PSCI and future functional outcomes, which is necessary to screen high-risk patients with poor prognosis and conduct an early intervention.
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Park JG. Update on Stroke Rehabilitation for Non-Motor Impairment. BRAIN & NEUROREHABILITATION 2022; 15:e13. [PMID: 36743206 PMCID: PMC9833475 DOI: 10.12786/bn.2022.15.e13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/13/2022] [Accepted: 07/18/2022] [Indexed: 11/08/2022] Open
Abstract
Various interventions exist to treat non-motor impairments caused by stroke. Adjuvant treatments such as non-invasive brain stimulation, virtual reality, computer-assisted training, neurostimulation, and biofeedback are being investigated and applied in the areas of cognitive dysfunction, language problems, visual disorders, dysphagia, mood disorders, and post-stroke pain. Most of these treatments have shown efficacy and symptom improvement, but further investigation is required to fully clarify their effects.
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Affiliation(s)
- Jin Gee Park
- Department of Physical Medicine and Rehabilitation, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
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Ding L, Ye H, Gu LD, Du AQ, Yuan XL. Echinacoside Alleviates Cognitive Impairment in Cerebral Ischemia Rats through α 7nAChR-Induced Autophagy. Chin J Integr Med 2022; 28:809-816. [PMID: 35799084 DOI: 10.1007/s11655-022-2893-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate the effect of echinacoside (ECH) on cognitive dysfunction in post cerebral stroke model rats. METHODS The post stroke cognitive impairment rat model was created by occlusion of the transient middle cerebral artery (MCAO). The rats were randomly divided into 3 groups by a random number table: the sham group (sham operation), the MCAO group (received operation for focal cerebral ischemia), and the ECH group (received operation for focal cerebral ischemia and ECH 50 mg/kg per day), with 6 rats in each group. The infarct volume and spatial learning were evaluated by triphenyl tetrazolium chloride staining and Morris water maze. The expression of α7nAChR in the hippocampus was detected by immunohistochemistry. The contents of acetylcholine (ACh), malondialdehyde (MDA), glutathione (GSH), superoxide dismutase (SOD), activities of choline acetyltransferase (ChAT), acetylcholinesterase (AChE), and catalase (CAT) were evaluated by enzyme linked immunosorbent assay. The neural apoptosis and autophagy were determined by TUNEL staining and LC3 staining, respectively. RESULTS ECH significantly lessened the brain infarct volume and ameliorated neurological deficit in infarct volume and water content (both P<0.01). Compared with MCAO rats, administration of ECH revealed shorter escape latency and long retention time at 7, 14 and 28 days (all P<0.01), increased the α7nAChR protein expression, ACh content, and ChAT activity, and decreased AChE activity in MCAO rats (all P<0.01). ECH significantly decreased MDA content and increased the GSH content, SOD, and CAT activities compared with MCAO rats (all P<0.05). ECH suppressed neuronal apoptosis by reducing TUNEL-positive cells and also enhanced autophagy in MCAO rats (all P<0.01). CONCLUSION ECH treatment helped improve cognitive impairment by attenuating neurological damage and enhancing autophagy in MCAO rats.
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Affiliation(s)
- Ling Ding
- Department of Endocrinology and Metabolic Diseases, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, China
| | - Hong Ye
- Department of Endocrinology and Metabolic Diseases, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, China
| | - Long-Dian Gu
- Department of Endocrinology and Metabolic Diseases, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, China
| | - An-Qing Du
- Department of Endocrinology and Metabolic Diseases, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, China
| | - Xin-Lu Yuan
- Department of Endocrinology and Metabolic Diseases, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, China.
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Bowren M, Bruss J, Manzel K, Edwards D, Liu C, Corbetta M, Tranel D, Boes AD. Post-stroke outcomes predicted from multivariate lesion-behaviour and lesion network mapping. Brain 2022; 145:1338-1353. [PMID: 35025994 PMCID: PMC9630711 DOI: 10.1093/brain/awac010] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 09/10/2021] [Accepted: 12/16/2021] [Indexed: 11/13/2022] Open
Abstract
Clinicians and scientists alike have long sought to predict the course and severity of chronic post-stroke cognitive and motor outcomes, as the ability to do so would inform treatment and rehabilitation strategies. However, it remains difficult to make accurate predictions about chronic post-stroke outcomes due, in large part, to high inter-individual variability in recovery and a reliance on clinical heuristics rather than empirical methods. The neuroanatomical location of a stroke is a key variable associated with long-term outcomes, and because lesion location can be derived from routinely collected clinical neuroimaging data there is an opportunity to use this information to make empirically based predictions about post-stroke deficits. For example, lesion location can be compared to statistically weighted multivariate lesion-behaviour maps of neuroanatomical regions that, when damaged, are associated with specific deficits based on aggregated outcome data from large cohorts. Here, our goal was to evaluate whether we can leverage lesion-behaviour maps based on data from two large cohorts of individuals with focal brain lesions to make predictions of 12-month cognitive and motor outcomes in an independent sample of stroke patients. Further, we evaluated whether we could augment these predictions by estimating the structural and functional networks disrupted in association with each lesion-behaviour map through the use of structural and functional lesion network mapping, which use normative structural and functional connectivity data from neurologically healthy individuals to elucidate lesion-associated networks. We derived these brain network maps using the anatomical regions with the strongest association with impairment for each cognitive and motor outcome based on lesion-behaviour map results. These peak regional findings became the 'seeds' to generate networks, an approach that offers potentially greater precision compared to previously used single-lesion approaches. Next, in an independent sample, we quantified the overlap of each lesion location with the lesion-behaviour maps and structural and functional lesion network mapping and evaluated how much variance each could explain in 12-month behavioural outcomes using a latent growth curve statistical model. We found that each lesion-deficit mapping modality was able to predict a statistically significant amount of variance in cognitive and motor outcomes. Both structural and functional lesion network maps were able to predict variance in 12-month outcomes beyond lesion-behaviour mapping. Functional lesion network mapping performed best for the prediction of language deficits, and structural lesion network mapping performed best for the prediction of motor deficits. Altogether, these results support the notion that lesion location and lesion network mapping can be combined to improve the prediction of post-stroke deficits at 12-months.
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Affiliation(s)
- Mark Bowren
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA 52242, USA
| | - Joel Bruss
- Department of Neurology, Carver College of Medicine, Iowa City, IA 52242, USA
| | - Kenneth Manzel
- Department of Neurology, Carver College of Medicine, Iowa City, IA 52242, USA
| | - Dylan Edwards
- Moss Rehabilitation Research Institute, Elkins Park, PA 19027, USA
- Edith Cowan University, Joondalup, WA 6027, Australia
| | - Charles Liu
- Neurorestoration Center and Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Rancho Los Amigos National Rehabilitation Center, Downey, CA, USA
| | - Maurizio Corbetta
- Department of Neuroscience, Venetian Institute of Molecular Medicine and Padova Neuroscience Center, University of Padua, Padova, PD 32122, Italy
| | - Daniel Tranel
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA 52242, USA
- Department of Neurology, Carver College of Medicine, Iowa City, IA 52242, USA
| | - Aaron D Boes
- Departments of Neurology, Psychiatry, and Pediatrics, Carver College of Medicine, Iowa City, IA 52242, USA
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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: 254] [Impact Index Per Article: 127.0] [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.
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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)
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White matter microstructural damage in chronic ischemic stroke affecting the left inferior frontal gyrus: association with cognitive functions. Clin Neurol Neurosurg 2022; 217:107238. [DOI: 10.1016/j.clineuro.2022.107238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 03/18/2022] [Accepted: 03/31/2022] [Indexed: 01/01/2023]
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Stein C, Bunker L, Chu B, Leigh R, Faria A, Hillis AE. Various tests of left neglect are associated with distinct territories of hypoperfusion in acute stroke. Brain Commun 2022; 4:fcac064. [PMID: 35386220 PMCID: PMC8977645 DOI: 10.1093/braincomms/fcac064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 12/18/2021] [Accepted: 03/15/2022] [Indexed: 11/24/2022] Open
Abstract
Hemispatial neglect is among the most disabling consequences of right hemisphere stroke. However, there is no consensus on the optimal assessments to identify neglect. We hypothesized that different tests for neglect given the same day (i) detect distinct aspects and types of neglect, (ii) are sensitive to different cognitive functions (beyond spatially specific processing) and (iii) are associated with distinct regions of hypoperfusion. We examined data from 135 participants with acute, right-hemispheric ischaemic stroke who received an MRI and neglect testing within 48 h of acute infarct in a cross-sectional study. The volume of infarct was calculated on diffusion-weighted imaging. We also scored severity and location of fluid-attenuated inversion recovery hyperintense vessels in six areas (anterior cerebral artery territory, posterior cerebral artery territory and four within the middle cerebral artery territory) to estimate the volume and location of hypoperfusion in acute stroke. Neglect tests included gap detection, scene copy, line bisection, line cancellation, oral reading and picture description. We found strong correlations between tests that evaluated viewer-centred processing, as well as strong correlations between tests that evaluated stimulus-centred processing. The error rate on different tests was associated with hypoperfusion in different vascular territories, even after controlling for the volume of an infarct. Our results confirm that it is essential to administer a battery of different tests of hemispatial neglect to capture various deficits in attention and spatially specific processing that underlies neglect. Our results also show the potential usefulness of hyperintense vessel ratings as an indication of dysfunction beyond the infarct, as the ratings (and not infarct volume) were highly associated with many clinical deficits. Finally, results underscore that diverse types of neglect are clinically important in acute stroke, as they reflect different areas of hypoperfused tissue, which may be salvageable in the absence of infarct in those areas. As such, neglect batteries may be useful for detecting patients with cortical hypoperfusion who are candidates for reperfusion therapies.
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Affiliation(s)
- Colin Stein
- Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Lisa Bunker
- Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Brian Chu
- Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Richard Leigh
- Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Andreia Faria
- Department of Radiology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Argye E. Hillis
- Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Department of Physical Medicine & Rehabilitation, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Department of Cognitive Science, Johns Hopkins University, Baltimore, MD, USA
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