1
|
Goldberg EB, Meier EL, Sheppard SM, Breining BL, Hillis AE. Stroke Recurrence and Its Relationship With Language Abilities. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:2022-2037. [PMID: 34043446 PMCID: PMC8740764 DOI: 10.1044/2021_jslhr-20-00347] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 11/23/2020] [Accepted: 02/20/2021] [Indexed: 06/12/2023]
Abstract
Purpose Many factors influence poststroke language recovery, yet little is known about the influence of previous stroke(s) on language after left hemisphere stroke. In this prospective longitudinal study, we investigated the role of prior stroke on language abilities following an acute left hemisphere ischemic stroke, while controlling for demographic and stroke-related factors, and examined if earlier stroke impacted language recovery at a chronic time point. Method Participants (n = 122) with acute left hemisphere ischemic stroke completed language evaluation and clinical neuroimaging. They were divided into two groups: single stroke (SS; n = 79) or recurrent stroke (RS; n = 43). A subset of participants (n = 31) completed chronic-stage re-evaluation. Factors studied included age, education, diabetes and hypertension diagnoses, lesion volume and broad location, group status, aphasia prevalence, and language scores. Results Groups did not differ in language performance across time points. The only significant group differences were that participants with RS were older, had smaller acute lesions, and were less educated. Stroke group membership (SS vs. RS) was not associated with language performance at either time point. In patients with prior stroke, large acute lesion volumes were associated with acute language performance, whereas both large acute and chronic volumes influenced recovery. Conclusions History of prior stroke in itself may not significantly influence language impairment after an additional acute left hemisphere stroke, unless it contributes substantially to the total volume of infarcted brain tissue. Chronic and acute lesion volumes should be accounted for in studies investigating poststroke language performance and recovery. Supplemental Material https://doi.org/10.23641/asha.14669715.
Collapse
Affiliation(s)
- Emily B. Goldberg
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Erin L. Meier
- Department of Communication Sciences and Disorders, Bouvé College of Health Sciences, Northeastern University, Boston, MA
| | - Shannon M. Sheppard
- Department of Communication Sciences and Disorders, Crean College of Health and Behavioral Sciences, Chapman University, Irvine, CA
| | - Bonnie L. Breining
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Argye E. Hillis
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD
| |
Collapse
|
2
|
He W, Ruan Y, Yuan C, Luan X, He J. Hemoglobin, anemia, and poststroke cognitive impairment: A cohort study. Int J Geriatr Psychiatry 2020; 35:564-571. [PMID: 31994213 DOI: 10.1002/gps.5272] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 01/21/2020] [Indexed: 11/12/2022]
Abstract
OBJECTIVES Several studies have demonstrated that anemia was associated with cognitive impairment. The aim of this study was to explore the relationship between hemoglobin and cognitive impairment in patient with acute ischemic stroke. METHODS In total, 326 patients with acute ischemic stroke were followed up for 1 month. The main outcome was the incidence and severity of poststroke cognitive impairment (PSCI) assessed by Mini-Mental State Examination (MMSE). The impact of hemoglobin levels and anemia on PSCI was assessed by multiple regression models controlling for potential confounders. RESULTS During the 1-month follow-up, 193 (59.2%) patients developed PSCI. Anemia was independently associated with PSCI (OR = 3.637; 95% CI, 1.216-10.881; P = .021) after adjusting for demographics, vascular risk factors, stroke severity, and functional outcome. When the hemoglobin levels stratified into tertiles, higher hemoglobin levels were associated with better cognitive function. This result was however not significant after adjusting for the same confounders above. CONCLUSIONS Low hemoglobin levels are associated with an increased risk of PSCI. Targeted interventions in this population may reduce the incidence of PSCI and require further evaluation.
Collapse
Affiliation(s)
- Weilei He
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yiting Ruan
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Chengxiang Yuan
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiaoqian Luan
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jincai He
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| |
Collapse
|
3
|
You W, Li Y, Ouyang J, Li H, Yang S, Hu Q, Zhong J. Predictors of Poor Outcome in Patients with Minor Ischemic Stroke by Using Magnetic Resonance Imaging. J Mol Neurosci 2019; 69:478-484. [PMID: 31325109 DOI: 10.1007/s12031-019-01379-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 07/09/2019] [Indexed: 02/06/2023]
Abstract
Although the symptoms of minor ischemic stroke are mild, poor prognosis may occur if left untreated. Therefore, it is particularly important to identify the predictors that associated with poor outcome in patients presenting minor ischemic stroke. The aim of this study was to elucidate the predictors of progression by using magnetic resonance imaging (MRI). A total of 516 patients diagnosed with minor ischemic stroke were enrolled in this study. They were divided into two groups, the progressive group and non-progressive group, according to the modified Rankin Scale (mRS) with the cutoff value of 2 points on day 90 after the stroke onset. We compared the results of MRI scan between the two groups to investigate the potential independent determinants of progression using multivariate logistic regression analysis. Ninety of 516 patients (17.44%) underwent progression. There were 9 factors that were independently associated with poor outcome, including age (OR = 1.045, 95% CI 1.017-1.074), heart disease (OR = 2.021, 95% CI 1.063-3.841), baseline NIHSS score (OR = 1.662, 95% CI 1.177-2.347), limb motor disturbance (OR = 2.430, 95% CI 1.010-5.850), ataxia (OR = 2.929, 95% CI 1.188-7.221), early neurological deterioration (OR = 50.994, 95% CI 17.659-147.258), diameter of infarction (OR = 1.279, 95% CI 1.075-1.521), non-responsible vessel size (OR = 2.518, 95% CI 1.145-5.536), and large-artery atherosclerosis (OR = 2.010, 95% CI 1.009-4.003). This study indicated that age, heart disease, motor disturbance of limb, ataxia, early neurological deterioration, diameter of infarction, size of non-responsible vessels, and large-artery atherosclerosis can be used to assess the prognosis of patients with minor ischemic stroke.
Collapse
Affiliation(s)
- Wenxia You
- Department of Neurology, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), No.1 Jiazi Road, Lunjiao, Shunde District, Foshan, Guangdong Province, 528308, China
| | - Yongxin Li
- Department of Neurology, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), No.1 Jiazi Road, Lunjiao, Shunde District, Foshan, Guangdong Province, 528308, China
| | - Jipeng Ouyang
- Department of Neurology, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), No.1 Jiazi Road, Lunjiao, Shunde District, Foshan, Guangdong Province, 528308, China
| | - Hongzhuang Li
- Department of Neurology, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), No.1 Jiazi Road, Lunjiao, Shunde District, Foshan, Guangdong Province, 528308, China
| | - Shaomin Yang
- Department of Radiology, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), No.1 Jiazi Road, Lunjiao, Shunde District, Foshan, Guangdong Province, 528308, China
| | - Qiugen Hu
- Department of Radiology, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), No.1 Jiazi Road, Lunjiao, Shunde District, Foshan, Guangdong Province, 528308, China
| | - Jianping Zhong
- Department of Neurology, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), No.1 Jiazi Road, Lunjiao, Shunde District, Foshan, Guangdong Province, 528308, China.
| |
Collapse
|
4
|
Lodha N, Harrell J, Eisenschenk S, Christou EA. Motor Impairments in Transient Ischemic Attack Increase the Odds of a Subsequent Stroke: A Meta-Analysis. Front Neurol 2017. [PMID: 28638365 PMCID: PMC5461338 DOI: 10.3389/fneur.2017.00243] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Background and purpose Transient ischemic attack (TIA) increases the risk for a subsequent stroke. Typical symptoms include motor weakness, gait disturbance, and loss of coordination. The association between the presence of motor impairments during a TIA and the chances of a subsequent stroke has not been examined. In the current meta-analysis, we examine whether the odds of a stroke are greater in TIA individuals who experience motor impairments as compared with those who do not experience motor impairments. Methods We conducted a systematic search of electronic databases as well as manual searches of the reference lists of retrieved articles. The meta-analysis included studies that reported an odds ratio relating motor impairments to a subsequent stroke, or the number of individuals with or without motor impairments who experienced a subsequent stroke. We examined these studies using rigorous meta-analysis techniques including random effects model, forest and funnel plots, I2, publication bias, and fail-safe analysis. Results Twenty-four studies with 15,129 participants from North America, Australia, Asia, and Europe qualified for inclusion. An odds ratio of 2.11 (95% CI, 1.67–2.65, p = 0.000) suggested that the chances of a subsequent stroke are increased by twofolds in individuals who experience motor impairments during a TIA compared with those individuals who have no motor impairments. Conclusion The presence of motor impairments during TIA is a significantly high-risk clinical characteristic for a subsequent stroke. The current evidence for motor impairments following TIA relies exclusively on the clinical reports of unilateral motor weakness. A comprehensive examination of motor impairments in TIA will enhance TIA prognosis and restoration of residual motor impairments.
Collapse
Affiliation(s)
- Neha Lodha
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO, United States
| | - Jane Harrell
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, United States
| | - Stephan Eisenschenk
- Department of Neurology, University of Florida, Gainesville, FL, United States
| | - Evangelos A Christou
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, United States
| |
Collapse
|