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Yoshimura Y, Wakabayashi H, Nagano F, Matsumoto A, Shimazu S, Shiraishi A, Kido Y, Bise T, Kuzuhara A, Hori K, Hamada T, Yoneda K, Maekawa K. Hyponatremia as a predictor of cognitive deterioration in hospitalized post-stroke patients. J Clin Neurosci 2024; 124:115-121. [PMID: 38703471 DOI: 10.1016/j.jocn.2024.04.027] [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: 02/19/2024] [Revised: 04/07/2024] [Accepted: 04/29/2024] [Indexed: 05/06/2024]
Abstract
PURPOSE Evidence is scarce regarding the association between hyponatremia and alterations in cognitive function among hospitalized older patients. We aimed to investigate the associations between hyponatremia and the baseline cognitive status, as well as the improvement in cognitive function, in hospitalized post-stroke patients. METHODS This retrospective cohort study included consecutive hospitalized post-stroke patients. Serum sodium concentrations were extracted from medical records based on blood tests performed within 24 h of admission, with hyponatremia defined as a serum sodium concentration < 135 mEq/L. The main outcomes included admission and discharge scores for cognitive levels, assessed through the cognitive domain of the Functional Independence Measure (FIM-cognition), as well as the score changes observed during the hospitalization period. Multivariate linear regression analyses were used to determine the association between hyponatremia and outcomes of interest, adjusted for potential confounders. RESULTS Data from 955 patients (mean age 73.2 years; 53.6 % men) were included in the analysis. The median baseline blood sodium level was 139 [137, 141], and 84 patients (8.8 %) exhibited hyponatremia. After full adjustment for confounders, the baseline hyponatremia was significantly and negatively associated with FIM-cognition values at admission (β = -0.009, p = 0.016), discharge (β = -0.038, p = 0.043), and the gain during hospital stay (β = -0.040, p = 0.011). CONCLUSION Baseline hyponatremia has demonstrated a correlation with decline in cognitive level over the course of rehabilitation in individuals after stroke. Assessing hyponatremia at the outset proves to be a pivotal prognostic indicator.
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Affiliation(s)
- Yoshihiro Yoshimura
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto 869-1106, Japan.
| | - Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Tokyo Women's Medical University Hospital, Tokyo 162-8666, Japan
| | - Fumihiko Nagano
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto 869-1106, Japan
| | - Ayaka Matsumoto
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto 869-1106, Japan
| | - Sayuri Shimazu
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto 869-1106, Japan
| | - Ai Shiraishi
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto 869-1106, Japan
| | - Yoshifumi Kido
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto 869-1106, Japan
| | - Takahiro Bise
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto 869-1106, Japan
| | - Aomi Kuzuhara
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto 869-1106, Japan
| | - Kota Hori
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto 869-1106, Japan
| | - Takenori Hamada
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto 869-1106, Japan
| | - Kouki Yoneda
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto 869-1106, Japan
| | - Kenichiro Maekawa
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto 869-1106, Japan
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Guo J, Huang N, Wang Y, Wu Y, Ye Y, Zhu G. Assessment of cognitive dysfunction and its influencing factors after acute ischemic stroke. Int J Neurosci 2024:1-8. [PMID: 38695689 DOI: 10.1080/00207454.2024.2350671] [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: 04/13/2024] [Accepted: 04/27/2024] [Indexed: 05/08/2024]
Abstract
OBJECTIVE In order to provide a more accurate and effective basis for clinical diagnosis and treatment, patients with cognitive dysfunction after acute ischemic stroke (AIS) were evaluated and their influencing factors were analyzed. METHODS A rigorous and systematic logistic regression analysis was conducted to comprehensively investigate the various influencing factors that contribute to cognitive dysfunction. RESULTS Among them, the sex granulocyte/lymphocyte ratio (NLR), low-density lipoprotein cholesterol (LDL-C) level, and C-reactive protein (CRP) were also higher than those in the control group (p < 0.05). The scores of memory, orientation, visual and spatial function, abstract thinking and language in the control group were higher than those in the experimental group (p < 0.05). The results of multivariate logistic regression analysis showed that history of diabetes mellitus, high NLR, high LDL-C, high CRP, smoking and temporal lobe infarction were risk factors for cognitive dysfunction after AIS, while elevated BMI and love of exercise were protective factors for cognitive dysfunction after AIS. CONCLUSION Patients with cognitive dysfunction had the highest incidence of temporal lobe infarction, and they scored lower than the control group on memory, orientation, visual and spatial function, abstract thinking, and language function. Multivariate logistic regression analysis showed that a history of diabetes mellitus, high NLR, high LDL-C, high CRP, smoking, and temporal lobe infarction were independent risk factors for cognitive dysfunction after acute ischemic stroke, while elevated BMI and a love of exercise were protective factors for cognitive dysfunction after acute ischemic stroke.
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Affiliation(s)
- Juan Guo
- Neurology Department, Shanghai Jiading District Anting Hospital, Shanghai, China
| | - Ningjing Huang
- Neurology Department, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai, China
| | - Yanan Wang
- Neurology Department, The People's Hospital of Suzhou New District, Suzhou, China
| | - Yanting Wu
- Endocrinology Department, Shanghai Jiading District Anting Hospital, Shanghai, China
| | - Yuanyuan Ye
- Neurology Department, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai, China
| | - Guoxing Zhu
- Neurology Department, Huashan Hospital Fudan University, Shanghai, China
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Esmailzade Moghimi S, Mohammadi F, Yadegari F, Dehghan M, Hojjati SMM, Saadat P, Geraili Z, Alizadeh M. Verbal and oral apraxia in patients with acute stroke: Frequency, relationship, and some risk factors. APPLIED NEUROPSYCHOLOGY. ADULT 2024; 31:97-108. [PMID: 34726969 DOI: 10.1080/23279095.2021.1993225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Verbal and oral apraxia are two possible consequences of stroke. It seems that there are not sufficient studies regarding the frequency of these disorders. This study aimed to evaluate the frequency of Verbal and oral apraxia. In addition, the relationship between apraxia and some variables such as age, gender, and education, as well as the relationship between types of apraxia with each other, and damaged areas of the brain in apraxia of the oral system in Persian-speaking patients with stroke were studied. In this descriptive-analytical study, 42 patients participated using the convenient sampling method. Verbal and oral apraxia were assessed using the oral and verbal apraxia tasks for adults test. Data were analyzed using independent t-test, Chi-square, and Fisher's exact test. The frequency of patients with oral apraxia was 35.7%, those with verbal apraxia was 2.3%, and the combination of both verbal and oral apraxia was 4.7%. People with apraxia were significantly older than those without apraxia. There was not any significant relationship between apraxia and gender, apraxia and education, and oral apraxia with verbal apraxia (p < 0.05). The present study's findings showed the high frequency of post-stroke apraxia and the high rate of its incidence with age.
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Affiliation(s)
| | - Fatemeh Mohammadi
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | - Fariba Yadegari
- Department of Speech Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mehdi Dehghan
- Mobility Impairment Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
- Department of Speech Therapy, School of Rehabilitation, Babol University of Medical Sciences, Babol, Iran
| | | | - Payam Saadat
- Mobility Impairment Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
- Department of Neurology, School of Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Zahra Geraili
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Maryam Alizadeh
- Mobility Impairment Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
- Department of Speech Therapy, School of Rehabilitation, Babol University of Medical Sciences, Babol, Iran
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Liang W, Wu D, Chuang YH, Fan YC, Chiu HY. Insomnia complaints correlated with higher risk of cognitive impairment in older adults following stroke: a National Representative Comparison Study. Sleep Biol Rhythms 2024; 22:41-47. [PMID: 38476858 PMCID: PMC10899963 DOI: 10.1007/s41105-023-00477-x] [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] [Received: 02/10/2023] [Accepted: 07/01/2023] [Indexed: 03/14/2024]
Abstract
Although associations among insomnia, cognitive impairment, and stroke have been demonstrated, whether insomnia increases the risk of cognitive impairment after stroke remains unclear. The aim of this study was to examine whether insomnia complaints moderated the association between stroke and cognitive impairment in older adults. This study was a secondary data analysis that used data from the National Health Interview Survey 2009. A total of 447 older adults with a mean age of 74.63 years (50.1% men) were included. Self-reported insomnia and stroke occurrence were determined using a questionnaire. Cognitive impairment was assessed using the Mini-Mental State Examination. We used multivariate logistic regression to analyze the association between insomnia complaints and cognitive impairment. Participants were categorized into four groups: those with stroke and insomnia (58), those with stroke without insomnia (91), those without stroke with insomnia (116), and those without stroke or insomnia (182). The prevalence of insomnia complaints was 38.9%, and the frequency of poststroke cognitive impairment was 50.3%. After controlling for potential confounders, participants with stroke (with or without insomnia) had a significantly higher risk of cognitive impairment than those without stroke or insomnia (adjusted odds ratios: 4.16 and 2.91, 95% confidence intervals: 1.91-9.07 and 1.56-5.43, respectively). Stroke with or without insomnia complaints was associated with a higher risk of cognitive impairment relative to older adults without stroke or insomnia. The risk of cognitive impairment was the highest among participants with both stroke and insomnia.
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Affiliation(s)
- Wei Liang
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Dean Wu
- Department of Neurology, Taipei Medical University-Shuang Ho Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan
- Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Research Center of Sleep Medicine, School of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yeu-Hui Chuang
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Department of Nursing, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Research Center in Nursing Clinical Practice, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Yen-Chun Fan
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Hsiao-Yean Chiu
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Research Center of Sleep Medicine, School of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Nursing, Taipei Medical University Hospital, Taipei, Taiwan
- Research Center of Sleep Medicine, Taipei Medical University Hospital, Taipei, Taiwan
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Zhang Y, Xia X, Zhang T, Zhang C, Liu R, Yang Y, Liu S, Li X, Yue W. Relation between sleep disorders and post-stroke cognitive impairment. Front Aging Neurosci 2023; 15:1036994. [PMID: 37547745 PMCID: PMC10400888 DOI: 10.3389/fnagi.2023.1036994] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 07/10/2023] [Indexed: 08/08/2023] Open
Abstract
Objective To investigate the effects of sleep disorders on post-stroke cognitive impairment (PSCI) and other factors affecting post-stroke cognitive impairment. Methods A total of 1,542 first-ever stroke inpatients in department of neurology of Tianjin Huanhu Hospital from 2015.6.1 to 2016.12.31. We recorded the personal history of patients. The MMSE (mini-mental state examination), MoCA (Montreal Cognitive Assessment), HAMD (Hamilton Depression Scale), BI (Barthel index), mRS (Modified Rankin Scale), PSQI (Pittsburgh Sleep Quality Index), ESS (Epworth Sleepiness Scale), Berlin questionnaire, nocturnal TST (total sleep time) were assessed before discharge. All patients were followed up at 3 months, 6 months, and 4 years (2019-2020) after stroke. During follow-up, the above scales should be evaluated again to assess the sleep status and cognitive function of patients at that time. Results Nocturnal TST (>8 h) (OR 3.540, 95% CI 1.692-7.406, P = 0.001) was a risk factor for cognitive impairment 3 months after stroke. Nocturnal TST (<7 h) (OR 6.504, 95% CI 3.404-12.427, P < 0.001) was a risk factor for cognitive impairment 6 months after stroke. Low sleep quality (OR 2.079, 95% CI 1.177-3.672, P = 0.012), sleepiness (OR 3.988, 95% CI 1.804-8.818, P = 0.001), nocturnal TST (<7 h) (OR 11.334, 95% CI 6.365-20.183, P < 0.001), nocturnal TST (>8 h) (OR 4.096, 95% CI 1.682-9.975, P = 0.002) were risk factors for cognitive impairment 4 years after stroke. The prevalence of cognitive impairment with TIA were 79.3% at admission, 68.1% at 3-months follow-up, 62.1% at 6-months follow-up and 52.2% at 4-year follow-up. Conclusion Long or short nocturnal TST (<7 h or >8 h) was a risk factor for cognitive impairment after stroke (3 months, 6 months and 4 years). Poor sleep quality and sleepiness were shown to be risk factors for cognitive impairment at 4-year follow-up. Cognitive impairment was very common in patients with TIA.
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Affiliation(s)
- Yajing Zhang
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
| | - Xiaoshuang Xia
- Department of Neurology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Ting Zhang
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
| | - Chao Zhang
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
| | - Ran Liu
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
| | - Yun Yang
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
| | - Shuling Liu
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
| | - Xin Li
- Department of Neurology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Wei Yue
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, 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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Lan X, Wu F, Wang C, Wu K, Fang Z, Lao G, Zhang B, Ning Y, Zhou Y. Sex differences in the association of plasma cytokines and neurocognition in first-episode major depressive disorder. J Affect Disord 2023; 322:258-266. [PMID: 36370912 DOI: 10.1016/j.jad.2022.11.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 09/08/2022] [Accepted: 11/06/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Peripheral cytokines were found to be involved in the pathophysiology of neurocognition in individuals with major depressive disorder (MDD). However, whether there are sex differences in this association between cytokines and cognition in MDD remains unknown. Our aim is to examine sex differences in the relationship between plasma cytokines and cognition in MDD. METHOD One hundred and twenty-seven first episode drug naïve patients with MDD and sixty healthy controls (HCs) were recruited for present study. The MATRICS Consensus Cognitive Battery was administered to measure the cognition. Plasma concentrations of nineteen cytokines were measured using high sensitivity multiplex bead-based assays. RESULTS Both female and male patients with MDD had significant cognitive impairment in verbal learning and visual learning and had higher levels of a range of cytokines than HCs (all p < 0.05). Female patients performed worse in trail making (F = 4.442, p = 0.018) and had higher concentration of interleukin (IL)-4 (F = 7.775, p = 0.006) than males. In female MDD, a significant positive association between category frequency and level of IL-4 was observed (B = 8.040, p = 0.031). However, this association was not present in male MDD or HCs (p > 0.05). LIMITATION Present study used a cross-sectional design. CONCLUSION Female MDD patients had worse trail making performance and higher level of IL-4 than males. The elevated IL-4 in female MDD was positively associated with category fluency, suggesting that IL-4 may be involved in the pathophysiology related to specific cognitive domain in female MDD patients.
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Affiliation(s)
- Xiaofeng Lan
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Fengchun Wu
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Chengyu Wang
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Kai Wu
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China; Department of Biomedical Engineering, School of Material Science and Engineering, South China University of Technology, Guangzhou, China
| | - Ziyan Fang
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Guohui Lao
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Bin Zhang
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Yuping Ning
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; The First School of Clinical Medicine, Southern Medical University, Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China.
| | - Yanling Zhou
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, 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. 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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Boutros CF, Khazaal W, Taliani M, Sadier NS, Salameh P, Hosseini H. Factors associated with cognitive impairment at 3, 6, and 12 months after the first stroke among Lebanese survivors. Brain Behav 2023; 13:e2837. [PMID: 36495111 PMCID: PMC9847618 DOI: 10.1002/brb3.2837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 10/10/2022] [Accepted: 11/14/2022] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION This study aimed to calculate the rate of post-stroke cognitive impairment (PSCI) by evaluating the cognitive domains among Lebanese stroke survivors at 3, 6, and 12 months post-stroke, and to identify the contributing factors including pre- and post-stroke related factors. METHODS A multicenter longitudinal prospective study was conducted in 10 hospitals from Beirut and Mount Lebanon for a 15-month period. Mini-Mental State Examination (MMSE), modified Rankin Scale (mRS), Short Form Health Survey (SF12), National Institutes of Health Stroke Scale (NIHSS), and Hospital Anxiety and Depression Scale (HADS) were used to assess cognitive function, disability degree, Quality of Life (QoL), stroke severity, and levels of anxiety and depression, respectively. Then, univariate and multivariable analyses were performed to identify the predictors of PSCI. RESULTS Low MMSE scores were found among survivors during the first 3 months post-stroke (74.8%) of whom 53.7% presented with an MMSE ≤ 17, followed by 46.7% in the 6 months, and 37.6% at 12 months post-stroke. Follow-up comparisons showed a significant increase of MMSE scores over time (p < .001), indicating a 37% improvement of the cognitive function over time. The most affected cognitive domain was the attention and concentration at the three time points. Independent factors that were positively associated with low MMSE scores were as follows: sedentary behavior ≥ 12 h/day (AOR = 3.062, p = .033), involvement of the left hemisphere (AOR = 2.710, p = .006), HADS ≥ 11 (AOR = 2.536, p = .049), and high NIHSS scores (AOR = 3, p = .009). Age was the main predictor in the three time periods (AOR ≈ 3, p < .05). Inversely, female gender (AOR = 0.09, p = .027), high educational level (AOR = 0.2, p < .02), employment post-stroke (AOR = 0.3, p = .023), high Physical Component Summary (PCS) of Quality of Life (QoL) (AOR = 0.8, p < .001), and the use of anti-diabetic treatment post-stroke (AOR = 0.17, p = .016) improved MMSE scores to > 23. CONCLUSION The risk of PSCI among Lebanese stroke survivors was high especially in the acute phase, depending on various determinants. Health care providers are invited to implement an emergency rehabilitation program for an appropriate successful management of the risk factors in order to reduce stroke burden and to improve overall cognitive performance.
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Affiliation(s)
- Celina F Boutros
- Institut Mondor de Recherche Biomédicale (IMRB)-Inserm U955, Ecole Doctorale Science de la Vie et de la Santé, Université Paris-Est Créteil, Paris, France
| | - Walaa Khazaal
- Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Hadath, Lebanon
| | - Maram Taliani
- Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Hadath, Lebanon
| | - Najwane Said Sadier
- Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Hadath, Lebanon.,College of Health Sciences, Abu Dhabi University, Abu Dhabi, United Arab Emirates
| | - Pascale Salameh
- Institut National de Santé Publique, Epidémiologie Clinique et Toxicologie (INSPECT-LB), Beirut, Lebanon.,Faculty of Pharmacy, Lebanese University, Hadath, Lebanon.,Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
| | - Hassan Hosseini
- Institut Mondor de Recherche Biomédicale (IMRB)-Inserm U955, Ecole Doctorale Science de la Vie et de la Santé, Université Paris-Est Créteil, Paris, France.,Institut National de Santé Publique, Epidémiologie Clinique et Toxicologie (INSPECT-LB), Beirut, Lebanon.,Neurology Department, Hôpital Henri Mondor, AP-HP, Créteil, France
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Fava-Felix PE, Bonome-Vanzelli SRC, Ribeiro FS, Santos FH. Systematic review on post-stroke computerized cognitive training: Unveiling the impact of confounding factors. Front Psychol 2022; 13:985438. [PMID: 36578681 PMCID: PMC9792177 DOI: 10.3389/fpsyg.2022.985438] [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: 07/08/2022] [Accepted: 11/16/2022] [Indexed: 12/14/2022] Open
Abstract
Background Stroke is a highly incapacitating disease that can lead to disabilities due to cognitive impairment, physical, emotional, and social sequelae, and a decrease in the quality of life of those affected. Moreover, it has been suggested that cognitive reserve (patients' higher levels of education or having a skilled occupation), for instance, can promote faster cognitive recovery after a stroke. For this reason, this review aims to identify the cognitive, functional, and behavioral effects of computerized rehabilitation in patients aged 50 years or older who had a stroke, considering cognitive reserve proxies. Methods We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis-PRISMA, and performed the search for peer-reviewed randomized controlled trials without a date restriction on CINAHL, LILACS, PubMed, Scopus, and Web of Science databases were chosen. Results We screened 780 papers and found 19 intervention studies, but only 4 met the inclusion criteria and shared data. These studies included computerized tools for motor and cognitive rehabilitation in the experimental groups. In all studies, computerized training was combined with other interventions, such as standard therapy, occupational therapy, and aerobic exercises. There were 104 participants affected by ischemic or hemorrhagic stroke, predominantly male (57.69%), and all with cognitive impairment. Conclusion Despite a limited number of studies, varied methods and insufficient information available, schooling as a CR proxy combined with high-intensity computerized cognitive training was key to mediating cognitive improvement. The systematic review also identified that the associated ischemic stroke and shorter time of onset for rehabilitation contribute to the cognitive evolution of patients. Findings do not support a greater benefit of computerized cognitive training compared to conventional cognitive therapies. Systematic review registration [https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=296193], identifier [CRD42022296193].
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Affiliation(s)
| | | | - Fabiana S. Ribeiro
- Department of Social Sciences, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Flávia H. Santos
- School of Psychology, University College Dublin, Dublin, Ireland
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11
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Lau SCL, Connor LT, Baum CM. Subjective and objective assessments are associated for physical function but not cognitive function in community-dwelling stroke survivors. Disabil Rehabil 2022; 44:8349-8356. [PMID: 34904503 DOI: 10.1080/09638288.2021.2012845] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE To investigate the relation between subjectively and objectively assessed cognitive and physical functioning among community-dwelling stroke survivors, and to examine the association of stroke severity with subjectively and objectively assessed cognitive and physical impairments. MATERIALS AND METHODS Secondary data analysis was conducted with 127 community-dwelling stroke survivors. For cognitive functioning, objective measures included the NIH Toolbox Cognition Battery and the Executive Function Performance Test; subjective measures included the Quality of Life in Neurological Disorders Applied Cognition. Objective and subjective physical functioning was measured by the NIH Toolbox 2-Minute Walk Test and the Patient-Reported Outcomes Measurement Information System Physical Function, respectively. RESULTS A positive correlation was observed between subjective and objective physical functioning, whereas the correlation between subjective and objective cognitive functioning was nonsignificant. Stroke severity was associated with objective cognitive impairment and objective and subjective physical impairment, but not subjective cognitive impairment. CONCLUSIONS The lack of association between objective and subjective cognitive functioning challenges the conventional assumption that perceived functioning reflects actual performance. We recommend using both objective and subjective measures to accurately identify cognitive and physical impairment following stroke.Implications for RehabilitationSubjective cognitive functioning is not associated with objective cognitive functioning, suggesting that solely relying on stroke patients' reports is inadequate and may inaccurately estimate patients' actual deficits.Both objective and subjective measures should be used to accurately identify cognitive and physical impairment following stroke.Practitioners should be cognizant of stroke patients' behavioral signs associated with underlying cognitive problems that warrant further evaluation.
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Affiliation(s)
- Stephen C L Lau
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - Lisa Tabor Connor
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA.,Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Carolyn M Baum
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA.,Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA.,Brown School of Social Work, Washington University in St. Louis, St. Louis, MO, USA
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12
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Lan X, Wang C, Li W, Chao Z, Lao G, Wu K, Li G, Ning Y, Zhou Y. The association between overweight/obesity and poor cognitive function is mediated by inflammation in patients with major depressive disorder. J Affect Disord 2022; 313:118-125. [PMID: 35777493 DOI: 10.1016/j.jad.2022.06.073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/27/2022] [Accepted: 06/23/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Cognitive dysfunction is a common and core feature of major depressive disorder (MDD). Evidences exerted a potentially harmful role of obesity and higher peripheral levels of inflammation in cognitive function, but few studies have explored whether markers of peripheral inflammation might mediate the association between overweight/obesity and deficits in cognitive function. Our study aimed to examine the cognitive function in MDD patients and clarify the effects of overweight/obesity and inflammatory cytokines on cognitive dysfunction in this population. METHOD We used a cross-sectional design in this study. A total of 265 patients with MDD were enrolled and divided into underweight, normal weight and overweight/obese groups. The MATRICS Consensus Cognitive Battery (MCCB) was administered to measure the cognition. Plasma levels of nineteen cytokines were measured using high sensitivity multiplex bead-based assays. RESULTS We found overweight/obese MDD patients associated with higher plasma levels of tumor necrosis factor (TNF)-α, interleukin (IL)-8, and macrophage inflammatory protein (MIP)-1β and worse performance in speed of processing and working memory. The mediation analysis found higher levels of IL-8 (direct: β = -0.591 (95 % Confidence Interval (CI): -1.0 to -0.2), P = 0.002; indirect: β = 0.060 (95 % CI.: 0.0-0.2), P = 0.032) and TNF-α (direct: β = -0.589 (95 % CI.: -1.0 to -0.2), P = 0.002; indirect: β = 0.059 (95 % CI.: 0.1-0.2), P = 0.037) were associated with more deficits in speed of processing, and partially mediated the relationship between body mass index and speed of processing. CONCLUSION Our results suggest that elevated inflammation might be one biological mechanism underlying the link between higher body mass and deficits in processing speed in patients with MDD.
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Affiliation(s)
- Xiaofeng Lan
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Chengyu Wang
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Weicheng Li
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Ziyuan Chao
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Guohui Lao
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Kai Wu
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China; School of Biomedical Sciences and Engineering, South china University of Technology, Guangzhou International Campus, Guangzhou, China
| | - Guixiang Li
- Institute of Biological and Medical Engineering, Guangdong Academy of Sciences, Guangzhou, China
| | - Yuping Ning
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China; The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Yanling Zhou
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China.
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13
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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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14
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Bako AT, Potter T, Tannous J, Pan AP, Johnson C, Baig E, Downer B, Vahidy FS. Sex differences in post-stroke cognitive decline: A population-based longitudinal study of nationally representative data. PLoS One 2022; 17:e0268249. [PMID: 35522611 PMCID: PMC9075630 DOI: 10.1371/journal.pone.0268249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 04/25/2022] [Indexed: 12/21/2022] Open
Abstract
Background Sex differences in post-stroke cognitive decline have not been systematically evaluated in a nationally representative cohort. We use a quasi-experimental design to investigate sex differences in rate of post-stroke cognitive decline. Methods Utilizing the event study design, we use the Health and Retirement Study (HRS) data (1996–2016) to evaluate the differences (percentage points [95% Confidence interval]) in the rate of change in cognitive function, measured using the modified version of the Telephone Interview for Cognitive Status (TICS-m) score, before and after incident stroke, and among patients with and without incident stroke. We estimated this event study model for the overall study population and separately fit the same model for male and female participants. Results Of 25,872 HRS participants included in our study, 14,459 (55.9%) were females with an overall mean age (SD) of 61.2 (9.3) years. Overall, 2,911 (11.3%) participants reported experiencing incident stroke. Participants with incident stroke (vs. no stroke) had lower baseline TICS-m score (15.6 vs. 16.1). Among participants with incident stroke, the mean pre-stroke TICS-m score was higher than the mean post-stroke TICS-m score (14.9 vs. 12.7). Event study revealed a significant short-term acceleration of cognitive decline for the overall population (4.2 [1.7–6.6] percentage points, p value = 0.001) and among female participants (5.0 [1.7–8.3] percentage points, p value = 0.003). We, however, found no evidence of long-term acceleration of cognitive decline after stroke. Moreover, among males, incident stroke was not associated with significant changes in rate of post-stroke cognitive decline. Conclusion Females, in contrast to males, experience post-stroke cognitive deficits, particularly during early post-stroke period. Identifying the sex-specific stroke characteristics contributing to differences in post stroke cognitive decline may inform future strategies for reducing the burden of post-stroke cognitive impairment and dementia.
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Affiliation(s)
- Abdulaziz T. Bako
- Center for Outcomes Research, Houston Methodist, Houston, TX, United States of America
| | - Thomas Potter
- Center for Outcomes Research, Houston Methodist, Houston, TX, United States of America
| | - Jonika Tannous
- Center for Outcomes Research, Houston Methodist, Houston, TX, United States of America
| | - Alan P. Pan
- Center for Outcomes Research, Houston Methodist, Houston, TX, United States of America
| | - Carnayla Johnson
- Center for Outcomes Research, Houston Methodist, Houston, TX, United States of America
| | - Eman Baig
- Center for Outcomes Research, Houston Methodist, Houston, TX, United States of America
| | - Brian Downer
- Department of Nutrition, Metabolism & Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX, United States of America
| | - Farhaan S. Vahidy
- Center for Outcomes Research, Houston Methodist, Houston, TX, United States of America
- Houston Methodist Neurological Institute, Houston, TX, United States of America
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States of America
- * E-mail:
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15
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Ma ZY, Wu YY, Cui HYL, Yao GY, Bian H. Factors Influencing Post-Stroke Cognitive Impairment in Patients with Type 2 Diabetes Mellitus. Clin Interv Aging 2022; 17:653-664. [PMID: 35520948 PMCID: PMC9063799 DOI: 10.2147/cia.s355242] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 04/11/2022] [Indexed: 01/04/2023] Open
Abstract
Objective Type 2 diabetes mellitus (T2DM) and ischemic stroke, which are common diseases among older people, are closely related to cognitive impairment. This study aims to investigate the influencing factors of post-stroke cognitive impairment (PSCI) in patients with T2DM. Methods We enrolled 161 patients with T2DM who experienced acute ischemic stroke and were hospitalized in the Department of Neurology, Jinan Central Hospital, Shandong, China. Cognitive function was evaluated with the Montreal Cognitive Assessment scale. According to the results, patients were divided into three groups-the cognitively normal group, mild cognitive impairment group, and severe cognitive impairment group. We analyzed general demographic data, laboratory information, imaging data, the results of neuropsychological evaluation, and clinical features as well as influencing factors of PSCI in these patients and established a prediction model. Results The three groups of patients were significantly different in terms of age, education level, course of diabetes mellitus (DM), recurrent cerebral infarction (RCI), and other factors. RCI, course of DM, and glycated hemoglobin (HbA1c) were independent risk factors of PSCI in patients with T2DM, with odds ratio (95% confidence interval): 7.17 (2.09, 30.37), 5.39 (2.40, 14.59), and 3.89 (1.66, 10.04), respectively, whereas female, senior high school, serum albumin were protective factors: 0.28 (0.07, 0.95), 0.05 (0.01, 0.21), 0.20 (0.08, 0.42), respectively. Furthermore, we constructed a prediction model using sex, age, education level, RCI, DM course, HbA1c and serum albumin and obtained a receiver operating characteristic (ROC) curve. The area under the ROC curve is 0.966, suggesting the significant association of these influencing factors with PSCI in patients with T2DM. Conclusion In this study, the occurrence of PSCI in patients with T2DM was related to RCI, course of DM, and HbA1c, among other factors. Attention to influencing factors is needed in these patients for early diagnosis and timely intervention of cognitive impairment.
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Affiliation(s)
- Zhao-Yin Ma
- Department of Diagnostic, Medical Integration and Practice Center, Shandong University, Jinan, Shandong, People's Republic of China
| | - Yong-Ya Wu
- Department of Emergency Critical Care Medicine, The Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, People's Republic of China
| | - Hong-Yin-Long Cui
- Department of Neurology, Central Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People's Republic of China
| | - Guang-Yan Yao
- Department of Neurology, Central Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People's Republic of China
| | - Hong Bian
- Department of Neurology, Central Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People's Republic of China.,Department of Neurology, Jinan Central Hospital, Shandong University, Jinan, Shandong, People's Republic of China
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16
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Obstructive sleep apnea is associated with cognitive impairment in minor ischemic stroke. Sleep Breath 2022; 26:1907-1914. [DOI: 10.1007/s11325-022-02575-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 01/27/2022] [Accepted: 01/28/2022] [Indexed: 11/30/2022]
Abstract
Abstract
Objectives
Obstructive sleep apnea (OSA) is commonly seen in stroke patients, and its relationship with cognitive impairment remains poorly understood. This study aimed to explore the roles of OSA in cognition impairment in patients with minor ischemic stroke.
Methods
Patients with minor ischemic stroke were consecutively enrolled from January 2020 to May 2021. Every patient underwent polysomnography (PSG) to assess for OSA. Based on the apnea hypopnea index (AHI), patients were grouped into the no OSA (AHI < 5), mild OSA (5 ≤ AHI < 15), and moderate-to-severe OSA (MS OSA, AHI ≥ 15) groups. Neuropsychological assessments were performed to evaluate cognitive function, and the correlations between cognitive function and OSA were investigated.
Results
Of 94 patients, 35 had no OSA, 32 had mild OSA, and 27 had moderate-to-severe OSA. Compared to the no or mild OSA groups, the moderate-to-severe OSA group performed worse on the Chinese version of the Auditory Verbal Learning Test (CAVLT)-Recognition (p < 0.001), Digital Span Test (DST)-Backward (p < 0.001), Montreal Cognitive Assessment (MoCA) (p < 0.001), and Stroop Color and Word Test (SCWT)-Interference (p < 0.001). The severity of cognitive impairment was assessed using the MoCA, which was negatively related to the AHI (p = 0.041) and lowest SpO2 (p = 0.048).
Conclusions
The findings suggest that OSA has significant effects on cognition impairment in patients with minor ischemic stroke and that hypoxemia may be a potential pathophysiological mechanism of OSA-induced cognitive impairment.
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17
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Sanchez-Lara E, Lozano-Ruiz A, Rute-Perez S, Saez-Sanz N, Bombin I, Caracuel A. Participation Predicts Cognitive Functioning in Older Adults Using the PART-O Transformed Scores Systems. J Appl Gerontol 2022; 41:1081-1089. [PMID: 35114842 DOI: 10.1177/07334648211057096] [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: 11/15/2022] Open
Abstract
Participation has been shown to be a protective factor for cognition in older adults, but instruments to assess it are limited. The main objective was to determine the validity of two scoring systems (direct vs transformed) for the Participation Assessment with Recombined Tools-Objective (PART-O) by applying structural equation modeling to the relationship between the subscales and the cognitive functions, in a sample of 245 people over 60 years of age. The transformed scores model showed stronger relationships and larger explained variance in overall participation (55.4% vs 37.4%), especially in the Social Relations subscale (31.4% vs 14.6%). Participation was a direct predictor of cognitive functions in both models. Age and depression inversely influenced participation in the transformed scores model. The proposed score transformation for the PART-O provides a more appropriate measurement of the older adults' participation. Participation has a mediating role in the relationship between cognition and both age and depression.
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Affiliation(s)
| | - Alvaro Lozano-Ruiz
- Mind, Brain, and Behavior Research Center (CIMCYC), 16741University of Granada, Granada, Spain.,Department of Personality, Evaluation, and Psychological Treatment, 16741University of Granada, Granada, Spain
| | - Sandra Rute-Perez
- Mind, Brain, and Behavior Research Center (CIMCYC), 16741University of Granada, Granada, Spain.,Department of Developmental and Educational Psychology, 16741University of Granada, Granada, Spain
| | - Noelia Saez-Sanz
- Mind, Brain, and Behavior Research Center (CIMCYC), 16741University of Granada, Granada, Spain
| | - Igor Bombin
- Reintegra Foundation, Centro de Rehabilitación Neurologica, Oviedo, Spain
| | - Alfonso Caracuel
- Mind, Brain, and Behavior Research Center (CIMCYC), 16741University of Granada, Granada, Spain.,Department of Developmental and Educational Psychology, 16741University of Granada, Granada, Spain
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Happ DF, Wegener G, Tasker RA. Behavioral and histopathological consequences of transient ischemic stroke in the Flinders Sensitive Line rat, a genetic animal model of depression. Brain Res 2021; 1771:147648. [PMID: 34492264 DOI: 10.1016/j.brainres.2021.147648] [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: 05/05/2021] [Revised: 07/30/2021] [Accepted: 09/01/2021] [Indexed: 10/20/2022]
Abstract
Patients with depression have an increased risk for stroke, higher mortality rates following stroke and worse functional outcomes among survivors. Preclinical studies may help to better understand the underlying mechanisms linking these two diseases, but only a few animal studies have investigated the effects of prestroke depression. The present study investigates whether Flinders Sensitive Line (FSL) rats, a genetic depression model, respond differently to focal ischemic stroke compared to control strains (Flinders Resistant Line [FRL] and Sprague-Dawley [SD]). Male adult FSL, FRL and SD rats received a unilateral injection of either vehicle or Endothelin-1 (ET-1) adjacent to the middle cerebral artery (MCA). Motor function was assessed at 48 h followed by euthanasia and infarct volume measurement using 2,3,5-triphenyltetrazolium chloride (TTC) staining and image analysis. In a separate cohort behavior was assessed using standard tests for motor function, locomotor activity, cognition, anxiety- and depression-like behavior beginning at 10 days post-injection followed by infarct quantification. We found that ET-1-induced MCA occlusion produced significant infarcts in all three strains. Stroke animals had slightly impaired motor function, but there was no clear interaction effects between strain and stroke surgery on behavioral outcomes. We conclude that FSL rats show no increased susceptibility to brain damage or behavioral deficits following ET-1-induced focal ischemic stroke compared to controls.
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Affiliation(s)
- Denise F Happ
- Translational Neuropsychiatry Unit, Department of Clinical Medicine, Aarhus University, Denmark
| | - Gregers Wegener
- Translational Neuropsychiatry Unit, Department of Clinical Medicine, Aarhus University, Denmark; Pharmaceutical Research Center of Excellence, School of Pharmacy (Pharmacology), North-West University, Potchefstroom, South Africa
| | - R Andrew Tasker
- Translational Neuropsychiatry Unit, Department of Clinical Medicine, Aarhus University, Denmark; Department of Biomedical Sciences, University of Prince Edward Island, Charlottetown, PEI, Canada.
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Mohd Safien A, Ibrahim N, Subramaniam P, Shahar S, Din NC, Ismail A, Singh DKA, Mat Ludin AF. Randomized Controlled Trials of a Psychosocial Intervention for Improving the Cognitive Function among Older Adults: A Scoping Review. Gerontol Geriatr Med 2021; 7:23337214211025167. [PMID: 34395815 PMCID: PMC8361523 DOI: 10.1177/23337214211025167] [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: 04/08/2021] [Accepted: 05/26/2021] [Indexed: 11/15/2022] Open
Abstract
Aim: The goal is to explore available evidence and provide greater clarity to what is described as psychosocial intervention to improve cognitive function among older population with MCI as well as identifying areas for future research. Methods: An electronic literature search of PubMed, Cochrane, Ebscohost, Medline, Scopus, and gray resource was conducted to find articles published in English language between 2010 and September 2020. This review focused on research undertaken using randomized clinical trials study design. We extracted information regarding the publication date, geographical location, study setting, intervention mechanism, type of cognitive measurement used, and outcome of the studies. References of this literature were also reviewed to ensure comprehensive search. Result: Out of 240 potential records found, a total of 27 articles were identified following the first round of screening and deletion of duplicates. Full-text article reviews and analysis in the second round of screening narrowed the selection down to four articles. Another three relevant articles obtained from references were also included making a total of seven articles in the final analysis. Findings: Psychosocial intervention strategies for improvement of cognitive function, done in various setting all over the globe, covered a range of approaches including art therapy, visual art therapy, therapeutic writing therapy, reminiscence activity, and cognitive behavioral approach. Most were conducted in weekly basis within 1-to-2-hour duration of session. Cognitive function of older adult in psychosocial intervention group was significantly improved in two studies. Three studies showed no significant improvement at all in the cognitive function, and another one reported success in improving cognitive function over time in the intervention group than in control group. One study did not describe the interaction effect. Different types of cognitive measurement also were used to quantify different domains of cognitive function in the reviewed studies. Conclusion: The idea of using psychosocial intervention for improving cognitive function has begun to increasingly accepted recently. Findings from the limited studies are encouraging, although the outcome of the cognitive function was mixed. Large-scale and longer duration of psychosocial intervention with bigger sample size is warranted for future studies.
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Affiliation(s)
| | | | | | | | | | - Aniza Ismail
- Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia
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20
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The Impact of Hypertension and Atrial Fibrillation on Cognitive Decline and Subclinical Atherosclerosis. Brain Sci 2021; 11:brainsci11060752. [PMID: 34204086 PMCID: PMC8228320 DOI: 10.3390/brainsci11060752] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 05/31/2021] [Accepted: 06/02/2021] [Indexed: 12/24/2022] Open
Abstract
Background: Assessment of cognitive impairment and the presence of subclinical atherosclerosis are very important especially in patients with cardiovascular risk factors. Methods: We included 155 hypertensive patients (84 with AF versus 71 without AF) to identify the premature cognitive impairment, the earliest signs of subclinical atherosclerosis and onset of myocardial dysfunction and to evaluate the type of anticoagulation used, the importance of CHA₂DS₂-VASc score (</>3), age (</>65 years) in hypertensive patients with AF. Results: Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment Scale (MoCA), Left Ventricular Ejection Fraction (LVEF) were significantly decreased, and Activities of Daily Living Score (ADL), Geriatric Depression Scale(GDS-15), and intima–media thickness (IMT) were significantly increased in hypertensive patients with AF vs. without AF (p < 0.05). MMSE was significantly decreased, ADL and IMT were significant increased in patients with AF and CHA₂DS₂-VASc>3 and non-vitamin K antagonists oral anticoagulants therapy (NOACs)(p < 0.05). Patients with age >65 with AF had higher rates of cognitive impairment (MMSE significant decrease) and a larger IMT (significant increase) versus patients with AF and age <65 (p < 0.05). Conclusions: Cognitive impairment is encountered in hypertensive patients having AF. Our conclusions suggest a direct link between cognitive impairment, depression, hypertension, AF, age, CHA₂DS₂-VASc score, type of anticoagulants used, LVEF, cognitive parameters, and IMT. We acknowledge the importance of identifying and preventing cognitive changes.
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Kulshrestha S, Agrawal M, Singh AK, Kulshreshtha D. Post Stroke Rehabilitation Using Computer-based Cognitive Intervention (CBCI): A Systematic Review. CURRENT PSYCHIATRY RESEARCH AND REVIEWS 2020. [DOI: 10.2174/2666082216999200622135105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Cognitive impairment as a consequence of stroke is a major cause affecting
the patient’s functional independence, activity participation, daily living skills, and occupation. Almost
75% of post-stroke patients are diagnosed with significant cognitive impairment, which includes
problems with attention, orientation, memory, language, and perception. Along with effective
pharmaceutical cures, cognitive intervention as a part of rehabilitation approaches that may prevent,
delay, or treat cognitive impairment is becoming increasingly important. Many studies have reported
improvement in cognitive functions of post-stroke patients after using computer-based cognitive
intervention (CBCI). CBCI can be an effective add-on to available rehabilitation programs.
Objective:
This article provides reviews related to relevant literature and, represents a structure to
specify the efficacy of CBCI for the rehabilitation of post-stroke patients for future research.
Methods:
We searched many search engines namely MEDLINE, Web of Science, clinical key and
The Cochrane Library, for studies investigating the effect of cognitive intervention based on a computer
program for post-stroke patients. The results of selected studies were summarized. Total 19
publications from January 2007 to January 2019 are included in this review. The search terms entered
were a combination of these search areas that defined (1) the population as adults who had suffered
a stroke and cognitive dysfunction, (2) intervention search term included cognitive abilities, cognitive
training, and computer-based training; computer-based cognitive intervention for rehabilitation.
Results:
The results after computer-based training showed improvement in various cognitive functions
such as; memory, attention and executive functions of post-stroke patients. However, a significant
difference between the study groups has not been observed in all the studies. Most studies analyzed
in this research project indicated that such interventions might contribute to the improvement
of cognitive function, especially attention concentration and memory. Of the 19 kinds of research
that discussed CBCI outcomes 18 found significant improvements for one or more cognitive functions.
When the effect size for CBCI was reported, effects were large in comparison to other traditional
cognitive interventions of post-stroke patients.
Conclusion:
Studies related to cognitive functions strongly support CBCI except few have reported
a significant difference. The review of all the studies suggests that CBCI may help to change the
functional aspect of post-stroke patients by improving their cognitive functions. In this field, it is a
challenge to conduct well designed and sufficiently powered studies due to low budgets availability,
the limited number of available patients, heterogeneity of the population, and ethical considerations.
Future studies should examine all the challenges, limitations, and valuable insights into the study
and emphasize the need for a carefully designed computer-based cognitive intervention program for
the future. Future studies should target to compare CBCI with active and passive control conditions
and include a larger sample size.
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Affiliation(s)
- Sudhi Kulshrestha
- Amity Institute of Behavioral and Allied Sciences, Amity University, Lucknow, India
| | - Manju Agrawal
- Amity Institute of Behavioral and Allied Sciences, Amity University, Lucknow, India
| | - Ajai K. Singh
- Department of Neurology, Dr. Ram ManoharLohia Institute of Medical Sciences, Lucknow, India
| | - Dinkar Kulshreshtha
- Department of Neurology, Dr. Ram ManoharLohia Institute of Medical Sciences, Lucknow, India
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Mohamed Fuad Z, Mahadzir H, Syed Zakaria SZ, Mohamed Ibrahim N. Frequency of Cognitive Impairment Among Malaysian Elderly Patients Following First Ischaemic Stroke—A Case Control Study. Front Public Health 2020; 8:577940. [PMID: 33282811 PMCID: PMC7689266 DOI: 10.3389/fpubh.2020.577940] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 10/09/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Stroke is highly prevalent globally and is an important cause of cognitive impairment and dementia. Aims: We determined the frequency of post-stroke cognitive impairment (PSCI) at 1, 3, and 6 months among patients with first clinical ischemic stroke compared to risk and age-matched controls. Methods: This study involved 32 cases and 32 controls, and was conducted over 6 months. Cases were inpatients aged >60 with first clinical ischemic stroke. Controls were age-matched subjects without prior stroke. Montreal Cognitive Assessment (MoCA) was performed in all patients at 1, 3, and 6 month post stroke. A MoCA score of <26 was used for mild PSCI and <22 for moderate PSCI (post stroke dementia). Results: Post-stroke dementia was detected in 12 patients (37.5%) at 1st month, in 13 (40.6%) at 3rd month and 15 (48.4%) at 6th months. Mild PSCI was present in 7 patients (21.6%) at 1 month, 16 patients (50%) at 3 months, and 15 patients (48%) at 6 months. The odds ratio (OR) for post-stroke dementia was 3.2 (95%CI 0.98–10.68; p = 0.05) at 1 month; 3.69(95% CI 1.13–12.11; p = 0.031) at 3 months, and 4.88 (95% CI 1.49–15.99; p = 0.009) at 6 months. Years of education was an independent predictor for dementia (OR 0.60; p = 0.046). The OR for post-stroke dementia at 6th month was 7.23 with education level adjusted (95%CI 1.46–35.86, p = 0.015). Conclusion: The frequency of PSCI was high as early as 1 month after stroke. Stroke alone conferred a 7.2 times risk for post-stroke dementia compared to controls.
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Affiliation(s)
- Zeena Mohamed Fuad
- Department of Medicine, Universiti Kebangsaan Medical Centre, Kuala Lumpur, Malaysia
| | - Hazlina Mahadzir
- Department of Medicine, Universiti Kebangsaan Medical Centre, Kuala Lumpur, Malaysia
| | | | - Norlinah Mohamed Ibrahim
- Department of Medicine, Universiti Kebangsaan Medical Centre, Kuala Lumpur, Malaysia
- *Correspondence: Norlinah Mohamed Ibrahim
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Higher level of acute serum VEGF and larger infarct volume are more frequently associated with post-stroke cognitive impairment. PLoS One 2020; 15:e0239370. [PMID: 33017430 PMCID: PMC7535035 DOI: 10.1371/journal.pone.0239370] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 09/07/2020] [Indexed: 01/01/2023] Open
Abstract
Background Serum vascular endothelial growth factor (VEGF) and infarct volume detected by brain imaging have been associated with stroke outcome. However, the relationship of these two variables with post-stroke cognitive impairment (PSCI) remains unclear. We aimed to investigate the association between acute serum VEGF levels and infarct volume with PSCI in ischemic stroke patients. Methods Fifty-six first-ever ischemic stroke patients who were hospitalized in Dr. Sardjito General Hospital Yogyakarta, Indonesia were prospectively recruited. Serum VEGF level was taken on day 5 of stroke onset and measured by ELISA. Infarct volume was calculated manually from head CT scan by expert radiologist. PSCI was assessed after 3 months follow up by using Montreal Cognitive Assessment-Indonesian version (MoCA-INA). We performed a ROC curve analysis to determine the cut-off point of VEGF level and infarct volume. Multivariate logistic regression analysis was performed to measure the contribution of VEGF level and infarct volume to PSCI after controlling covariates (demographic and clinical data). Results The mean age of PSCI and non-PSCI patients was 61.63% ± 8.47 years and 58.67% ± 9.01 years, respectively (p = 0.221). No differences observed for vascular risk factors, infarct location, and NIHSS in both groups. Multivariate logistic regression showed that patients with higher VEGF level alone (≥519.8 pg/ml) were 4.99 times more likely to have PSCI than those with lower VEGF level (OR = 4.99, 95% CI = 1.01–24.7, p = 0.048). In addition, patients with larger infarct volume alone (≥0.054 ml) were also more frequently associated with PSCI (OR = 7.71, 95% CI = 1.39–42.91, p = 0.019). Conclusions Acute ischemic stroke patients with higher serum VEGF level (≥519.8 pg/ml) and larger infarct volume (≥0.054 ml) were more likely to have PSCI 3 months after stroke. These findings may contribute to predict PSCI earlier and thus better prevention strategy could be made.
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24
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Abba MA, Olaleye OA, Hamzat TK. Effects of over-ground walking and cognitive rehabilitation on cognition, brain-derived neurotrophic factor, participation and quality of life among stroke survivors: a study protocol. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2020. [DOI: 10.1080/21679169.2020.1808056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Muhammad Aliyu Abba
- Department of Physiotherapy, Faculty of Allied Health Sciences, College of Health Sciences, Bayero University Kano, Kano, Nigeria
- Department of Physiotherapy, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Olubukola A. Olaleye
- Department of Physiotherapy, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Talhatu K. Hamzat
- Department of Physiotherapy, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
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25
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West A, Simonsen SA, Jennum P, Cyril Hansen N, Schønsted M, Zielinski A, Sander B, Iversen HK. An exploratory investigation of the effect of naturalistic light on fatigue and subjective sleep quality in stroke patients admitted for rehabilitation: A randomized controlled trial. NeuroRehabilitation 2020; 45:187-200. [PMID: 31498136 DOI: 10.3233/nre-192752] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Daylight entrains the central circadian pacemaker to the 24-hour day and is crucial for optimal alertness and sleep-quality. Rehabilitation patients tend to lack exposure to sufficient natural light. OBJECTIVE Installed diurnal naturalistic light may reduce the known disrupted sleep quality and fatigue seen in post stroke patients. METHODS Stroke patients were randomized to either an intervention rehabilitation unit (IU) equipped with naturalistic lighting (artificial sunlight spectrum) or to a control rehabilitation unit (CU) with standard indoor lighting. At inclusion and discharge, fatigue and subjective sleep quality were measured. RESULTS Ninety stroke patients were included between May 2014, and June 2015. At discharge, patients from the IU experienced less fatigue than the CU patients, based on the Multidimensional Fatigue Inventory questionnaire general (IU, n = 28; CU, n = 30; diff - 20.6%, 95% confidence interval (CI) [- 35.0%; - 3.0%]; P = 0.025) and the Rested Statement (IU, n = 28; CU, n = 30; diff + 41.6%, 95% CI [+4.6%; +91.8%]; P = 0.025). No differences were detected between groups in sleepiness or subjective sleep quality by the Pittsburgh Sleep Quality Index. CONCLUSIONS Fatigue was significantly reduced in rehabilitation patients exposed to naturalistic lighting during admission.
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Affiliation(s)
- Anders West
- Clinical Stroke Research Unit, Department of Neurology, Rigshospitalet, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Sofie Amalie Simonsen
- Clinical Stroke Research Unit, Department of Neurology, Rigshospitalet, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Poul Jennum
- Danish Center for Sleep Medicine, Department of Neurophysiology Rigshospitalet, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Niklas Cyril Hansen
- Clinical Stroke Research Unit, Department of Neurology, Rigshospitalet, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Marie Schønsted
- Clinical Stroke Research Unit, Department of Neurology, Rigshospitalet, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Alexander Zielinski
- Clinical Stroke Research Unit, Department of Neurology, Rigshospitalet, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Birgit Sander
- Department of Ophthalmology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Helle K Iversen
- Clinical Stroke Research Unit, Department of Neurology, Rigshospitalet, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
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26
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Nie XD, Wang Q, Zhang YH, Xiong ZY, Liao JL, Hao L, Liu GL, Duan LP, Zheng ZX, Ren YP, Dong J. Depression at Baseline is an Independent Risk Factor for Cognitive Decline in Patients on Peritoneal Dialysis: A Multicenter Prospective Cohort Study. Perit Dial Int 2019; 39:465-471. [PMID: 31501292 DOI: 10.3747/pdi.2018.00239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 01/26/2019] [Indexed: 11/15/2022] Open
Abstract
Background Depression has been recognized as a risk factor for cognitive impairment (CI) from cross-sectional datasets. This multicenter prospective study investigated the association between depression and cognitive decline in peritoneal dialysis (PD) patients. Methods This multicenter prospective cohort study included 458 PD patients who were followed up for 2 years. The Modified Mini-Mental State Examination (3MS) was used for assessment of global cognitive function, Trail-Making Tests A and B for executive function, subtests of the Battery for the Assessment of Neuropsychological Status for immediate and delayed memory, visuospatial skill, and language ability. Depression was assessed using Zung's Self-Rating Depression Scale. Results During the 2-year follow-up, patients with moderate/severe depression at baseline showed a significant decline in global cognitive function (80.5 ± 15.2 vs 76.6 ± 15.5, p = 0.008), while patients without depression or with mild depression kept a stable global cognitive function. In the meantime, patients without depression showed significant improvements in immediate memory, visuospatial skill, and language ability. However, no significant improvement in these parameters was shown in depression groups. In multivariable linear regression analysis, depression at baseline was a significant predictor of worsening global cognitive function, whether depression was analyzed as a continuous variable (odds ratio [OR] = -0.14, 95% confidence interval [CI] -0.27, -0.01, p = 0.031) or a rank variable (OR = -1.88, 95% CI -3.30, -0.45, p = 0.010). Moreover, higher depression score or more severe depression degradation was significantly associated with decline of immediate memory, delayed memory, and language skill. Conclusion Depression was a significant risk factor for worsening of CI in PD patients.
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Affiliation(s)
- Xue-dan Nie
- Department of Neurology, The Second Affiliated Hospital of Harbin Medical University, Heilongjiang, China
| | - Qin Wang
- Department of Nephrology, The Second Affiliated Hospital of Harbin Medical University, Heilongjiang, China
| | - Yu-hui Zhang
- Renal Division, Department of Medicine, Peking University First Hospital, Institute of Nephrology, Peking University, Key Laboratory of Renal Disease, Ministry of Health, Key Laboratory of Renal Disease, Ministry of Education, Beijing, China
| | - Zu-ying Xiong
- Renal Division, Peking University Shenzhen Hospital, Shenzhen, China
| | - Jin-lan Liao
- Renal Division, Peking University Shenzhen Hospital, Shenzhen, China
| | - Li Hao
- Renal Division, The Second Hospital of Anhui Medical University, Anhui, China
| | - Gui-ling Liu
- Renal Division, The Second Hospital of Anhui Medical University, Anhui, China
| | - Li-ping Duan
- Renal Division, Handan Central Hospital, Hebei, China
| | | | - Ye-ping Ren
- Department of Nephrology, The Second Affiliated Hospital of Harbin Medical University, Heilongjiang, China
| | - Jie Dong
- Renal Division, Department of Medicine, Peking University First Hospital, Institute of Nephrology, Peking University, Key Laboratory of Renal Disease, Ministry of Health, Key Laboratory of Renal Disease, Ministry of Education, Beijing, China
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27
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West A, Simonsen SA, Zielinski A, Cyril N, Schønsted M, Jennum P, Sander B, Iversen HK. An exploratory investigation of the effect of naturalistic light on depression, anxiety, and cognitive outcomes in stroke patients during admission for rehabilitation: A randomized controlled trial. NeuroRehabilitation 2019; 44:341-351. [PMID: 31177236 DOI: 10.3233/nre-182565] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Patients admitted for rehabilitation often lack sufficient natural light to entrain their circadian rhythm. OBJECTIVE Installed diurnal naturalistic light may positively influence the outcome of depressive mood, anxiety, and cognition in such patients. METHODS A quasi-randomized controlled trial. Ninety stroke patients in need of rehabilitation were randomized between May 1, 2014, and June 1, 2015 to either a rehabilitation unit equipped entirely with always on naturalistic lighting (IU), or to a rehabilitation unit with standard indoor lighting (CU).Examinations were performed at inclusion and discharge. The following changes were investigated: depressive mood based on the Hamilton Depression scale (HAM-D6) and Major Depression Inventory scale (MDI), anxiety based on the Hospital Anxiety and Depression Scale (HADS), cognition based on the Montreal Cognitive Assessment (MoCA) and well-being based on the Well-being Index (WHO-5). RESULTS Depressive mood (MDI p = 0.0005, HAM-D6 p = 0.011) and anxiety (HADS anxiety p = 0.045) was reduced, and well-being (WHO-5 p = 0.046) was increased, in the IU at discharge compared to the CU. No difference was found in cognition (MoCA p = 0.969). CONCLUSIONS This study is the first to demonstrate that exposure to naturalistic light during admission may significantly improve mental health in rehabilitation patients. Further studies are needed to confirm these findings.
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Affiliation(s)
- Anders West
- Department of Neurology, Clinical Stroke Research Unit, Rigshospitalet Glostrup, Glostrup, Denmark.,Faculty of Health Sciences, University of Copenhagen, Denmark
| | - Sofie Amalie Simonsen
- Department of Neurology, Clinical Stroke Research Unit, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Alexander Zielinski
- Department of Neurology, Clinical Stroke Research Unit, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Niklas Cyril
- Department of Neurology, Clinical Stroke Research Unit, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Marie Schønsted
- Department of Neurology, Clinical Stroke Research Unit, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Poul Jennum
- Faculty of Health Sciences, University of Copenhagen, Denmark.,Department of Neurophysiology, Danish Center for Sleep Medicine, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Birgit Sander
- Faculty of Health Sciences, University of Copenhagen, Denmark.,Department of Ophthalmology, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Helle K Iversen
- Department of Neurology, Clinical Stroke Research Unit, Rigshospitalet Glostrup, Glostrup, Denmark.,Faculty of Health Sciences, University of Copenhagen, Denmark
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Lee KS, Park KW. Social determinants of the association among cerebrovascular disease, hearing loss and cognitive impairment in a middle-aged or older population: Recurrent neural network analysis of the Korean Longitudinal Study of Aging (2014-2016). Geriatr Gerontol Int 2019; 19:711-716. [PMID: 31257714 PMCID: PMC6851663 DOI: 10.1111/ggi.13716] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 04/09/2019] [Accepted: 04/19/2019] [Indexed: 11/26/2022]
Abstract
Aim The present study used a deep learning model (recurrent neural network) for testing: (i) whether social determinants are major determinants of the association among cerebrovascular disease, hearing loss and cognitive impairment in a middle‐aged or older population (hypothesis 1); and (ii) whether the association among the three diseases is very strong in the middle‐aged or older population (hypothesis 2). Methods Data came from the Korean Longitudinal Study of Aging (2014–2016), with 6060 participants aged ≥53 years. The association among the three diseases was divided into eight categories: one category for having no disease, three categories for having one disease, three categories for having two diseases and one category for having three diseases. Variable importance, the effect of a variable on model performance, was used for evaluating the two hypotheses. Hypothesis 1 was based on whether family support, socioeconomic status and social activity in the year 2014 were the top 10 determinants of the association in the year 2016. Hypothesis 2 was based on whether cerebrovascular disease, hearing loss and cognitive impairment in the year 2014 were the top five determinants of the association in the year 2016. Results Based on variable importance from the recurrent neural network, cerebrovascular disease (0.0386), cognitive impairment (0.0151) and hearing loss (0.0092) in 2014 were the top three determinants of the association in 2016. Children alive (0.0072), education (0.0049), income (0.0075), friendship activity (0.0042) and marriage (0.0036) in 2014 were the top 10 determinants of the association in 2016. Conclusions The findings of the present study support the two hypotheses, highlighting the importance of preventive measures, family support, socioeconomic status and friendship activity for managing the three diseases. Geriatr Gerontol Int 2019; 19: 711–716.
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Affiliation(s)
- Kwang-Sig Lee
- Department of Research Affairs, Center for Artificial Intelligence, Korea University College of Medicine, Seoul, Korea
| | - Kun Woo Park
- Department of Neurology, Korea University College of Medicine, Seoul, Korea
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29
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Hassan TM, Yarube IU. Peripheral brain-derived neurotrophic factor is reduced in stroke survivors with cognitive impairment. PATHOPHYSIOLOGY 2018; 25:405-410. [DOI: 10.1016/j.pathophys.2018.08.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 07/09/2018] [Accepted: 08/10/2018] [Indexed: 11/25/2022] Open
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30
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Li J, You SJ, Xu YN, Yuan W, Shen Y, Huang JY, Xiong KP, Liu CF. Cognitive impairment and sleep disturbances after minor ischemic stroke. Sleep Breath 2018; 23:455-462. [PMID: 30145676 DOI: 10.1007/s11325-018-1709-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 07/26/2018] [Accepted: 08/15/2018] [Indexed: 12/23/2022]
Abstract
PURPOSE Post-stroke cognitive impairment (PSCI) is common among stroke survivors, although its risk factors are not well understood. Here, we assessed cognitive function in patients within 14 days after minor stroke and investigated the risk factors of PSCI, including sleep-related factors. METHODS Patients with minor acute ischemic stroke (n = 86) were continuously recruited from November 2015 to October 2016. Demographic and clinical data were collected, and cognitive assessment and polysomnography were performed. Based on their cognitive performance, stroke patients were divided into PSCI and no PSCI groups. Age-, sex-, and education-matched participants (n = 36) were included as a healthy control (HC) group. RESULTS Stroke patients showed impairments in multiple cognitive domains relative to HC participants (p < 0.01). Among stroke patients, the prevalence of PSCI and obstructive sleep apnea was 81.4 and 74.4%, respectively. Impairments in attention and working memory (87.1%) and executive function (84.3%) were the most common among stroke patients. Compared with no PSCI patients, PSCI patients showed a higher prevalence of obstructive sleep apnea (50.0 vs. 80.0%, p = 0.030) and shorter total sleep time (435.1 ± 104.0 vs. 347.3 ± 98.1 min, p = 0.002). Logistic regression analysis showed that education duration, total sleep time, and lowest SaO2 were independent risk factors for PSCI. CONCLUSIONS The prevalence of PSCI is high after minor ischemic stroke. In particular, attention and working memory and executive function are most commonly impaired. Although the risk factors for PSCI are numerous, shorter total sleep time and degree of hypoxia at night warrant further attention.
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Affiliation(s)
- Jie Li
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Suzhou, 215004, China
| | - Shou-Jiang You
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Suzhou, 215004, China
| | - Ya-Nan Xu
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Suzhou, 215004, China
| | - Wen Yuan
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Suzhou, 215004, China
| | - Yun Shen
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Suzhou, 215004, China
| | - Jun-Ying Huang
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Suzhou, 215004, China
| | - Kang-Ping Xiong
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Suzhou, 215004, China
| | - Chun-Feng Liu
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Suzhou, 215004, China.
- Institute of Neuroscience, Soochow University, Suzhou, 215123, China.
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31
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Stradecki-Cohan HM, Cohan CH, Raval AP, Dave KR, Reginensi D, Gittens RA, Youbi M, Perez-Pinzon MA. Cognitive Deficits after Cerebral Ischemia and Underlying Dysfunctional Plasticity: Potential Targets for Recovery of Cognition. J Alzheimers Dis 2018; 60:S87-S105. [PMID: 28453486 DOI: 10.3233/jad-170057] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Cerebral ischemia affects millions of people worldwide and survivors suffer from long-term functional and cognitive deficits. While stroke and cardiac arrest are typically considered when discussing ischemic brain injuries, there is much evidence that smaller ischemic insults underlie neurodegenerative diseases, including Alzheimer's disease. The "regenerative" capacity of the brain relies on several aspects of plasticity that are crucial for normal functioning; less affected brain areas may take over function previously performed by irreversibly damaged tissue. To harness the endogenous plasticity mechanisms of the brain to provide recovery of cognitive function, we must first understand how these mechanisms are altered after damage, such as cerebral ischemia. In this review, we discuss the long-term cognitive changes that result after cerebral ischemia and how ischemia alters several plasticity processes. We conclude with a discussion of how current and prospective therapies may restore brain plasticity and allow for recovery of cognitive function, which may be applicable to several disorders that have a disruption of cognitive processing, including traumatic brain injury and Alzheimer's disease.
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Affiliation(s)
- Holly M Stradecki-Cohan
- Department of Neurology Cerebral Vascular Disease Research Laboratories, Miami, FL, USA.,Neuroscience Program, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Charles H Cohan
- Department of Neurology Cerebral Vascular Disease Research Laboratories, Miami, FL, USA
| | - Ami P Raval
- Department of Neurology Cerebral Vascular Disease Research Laboratories, Miami, FL, USA
| | - Kunjan R Dave
- Department of Neurology Cerebral Vascular Disease Research Laboratories, Miami, FL, USA.,Neuroscience Program, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Diego Reginensi
- Centro de Neurociencias, Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT AIP), City of Knowledge, Panama, Republic of Panama
| | - Rolando A Gittens
- Centro de Neurociencias, Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT AIP), City of Knowledge, Panama, Republic of Panama
| | - Mehdi Youbi
- Department of Neurology Cerebral Vascular Disease Research Laboratories, Miami, FL, USA
| | - Miguel A Perez-Pinzon
- Department of Neurology Cerebral Vascular Disease Research Laboratories, Miami, FL, USA.,Neuroscience Program, University of Miami Miller School of Medicine, Miami, FL, USA
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Chen YK, Xiao WM, Li W, Ni ZX, Liu YL, Xu L, Qu JF, Ng CH, Xiang YT. Microbleeds in fronto-subcortical circuits are predictive of dementia conversion in patients with vascular cognitive impairment but no dementia. Neural Regen Res 2018; 13:1913-1918. [PMID: 30233064 PMCID: PMC6183047 DOI: 10.4103/1673-5374.239441] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Cerebral small vessel disease (CSVD) is a common etiology of vascular cognitive impairment with no dementia (V-CIND). Studies have revealed that cerebral microbleeds (CMBs), a feature of CSVD, contribute to cognitive impairment. However, the association between CMBs and dementia conversion in individuals with V-CIND is still unclear. Here, we analyzed the predictive role of CMBs in the conversion from V-CIND to dementia in CSVD patients. We recruited and prospectively assessed 85 patients with CSVD and V-CIND. V-CIND was evaluated using a series of comprehensive neuropsychological scales, including the Chinese version of the Montreal Cognitive Assessment and the Clinical Dementia Rating. MRI assessments were used to quantify lacunar infarcts, white matter hyperintensities, CMBs, and medial temporal lobe atrophy. Eighty-two of the 85 patients completed the assessment for dementia conversion at a 1-year follow-up assessment. Multivariate logistic regression analyses were conducted to examine independent clinical and MRI variables associated with dementia conversion. Twenty-four patients (29.3%) had converted to dementia at the 1-year follow-up, and these individuals had significantly more CMBs in the fronto-subcortical circuits. Multivariate logistic regression analyses revealed that the patients with CMBs in the fronto-subcortical circuits (odds ratio = 4.4; 95% confidence interval: 1.602–12.081, P = 0.004) and 5 or more CMBs overall (odds ratio = 17.6, 95% confidence interval: 3.23–95.84, P = 0.001) had a significantly increased risk of dementia at the 1-year follow-up. These findings indicate that CMBs in the fronto-subcortical circuits may be predictive of dementia conversion in CSVD patients with V-CIND, and thus extend the clinical significance of CMBs. This trial was registered with the Chinese Clinical Trial Registry (registration number: ChiCTR1800017077). Protocol version: 1.0.
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Affiliation(s)
- Yang-Kun Chen
- Department of Neurology, Dongguan People's Hospital (Affiliated Dongguan Hospital, South Medical University), Dongguan, Guangdong Province, China
| | - Wei-Min Xiao
- Department of Neurology, Dongguan People's Hospital (Affiliated Dongguan Hospital, South Medical University), Dongguan, Guangdong Province, China
| | - Wei Li
- Department of Neurology, Dongguan People's Hospital (Affiliated Dongguan Hospital, South Medical University), Dongguan, Guangdong Province, China
| | - Zhuo-Xin Ni
- Department of Neurology, Dongguan People's Hospital (Affiliated Dongguan Hospital, South Medical University), Dongguan; Faculty of Neurology, Guangdong Medical University, Zhanjiang, Guangdong Province, China
| | - Yong-Lin Liu
- Department of Neurology, Dongguan People's Hospital (Affiliated Dongguan Hospital, South Medical University), Dongguan, Guangdong Province, China
| | - Li Xu
- Department of Neurology, Dongguan People's Hospital (Affiliated Dongguan Hospital, South Medical University), Dongguan, Guangdong Province, China
| | - Jian-Feng Qu
- Department of Neurology, Dongguan People's Hospital (Affiliated Dongguan Hospital, South Medical University), Dongguan, Guangdong Province, China
| | - Chee H Ng
- Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia
| | - Yu-Tao Xiang
- Faculty of Health Sciences, University of Macau, Macao SAR, China
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