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Wang J, Cheng G, Yang Y, Cheng W. Risk Factors of Poststroke Cognitive Impairment: A Meta-Analysis. Vasc Endovascular Surg 2024:15385744241259700. [PMID: 39036866 DOI: 10.1177/15385744241259700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2024]
Abstract
OBJECTIVE To explore the potential risk factors of post stroke cognitive impairment (PSCI) by conducting a meta-analysis. METHODS Literature search was performed in databases (PubMed, Embase, Web of Science, CNKI) using keywords of PSCI. Cochrane ROB tool was adopted for evaluating the quality of the included studies. Afterwards, data was independently extracted by 2 investigators. Heterogeneity was quantified across studies by Chi-squared-based Q statistic test and I2 statistic. The random-effects model or fixed-effects model was employed to compute the pooled estimates depends on whether the heterogeneity was significant (I2 > 50% or P < .05) or not. Publication bias was evaluated by the funnel plot and Egger's test. Sensitivity analysis was accomplished through eliminating studies 1 at a time to evaluate the stability of the pooled estimates. RESULTS 23 high-quality studies with 13322 patients were included. Compared with patients with no cognitive impairment, PSCI was more likely to develop in the elderly (pooled MD = 3.58, 95% CI = [1.82, 5.34]), female (pooled RR = 1.23, 95% CI = [1.07, 1.41]), or less-educated (pooled MD = -1.63, 95% CI = [-2.96, -.31]) patients with a history of hypertension (pooled RR = 1.07, 95% CI = [1.03, 1.11]), diabetes mellitus (pooled RR = 1.10, 95% CI = [1.03, 1.17]), atrial fibrillation (pooled RR = 1.38, 95% CI = [1.10, 1.74]), or stroke (pooled RR = 1.36, 95% CI = [1.09, 1.70]). Smoking did not affect the development of PSCI in patients (pooled RR = .96, 95% CI = [.78, 1.19]). Ischemic heart disease and region represented the sources of significant heterogeneity across studies. The pooled estimates were robust, and no publication bias was seen. CONCLUSION Age, gender, education, hypertension, diabetes mellitus, atrial fibrillation, and stroke were the risk factors of PSCI. Controlling these risk factors can help prevent PSCI.
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Affiliation(s)
- Jinyu Wang
- Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang, China
| | | | - Yuanyuan Yang
- Acupuncture and Moxibustion Department, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China
| | - Weiping Cheng
- Acupuncture and Moxibustion Department, The First Hospital Affiliated to Heilongjiang University of Chinese Medicine, Heilongjiang, China
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Ayehu GW, Admasu FT, Yitbarek GY, Agegnehu Teshome A, Amare AT, Atlaw D, Sharma S. Early post-stroke cognitive impairment and in-hospital predicting factors among stroke survivors in Ethiopia. Front Neurol 2023; 14:1163812. [PMID: 37284182 PMCID: PMC10239813 DOI: 10.3389/fneur.2023.1163812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 04/24/2023] [Indexed: 06/08/2023] Open
Abstract
Background In low-and middle-income countries, post-stroke cognitive impairment (PSCI) is the least investigated stroke complication that clinically is given little attention. Finding patients who are at high risk of having cognitive problems after a stroke could allow targeted follow-up and help with prognosis discussions, which would then contribute to improved treatment outcomes. The main aim of this study was to determine the incidence and predictors of PSCI among stroke survivors in Northwest Ethiopia. Methods The study was a multicenter prospective cohort study. The study participants were 403 stroke survivors who were alive on follow-up after 3 months of stroke onset at the neurology department of three hospitals in Northwest Ethiopia. To investigate the link between the outcome and the explanatory variables, analyses of bivariable and logistic multivariable regression were performed. A value of p of 0.05 or less was regarded as statistically significant, and data were presented as odds ratios and 95% confidence intervals. Results The mean age of the participants was 61.3 years (SD = 0.7), 56% were females, the mean time from symptom onset to hospital arrival was 46 h (SD = 3.32), and the mean National Institute of Health Stroke Scale (NIHSS) score at admission was 14.79 (SD = 0.25). PSCI was observed in 122 patients (30.3%) after 90 days of stroke onset, that is, 83 (20.6%) of female and 39 (9.7%) of male stroke survivors. The result of multivariable logistic regression analysis revealed PSCI was independently associated with age (adjusted OR = 1.04, 95% CI = 1.061-1.981), women (AOR = 1.390, 95% CI = 1.221-2.690), admission modified Rankin scale (mRS) (AOR = 1.629, 95% CI = 1.381-2.037), moderate Glasgow coma scale (GCS) score (AOR = 1.149, 95% CI = 1.402-3.281), and poor GCS score (AOR = 1.632, 95% CI = 1.610-4.361) and stage one (AOR = 1.428, 95% CI = 1.198-2.922) and stage two hypertension (AOR = 1.255, 95% CI = 1.107-2.609). Conclusion Nearly one-third of stroke survivors developed PSCI. Moreover, further research is needed with a larger sample size, showing a time trend and longer follow-up duration.
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Affiliation(s)
- Gashaw Walle Ayehu
- Department of Biomedical Sciences, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Fitalew Tadele Admasu
- Department of Biomedical Sciences, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Getachew Yideg Yitbarek
- Department of Biomedical Sciences, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Assefa Agegnehu Teshome
- Department of Biomedical Sciences, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Abraham Tsedalu Amare
- Department of Adult Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Daniel Atlaw
- Department of Biomedical Sciences, Goba Referral Hospital, Madda Walabu University, Goba, Oromia, Ethiopia
| | - Saurab Sharma
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia (NeuRA), Sydney, NSW, Australia
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Baraka A, Meda J, Nyundo A. Predictors of post-stroke cognitive impairment at three-month following first episode of stroke among patients attended at tertiary hospitals in Dodoma, central Tanzania: A protocol of a prospective longitudinal observational study metadata. PLoS One 2023; 18:e0273200. [PMID: 36862705 PMCID: PMC9980770 DOI: 10.1371/journal.pone.0273200] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 02/03/2023] [Indexed: 03/03/2023] Open
Abstract
INTRODUCTION Neurocognitive deficits after stroke are a common manifestation and pose a significant impact on the quality of life for patients and families; however, little attention is given to the burden and associated impact of cognitive impairment following stroke. The study aims to determine the prevalence and predictors of post-stroke cognitive impairment (PSCI) among adult stroke patients admitted to tertiary hospitals in Dodoma, Tanzania. METHODOLOGY A prospective longitudinal study is conducted at tertiary hospitals in the Dodoma region, central Tanzania. Participants with the first stroke confirmed by CT/MRI brain aged ≥ 18 years who meet the inclusion criteria are enrolled and followed up. Baseline socio-demographic and clinical factors are identified during admission, while other clinical variables are determined during the three-month follow-up period. Descriptive statistics are used to summarize data; continuous data will be reported as Mean (SD) or Median (IQR), and categorical data will be summarized using proportions and frequencies. Univariate and multivariate logistic regression analysis will be used to determine predictors of PSCI.
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Affiliation(s)
- Alphonce Baraka
- 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 Psychiatry and Mental Health, School of Medicine, The University of Dodoma, Dodoma, Tanzania
- Division of Psychiatry, Department of Internal Medicine, The Benjamin Mkapa Hospital, Dodoma, Tanzania
- * E-mail: ,
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Andrew NE, Srikanth V. Plasma Soluble Dipeptidyl Peptidase-4: A Possible Mechanism for Identifying and Managing Poststroke Cognitive Impairment. Stroke 2023; 54:122-123. [PMID: 36475463 DOI: 10.1161/strokeaha.122.041522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Nadine E Andrew
- Department of Medicine, Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Victoria, Australia (N.E.A., V.S.).,National Centre for Healthy Ageing, Frankston, Victoria, Australia (N.E.A., V.S.)
| | - Velandai Srikanth
- Department of Medicine, Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Victoria, Australia (N.E.A., V.S.).,National Centre for Healthy Ageing, Frankston, Victoria, Australia (N.E.A., V.S.).,Department of Medicine & Geriatric Medicine, Frankston Hospital, Peninsula Health, Melbourne, Australia (V.S.)
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Li Y, Chen X, Zhou R, Xu W, Wang X, Chao W, Xue S. Correlation Between Cognitive Impairment and Homocysteine and S100B Protein in Patients with Progressive Ischemic Stroke. Neuropsychiatr Dis Treat 2023; 19:209-217. [PMID: 36714163 PMCID: PMC9875579 DOI: 10.2147/ndt.s393624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 01/13/2023] [Indexed: 01/21/2023] Open
Abstract
PURPOSE This study aimed to investigate the relationship between cognitive impairment and homocysteine (Hcy) and S100B protein in patients with progressive ischemic stroke (PIS). PATIENTS AND METHODS A total of 158 patients with PIS hospitalized in the Department of Neurology in Taixing People's Hospital from January 2020 to March 2022 were enrolled in the study. After 90 days of follow-up, the patients were divided into two groups according to the MoCA score-99 cases with cognitive impairment group (observation group) and 59 cases with cognitive normal group (control group). Causal diagram was drawn to assess the association between risk factors and PIS with observation group. The risk factors indicators of cognitive impairment in patients with PIS were screened. The related predictive indicators were screened by multivariate logistic regression analysis, and Pearson correlation analysis. The predictive value was analyzed by Receiver Operating Characteristic (ROC) curve. RESULTS Multivariate logistic regression analysis showed that age, hypertension, lesion position, Hcy and S100B protein were related risk factors for cognitive impairment in patients with PIS. Pearson correlation analysis was conducted between Hcy and S100 B protein and MoCA score, and revealed that Hcy and S100 B protein were negatively correlated with MoCA score. ROC curve analysis showed that the Area Under the Curve (AUC) of S100 B protein and Hcy in identifying cognitive impairment after PIS was 0.709 and 0.673, respectively, and the combined AUC of Hcy and S100B protein in predicting cognitive impairment after PIS was 0.739. CONCLUSION Hcy and S100B protein are related risk factors for cognitive impairment in patients with PIS, and may be used as in a prediction model to predict cognitive impairment after PIS in the future.
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Affiliation(s)
- Yan Li
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China.,Department of Neurology, The Taixing People's Hospital, Taixing, People's Republic of China
| | - Xiaopeng Chen
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China.,Department of Neurology, The Affiliated People's Hospital of Jiangsu University, Zhenjiang, People's Republic of China
| | - Rujuan Zhou
- Department of Neurology, The Taixing People's Hospital, Taixing, People's Republic of China
| | - Wu Xu
- Department of Neurology, The Taixing People's Hospital, Taixing, People's Republic of China
| | - Xiaorong Wang
- Department of Neurology, The Taixing People's Hospital, Taixing, People's Republic of China
| | - Wa Chao
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China
| | - Shouru Xue
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China
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Wang Y, Li S, Pan Y, Wang M, Liao X, Shi J, Wang Y. The effects of blood pressure on post stroke cognitive impairment: BP and PSCI. J Clin Hypertens (Greenwich) 2021; 23:2100-2105. [PMID: 34800332 PMCID: PMC8696235 DOI: 10.1111/jch.14373] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 09/12/2021] [Accepted: 09/21/2021] [Indexed: 11/29/2022]
Abstract
Cognitive function following acute ischemic stroke (AIS) is critical to prognosis and quality of life. Hypertension is a risk factor for stroke and is associated with post stroke cognitive impairment (PSCI). However, the optimal blood pressure parameters after AIS is unknown. This is a sub‐study of the Impairment of CognitiON and Sleep after acute ischemic stroke or transient ischemic attack in Chinese patients (ICONS) study conducted between August 2015 and March 2018. Cognition was assessed at two‐week (2w), three‐month (3 m), and twelve‐month (12 m) by Montreal Cognitive Assessment (MoCA). A total of 682 participants who met the inclusion criteria were enrolled. The primary outcome was cognitive changes after 3 and 12 months post stroke. Among 682 participants, the mean age was 59.35 ± 10.40 years and 72.29% were men. PSCI patients with high systolic blood pressure (SBP ≥140 mm Hg) at 3 m not only had worse cognition as evidenced by MoCA scores at 3 m but also predicted worse scores at 12 m. When participants were stratified into cognitively stable/improved (MoCA score ≥0, 2w vs. 12 m) and cognitively impaired (MoCA score ≤‐2, 2w vs. 12 m), those with high SBP were more likely to be cognitively impaired (OR 2.17, 95%CI 1.12–4.21, p < .05) and less likely to be cognitively stable/improved (OR 0.66, 95%CI 0.44–0.99, p < .05). SBP more than 140 mm Hg is associated with worse cognitive performance after ischemic stroke. Patients with SBP lower than 140 mm Hg have better cognitive outcome at 3‐month and 1 year after stroke.
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Affiliation(s)
- Yue Wang
- National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.,Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Shiping Li
- National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Yuesong Pan
- National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Mengxing Wang
- National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Xiaoling Liao
- National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.,Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Jiong Shi
- National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.,Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Yongjun Wang
- National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.,Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
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