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Ebbesen BH, Modrau B, Rathleff MS, Johnsen SP, Andreasen J. 'There are things I have learned the hard way' Patient experiences on lasting challenges 4 months after Transient Ischemic Attack: A qualitative study. J Clin Nurs 2024. [PMID: 39128965 DOI: 10.1111/jocn.17399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 07/12/2024] [Accepted: 07/25/2024] [Indexed: 08/13/2024]
Abstract
BACKGROUND Fatigue, depression, anxiety and cognitive difficulties are reported by 1/3 of patients following transient ischemic attack (TIA). AIMS To explore the timeline and how the diagnosis impacts individuals experiencing lasting challenges after TIA. Furthermore, to identify what they believed facilitated return to everyday life. DESIGN Qualitative exploratory study with a phenomenological-hermeneutic approach. METHODS Individual semi-structured interviews and thematic analysis. RESULTS Fifteen patients were included. Four themes were identified; (1) 'They say it is transient - no, not for me' where all participants described lasting challenges emphasizing invalidating fatigue and impaired social participation, (2) 'I am a changed person; how does this impact my future?' which reflects altered identity and elevated alertness to symptoms, (3) 'Time has been my ally and new perspectives have evolved' where most participants described improvement over time and a few considered the diagnosis a wake-up call to change lifestyle. Lastly (4) 'What would have helped me recover?' which unfolds that close, trustful relations influence positively. In addition, the system often failed to support. Participants described pressure to return to work and lack of trust and negative experiences when involving their general practitioner. CONCLUSIONS During the 4 months since diagnosis, participants experienced limitations impacting physical, psychological and social domains. They felt uninformed that lasting challenges could affect them. Different coping strategies were activated, and participants with close, supportive relations managed better. A pressure to return to work and a lack of trust in the general practitioner affected their recovery negatively. Overall, return to everyday life after TIA was considered stressful and appropriate support lacking. RELEVANCE TO CLINICAL PRACTICE To be able to support patients with challenges following TIA, we as healthcare professionals need to understand the identified impact and life changing circumstances. Currently the system seemingly is not able to provide timely, sufficient and competent support. IMPACT (ADDRESSING) WHAT PROBLEM DID THE STUDY ADDRESS?: We know from the literature that up to 1/3 of patients following transient ischemic attack experience lasting challenges measured on a variety of questionnaires. This is paradoxical to a diagnosis defined by focal neurological symptoms that resolve within 24 h. It is unknown how patients with lasting challenges experience the timeline from diagnosis and until 4 months after, how the diagnosis impacts the lives of these individuals, and what they believe as beneficial in returning to their everyday life. WHAT WERE THE MAIN FINDINGS?: These participants with self-reported lasting challenges experienced substantial impacts on physical, psychological and social domains. Further, they felt alone with their struggles and when in need of support from the healthcare system, it failed to provide this. A pressure to return to work and a lack of trust in the general practitioner affected return to everyday life negatively, whereas close and supportive relations facilitated positively. WHERE AND ON WHOM WILL THE RESEARCH HAVE AN IMPACT?: This study will have an impact on the healthcare professionals that provide support and the (limited) follow-up services to patients after TIA. These healthcare professionals are often specialized nurses who need to know what these patients experience and need in order to act upon their struggles and provide timely support. REPORTING METHOD The Standards of Reporting Qualitative Research (SRQR). PATIENT OR PUBLIC CONTRIBUTION Patients with TIA was involved in planning this study. They participated in a panel to plan a prospective observational cohort study and emphasized the importance of exploring the subjective perspectives of impact and prognosis for those patients struggling in a longer term (through qualitative interviews).
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Affiliation(s)
- Birgitte Hede Ebbesen
- Department of Physiotherapy and Occupational Therapy, Aalborg University Hospital, Aalborg, Denmark
- Department of Neurology, Aalborg University Hospital, Aalborg, Denmark
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Boris Modrau
- Department of Neurology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Michael Skovdal Rathleff
- Department of Physiotherapy and Occupational Therapy, Aalborg University Hospital, Aalborg, Denmark
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Søren Paaske Johnsen
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Jane Andreasen
- Department of Physiotherapy and Occupational Therapy, Aalborg University Hospital, Aalborg, Denmark
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- Aalborg Centre of Health and Rehabilitation, Aalborg Municipality, Aalborg, Denmark
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Zawada SJ, Ganjizadeh A, Conte GM, Demaerschalk BM, Erickson BJ. Accelerometer-Measured Behavior Patterns in Incident Cerebrovascular Disease: Insights for Preventative Monitoring From the UK Biobank. J Am Heart Assoc 2024; 13:e032965. [PMID: 38818948 PMCID: PMC11255632 DOI: 10.1161/jaha.123.032965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 04/03/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND The goal was to compare patterns of physical activity (PA) behaviors (sedentary behavior [SB], light PA, moderate-to-vigorous PA [MVPA], and sleep) measured via accelerometers for 7 days between patients with incident cerebrovascular disease (CeVD) (n=2141) and controls (n=73 938). METHODS AND RESULTS In multivariate models, cases spent 3.7% less time in MVPA (incidence rate ratio [IRR], 0.963 [95% CI, 0.929-0.998]) and 1.0% more time in SB (IRR, 1.010 [95% CI, 1.001-1.018]). Between 12 and 24 months before diagnosis, cases spent more time in SB (IRR, 1.028 [95% CI, 1.001-1.057]). Within the year before diagnosis, cases spent less time in MVPA (IRR, 0.861 [95% CI, 0.771-0.964]). Although SB time was not associated with CeVD risk, MVPA time, both total min/d (hazard ratio [HR], 0.998 [95% CI, 0.997-0.999]) and guideline threshold adherence (≥150 min/wk) (HR, 0.909 [95% CI, 0.827-0.998]), was associated with decreased CeVD risk. Comorbid burden had a significant partial mediation effect on the relationship between MVPA and CeVD. Cases slept more during 12:00 to 17:59 hours (IRR, 1.091 [95% CI, 1.002-1.191]) but less during 0:00 to 5:59 hours (IRR, 0.984 [95% CI, 0.977-0.992]). No between-group differences were significant at subgroup analysis. CONCLUSIONS Daily behavior patterns were significantly different in patients before CeVD. Although SB was not associated with CeVD risk, the association between MVPA and CeVD risk is partially mediated by comorbid burden. This study has implications for understanding observable behavior patterns in cerebrovascular dysfunction and may help in developing remote monitoring strategies to prevent or reduce cerebrovascular decline.
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Affiliation(s)
| | - Ali Ganjizadeh
- Mayo Clinic Artificial Intelligence LaboratoryRochesterMN
| | | | - Bart M. Demaerschalk
- Mayo Clinic College of Medicine and SciencePhoenixAZ
- Mayo Clinic Division of Stroke and Cerebrovascular DiseasesDepartment of NeurologyPhoenixAZ
- Mayo Clinic Center for Digital HealthPhoenixAZ
| | - Bradley J. Erickson
- Mayo Clinic College of Medicine and SciencePhoenixAZ
- Mayo Clinic Artificial Intelligence LaboratoryRochesterMN
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Sforza M, Bianchini E, Alivernini D, Spalloni A, Teresi V, Madonia I, Salvetti M, Pontieri FE, Sette G. Cerebral hemodynamics and cognitive functions in the acute and subacute stage of mild ischemic stroke: a longitudinal pilot study. Neurol Sci 2024; 45:2097-2105. [PMID: 38114853 DOI: 10.1007/s10072-023-07260-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 12/08/2023] [Indexed: 12/21/2023]
Abstract
The association between cerebral hemodynamics and cognitive impairment has been reported in neurodegenerative and cerebrovascular disorders (CVD). However, it is still unclear whether changes occur in the acute phase of CVD. Here we investigated cognitive and hemodynamic parameters and their association in patients with CVD during the acute and subacute phases. Seventy-three patients with mild stroke, not undergoing endovascular treatment, were recruited. All subjects were devoid of intracranial or external carotid stenosis, significant chronic cerebrovascular pathology, dementia or non-compensated cardiovascular diseases. Patients were evaluated within 7 days from symptoms onset (T1) and after 3 months (T2). Clinical and demographic data were collected. NIHSS, MoCA, FAB, and Word-Color Stroop test (WCST) were used to evaluate disease severity and cognitive functions. Basal hemodynamic parameters in the middle cerebral artery were measured with transcranial Doppler. Differences between T2 and T1, correlations between cognitive and hemodynamic variables at T1 and T2, as well as correlations between the T2-T1 variation in cognitive and hemodynamic parameters were assessed. At T1, cognitive performance of MoCA, FAB, and WCST was lower compared with T2; and pulsatility index, a parameter reflecting distal vascular resistance, was higher. However, no correlations between the changes in cognitive and hemodynamic variables were found; therefore, the two seems to be independent phenomena. In the acute phase, the linear association between cerebral blood flow and cognitive performances was lost, probably due to a differential effect of microenvironment changes and vascular-specific phenomena on cognition and cerebral hemodynamics. This relationship was partially restored in the subacute phase.
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Affiliation(s)
- Michela Sforza
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, Via Di Grottarossa, 1035-00189, Rome, Italy
- Sant'Andrea University Hospital, Rome, Italy
| | - Edoardo Bianchini
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, Via Di Grottarossa, 1035-00189, Rome, Italy
- Sant'Andrea University Hospital, Rome, Italy
| | - Diletta Alivernini
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, Via Di Grottarossa, 1035-00189, Rome, Italy
| | | | - Valentina Teresi
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, Via Di Grottarossa, 1035-00189, Rome, Italy
- Sant'Andrea University Hospital, Rome, Italy
| | - Irene Madonia
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, Via Di Grottarossa, 1035-00189, Rome, Italy
- Sant'Andrea University Hospital, Rome, Italy
| | - Marco Salvetti
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, Via Di Grottarossa, 1035-00189, Rome, Italy
- Sant'Andrea University Hospital, Rome, Italy
- INM Neuromed IRCCS, Pozzilli, IS, Italy
| | - Francesco E Pontieri
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, Via Di Grottarossa, 1035-00189, Rome, Italy
- Sant'Andrea University Hospital, Rome, Italy
| | - Giuliano Sette
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, Via Di Grottarossa, 1035-00189, Rome, Italy.
- Sant'Andrea University Hospital, Rome, Italy.
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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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Deijle IA, Jonkers IM, Hooghiemstra AM, Engels G, Twisk JWR, Weinstein HC, Van Schaik SM, Van den Berg-Vos RM. Effects of a 1 year aerobic and strength training on cognitive functioning after transient ischemic attack or minor stroke: A randomized controlled trial. J Stroke Cerebrovasc Dis 2024; 33:107441. [PMID: 37966094 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 10/18/2023] [Accepted: 10/20/2023] [Indexed: 11/16/2023] Open
Abstract
OBJECTIVES Patients who have recently suffered a transient ischemic attack (TIA) or minor ischemic stroke are at increased risk of cognitive impairment. In the present study, we aimed to investigate the effect of a 1-year exercise intervention on cognitive functioning up to 2 years post intervention. MATERIAL AND METHODS We conducted a single-blind randomized controlled trial to investigate the effect of an exercise intervention on cognitive functioning, compared with usual care, for up to 2 years. Patients with a TIA or minor stroke were randomly allocated to an intervention group receiving the 1-year exercise intervention (n = 60) or to usual care (n = 59). Outcome measures were assessed at baseline and after 1 and 2 years. We measured cognition with neuropsychological tests on three domains: (1) executive functioning, (2) attention-psychomotor speed, and (3) memory. Linear mixed models were used for longitudinal data to determine the effect of the exercise intervention on cognitive functioning. Statistical analyses were performed using IBM SPSS software 24.0. RESULTS We found that over the two years study period -and corrected for age, sex, and educational level- the intervention group on average improved significantly more in executive functioning than the control group (β = 0.13; 95 % CI [0.02 to 0.25]; p = 0.03). No significant intervention effects were found on either memory or attention-psychomotor speed. CONCLUSIONS Our data show that a 1-year exercise intervention significantly improved executive functioning over time, compared to usual care. We recommend that health care professionals consider broadening standard secondary stroke prevention treatment in patients with TIA/minor stroke by adding exercise and physical activity.
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Affiliation(s)
- Inger A Deijle
- Department of Neurology, OLVG, Amsterdam, the Netherlands; Department of Quality and Improvement, OLVG, Amsterdam, the Netherlands.
| | - Ilse M Jonkers
- Department of Psychology, Woonzorggroep Samen, Schagen, the Netherlands
| | - Astrid M Hooghiemstra
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Gwenda Engels
- Department of Neurology, OLVG, Amsterdam, the Netherlands
| | - Jos W R Twisk
- Department of Epidemiology and Data Science, Amsterdam UMC, Amsterdam, the Netherlands
| | | | | | - Renske M Van den Berg-Vos
- Department of Neurology, OLVG, Amsterdam, the Netherlands; Department of Neurology, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands
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Hammant A, Chithiramohan T, Haunton V, Beishon L. Cognitive testing following transient ischaemic attack: A systematic review of clinical assessment tools. COGENT PSYCHOLOGY 2023; 10:2196005. [PMID: 37025393 PMCID: PMC10069374 DOI: 10.1080/23311908.2023.2196005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023] Open
Abstract
Cognitive deficits are prevalent after transient ischaemic attack (TIA) and result in loss of function, poorer quality of life and increased risks of dependency and mortality. This systematic review aimed to synthesise the available evidence on cognitive assessment in TIA patients to determine the prevalence of cognitive deficits, and the optimal tests for cognitive assessment. Medline, Embase, PsychINFO and CINAHL databases were searched for relevant articles. Articles were screened by title and abstract. Full-text analysis and quality assessment was performed using the National Institute of Health Tool. Data were extracted on study characteristics, prevalence of TIA deficits, and key study findings. Due to significant heterogeneity, meta-analysis was not possible. Twenty-five full-text articles met the review inclusion criteria. There was significant heterogeneity in terms of cognitive tests used, definitions of cognitive impairment and TIA, time points post-event, and analysis methods. The majority of studies used the Mini-Mental State Examination (MMSE) or Montreal Cognitive Assessment (MoCA) (n = 23). Prevalence of cognitive impairment ranged from 2% to 100%, depending on the time-point and cognitive domain studied. The MoCA was more sensitive than the MMSE for identifying cognitive deficits. Deficits were common in executive function, attention, and language. No studies assessed diagnostic test accuracy against a reference standard diagnosis of cognitive impairment. Recommendations on cognitive testing after TIA are hampered by significant heterogeneity between studies, as well as a lack of diagnostic test accuracy studies. Future research should focus on harmonising tools, definitions, and time-points, and validating tools specifically for the TIA population.
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Affiliation(s)
- Alexander Hammant
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | | | - Victoria Haunton
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK
| | - Lucy Beishon
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
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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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Schaeffer MJ, Reaume N, Wang M, Aftab A, Pan A, Tariq S, Reid M, Smith EE, D'Esterre C, Barber PA. Visualization of atrophy of medial temporal lobes and the septal nuclei in patients with transient ischaemic attack and controls. CEREBRAL CIRCULATION - COGNITION AND BEHAVIOR 2023; 5:100177. [PMID: 37519344 PMCID: PMC10372167 DOI: 10.1016/j.cccb.2023.100177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 06/28/2023] [Accepted: 07/06/2023] [Indexed: 08/01/2023]
Abstract
Introduction Transient ischaemic attack (TIA) is associated with increased risk of cognitive decline and dementia as early as one-year post-event. Regional brain atrophy measurements may predict future cognitive decline. Aims: 1) To determine whether Medial Temporal Atrophy (MTA) scores and interseptal distance (ISD) measurements are greater in patients with TIA compared to controls; and 2) To determine whether MTA and ISD predicts cognitive change one year after TIA. Methods Baseline demographic, vascular risk factors, structural imaging and cognitive tests scores were compared between 103 Patients with TIA and 103 age-and-sex-matched controls from the Predementia Neuroimaging of Transient Ischaemic Attack (PREVENT) Study. MTA was assessed using the Schelten's Scale, and ISD was calculated as the distance between the septal nucleus of each hemisphere. Multiple linear regression models were used to evaluate how MTA and ISD related to cognitive change after adjusting for covariates. Results Patients with TIA had larger ISD measurements (1.4 mm [SD=1.2] vs. 0.9 mm [SD=1.0]); p < 0.001) and higher right/left MTA scores (both p < 0.05) compared to controls. At baseline, controls performed significantly better on the RAVLT (total recall), BVMT (total and delayed recall) and the Trail Making Task (A and B) compared to patients with TIA. However, at one-year follow-up there was no evidence of decline in the patients with TIA compared with controls. Higher MTA and ISD scores were not associated with cognitive decline. Conclusions Patients with TIA had higher MTA scores and ISD measurements than controls, but neither were predictors of cognitive decline at one year. Future studies with longer follow-up periods will be required to determine whether higher MTA scores and ISD predict risk of cognitive decline in patients with TIA.
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Affiliation(s)
- Morgan J. Schaeffer
- Department of Psychology, University of Victoria, Victoria, British Columbia, Canada
| | - Noaah Reaume
- Department of Clinical Neurosciences, University of Calgary, 1403 29th Street NW, Calgary, Alberta, Canada
| | - Meng Wang
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW Alberta, Calgary, Canada
| | - Arooj Aftab
- Department of Clinical Neurosciences, University of Calgary, 1403 29th Street NW, Calgary, Alberta, Canada
| | - Alexander Pan
- Department of Clinical Neurosciences, University of Calgary, 1403 29th Street NW, Calgary, Alberta, Canada
| | - Sana Tariq
- Calgary Stroke Program, Department of Clinical Neurosciences, Foothills Medical Centre, 1403 - 29 Street NW, Calgary, Alberta, Canada
- Seaman Family MR Center, Foothills Medical Centre, 1403 29th Street NW, Calgary, Alberta, Canada
| | - Meaghan Reid
- Calgary Stroke Program, Department of Clinical Neurosciences, Foothills Medical Centre, 1403 - 29 Street NW, Calgary, Alberta, Canada
- Seaman Family MR Center, Foothills Medical Centre, 1403 29th Street NW, Calgary, Alberta, Canada
| | - Eric E. Smith
- Department of Clinical Neurosciences, University of Calgary, 1403 29th Street NW, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW Alberta, Calgary, Canada
- Department of Radiology, University of Calgary, 1403 29th Street NW, Calgary, Alberta, Canada
- Calgary Stroke Program, Department of Clinical Neurosciences, Foothills Medical Centre, 1403 - 29 Street NW, Calgary, Alberta, Canada
- Cumming School of Medicine, Hotchkiss Brain Institute, 3330 Hospital Drive NW, Calgary, Alberta, Canada
| | - Chris D'Esterre
- Department of Clinical Neurosciences, University of Calgary, 1403 29th Street NW, Calgary, Alberta, Canada
| | - Philip A. Barber
- Department of Clinical Neurosciences, University of Calgary, 1403 29th Street NW, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW Alberta, Calgary, Canada
- Department of Radiology, University of Calgary, 1403 29th Street NW, Calgary, Alberta, Canada
- Calgary Stroke Program, Department of Clinical Neurosciences, Foothills Medical Centre, 1403 - 29 Street NW, Calgary, Alberta, Canada
- Seaman Family MR Center, Foothills Medical Centre, 1403 29th Street NW, Calgary, Alberta, Canada
- Cumming School of Medicine, Hotchkiss Brain Institute, 3330 Hospital Drive NW, Calgary, Alberta, Canada
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Hede Ebbesen B, Modrau B, Kontou E, Finch E, Crowfoot G, Crow J, Heron N, Hodson T, Skrubbeltrang C, Turner G. Lasting impairments following transient ischemic attack and minor stroke: a systematic review protocol. Front Neurol 2023; 14:1177309. [PMID: 37251235 PMCID: PMC10213239 DOI: 10.3389/fneur.2023.1177309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 04/20/2023] [Indexed: 05/31/2023] Open
Abstract
Introduction The focus on medical management and secondary prevention following Transient Ischemic Attack (TIA) and minor stroke is well-established. Evidence is emerging that people with TIA and minor stroke can experience lasting impairments as fatigue, depression, anxiety, cognitive impairment, and communication difficulties. These impairments are often underrecognized and inconsistently treated. Research in this area is developing rapidly and an updated systematic review is required to evaluate new evidence as it emerges. This living systematic review aims to describe the prevalence of lasting impairments and how they affect the lives of people with TIA and minor stroke. Furthermore, we will explore whether there are differences in impairments experienced by people with TIA compared to minor stroke. Methods Systematic searches of PubMed, EMBASE, CINAHL, PsycINFO, Cochrane Libraries will be undertaken. The protocol will follow the Cochrane living systematic review guideline with an update annually. A team of interdisciplinary reviewers will independently screen search results, identify relevant studies based on the defined criteria, conduct quality assessments, and extract data. This systematic review will include quantitative studies on people with TIA and/or minor stroke that report on outcomes in relation to fatigue, cognitive and communication impairments, depression, anxiety, quality of life, return to work/education, or social participation. Where possible, findings will be grouped for TIA and minor stroke and collated according to the time that follow-up occurred (short-term < 3 months, medium-term 3-12 months, and long-term > 12 months). Sub-group analysis on TIA and minor stroke will be performed based on results from the included studies. Data from individual studies will be pooled to perform meta-analysis where possible. Reporting will follow the Preferred Reporting Items for Systematic review and Meta-Analysis Protocol (PRISMA-P) guideline. Perspectives This living systematic review will collate the latest knowledge on lasting impairments and how these affect the lives of people with TIA and minor stroke. It will seek to guide and support future research on impairments emphasizing distinctions between TIA and minor stroke. Finally, this evidence will allow healthcare professionals to improve follow-up care for people with TIA and minor stroke by supporting them to identify and address lasting impairments.
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Affiliation(s)
- Birgitte Hede Ebbesen
- Department of Physiotherapy and Occupational Therapy, Aalborg University Hospital, Aalborg, Denmark
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- Department of Neurology, Aalborg University Hospital, Aalborg University, Aalborg, Denmark
| | - Boris Modrau
- Department of Neurology, Aalborg University Hospital, Aalborg University, Aalborg, Denmark
| | - Eirini Kontou
- Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Institute of Mental Health, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, United Kingdom
| | - Emma Finch
- Research and Innovation, West Moreton Health, Ipswich, QLD, Australia
- Speech Pathology Department, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Gary Crowfoot
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
| | - Jennifer Crow
- Department of Brain Sciences, Imperial College London, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Neil Heron
- Centre for Public Health, Queen’s University Belfast, Belfast, Ireland
- School of Medicine, Keele University, Staffordshire, United Kingdom
| | - Tenelle Hodson
- School of Health Sciences and Social Work and The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Nathan, QLD, Australia
| | | | - Grace Turner
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
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10
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Gonçalves M, Lima MJ, Fonseca Â, Duque C, Costa AR, Cruz VT. Study protocol for a pilot randomised controlled trial evaluating the feasibility and effectiveness of non-pharmacological interventions to recover functionality after a transient ischaemic attack or a minor stroke: the 'Back to Normal' trial. BMJ Open 2023; 13:e069593. [PMID: 37117001 PMCID: PMC10151926 DOI: 10.1136/bmjopen-2022-069593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/30/2023] Open
Abstract
INTRODUCTION Transient ischaemic attack (TIA) and minor stroke are frequently assumed as temporary or non-disabling events. However, evidence suggests that these patients can experience relevant impairment and functional disability. Therefore, the present study aims to evaluate the feasibility and effectiveness of a 3-month multidomain intervention programme, composed of five non-pharmacological strategies, aimed at accelerating return to pre-event level of functionality in patients with TIA or minor stroke. METHODS AND ANALYSIS Patients diagnosed with a TIA or a minor stroke are being recruited at the emergency or neurology departments of the Hospital Pedro Hispano, located in Matosinhos, Portugal (n=70). Those who accept to participate will be randomly allocated to two groups (1:1): (a) Intervention-receives a 3 months combined approach, initiating early post-event, composed of cognitive training, physical exercise, nutrition, psychoeducation and assessment/correction of hearing loss; (b) Control-participants will not be subject to any intervention. Both groups will receive the usual standard of care provided to these diseases. Recruitment began in May 2022 and is expected to continue until March 2023. Socio-demographic characteristics, lifestyles, health status, cognitive function, symptoms of anxiety and depression and quality of life will be assessed; as well as anthropometry, blood pressure and physical condition. Time to complete or partial recovery of instrumental activities of daily living will be assessed using an adapted version of the Frenchay Activities Index. All participants will be evaluated before the intervention and after 3 months. ETHICS AND DISSEMINATION This study was approved by the Ethics Committee of the Local Health Unit of Matosinhos (Ref. 75/CES/JAS). Written informed consent will be required from all the participants; data protection and confidentiality will be also ensured. The findings of this project are expected to be submitted for publication in scientific articles, and the main results will be presented at relevant scientific meetings. TRIAL REGISTRATION NUMBER NCT05369637.
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Affiliation(s)
- Micaela Gonçalves
- EPIUnit, Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
| | - Maria João Lima
- Serviço de Neurologia, Unidade Local de Saúde de Matosinhos EPE, Matosinhos, Portugal
| | - Ângelo Fonseca
- Serviço de Neurologia, Unidade Local de Saúde de Matosinhos EPE, Matosinhos, Portugal
| | - Cristina Duque
- Serviço de Neurologia, Unidade Local de Saúde de Matosinhos EPE, Matosinhos, Portugal
| | - Ana Rute Costa
- EPIUnit, Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Vitor Tedim Cruz
- EPIUnit, Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
- Serviço de Neurologia, Unidade Local de Saúde de Matosinhos EPE, Matosinhos, Portugal
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11
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Smith LJ, Gregory P, Clatworthy P, Gallop L, Stothart G. Working Memory Impairment in Transient Ischaemic Attack: N-back as a Sensitive Measure for Detection. BRAIN IMPAIR 2023; 24:124-131. [PMID: 38167581 DOI: 10.1017/brimp.2021.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Transient ischaemic attack (TIA) can lead to lasting changes in brain structure and function resulting in cognitive impairment. Cognitive screening tools may lack sensitivity for detecting cognitive impairments, particularly executive function, which tends to be the earliest affected domain in vascular cognitive impairment. AIM In this preliminary study, we examine a working memory (WMem) task as a sensitive measure of cognitive impairment in TIA. METHOD Patients referred to a TIA clinic for transient neurological symptoms completed a general cognitive screening tool (Montreal Cognitive Assessment; MoCA), and a WMem task (2-N-back) in a cross-sectional design. RESULTS TIA patients (n = 12) showed significantly reduced WMem performance on the N-back compared to patients diagnosed with mimic clinical conditions with overlapping symptoms (n = 16). No group differences were observed on the MoCA. CONCLUSIONS Assessing WMem may provide a sensitive measure of cognitive impairment after TIA, with implications for cognitive screening in TIA services to triage patients for further neuropsychological support, or for interventions to prevent vascular dementia.
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Affiliation(s)
- Laura J Smith
- Department of Psychology, University of Bath, Bath, UK
- School of Psychology, University of Kent, Kent, UK
| | - Polly Gregory
- Department of Psychology, University of Bath, Bath, UK
| | | | - Lucy Gallop
- Department of Psychology, University of Bath, Bath, UK
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12
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Risk of dementia according to the smoking habit change after ischemic stroke: a nationwide population-based cohort study. Sci Rep 2022; 12:22422. [PMID: 36575201 PMCID: PMC9794689 DOI: 10.1038/s41598-022-27083-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 12/26/2022] [Indexed: 12/28/2022] Open
Abstract
There is a paucity of research regarding the association between the risk of incident dementia and changes in smoking habits in the acute ischemic stroke population. We aimed to investigate the effects of smoking habit change on the risk of incident dementia in an ischemic stroke population using data from the Korean National Health Insurance Services Database. This nationwide population-based cohort study included 197,853 patients with ischemic stroke. The patients were divided into never smokers, former smokers, smoking quitters, sustained smokers, and new smokers, based on the 2-year change in smoking status between the two consecutive health examinations before and after the index stroke. The patients were followed up from the index date to 2018 to assess the development of dementia. Dementia was further categorized into Alzheimer's, vascular, and other types of dementia according to the International Classification of Diseases, Tenth Revision diagnosis. Multivariable Cox proportional hazards models were used to assess the association between changes in smoking habits and the risk of dementia. After a median of 4.04 years of follow-up, 19,595 (9.9%) dementia cases were observed. Among them, 15,189 (7.7%) were diagnosed with Alzheimer's disease dementia and 2719 (1.4%) were diagnosed with vascular dementia. After adjusting for covariates, including age, sex, alcohol intake habits, cigarette pack-year, regular physical activity, income, history of hypertension, diabetes mellitus, dyslipidemia, and chronic kidney disease, new smokers, sustained smokers, and smoking quitters were significantly associated with a higher risk of all-cause dementia than never smokers (adjusted hazard ratio [aHR] 1.395, 95% confidence interval [CI] 1.254-1.552; aHR 1.324, 95% CI 1.236-1.418; and aHR 1.170, 95% CI 1.074-1.275, respectively). Similar trends were observed for both Alzheimer's dementia and vascular dementia, but the association between new smokers and vascular dementia was not significant. The impact of smoking habit change was more prominent in the 40-65-year-old group. New and sustained smokers had a substantially higher risk of incident dementia after ischemic stroke than never smokers. Smoking quitters also had an elevated risk of incident dementia, but the detrimental effects were lower than those in new and sustained smokers.
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13
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Deijle IA, Hemmes R, Boss HM, de Melker EC, van den Berg BTJ, Kwakkel G, van Wegen E, Bosboom WM, Weinstein HC, van Schaik SM, Van den Berg-Vos RM. Effect of an exercise intervention on global cognition after transient ischemic attack or minor stroke: the MoveIT randomized controlled trial. BMC Neurol 2022; 22:289. [PMID: 35927622 PMCID: PMC9351151 DOI: 10.1186/s12883-022-02805-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 07/14/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Patients with a transient ischemic attack (TIA) or ischemic stroke are at increased risk of developing cognitive impairment in the subacute phase. At present, the effects of exercise on cognitive functioning following a TIA or stroke are not fully known. The purpose of this trial was to investigate the effect of exercise on global cognition. METHODS The MoveIT trial is a single-centre, observer-blinded, randomized controlled trial involving a 1-year exercise intervention consisting of a 12-week group exercise program, combined with three counselling visits to the physiotherapists over a 9-month period. The control group received standard care. The primary outcome was global cognitive functioning, assessed at one year, using the Montreal Cognitive Assessment (MoCA). Secondary outcomes included cardiorespiratory fitness, the cardiovascular profile, and attainment of secondary prevention targets, anxiety, depression and fatigue at one and two years. RESULTS The experimental group consisted of 60 patients, while the control group consisted of 59 patients. The mean age was 64.3 years and 41% were female. No between-group differences were found on global cognitive functioning (MD, 0.7 out of 30, 95% CI, - 0.2 to 1.6) or on secondary outcome measures at 12 months. The only significant between-group difference was found for fatigue, in favour of the experimental group at 12 months (MD, 0.6 out of 63, 95% CI, 0.1 to 1.1). CONCLUSIONS No benefit of this exercise intervention was found regarding global cognition. Future studies need to focus on optimizing rehabilitation strategies for this vulnerable group of patients. TRIAL REGISTRATION http://www.trialregister.nl . Unique identifier: NL3721 . Date first registration: 06-03-2013.
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Affiliation(s)
- Inger A. Deijle
- Department of Neurology, OLVG, Amsterdam, The Netherlands
- Department of Physical Therapy, OLVG, Amsterdam, The Netherlands
| | | | - H. Myrthe Boss
- Department of Neurology, Gelderse Vallei Hospital, Ede, The Netherlands
| | | | | | - Gert Kwakkel
- Department of Rehabilitation Medicine, Amsterdam UMC, location Vrije Universiteit Amsterdam, De Boelelaan 1118, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, The Netherlands
- Amsterdam Neurosciences, Neurovascular Disorders, Amsterdam, The Netherlands
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL USA
- Department of Neurorehabilitation, Amsterdam Rehabilitation Research Centre Reade, Amsterdam, The Netherlands
| | - Erwin van Wegen
- Department of Rehabilitation Medicine, Amsterdam UMC, location Vrije Universiteit Amsterdam, De Boelelaan 1118, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, The Netherlands
- Amsterdam Neurosciences, Neurovascular Disorders, Amsterdam, The Netherlands
| | - Wendy M. Bosboom
- Board of directors, Rivierenland Hospital, Tiel, The Netherlands
| | - Henry C. Weinstein
- Department of Neurology, OLVG, Amsterdam, The Netherlands
- Amsterdam Neurosciences, Neurovascular Disorders, Amsterdam, The Netherlands
| | | | - Renske M. Van den Berg-Vos
- Department of Neurology, OLVG, Amsterdam, The Netherlands
- Amsterdam Neurosciences, Neurovascular Disorders, Amsterdam, The Netherlands
- Department of Neurology, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
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14
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Su C, Yang X, Wei S, Zhao R. Periventricular white matter hyperintensities are associated with gait and balance in patients with minor stroke. Front Neurol 2022; 13:941668. [PMID: 35937058 PMCID: PMC9355320 DOI: 10.3389/fneur.2022.941668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 06/27/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveCerebral small vessel disease (CSVD) is associated with gait and balance deficits in older adults. However, the effect of CSVD-related brain injury on post-stroke mobility is unknown. This study aimed to investigate the association of CSVD with gait and balance impairment after a minor stroke.MethodsA total of 273 patients with a minor stroke (NIHSS ≤ 5 points) who were hospitalized at the Affiliated Hospital of Qingdao University were enrolled. The manifestations of white matter hyperintensities (WMH), lacunes, enlarged perivascular spaces (EPVS), and cerebral microbleeds (CMB) were statistically analyzed according to magnetic resonance imaging results, and the total burden score of CSVD was calculated. Gait function was assessed by a 6-m walking speed test, and balance function was assessed by the timed-up-and-go (TUG) test. Linear regression analysis was applied to determine the association after adjusting for key variables.ResultsThe correlation results showed that in patients with minor stroke, age, sex, smoking history, and the infarct site were associated with gait speed, and age and the infarct site were associated with the TUG test. In the univariate linear regression model, periventricular white matter hyperintensities (PVWMH), deep white matter hyperintensities (DWMH), and the total burden of CSVD were correlated with gait speed, while only PVWMH correlated with the TUG test. After adjusting for confounders, only PVWMH were independent predictors of gait speed (β = −0.089, p < 0.05) and the TUG test (β = 0.517, p < 0.05).ConclusionsOur study confirmed that CSVD is associated with gait and balance disorders after a minor stroke. PVWMH are independent predictors of gait and balance disorders in patients with minor stroke. These findings should be confirmed in larger prospective studies.
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15
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Turner GM, Jones R, Collis P, Patel S, Jowett S, Tearne S, Foy R, Atkins L, Mant J, Calvert M. Structured follow-up pathway to support people after transient ischaemic attack and minor stroke (SUPPORT TIA): protocol for a feasibility study and process evaluation. BMJ Open 2022; 12:e060280. [PMID: 35710247 PMCID: PMC9207897 DOI: 10.1136/bmjopen-2021-060280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION People who experience transient ischaemic attack (TIA) and minor stroke have limited follow-up despite rapid specialist review in hospital. This means they often have unmet needs and feel abandoned following discharge. Care needs after TIA/minor stroke include information provision (diagnosis and stroke risk), stroke prevention (medication and lifestyle change) and holistic care (residual problems and return to work or usual activities). This protocol describes a feasibility study and process evaluation of an intervention to support people after TIA/minor stroke. The study aims to assess the feasibility and acceptability of (1) the intervention and (2) the trial procedures for a future randomised controlled trial of this intervention. METHODS AND ANALYSIS This is a multicentre, randomised (1:1) feasibility study with a mixed-methods process evaluation. Sixty participants will be recruited from TIA clinics or stroke wards at three hospital sites (England). Intervention arm participants will be offered a nurse or allied health professional-led follow-up appointment 4 weeks after TIA/minor stroke. The multifaceted intervention includes: a needs checklist, action plan, resources to support management of needs, a general practitioner letter and training to deliver the intervention. Control arm participants will receive usual care. Follow-up will be self-completed questionnaires (12 weeks and 24 weeks) and a clinic appointment (24 weeks). Follow-up questionnaires will measure anxiety, depression, fatigue, health related quality of life, self-efficacy and medication adherence. The clinic appointment will collect body mass index, blood pressure, cholesterol and medication. Assessment of feasibility and acceptability will include quantitative process variables (such as recruitment and questionnaire response rates), structured observations of study processes, and interviews with a subsample of participants and clinical staff. ETHICS AND DISSEMINATION Favourable ethical opinion was gained from the Wales Research Ethics Committee (REC) 1 (23 February 2021, REC reference: 21/WA/0036). Study results will be published in peer-reviewed journals and presented at conferences. A lay summary and dissemination strategy will be codesigned with consumers. The lay summary and journal publication will be distributed on social media. TRIAL REGISTRATION NUMBER ISRCTN39864003.
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Affiliation(s)
- Grace M Turner
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Centre for Patient Reported Outcomes Research and Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Rachael Jones
- Royal Wolverhampton NHS Trust, Wolverhampton, UK
- Clinical Research Network West Midlands, West Midlands, UK
| | - Phillip Collis
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Centre for Patient Reported Outcomes Research and Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Smitaa Patel
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Sue Jowett
- Health Economics Unit, University of Birmingham, Birmingham, UK
| | - Sarah Tearne
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Robbie Foy
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Lou Atkins
- Centre for Behaviour Change, University College London, London, UK
| | - Jonathan Mant
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Melanie Calvert
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Centre for Patient Reported Outcomes Research and Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
- NIHR Applied Research Collaboration (ARC) West Midlands, University of Birmingham, Birmingham, UK
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Linassi F, De Laurenzis A, Maran E, Gadaldi A, Spano' L, Gerosa G, Pittarello D, Zanatta P, Carron M. Influence of Previous General Anesthesia on Cognitive Impairment: An Observational Study Among 151 Patients. Front Hum Neurosci 2022; 16:810046. [PMID: 35652004 PMCID: PMC9148968 DOI: 10.3389/fnhum.2022.810046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 04/14/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction Preoperative neurocognitive disorder (preO-NCD) is a common condition affecting 14–51. 7% of the elderly population. General anesthesia has already been associated with the one-year post-operative neurocognitive disorder (PostO-NCD), specifically, a deficit in executive function, measured by the Trail Making Test B (TMT-B), but its long-term effects on cognitive function have not been investigated. We aimed to detect preO-NCD prevalence in patients scheduled for cardiac surgery and further investigate the possible role of previous general anesthesia (pGA) in general preoperative cognitive status [measured via the Montreal Cognitive Assessment (MoCA)] and/or in executive functioning (measured via TMT-B). Methods In this observational, prospective study, 151 adult patients scheduled for elective cardiac surgery underwent MoCA and TMT-B. Data on age, education, pGA, comorbidities, and laboratory results were collected. Results We discovered a general cognitive function impairment of 79.5% and an executive function impairment of 22%. Aging is associated with an increased likelihood (OR 2.99, p = 0.047) and education with a decreased likelihood (OR 0.35, p = 0.0045) of general cognitive impairment, but only education was significantly associated with a decreased likelihood (OR 0.22, p = 0.021) of executive function impairment. While pGA did not significantly affect preO-NCD, a noteworthy interaction between aging and pGA was found, resulting in a synergistic effect, increasing the likelihood of executive function impairment (OR 9.740, p = 0.0174). Conclusion We found a high prevalence of preO-NCD in patients scheduled for cardiac surgery. General cognitive function impairment is highly associated with advancing age (not pGA). However, older patients with at least one pGA appeared to be at an increased risk of preO-NCD, especially executive function impairment, suggesting that TMT-B should be associated with MoCA in the preoperative cognitive evaluation in this population.
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Affiliation(s)
- Federico Linassi
- Department of Pharmaceutical and Pharmacological Sciences, University of Padova, Padova, Italy
- *Correspondence: Federico Linassi
| | - Alessandro De Laurenzis
- Department of Medicine, Anaesthesiology and Intensive Care, University of Padova, Padova, Italy
| | - Eleonora Maran
- Department of Medicine, Anaesthesiology and Intensive Care, University of Padova, Padova, Italy
| | - Alessandra Gadaldi
- Department of Medicine, Anaesthesiology and Intensive Care, University of Padova, Padova, Italy
| | - Leonardo Spano'
- Department of Medicine, Anaesthesiology and Intensive Care, University of Padova, Padova, Italy
| | - Gino Gerosa
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Demetrio Pittarello
- Department of Medicine, Anaesthesiology and Intensive Care, University of Padova, Padova, Italy
| | - Paolo Zanatta
- Department of Anesthesia and Intensive Care, Integrated University Hospital of Verona, Verona, Italy
| | - Michele Carron
- Department of Medicine, Anaesthesiology and Intensive Care, University of Padova, Padova, Italy
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Ganesh A, Barber PA. The Cognitive Sequelae of Transient Ischemic Attacks-Recent Insights and Future Directions. J Clin Med 2022; 11:2637. [PMID: 35566762 PMCID: PMC9104376 DOI: 10.3390/jcm11092637] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 05/02/2022] [Accepted: 05/05/2022] [Indexed: 02/05/2023] Open
Abstract
There is now considerable evidence that Transient Ischemic Attack (TIA) carries important sequelae beyond the risk of recurrent stroke, particularly with respect to peri-event and post-event cognitive dysfunction and subsequent cognitive decline. The occurrence of a TIA could provide an important window in understanding the relationship of early mixed vascular-neurodegenerative cognitive decline, and by virtue of their clinical relevance as a "warning" event, TIAs could also furnish the opportunity to act preventatively not only for stroke prevention but also for dementia prevention. In this review, we discuss the current state of the literature regarding the cognitive sequelae associated with TIA, reviewing important challenges in the field. In particular, we discuss definitional and methodological challenges in the study of TIA-related cognitive impairment, confounding factors in the cognitive evaluation of these patients, and provide an overview of the evidence on both transient and long-term cognitive impairment after TIA. We compile recent insights from clinical studies regarding the predictors and mediators of cognitive decline in these patients and highlight important future directions for work in this area.
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Affiliation(s)
- Aravind Ganesh
- Calgary Stroke Program, Departments of Clinical Neurosciences, University of Calgary Cumming School of Medicine, Calgary, AB T2N 4N1, Canada;
- Department of Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, AB T2N 4N1, Canada
- Hotchkiss Brain Institute, University of Calgary Cumming School of Medicine, Calgary, AB T2N 4N1, Canada
| | - Philip A. Barber
- Calgary Stroke Program, Departments of Clinical Neurosciences, University of Calgary Cumming School of Medicine, Calgary, AB T2N 4N1, Canada;
- Department of Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, AB T2N 4N1, Canada
- Hotchkiss Brain Institute, University of Calgary Cumming School of Medicine, Calgary, AB T2N 4N1, Canada
- Department of Radiology, University of Calgary Cumming School of Medicine, Calgary, AB T2N 4N1, Canada
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18
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Turner GM, Aquino MRJV, Atkins L, Foy R, Mant J, Calvert M. Factors influencing follow-up care post-TIA and minor stroke: a qualitative study using the theoretical domains framework. BMC Health Serv Res 2022; 22:235. [PMID: 35189884 PMCID: PMC8859903 DOI: 10.1186/s12913-022-07607-0] [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: 10/11/2021] [Accepted: 01/27/2022] [Indexed: 11/10/2022] Open
Abstract
Background Follow-up care after transient ischaemic attack (TIA) and minor stroke has been found to be sub-optimal, with individuals often feeling abandoned. We aimed to explore factors influencing holistic follow-up care after TIA and minor stroke. Methods Qualitative semi-structured interviews with 24 healthcare providers (HCPs): 5 stroke doctors, 4 nurses, 9 allied health professionals and 6 general practitioners. Participants were recruited from three TIA clinics, seven general practices and one community care trust in the West Midlands, England. Interview transcripts were deductively coded using the Theoretical Domains Framework and themes were generated from coded data. Results There was no clear pathway for supporting people with TIA or minor stroke after rapid specialist review in hospital; consequently, these patients had limited access to HCPs from all settings (‘Environmental context and resources’). There was lack of understanding of potential needs post-TIA/minor stroke, in particular residual problems such as anxiety/fatigue (‘Knowledge’). Identification and management of needs was largely influenced by HCPs’ perceived role, professional training (‘Social professional role and identity’) and time constraints (‘Environmental context and resources’). Follow-up was often passive – with onerous on patients to seek support – and predominantly focused on acute medical management (‘Intentions’/‘Goal’). Conclusions Follow-up care post-TIA/minor stroke is currently sub-optimal. Through identifying factors which influence follow-up, we can inform guidelines and practical strategies to improve holistic healthcare. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07607-0.
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Affiliation(s)
- Grace M Turner
- Institute of Applied Health Research, University of Birmingham, B15 2TT, Birmingham, UK. .,Centre for Patient Reported Outcomes Research, University of Birmingham, B15 2TT, Birmingham, UK. .,NIHR Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, B15 2TH, Birmingham, UK.
| | - Maria Raisa Jessica V Aquino
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK.,Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, CB1 8RN, UK
| | - Lou Atkins
- Centre for Behaviour Change, University College London, WC1E 6BT, London, UK
| | - Robbie Foy
- Leeds Institute for Health Sciences, University of Leeds, Leeds, LS2 9JT, UK
| | - Jonathan Mant
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, CB1 8RN, UK
| | - Melanie Calvert
- Institute of Applied Health Research, University of Birmingham, B15 2TT, Birmingham, UK.,Centre for Patient Reported Outcomes Research, University of Birmingham, B15 2TT, Birmingham, UK.,NIHR Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, B15 2TH, Birmingham, UK.,NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, B15 2TH, Birmingham, UK.,Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, B15 2TT, Birmingham, UK.,NIHR Applied Research Collaboration (ARC) West Midlands, University of Birmingham, B15 2TT, Birmingham, UK
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19
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Ramírez-Moreno J, Bartolomé Alberca S, Muñoz Vega P, Guerrero Barona E. Screening for cognitive impairment with the Montreal Cognitive Assessment in Spanish patients with minor stroke or transient ischaemic attack. NEUROLOGÍA (ENGLISH EDITION) 2022; 37:38-44. [DOI: 10.1016/j.nrleng.2018.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 11/17/2018] [Indexed: 10/23/2022] Open
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20
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Relationship between homocysteine levels and post-stroke cognitive impairment in female and male population: from a prospective multicenter study. J Transl Int Med 2021; 9:264-272. [PMID: 35136725 PMCID: PMC8802403 DOI: 10.2478/jtim-2021-0035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Background and Objectives: To investigate the relationship between homocysteine levels and post-stroke cognitive impairment (PSCI) in Chinese female and male populations with minor acute ischemic stroke or transient ischemic attack. Materials and methods: A total of 1070 participants with clinically confirmed acute minor ischemic stroke or transient ischemic attack and baseline homocysteine information from a nationwide multicenter prospective registry study in China were included in this study. Of these, 919 patients had cognitive assessments at 3-month follow-ups and 584 participants had cognitive assessments at 12-month follow-ups. The incidence of PSCI was defined as a Montreal Cognitive Assessment score ≤22. The differences in homocysteine levels and the incidence of PSCI were compared between female and male populations. Relationships between homocysteine levels and the incidence of PSCI in female and male populations were analyzed using multiple logistic regression, respectively. Results: Females had lower baseline homocysteine levels than males. Compared to males, females had lower education levels, lower rates of smoking and alcohol intake, and higher rates of diabetes and hypertension. No relationship was observed between elevated homocysteine level and 3-month PSCI incidence in either females or males. After adjusting the confounders, elevated baseline homocysteine significantly increased the 12-month PSCI risk (odds ratio 3.28, 95% confidence interval 1.47–7.34, P = 0.004) in females, but not in males (odds ratio 0.86, 95% confidence interval 0.49–1.49, P = 0.586). Conclusion: Elevated homocysteine levels increased the 12-month PSCI risk in females, but not in males with minor acute ischemic stroke or transient ischemic attack.
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21
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Li Z, McConnell HL, Stackhouse TL, Pike MM, Zhang W, Mishra A. Increased 20-HETE Signaling Suppresses Capillary Neurovascular Coupling After Ischemic Stroke in Regions Beyond the Infarct. Front Cell Neurosci 2021; 15:762843. [PMID: 34819839 PMCID: PMC8606525 DOI: 10.3389/fncel.2021.762843] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 10/06/2021] [Indexed: 12/23/2022] Open
Abstract
Neurovascular coupling, the process by which neuronal activity elicits increases in the local blood supply, is impaired in stroke patients in brain regions outside the infarct. Such impairment may contribute to neurological deterioration over time, but its mechanism is unknown. Using the middle cerebral artery occlusion (MCAO) model of stroke, we show that neuronal activity-evoked capillary dilation is reduced by ∼75% in the intact cortical tissue outside the infarct border. This decrease in capillary responsiveness was not explained by a decrease in local neuronal activity or a loss of vascular contractility. Inhibiting synthesis of the vasoconstrictive molecule 20-hydroxyeicosatetraenoic acid (20-HETE), either by inhibiting its synthetic enzyme CYP450 ω-hydroxylases or by increasing nitric oxide (NO), which is a natural inhibitor of ω-hydroxylases, rescued activity-evoked capillary dilation. The capillary dilation unmasked by inhibiting 20-HETE was dependent on PGE2 activation of endoperoxide 4 (EP4) receptors, a vasodilatory pathway previously identified in healthy animals. Cortical 20-HETE levels were increased following MCAO, in agreement with data from stroke patients. Inhibition of ω-hydroxylases normalized 20-HETE levels in vivo and increased cerebral blood flow in the peri-infarct cortex. These data identify 20-HETE-dependent vasoconstriction as a mechanism underlying capillary neurovascular coupling impairment after stroke. Our results suggest that the brain's energy supply may be significantly reduced after stroke in regions previously believed to be asymptomatic and that ω-hydroxylase inhibition may restore healthy neurovascular coupling post-stroke.
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Affiliation(s)
- Zhenzhou Li
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, United States
- Department of Anesthesiology, General Hospital of Ningxia Medical University, Ningxia, China
| | - Heather L. McConnell
- Department of Neurology, Jungers Center for Neurosciences Research, Oregon Health & Science University, Portland, OR, United States
| | - Teresa L. Stackhouse
- Department of Neurology, Jungers Center for Neurosciences Research, Oregon Health & Science University, Portland, OR, United States
| | - Martin M. Pike
- Advanced Imaging Research Center, Oregon Health & Science University, Portland, OR, United States
| | - Wenri Zhang
- Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, OR, United States
| | - Anusha Mishra
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, United States
- Department of Neurology, Jungers Center for Neurosciences Research, Oregon Health & Science University, Portland, OR, United States
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22
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Carotid revascularization and cognitive impairment: the neglected role of cerebral small vessel disease. Neurol Sci 2021; 43:139-152. [PMID: 34596778 DOI: 10.1007/s10072-021-05629-w] [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: 07/01/2021] [Accepted: 09/22/2021] [Indexed: 10/20/2022]
Abstract
Carotid atherosclerosis is a pathological process that leads to narrowing of the vessel lumen and a consequent risk of stroke. Revascularization procedures such as carotid endarterectomy (CEA) and carotid stenting aim to reduce occurrence of stroke in selected patients. Due to the proven benefit and low intraoperative risk, CEA is currently the preferred choice in candidates for carotid revascularization. However, the risk of cognitive impairment subsequent to CEA has not been fully elucidated and is unclear whether certain conditions, such as frailty, may increase this risk. There is consistent evidence that shows that frail patients have higher risk of cognitive impairment after surgical procedure. Moreover, brain pre-existing conditions may play a role in cognitive impairment after CEA. Cerebral small vessel disease (SVD) is a pathology that involves microcirculation and is detectable with computed tomography or magnetic resonance. SVD shares common vascular risk factors with carotid atherosclerosis, is a major contributor to vascular cognitive impairment and vascular dementia, and has been proposed as a marker of brain frailty. In this review, we discuss the current evidence about the link between carotid revascularization and cognitive impairment and advance the hypothesis that SVD may play a relevant role in development of cognitive impairment after carotid revascularization.
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23
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Miao M, Power E, Rietdijk R, Brunner M, Togher L. Implementation of online psychosocial interventions for people with neurological conditions and their caregivers: A systematic review protocol. Digit Health 2021; 7:20552076211035988. [PMID: 34567610 PMCID: PMC8456620 DOI: 10.1177/20552076211035988] [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: 11/02/2020] [Accepted: 07/11/2021] [Indexed: 11/17/2022] Open
Abstract
Background As the burden of neurological conditions increases globally, online psychosocial interventions offer a potentially scalable solution to enabling healthcare access. However, their successful development and implementation require research into electronic healthcare implementation specifically. Methods Using a search strategy combining the concepts of implementation, electronic healthcare, psychosocial interventions and neurological conditions, we will conduct comprehensive electronic searches for primary implementation evidence in MEDLINE, EMBASE, PsycINFO, CINAHL, Scopus, SpeechBITE and NeuroBITE databases. Included studies will be analysed according to the Non-adoption, Abandonment, Scale-Up, Spread, and Sustainability framework, appraised using the Mixed-Methods Appraisal Tool and evaluated for theoretical underpinning in implementation science, with hybrid studies of effectiveness-implementation research classified according to the type of hybrid design. Discussion This review will be the first to use a theoretical underpinning in the Non-adoption, Abandonment, Scale-Up, Spread, and Sustainability framework to evaluate strengths and gaps in existing implementation research into online psychosocial interventions for people with neurological conditions and/or their caregivers. The results may be useful to provide direction and recommendations for future clinical implementation and research into online psychosocial interventions for people with neurological conditions and/or their caregivers. Systematic review registration PROSPERO 2020: CRD42020186387.
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Affiliation(s)
- Melissa Miao
- Graduate School of Health, University of Technology Sydney, Australia
| | - Emma Power
- Graduate School of Health, University of Technology Sydney, Australia
| | - Rachael Rietdijk
- Faculty of Medicine and Health, The University of Sydney, Australia
| | - Melissa Brunner
- Faculty of Medicine and Health, The University of Sydney, Australia
| | - Leanne Togher
- Faculty of Medicine and Health, The University of Sydney, Australia
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24
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Quantifying changes over 1 year in motor and cognitive skill after transient ischemic attack (TIA) using robotics. Sci Rep 2021; 11:17011. [PMID: 34426586 PMCID: PMC8382836 DOI: 10.1038/s41598-021-96177-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 07/29/2021] [Indexed: 12/01/2022] Open
Abstract
Recent work has highlighted that people who have had TIA may have abnormal motor and cognitive function. We aimed to quantify deficits in a cohort of individuals who had TIA and measured changes in their abilities to perform behavioural tasks over 1 year of follow-up using the Kinarm Exoskeleton robot. We additionally considered performance and change over time in an active control cohort of migraineurs. Individuals who had TIA or migraine completed 8 behavioural tasks that assessed cognition as well as motor and sensory functionality in the arm. Participants in the TIA cohort were assessed at 2, 6, 12, and 52 weeks after symptom resolution. Migraineurs were assessed at 2 and 52 weeks after symptom resolution. We measured overall performance on each task using an aggregate metric called Task Score and quantified any significant change in performance including the potential influence of learning. We recruited 48 individuals to the TIA cohort and 28 individuals to the migraine cohort. Individuals in both groups displayed impairments on robotic tasks within 2 weeks of symptom cessation and also at approximately 1 year after symptom cessation, most commonly in tests of cognitive-motor integration. Up to 51.3% of people in the TIA cohort demonstrated an impairment on a given task within 2-weeks of symptom resolution, and up to 27.3% had an impairment after 1 year. In the migraine group, these numbers were 37.5% and 31.6%, respectively. We identified that up to 18% of participants in the TIA group, and up to 10% in the migraine group, displayed impairments that persisted for up to 1 year after symptom resolution. Finally, we determined that a subset of both cohorts (25-30%) experienced statistically significant deteriorations in performance after 1 year. People who have experienced transient neurological symptoms, such as those that arise from TIA or migraine, may continue to experience lasting neurological impairments. Most individuals had relatively stable task performance over time, with some impairments persisting for up to 1 year. However, some individuals demonstrated substantial changes in performance, which highlights the heterogeneity of these neurological disorders. These findings demonstrate the need to consider factors that contribute to lasting neurological impairment, approaches that could be developed to alleviate the lasting effects of TIA or migraine, and the need to consider individual neurological status, even following transient neurological symptoms.
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25
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Zhao X, Chong EJY, Qi W, Pang T, Xu X, Chen C. Domain-Specific Cognitive Trajectories Among Patients with Minor Stroke or Transient Ischemic Attack in a 6-Year Prospective Asian Cohort: Serial Patterns and Indicators. J Alzheimers Dis 2021; 83:557-568. [PMID: 34334410 DOI: 10.3233/jad-210619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Long-term post-stroke cognitive impairment (PSCI) has often been overlooked, especially among patients with minor stroke or transient ischemic attack (TIA). OBJECTIVE To assess 6-year domain-specific cognitive trajectories among survivors of minor stroke or TIA and to identify possible indicators associated with cognitive trajectories, as well as long-term and incident PSCI. METHODS Eligible participants completed cognitive and clinical assessments at baseline (2 weeks after stroke) and up to 5 follow-up visits in 6 years. Mixed linear models and generalized estimating equations were adopted to analyze longitudinal data and survival analysis to explore incident PSCI, controlling for demographic, clinical, and vascular indicators. RESULTS The prevalence of PSCI and mortality rate ranged from 34.6% to 53.7%, and 0 to 7.7% respectively, among 244 patients. Incidence of PSCI was 21.9%. While visual memory demonstrated a significant improvement (p < 0.05), other cognitive domains showed a fluctuating yet stable pattern across visits (all ps > 0.05). Besides age, baseline IQCODE (attention: -0.218 SD/y, executive function: -0.238 SD/y, visual memory: -0.266 SD/y), and MoCA improvement within 1 year (visuoconstruction: 0.007 SD/y, verbal memory: 0.012 SD/y) were associated with longitudinal cognitive changes. Baseline MoCA (OR = 0.66, 95% CI = [0.59-0.74]), MoCA improvement within 3-6 months (OR = 0.79, 95% CI = [0.71-0.89], and within 1 year (OR = 0.86, 95% CI = [0.76-0.96]) were associated with long-term PSCI, while baseline MoCA (OR = 0.76, 95% CI = [0.61-0.96]) was also associated with incident PSCI. CONCLUSION While most domains remained stable across-time, visual memory demonstrated an overall improvement. Short-term cognitive improvement could be an early indicator of long-term cognitive trajectory to identify individuals who may be resilient to PSCI.
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Affiliation(s)
- Xuhao Zhao
- School of Public Health & the 2nd Affiliated Hospital of School of Medicine, Zhejiang University, China
| | - Eddie Jun Yi Chong
- Memory, Ageing and Cognition Centre (MACC), Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Wei Qi
- School of Public Health & the 2nd Affiliated Hospital of School of Medicine, Zhejiang University, China
| | - Ting Pang
- School of Public Health & the 2nd Affiliated Hospital of School of Medicine, Zhejiang University, China
| | - Xin Xu
- School of Public Health & the 2nd Affiliated Hospital of School of Medicine, Zhejiang University, China.,Memory, Ageing and Cognition Centre (MACC), Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Christopher Chen
- Memory, Ageing and Cognition Centre (MACC), Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Memory, Ageing and Cognition Centre (MACC), Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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26
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Katzan IL, Schuster A, Daboul L, Doherty C, Speaker S, Uchino K, Lapin B. Changes in Health-Related Quality of Life After Transient Ischemic Attack. JAMA Netw Open 2021; 4:e2117403. [PMID: 34283228 PMCID: PMC8293018 DOI: 10.1001/jamanetworkopen.2021.17403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
IMPORTANCE Numerous studies have found that patients diagnosed with TIA have decreased health-related quality of life, which has been interpreted as suggesting that patients with TIA have residual symptoms after the event. Studies assessing health status in the same patients before and after an event are lacking but may allow a direct determination of the association of TIA with postevent health status. OBJECTIVE To examine patient-reported health before transient ischemic attack (TIA) among individuals diagnosed with this event and evaluate change in patient-reported health after the event overall and by TIA characterization subgroups. DESIGN, SETTING, AND PARTICIPANTS This cohort study was conducted among 236 patients with a clinical diagnosis of TIA from October 2015 to December 2017 in a large US health system that collects a patient-reported outcome measure in ambulatory setting as part of routine care. Included patients had patient-reported global health scale assessments completed as part of routine care before and after a TIA event. Data were analyzed from March through July 2020. MAIN OUTCOMES AND MEASURES The main outcome was Patient-Reported Outcome Measurement Information System Global Health (PROMIS GH) scale score before and after TIA. A change of 5 or more points in this score is considered clinically relevant. The secondary outcomes included change in patient-reported global health by clinical impression of the probability of a TIA event, pattern of neurological deficits, and short-term risk of stroke, as assessed by the ABCD2 score. RESULTS Among 263 patients who experienced TIA, mean (SD) age was 67.9 (13.4) years and 138 (52.5%) were women. The median (interquartile range) time between patient-reported global health scores was 152 (94-284) days. Mean (SD) baseline patient-reported global physical health and mental health scale summary scores were 43.4 (8.2) and 47.7 (9.7), respectively, and were statistically significantly decreased compared with the general population mean (SD) scores of 50 (10; P < .001) for physical and mental health. The difference between physical health summary score among study participants and the general population was clinically relevant. Mean (SD) summary scores were not statistically significantly different after the event compared with before the event overall (physical health: 44.1 [8.2], for a mean [SE] improvement of 0.65 [0.38] points; P = .09; mental health: 47.4 [9.1], for a mean [SE] worsening of 0.25 [0.38] points; P = .51) or within subgroups. CONCLUSIONS AND RELEVANCE These findings suggest that impaired health status among patients diagnosed with TIA reflect, at least in part, an impaired premorbid state of health. This study did not find that TIA events were associated with worsening of health status overall or within subgroups.
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Affiliation(s)
| | | | - Lynn Daboul
- Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
| | | | - Sidra Speaker
- Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
| | - Ken Uchino
- Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | - Brittany Lapin
- Neurological Institute, Cleveland Clinic, Cleveland, Ohio
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27
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Nicolas K, Goodin P, Visser MM, Michie PT, Bivard A, Levi C, Parsons MW, Karayanidis F. Altered Functional Connectivity and Cognition Persists 4 Years After a Transient Ischemic Attack or Minor Stroke. Front Neurol 2021; 12:612177. [PMID: 34163417 PMCID: PMC8215289 DOI: 10.3389/fneur.2021.612177] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 04/30/2021] [Indexed: 11/25/2022] Open
Abstract
Background and Purpose: Altered executive functions and resting-state functional connectivity (rsFC) are common following a minor stroke or transient ischemic attack (TIA). However, the long-term persistence of these abnormalities is not well-studied. We investigated whether there were cognitive and rsFC differences between (a) controls and minor cerebrovascular event (CVE) patients and (b) between CVE patients with and without an imaging confirmed infarct (i.e., minor stroke and TIA, respectively) at an average of 3.8 years following their event. Methods: Structural and resting-state imaging and cognitive assessments including the Montreal Cognitive Assessment, the Trail Making Task and the National Institute of Health (NIH) Cognition Toolbox were conducted on 42 patients (minor stroke = 17, TIA = 25) and 20 healthy controls (total N = 62). Results: Controls performed better than patients on two measures of executive functioning (both p < 0.046) and had reduced rsFC between the frontoparietal and default mode networks (FPN and DMN, respectively; p = 0.035). No cognitive differences were found between minor stroke and TIA patients, however, rsFC differences were found within the FPN and the DMN (both p < 0.013). Specifically, increased connectivity within the FPN was associated with faster performance in the minor stroke group but not the TIA group (p = 0.047). Conclusions: These findings suggest that transient or relatively minor cerebrovascular events are associated with persistent disruption of functional connectivity of neural networks and cognitive performance. These findings suggest a need for novel interventions beyond secondary prevention to reduce the risk of persistent cognitive deficits.
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Affiliation(s)
- Korinne Nicolas
- Functional Neuroimaging Laboratory, School of Psychology, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, Newcastle, NSW, Australia.,Priority Research Centre for Stroke and Brain Injury, The University of Newcastle, Callaghan, NSW, Australia
| | - Peter Goodin
- Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Milanka M Visser
- Priority Research Centre for Stroke and Brain Injury, The University of Newcastle, Callaghan, NSW, Australia.,Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Patricia T Michie
- Functional Neuroimaging Laboratory, School of Psychology, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Andrew Bivard
- Priority Research Centre for Stroke and Brain Injury, The University of Newcastle, Callaghan, NSW, Australia.,Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Christopher Levi
- Hunter Medical Research Institute, Newcastle, NSW, Australia.,Priority Research Centre for Stroke and Brain Injury, The University of Newcastle, Callaghan, NSW, Australia.,Sydney Partnership for Health, Education, Research and Enterprise, Sydney, NSW, Australia
| | - Mark W Parsons
- Hunter Medical Research Institute, Newcastle, NSW, Australia.,Priority Research Centre for Stroke and Brain Injury, The University of Newcastle, Callaghan, NSW, Australia.,Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Frini Karayanidis
- Functional Neuroimaging Laboratory, School of Psychology, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, Newcastle, NSW, Australia.,Priority Research Centre for Stroke and Brain Injury, The University of Newcastle, Callaghan, NSW, Australia
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28
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Snyder BD, Simone SM, Giovannetti T, Floyd TF. Cerebral Hypoxia: Its Role in Age-Related Chronic and Acute Cognitive Dysfunction. Anesth Analg 2021; 132:1502-1513. [PMID: 33780389 PMCID: PMC8154662 DOI: 10.1213/ane.0000000000005525] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Postoperative cognitive dysfunction (POCD) has been reported with widely varying frequency but appears to be strongly associated with aging. Outside of the surgical arena, chronic and acute cerebral hypoxia may exist as a result of respiratory, cardiovascular, or anemic conditions. Hypoxia has been extensively implicated in cognitive impairment. Furthermore, disease states associated with hypoxia both accompany and progress with aging. Perioperative cerebral hypoxia is likely underdiagnosed, and its contribution to POCD is underappreciated. Herein, we discuss the various disease processes and forms in which hypoxia may contribute to POCD. Furthermore, we outline hypoxia-related mechanisms, such as hypoxia-inducible factor activation, cerebral ischemia, cerebrovascular reserve, excitotoxicity, and neuroinflammation, which may contribute to cognitive impairment and how these mechanisms interact with aging. Finally, we discuss opportunities to prevent and manage POCD related to hypoxia.
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Affiliation(s)
- Brina D. Snyder
- Department of Anesthesiology and Pain Management, UT Southwestern Medical Center, Dallas, TX
| | | | | | - Thomas F. Floyd
- Department of Anesthesiology and Pain Management, UT Southwestern Medical Center, Dallas, TX
- Department of Cardiothoracic Surgery, UT Southwestern Medical Center, Dallas, TX
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29
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Chu SA, Chen TY, Chen PY, Tzeng WJ, Liang CL, Lu K, Chen HJ, Wu CC, Chen JH, Tsai CC, Wang HK. Acupuncture May Decrease the Incidence of Post-stroke Dementia: A Taiwan Nationwide Retrospective Cohort Study. Front Neurol 2021; 12:657048. [PMID: 34093405 PMCID: PMC8176024 DOI: 10.3389/fneur.2021.657048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 04/30/2021] [Indexed: 12/11/2022] Open
Abstract
Background: Post-stroke dementia may affect up to one-third of stroke survivors. Acupuncture as a complementary treatment for stroke has been shown to be beneficial for subsequent post-stroke rehabilitation. The purpose of this retrospective cohort study was to investigate the potential effect of acupuncture to protect stroke patients from dementia. Methods: We included 9,547 patients receiving ambulatory or hospital care for stroke and 9.547 non-stroke patients; patients were matched for sex, age, and Charlson Comorbidity Index. Each individual was traced for the subsequent development of dementia. Two thousand four hundred and forty-nine stroke patients received acupuncture treatment and 7,098 residue stroke patients without acupuncture treatment served as control groups. This is a 3-year follow-up cohorts study: the incidence and adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) of post- stroke dementia in the Cox proportional hazard regression. Results: During the 3-year follow-up, 1,403 patients with stroke (14.70%) and 427 patients without stroke (4.47%) developed dementia. The adjusted HRs of development of dementia among stroke patients were 3.64-times (range, 3.27–4.06), and the incidence of dementia was higher in male. Stroke patients receiving acupuncture treatment had a lower probability of dementia than those without acupuncture during the follow-up period, the adjusted HRs was 0.49 (95% CI, 0.42–0.58; p < 0.001). Conclusions: The association between stroke and dementia existed in both sexes, more prominent in male. Patients with stroke receiving acupuncture treatments showed decreased risk of dementia. Care must be taken evaluating these results because this study was limited to lack of information regarding lifestyles, stroke severities, and acupuncture methods that were used in treatments.
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Affiliation(s)
- Shao-Ang Chu
- Department of Neurosurgery, E-Da Hospital, Kaohsiung, Taiwan.,School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Te-Yuan Chen
- Department of Neurosurgery, E-Da Hospital, Kaohsiung, Taiwan.,School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Po-Yuan Chen
- Department of Neurosurgery, E-Da Hospital, Kaohsiung, Taiwan.,School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Wei-Jie Tzeng
- Department of Neurosurgery, E-Da Hospital, Kaohsiung, Taiwan.,School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Cheng-Loong Liang
- Department of Neurosurgery, E-Da Hospital, Kaohsiung, Taiwan.,School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Kang Lu
- Department of Neurosurgery, E-Da Hospital, Kaohsiung, Taiwan.,School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Han-Jung Chen
- Department of Neurosurgery, E-Da Hospital, Kaohsiung, Taiwan.,School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Cheng-Chun Wu
- Department of Neurosurgery, E-Da Hospital, Kaohsiung, Taiwan.,School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Jian-Han Chen
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan.,Department of General Surgery, E-Da Hospital, Kaohsiung, Taiwan
| | - Chin-Chuan Tsai
- Chinese Medicine Department, E-Da Hospital, Kaohsiung, Taiwan.,School of Chinese Medicine for Post-Baccalaureates, I-Shou University, Kaohsiung, Taiwan
| | - Hao-Kuang Wang
- Department of Neurosurgery, E-Da Hospital, Kaohsiung, Taiwan.,School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
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30
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Wardlaw JM, Doubal F, Brown R, Backhouse E, Woodhouse L, Bath P, Quinn TJ, Robinson T, Markus HS, McManus R, O’Brien JT, Werring DJ, Sprigg N, Parry-Jones A, Touyz RM, Williams S, Mah YH, Emsley H. Rates, risks and routes to reduce vascular dementia (R4vad), a UK-wide multicentre prospective observational cohort study of cognition after stroke: Protocol. Eur Stroke J 2021; 6:89-101. [PMID: 33817339 PMCID: PMC7995325 DOI: 10.1177/2396987320953312] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 07/27/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Stroke commonly affects cognition and, by definition, much vascular dementia follows stroke. However, there are fundamental limitations in our understanding of vascular cognitive impairment, restricting understanding of prevalence, trajectories, mechanisms, prevention, treatment and patient-service needs. AIMS Rates, Risks and Routes to Reduce Vascular Dementia (R4VaD) is an observational cohort study of post-stroke cognition. We aim to recruit a wide range of patients with stroke, presenting to geographically diverse UK hospitals, into a longitudinal study to determine rates of, and risk factors for, cognitive and related impairments after stroke, to assess potential mechanisms and improve prediction models. METHODS We will recruit at least 2000 patients within six weeks of stroke with or without capacity to consent and collect baseline demographic, clinical, socioeconomic, lifestyle, cognitive, neuropsychiatric and informant data using streamlined patient-centred methods appropriate to the stage after stroke. We will obtain more detailed assessments at four to eight weeks after the baseline assessment and follow-up by phone and post yearly to at least two years. We will assess diagnostic neuroimaging in all and high-sensitivity inflammatory markers, genetics, blood pressure and diffusion tensor imaging in mechanistic sub-studies.Planned outputs: R4VaD will provide reliable data on long-term cognitive function after stroke, stratified by prior cognition, stroke- and patient-related variables and improved risk prediction. It will create a platform enabling sharing of data, imaging and samples. Participants will be consented for re-contact, facilitating future clinical trials and providing a resource for the stroke and dementia research communities.
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Affiliation(s)
- Joanna M Wardlaw
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Fergus Doubal
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Rosalind Brown
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Ellen Backhouse
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Lisa Woodhouse
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Philip Bath
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Terence J Quinn
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK
| | - Thompson Robinson
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, UK
| | - Hugh S Markus
- Department of Neurology, University of Cambridge, Cambridge, UK
| | | | - John T O’Brien
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - David J Werring
- National Hospital for Neurology and Neurosurgery, London, UK
- NHS Foundation Trust and Stroke Research Centre, University College Hospitals, London, UK
- Institute of Neurology, University College, London, UK
| | - Nikola Sprigg
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Adrian Parry-Jones
- Division of Cardiovascular Sciences, School of Medicine, Faculty of Biology, Medicine & Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Rhian M Touyz
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK
| | - Steven Williams
- King’s College Hospital NHS Foundation Trust, School of Biomedical Engineering and Imaging Sciences, King’s College London, UK
| | - Yee-Haur Mah
- King’s College Hospital NHS Foundation Trust, School of Biomedical Engineering and Imaging Sciences, King’s College London, UK
| | - Hedley Emsley
- Department of Neurology, Lancashire Teaching Hospitals NHS Foundation Trust & Lancaster Medical School, Lancaster University, UK
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Lugtmeijer S, Lammers NA, de Haan EHF, de Leeuw FE, Kessels RPC. Post-Stroke Working Memory Dysfunction: A Meta-Analysis and Systematic Review. Neuropsychol Rev 2020; 31:202-219. [PMID: 33230717 PMCID: PMC7889582 DOI: 10.1007/s11065-020-09462-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 10/07/2020] [Indexed: 12/16/2022]
Abstract
This review investigates the severity and nature of post-stroke working memory deficits with reference to the multi-component model of working memory. We conducted a systematic search in PubMed up to March 2019 with search terms for stroke and memory. Studies on adult stroke patients, that included a control group, and assessed working memory function, were selected. Effect sizes (Hedges' g) were extracted from 50 studies (in total 3,084 stroke patients) based on the sample size, mean and standard deviation of patients and controls. Performance of stroke patients was compared to healthy controls on low-load (i.e. capacity) and high-load (executively demanding) working memory tasks, grouped by modality (verbal, non-verbal). A separate analysis compared patients in the sub-acute and the chronic stage. Longitudinal studies and effects of lesion location were systematically reviewed. Stroke patients demonstrated significant deficits in working memory with a moderate effect size for both low-load (Hedges' g = -.58 [-.82 to -.43]) and high-load (Hedges' g = -.59 [-.73 to -.45]) tasks. The effect sizes were comparable for verbal and non-verbal material. Systematically reviewing the literature showed that working memory deficits remain prominent in the chronic stage of stroke. Lesions in a widespread fronto-parietal network are associated with working memory deficits. Stroke patients show decrements of moderate magnitude in all subsystems of working memory. This review clearly demonstrates the global nature of the impairment in working memory post-stroke.
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Affiliation(s)
- Selma Lugtmeijer
- University of Amsterdam, Amsterdam, the Netherlands. .,Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands.
| | | | | | - Frank-Erik de Leeuw
- Radboud University Medical Center, Department of Neurology, Nijmegen, the Netherlands
| | - Roy P C Kessels
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands.,Department of Medical Psychology, Radboud University Medical Center, Nijmegen, the Netherlands
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32
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Ettelt P, Maier IL, Schnieder M, Bähr M, Behme D, Psychogios MN, Liman J. Bridging therapy is associated with improved cognitive function after large vessel occlusion stroke - an analysis of the German Stroke Registry. Neurol Res Pract 2020; 2:29. [PMID: 33324931 PMCID: PMC7650060 DOI: 10.1186/s42466-020-00079-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 03/13/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The targeted use of endovascular therapy (EVT), with or without intravenous thrombolysis (IVT) in acute large cerebral vessel occlusion stroke (LVOS) has been proven to be superior compared to IVT alone. Despite favorable functional outcome, many patients complain about cognitive decline after EVT. If IVT in addition to EVT has positive effects on cognitive function is unclear. METHODS We analyzed data from the German Stroke Registry (GSR, an open, multicenter and prospective observational study) and compared cognitive function 90 days after index ischemic stroke using MoCA in patients with independent (mRS ≤ 2 pts) and excellent (mRS = 0 pts) functional outcome receiving combined EVT and IVT (EVT + IVT) vs. EVT alone (EVT-IVT). RESULTS Of the 2636 GSR patients, we included 166 patients with mRS ≤ 2 at 90 days in our analysis. Of these, 103 patients (62%) received EVT + IVT, 63 patients (38%) were treated with EVT alone. There was no difference in reperfusion status between groups (mTICI ≥ 2b in both groups at 95%, p = 0.65). Median MoCA score in the EVT + IVT group was 20 pts. (18-25 IQR) vs. 18 pts. (16-21 IQR) in the EVT-IVT group (p = 0.014). There were more patients with cognitive impairment (defined as MoCA < 26 pts) in the EVT-IVT group (54 patients (86%)) compared to the EVT + IVT group (78 patients (76%)). EVT + IVT was associated with a higher MoCA score at 90 days (mRS ≤ 2: p = 0.033, B = 2.39; mRS = 0: p = 0.021, B = 4.38). CONCLUSIONS In Patients with good functional outcome after LVOS, rates of cognitive impairment are lower with combined EVT and IVT compared to EVT alone. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03356392.
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Affiliation(s)
- Philipp Ettelt
- Department of Neurology, Allgemeines Krankenhaus Celle, Celle, Germany
| | - Ilko L. Maier
- Department of Neurology, University Medicine Göttingen, Göttingen, Germany
| | - Marlena Schnieder
- Department of Neurology, University Medicine Göttingen, Göttingen, Germany
| | - Mathias Bähr
- Department of Neurology, University Medicine Göttingen, Göttingen, Germany
| | - Daniel Behme
- Department of Neuroradiology, University Medicine Göttingen, Göttingen, Germany
| | | | - Jan Liman
- Department of Neurology, University Medicine Göttingen, Göttingen, Germany
| | - on behalf of the GSR-ET Collaborators
- Department of Neurology, Allgemeines Krankenhaus Celle, Celle, Germany
- Department of Neurology, University Medicine Göttingen, Göttingen, Germany
- Department of Neuroradiology, University Medicine Göttingen, Göttingen, Germany
- Department of Neuroradiology, Universitätsspital Basel, Basel, Switzerland
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33
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Nicolas K, Levi C, Evans TJ, Michie PT, Magin P, Quain D, Bivard A, Karayanidis F. Cognition in the First Year After a Minor Stroke, Transient Ischemic Attack, or Mimic Event and the Role of Vascular Risk Factors. Front Neurol 2020; 11:216. [PMID: 32373041 PMCID: PMC7186464 DOI: 10.3389/fneur.2020.00216] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 03/09/2020] [Indexed: 11/17/2022] Open
Abstract
Background: Cognitive impairment following a minor stroke or transient ischemic attack (TIA) is common; however, due to diagnostic difficulties, the prevalence and underlying cause of impairment remain poorly defined. We compared cognition in patients after a minor stroke, TIA, or mimic event at three time points in the first year following the event. We examine whether cognitive impairment occurs following these events and whether this impairment differs based on the event type. Further, we measure whether these findings persist after controlling for age, education, and the presence of vascular risk factors and whether the presence of vascular risk factors, independent of event etiology, is associated with cognitive impairment. Lastly, we investigate whether increased stroke risk, as assessed by the ABCD2, is associated with reduced cognition. Methods: Medical information, a cognitive screening test, and a measure of executive functioning were collected from 613 patients (123 minor stroke, 175 TIA, and 315 mimics) using phone interviews at three time points in the first year following the event. Linear mixed models were used to determine the effect of event type, vascular risk factors, and predicted stroke risk on cognitive performance while controlling for confounders. Results: There was no relationship between event type and performance on either cognitive measure. When all confounders are controlled for, performance on the cognitive screening test was uniquely accounted for by the presence of heart failure, myocardial infarction, angina, and hypertension (all p < 0.047), whereas the measure of executive functioning was uniquely accounted for by the presence of hypertension and angina (all p < 0.032). Increased stroke risk also predicted performance on the cognitive screening test and the measure of executive functioning (all p < 0.002). Conclusions: Our findings indicate that cognitive impairment following a minor stroke or TIA may be attributed to the high prevalence of chronic vascular risk factors in these patients. This highlights the importance of long-term management of vascular risk factors beyond event recovery to reduce the risk of cognitive impairment. Increased stroke risk (i.e., ABCD2 score) was also associated with reduced cognition, suggesting that it may be helpful in signaling the need for further cognitive evaluation and intervention post-event.
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Affiliation(s)
- Korinne Nicolas
- Functional Neuroimaging Laboratory, School of Psychology, University of Newcastle, Newcastle, NSW, Australia.,Brain and Mental Program, Hunter Medical Research Institute, Newcastle, NSW, Australia.,Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Newcastle, NSW, Australia
| | - Christopher Levi
- Brain and Mental Program, Hunter Medical Research Institute, Newcastle, NSW, Australia.,Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Newcastle, NSW, Australia.,University of New South Wales, Sydney, NSW, Australia.,Sydney Partnership for Health, Education, Research and Enterprise, Sydney, NSW, Australia
| | - Tiffany-Jane Evans
- Functional Neuroimaging Laboratory, School of Psychology, University of Newcastle, Newcastle, NSW, Australia
| | - Patricia T Michie
- Functional Neuroimaging Laboratory, School of Psychology, University of Newcastle, Newcastle, NSW, Australia.,Brain and Mental Program, Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Parker Magin
- Functional Neuroimaging Laboratory, School of Psychology, University of Newcastle, Newcastle, NSW, Australia.,Brain and Mental Program, Hunter Medical Research Institute, Newcastle, NSW, Australia.,Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Newcastle, NSW, Australia
| | - Debbie Quain
- Functional Neuroimaging Laboratory, School of Psychology, University of Newcastle, Newcastle, NSW, Australia.,Brain and Mental Program, Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Andrew Bivard
- Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Newcastle, NSW, Australia.,Melbourne Brain Center, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - Frini Karayanidis
- Functional Neuroimaging Laboratory, School of Psychology, University of Newcastle, Newcastle, NSW, Australia.,Brain and Mental Program, Hunter Medical Research Institute, Newcastle, NSW, Australia.,Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Newcastle, NSW, Australia
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Abstract
This article summarizes stroke rehabilitation, with a particular focus on rehabilitation from acute diagnosis to chronic impairments of stroke. The emphasis is on both pharmacologic and nonpharmacologic intervention and interdisciplinary collaboration.
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Affiliation(s)
- Leroy R Lindsay
- Department of Rehabilitation Medicine, Weill Cornell Medical College, 525 East 68th Street, Baker 16, New York, NY 10065, USA.
| | - Diane A Thompson
- Department of Rehabilitation Medicine, Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital, 180 Fort Washington Avenue, HP1-199, New York, NY 10032, USA
| | - Michael W O'Dell
- Department of Rehabilitation Medicine, Weill Cornell Medical College, 525 East 68th Street, Baker 16, New York, NY 10065, USA
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Turner GM, McMullan C, Atkins L, Foy R, Mant J, Calvert M. TIA and minor stroke: a qualitative study of long-term impact and experiences of follow-up care. BMC FAMILY PRACTICE 2019; 20:176. [PMID: 31847828 PMCID: PMC6918619 DOI: 10.1186/s12875-019-1057-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 11/21/2019] [Indexed: 12/15/2022]
Abstract
Background Transient ischaemic attack (TIA) and minor stroke are often considered transient events; however, many patients experience residual problems and reduced quality of life. Current follow-up healthcare focuses on stroke prevention and care for other long-term problems is not routinely provided. We aimed to explore patient and healthcare provider (HCP) experiences of residual problems post-TIA/minor stroke, the impact of TIA/minor stroke on patients’ lives, and current follow-up care and sources of support. Methods This qualitative study recruited participants from three TIA clinics, seven general practices and one community care trust in the West Midlands, England. Semi-structured interviews were conducted with 12 TIA/minor stroke patients and 24 HCPs from primary, secondary and community care. Data was analysed using framework analysis. Results A diverse range of residual problems were reported post-TIA/minor stroke, including psychological, cognitive and physical impairments. Consultants and general practitioners generally lacked awareness of these long-term problems; however, there was better recognition among nurses and allied HCPs. Residual problems significantly affected patients’ lives, including return to work, social activities, and relationships with family and friends. Follow-up care was variable and medically focused. While HCPs prioritised medical investigations and stroke prevention medication, patients emphasised the importance of understanding their diagnosis, individualised support regarding stroke risk, and addressing residual problems. Conclusion HCPs could better communicate information about TIA/minor stroke diagnosis and secondary stroke prevention using lay language, and improve their identification of and response to important residual impairments affecting patients.
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Affiliation(s)
- Grace M Turner
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK. .,Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, B15 2TT, UK.
| | - Christel McMullan
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK.,Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - Lou Atkins
- Centre for Behaviour Change, University College London, London, WC1E 6BT, UK
| | - Robbie Foy
- Faculty of Medicine and Health, University of Leeds, Leeds, LS2 9JT, UK
| | - Jonathan Mant
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, CB1 8RN, UK
| | - Melanie Calvert
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK.,Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, B15 2TT, UK
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Abstract
The concept of mild cognitive impairment is one of the promising directions for studying the predementia stages of different diseases. The feasibility of studying this phenomenon is due not only to a high risk of dementia, but also the potential reversibility of cognitive decline in old age. Long-term follow-up of patients shows different trajectories of cognitive decline in aging. The study of risk factors for the progression of moderate cognitive impairment provided an opportunity to highlight new horizons of prevention of dementia of various etiologies. Despite the insufficient effectiveness of drug therapy in patients with moderate cognitive impairment, exploring the opportunities for possible treatment of their subtypes seems promising from the point of view of improving clinical symptoms and a possible reduction in the rate of disease progression.
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Affiliation(s)
- G R Tabeeva
- Sechenov First Moscow State Medical University, Moscow, Russia
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37
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Riva S, Mancini I, Maino A, Ferrari B, Artoni A, Agosti P, Peyvandi F. Long-term neuropsychological sequelae, emotional wellbeing and quality of life in patients with acquired thrombotic thrombocytopenic purpura. Haematologica 2019; 105:1957-1962. [PMID: 31558667 PMCID: PMC7327631 DOI: 10.3324/haematol.2019.226423] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 09/19/2019] [Indexed: 11/30/2022] Open
Abstract
Neurological symptoms related to microthrombosis are the hallmark of acute manifestations of acquired thrombotic thrombocytopenic purpura (TTP). Despite the achievement of hematological remission, patients may report persisting neurological impairment that affects their quality of life. To assess the long-term neuropsychological consequences of acute TTP, we recruited 35 acquired TTP patients (77% females, median age at onset 41 years, interquartile range: 35–48) regularly followed at our out-patient clinic of thrombotic microangiopathies in Milan (Italy) from December 2015 to October 2016. Patients underwent a psychological evaluation of memory and attentional functions, emotional wellbeing and health-related quality of life at least three months after their last acute TTP event (median 36 months, interquartile range: 17–54). During the psychological consultation, 17 patients (49%) referred persisting subjective neurological impairment in the frame of a remission phase, with at least one symptom as disorientation, loss of concentration, dizziness, lack of balance, headache and diplopia. Neuropsychological assessment revealed lower scores than the Italian general population pertaining to direct, indirect and deferred memory. A higher degree of impairment of memory domains was found in patients with neurological involvement at the time of presentation of the first acute TTP episode. Anxiety and depression were detected in seven (20%) and 15 (43%) patients, respectively. Health-related quality of life was lower than the Italian general population, with mental domains more impacted than physical domains (mean difference 58.43, 95% confidence interval: 71.49–45.37). Our study demonstrates compromised memory and attention functions, persisting anxiety/depression symptoms and a generally reduced quality of life in patients recovering from acute acquired TTP. New clinical strategies should be considered to improve these symptoms.
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Affiliation(s)
- Silvia Riva
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy.,St Mary's University, Twickenham, London, UK
| | - Ilaria Mancini
- Università degli Studi di Milano, Department of Pathophysiology and Transplantation, and Fondazione Luigi Villa, Milan, Italy
| | - Alberto Maino
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy.,Azienda Provinciale per i Servizi Sanitari, Internal Medicine Unit, Trento, Italy
| | - Barbara Ferrari
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy
| | - Andrea Artoni
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy
| | - Pasquale Agosti
- Università degli Studi di Milano, Department of Pathophysiology and Transplantation, and Fondazione Luigi Villa, Milan, Italy
| | - Flora Peyvandi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy.,Università degli Studi di Milano, Department of Pathophysiology and Transplantation, and Fondazione Luigi Villa, Milan, Italy
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38
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Pendlebury ST, Rothwell PM. Incidence and prevalence of dementia associated with transient ischaemic attack and stroke: analysis of the population-based Oxford Vascular Study. Lancet Neurol 2019; 18:248-258. [PMID: 30784556 PMCID: PMC6390174 DOI: 10.1016/s1474-4422(18)30442-3] [Citation(s) in RCA: 307] [Impact Index Per Article: 61.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 11/05/2018] [Accepted: 11/06/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Risk of dementia after stroke is a major concern for patients and carers. Reliable data for risk of dementia, particularly after transient ischaemic attack or minor stroke, are scarce. We studied the risks of, and risk factors for, dementia before and after transient ischaemic attack and stroke. METHODS The Oxford Vascular Study is a prospective incidence study of all vascular events in a population of 92 728 people residing in Oxfordshire, UK. Patients with transient ischaemic attack or stroke occurring between April 1, 2002, and March 31, 2012, were ascertained with multiple methods, including assessment in a dedicated daily emergency clinic and daily review of all hospital admissions. Pre-event and post-event (incident) dementia were diagnosed at initial assessment and during 5-years' follow-up on the basis of cognitive testing supplemented by data obtained from hand searches of all hospital and primary care records. We assessed the association between post-event dementia and stroke severity (as measured with the US National Institutes of Health Stroke Scale [NIHSS] score), location (ie, dysphasia), previous events, markers of susceptibility or reserve (age, low education, pre-morbid dependency, leucoaraiosis), baseline cognition, and vascular risk factors with Cox regression models adjusted for age, sex, and education. We compared incidence and prevalence of dementia in our population with published UK population age-matched and sex-matched rates. FINDINGS Among 2305 patients (mean age 74·4 years [SD 13·0]), 688 (30%) had transient ischaemic attacks and 1617 (70%) had strokes. Pre-event dementia was diagnosed in 225 patients; prevalence was highest in severe stroke (ie, NIHSS >10) and lowest in transient ischaemic attack. Of 2080 patients without pre-event dementia, 1982 (95%) were followed up to the end of study or death. Post-event dementia occurred in 432 of 2080 patients during 5 years of follow-up. The incidence of post-event dementia at 1 year was 34·4% (95% CI 29·7-41·5) in patients with severe stroke (NIHSS score >10), 8·2% (6·2-10·2) in those with minor stroke (NIHSS score <3), and 5·2% (3·4-7·0) in those with transient ischaemic attack. Compared with the UK age-matched and sex-matched population, the 1-year standardised morbidity ratio for the incidence of dementia was 47·3 (95% CI 35·9-61·2), 5·8 (4·4-7·5), and 3·5 (2·5-4·8), respectively. Consequently, prevalence of dementia in 1-year survivors was brought forward by approximately 25 years in those who had severe strokes, 4 years in those who had minor strokes, and 2 years in those who had transient ischaemic attacks. 5-year risk of dementia was associated with age, event severity, previous stroke, dysphasia, baseline cognition, low education, pre-morbid dependency, leucoaraiosis, and diabetes (p<0·0001 for all comparisons, except for previous stroke [p=0·006]). INTERPRETATION The incidence of dementia in patients who have had a transient ischaemic attack or stroke varies substantially depending on clinical characteristics including lesion burden and susceptibility factors. Incidence of dementia is nearly 50 times higher in the year after a major stroke compared with that in the general population, but excess risk is substantially lower after transient ischaemic attack and minor stroke. FUNDING Wellcome Trust, Wolfson Foundation, British Heart Foundation, National Institute for Health Research, and the National Institute for Health Research Oxford Biomedical Research Centre.
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Affiliation(s)
- Sarah T Pendlebury
- Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital and University of Oxford, Oxford, UK.
| | - Peter M Rothwell
- Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital and University of Oxford, Oxford, UK
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Ramírez-Moreno JM, Bartolomé Alberca S, Muñoz Vega P, Guerrero Barona EJ. Screening for cognitive impairment with the Montreal Cognitive Assessment in Spanish patients with minor stroke or transient ischaemic attack. Neurologia 2019; 37:38-44. [PMID: 30737125 DOI: 10.1016/j.nrl.2018.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 11/08/2018] [Accepted: 11/17/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The symptoms of minor stroke and transient ischemic attack (TIA) are temporary and mild. Despite the transient nature of the focal symptoms and the absence of visible brain lesions in some patients, many experience persistent cognitive problems subsequently. We aimed to establish the discriminant capacity of the Montreal Cognitive Assessment (MoCA) in screening for cognitive impairment (CI) within 90 days of TIA. METHOD A total of 50 patients with minor stroke or TIA were recruited. Patients were administered the MoCA test and a formal neuropsychological test battery. CI was defined clinically according to neuropsychological test findings. RESULTS The average age of recruited patients was 57.7±8.0 years; 70.0% were men; all patients had completed at least primary education. Thirty-seven patients (74.0%) presented CI. Receiver operating characteristic curve analysis obtained an optimal MoCA cut-off point of 25 for discriminating between patients with CI and those without, with an area under the curve of 0.835 (95% confidence interval [95% CI] 0.720-0.949), sensitivity of 78.4% (95% CI 62.8-88.6%), specificity of 76.9% (95% CI 49.7-91.8%), positive predictive value of 90.6% (95% CI 81.0-95.6%), and negative predictive value of 55.6% (95% CI 39.5-70.4%). CONCLUSIONS More than half of the patients presented CI as determined by the formal battery of neuropsychological tests. A MoCA cut-off point of 25 is sufficiently sensitive and specific for detecting CI after minor stroke or TIA, and may be implemented as a screening technique in routine clinical practice.
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Affiliation(s)
- J M Ramírez-Moreno
- Departamento de Ciencias Biomédicas, Universidad de Extremadura, Badajoz, España; Centro de Ictus, Sección de Neurología, Hospital Universitario Infanta Cristina, Badajoz, España; Grupo de Investigación Multidisciplinar de Extremadura (GRIMEX), Villanueva de la Serena, España.
| | - S Bartolomé Alberca
- Centro de Ictus, Sección de Neurología, Hospital Universitario Infanta Cristina, Badajoz, España
| | - P Muñoz Vega
- Centro de Neurorrehabilitación Casaverde, Mérida, España
| | - E J Guerrero Barona
- Departamento de Psicología y Antropología, Universidad de Extremadura, Badajoz, España
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Meguro K, Dodge HH. Vascular Mild Cognitive Impairment: Identifying Disease in Community-Dwelling Older Adults, Reducing Risk Factors, and Providing Support. The Osaki-Tajiri and Kurihara Projects. J Alzheimers Dis 2019; 70:S293-S302. [PMID: 30909215 PMCID: PMC6699913 DOI: 10.3233/jad-180899] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2019] [Indexed: 01/15/2023]
Abstract
Vascular mild cognitive impairment (MCI) is a critical disease. Its prognosis includes not only onset of vascular dementia, but also death by cardiovascular disease. The vascular risk factors for vascular MCI are treatable, and appropriate treatment can prevent or delay the progression to dementia. Therefore, this group is an excellent candidate for secondary prevention. However, community-dwelling older adults with vascular MCI are often undetected and are not clinically identified until they develop frank dementia. Furthermore, older adults with undetected vascular MCI often have decreased ability to follow their medication regimens and this poor medication adherence worsens their vascular comorbidities. This vicious cycle needs to be prevented through community-based interventions. There is evidence that treatment of hypertension or diabetes mellitus could lead to a reduced incidence of vascular MCI and dementia. In this review article, we first explain the background and etiology of vascular MCI. We then summarize phenotype of subcortical vascular dementia which is often unrecognized or "hidden" in the community. Then we introduce the Osaki-Tajiri and Kurihara Projects which have been conducted in Northern Japan, as an example of prevention projects aimed to identify early-stage vascular MCI in the community, reduce the risk factors and facilitate their treatment. Early identification of vascular MCI in the community could lead to a large reduction in the dementia burden worldwide. The outreach efforts presented here could be useful in developing secondary prevention strategies targeted to vascular MCI.
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Affiliation(s)
- Kenichi Meguro
- Geriatric Behavioral Neurology Project, New Industry Creation Hatchery Center (NICHe), Tohoku University, Sendai, Japan
- The Osaki-Tajiri SKIP Center, Osaki, Japan
| | - Hiroko H. Dodge
- Department of Neurology, Michigan Alzheimer’s Disease Center, University of Michigan, Ann Arbor, MI, USA
- Department of Neurology, Layton Aging and Alzheimer’s Disease Center, Oregon Health and Science University, Portland, OR, USA
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Pascual KJ, Vlasova E, Lockett KJ, Richardson J, Yochelson M. Evaluating the Impact of Personalized Stroke Management Tool Kits on Patient Experience and Stroke Recovery. J Patient Exp 2018; 5:244-249. [PMID: 30574543 PMCID: PMC6295809 DOI: 10.1177/2374373517750416] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Hallmarks of the difficult period of transition from hospital to home following stroke include stroke survivor and caregiver uncertainty about actionable steps toward recovery and prevention and unfamiliarity with related resources. Current research shows that interdisciplinary interventions focusing on patient experience and patient education enable health-care providers to activate and empower patients, potentially leading to better clinical outcomes. Tool kit approaches have been successfully used to aid patients through ongoing education after hospital discharge and to improve patient experience. In this article, we describe our efforts to iteratively develop and test personalized stroke management tool kits aimed at connecting stroke survivors and their caregivers to empowering resources, while soliciting feedback from patients and family members.
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Katzan IL, Schuster A, Newey C, Uchino K, Lapin B. Patient-reported outcomes across cerebrovascular event types: More similar than different. Neurology 2018; 91:e2182-e2191. [PMID: 30381370 DOI: 10.1212/wnl.0000000000006626] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 08/21/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To compare the degrees to which 8 domains of health are affected across types of cerebrovascular events and to identify factors associated with domain scores in different event types. METHODS This was an observational cohort study of 2,181 patients with ischemic stroke, intracerebral hemorrhage (ICH), subarachnoid hemorrhage (SAH), or TIA in a cerebrovascular clinic from February 17, 2015, to June 2, 2017 who completed Quality of Life in Neurologic Disorders executive function and the following Patient-Reported Outcomes Measurement Information System scales as part of routine care: physical function, satisfaction with social roles, fatigue, anxiety, depression, pain interference, and sleep disturbance. RESULTS All health domains were affected to similar degrees in patients with ICH, SAH, and ischemic stroke after adjustment for disability and other clinical factors, whereas patients with TIA had worse adjusted scores for 5 of the 8 domains of health. Female sex, younger age, lower income, and event <90 days were associated with worse scores in multiple domains. Factors associated with health domain scores were similar for all cerebrovascular events. Most affected domains for all were physical function, satisfaction with social roles, and executive function. CONCLUSIONS The subtype of stroke (ischemic stroke, ICH, and SAH) had similar effects in multiple health domains, while patients with TIA had worse adjusted outcomes, suggesting that the mechanisms for outcomes after TIA may differ from those of other cerebrovascular events. The most affected domains across all event types were physical function, satisfaction with social roles, and executive function, highlighting the need to develop effective interventions to improve these health domains in survivors of these cerebrovascular events.
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Affiliation(s)
- Irene L Katzan
- From the Neurological Institute Center for Outcomes Research & Evaluation (I.L.K., A.S., B.L.) and Cerebrovascular Center (I.L.K. C.N., K.U.), Cleveland Clinic, OH.
| | - Andrew Schuster
- From the Neurological Institute Center for Outcomes Research & Evaluation (I.L.K., A.S., B.L.) and Cerebrovascular Center (I.L.K. C.N., K.U.), Cleveland Clinic, OH
| | - Christopher Newey
- From the Neurological Institute Center for Outcomes Research & Evaluation (I.L.K., A.S., B.L.) and Cerebrovascular Center (I.L.K. C.N., K.U.), Cleveland Clinic, OH
| | - Ken Uchino
- From the Neurological Institute Center for Outcomes Research & Evaluation (I.L.K., A.S., B.L.) and Cerebrovascular Center (I.L.K. C.N., K.U.), Cleveland Clinic, OH
| | - Brittany Lapin
- From the Neurological Institute Center for Outcomes Research & Evaluation (I.L.K., A.S., B.L.) and Cerebrovascular Center (I.L.K. C.N., K.U.), Cleveland Clinic, OH
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Bowman L, Mafham M, Wallendszus K, Stevens W, Buck G, Barton J, Murphy K, Aung T, Haynes R, Cox J, Murawska A, Young A, Lay M, Chen F, Sammons E, Waters E, Adler A, Bodansky J, Farmer A, McPherson R, Neil A, Simpson D, Peto R, Baigent C, Collins R, Parish S, Armitage J. Effects of Aspirin for Primary Prevention in Persons with Diabetes Mellitus. N Engl J Med 2018; 379:1529-1539. [PMID: 30146931 DOI: 10.1056/nejmoa1804988] [Citation(s) in RCA: 694] [Impact Index Per Article: 115.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Diabetes mellitus is associated with an increased risk of cardiovascular events. Aspirin use reduces the risk of occlusive vascular events but increases the risk of bleeding; the balance of benefits and hazards for the prevention of first cardiovascular events in patients with diabetes is unclear. METHODS We randomly assigned adults who had diabetes but no evident cardiovascular disease to receive aspirin at a dose of 100 mg daily or matching placebo. The primary efficacy outcome was the first serious vascular event (i.e., myocardial infarction, stroke or transient ischemic attack, or death from any vascular cause, excluding any confirmed intracranial hemorrhage). The primary safety outcome was the first major bleeding event (i.e., intracranial hemorrhage, sight-threatening bleeding event in the eye, gastrointestinal bleeding, or other serious bleeding). Secondary outcomes included gastrointestinal tract cancer. RESULTS A total of 15,480 participants underwent randomization. During a mean follow-up of 7.4 years, serious vascular events occurred in a significantly lower percentage of participants in the aspirin group than in the placebo group (658 participants [8.5%] vs. 743 [9.6%]; rate ratio, 0.88; 95% confidence interval [CI], 0.79 to 0.97; P=0.01). In contrast, major bleeding events occurred in 314 participants (4.1%) in the aspirin group, as compared with 245 (3.2%) in the placebo group (rate ratio, 1.29; 95% CI, 1.09 to 1.52; P=0.003), with most of the excess being gastrointestinal bleeding and other extracranial bleeding. There was no significant difference between the aspirin group and the placebo group in the incidence of gastrointestinal tract cancer (157 participants [2.0%] and 158 [2.0%], respectively) or all cancers (897 [11.6%] and 887 [11.5%]); long-term follow-up for these outcomes is planned. CONCLUSIONS Aspirin use prevented serious vascular events in persons who had diabetes and no evident cardiovascular disease at trial entry, but it also caused major bleeding events. The absolute benefits were largely counterbalanced by the bleeding hazard. (Funded by the British Heart Foundation and others; ASCEND Current Controlled Trials number, ISRCTN60635500 ; ClinicalTrials.gov number, NCT00135226 .).
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Kragsterman B, Nordanstig A, Lindström D, Strömberg S, Thuresson M, Nordanstig J. Editor's Choice – Effect of More Expedited Carotid Intervention on Recurrent Ischaemic Event Rate: A National Audit. Eur J Vasc Endovasc Surg 2018; 56:467-474. [DOI: 10.1016/j.ejvs.2018.06.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 06/18/2018] [Indexed: 11/27/2022]
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Su W, Guo J, Zhang Y, Zhou J, Chen N, Zhou M, Li R, Chen H, He L. A Longitudinal Functional Magnetic Resonance Imaging Study of Working Memory in Patients Following a Transient Ischemic Attack: A Preliminary Study. Neurosci Bull 2018; 34:963-971. [PMID: 30128690 DOI: 10.1007/s12264-018-0270-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Accepted: 04/16/2018] [Indexed: 02/05/2023] Open
Abstract
In this study, we used functional magnetic resonance imaging (fMRI) to investigate longitudinal changes in brain activation during a verbal working memory (VWM) task performed by patients who had experienced a transient ischemic attack (TIA). Twenty-five first-ever TIA patients without visible lesions in conventional MRI and 25 healthy volunteers were enrolled. VWM task-related fMRI was conducted 1 week and 3 months post-TIA. The brain activity evoked by the task and changes over time were assessed. We found that, compared with controls, patients exhibited an increased activation in the bilateral inferior frontal gyrus (IFG), right dorsolateral prefrontal cortex (DLPFC), insula, inferior parietal lobe (IPL), and cerebellum during the task performed 1 week post-TIA. But only the right IFG still exhibited an increased activation at 3 months post-TIA. A direct comparison of fMRI data between 1 week and 3 months post-TIA showed greater activation in the bilateral middle temporal gyrus, right DLPFC, IPL, cerebellum, and left IFG in patients at 1 week post-TIA. We conclude that brain activity patterns induced by a VWM task remain dynamic for a period of time after a TIA, despite the cessation of clinical symptoms. Normalization of the VWM activation pattern may be progressively achieved after transient episodes of ischemia in TIA patients.
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Affiliation(s)
- Wei Su
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, 610041, China.,Department of Science and Technology, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Jian Guo
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Yun Zhang
- Department of Neurology, Mianyang Central Hospital, Mianyang, 621000, China
| | - Jie Zhou
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Ning Chen
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Muke Zhou
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Rong Li
- Key Laboratory for Neuroinformation of The Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, 610041, China
| | - Huafu Chen
- Key Laboratory for Neuroinformation of The Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, 610041, China
| | - Li He
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, 610041, China.
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Turner GM, Backman R, McMullan C, Mathers J, Marshall T, Calvert M. Establishing research priorities relating to the long-term impact of TIA and minor stroke through stakeholder-centred consensus. RESEARCH INVOLVEMENT AND ENGAGEMENT 2018; 4:2. [PMID: 29416879 PMCID: PMC5784709 DOI: 10.1186/s40900-018-0089-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 01/10/2018] [Indexed: 06/08/2023]
Abstract
PLAIN ENGLISH SUMMARY What is the problem and why is this important? Mini-strokes are similar to full strokes, but symptoms last less than 24 h. Many people (up to 70%) have long-term problems after a mini-stroke, such as anxiety; depression; problems with brain functioning (like memory loss); and fatigue (feeling tired). However, the current healthcare pathway only focuses on preventing another stroke and care for other long-term problems is not routinely given. Without proper treatment, people with long-term problems after a mini-stroke could have worse quality of life and may find it difficult to return to work and their social activities. What is the aim of the research? We wanted to understand the research priorities of patients, health care professionals and key stakeholders relating to the long-term impact of mini-stroke. How did we address the problem? We invited patients, clinicians, researchers and other stakeholders to attend a meeting. At the meeting people discussed the issues relating to the long-term impact of mini-stroke and came to an agreement on their research priorities. There were three stages: (1) people wrote down their individual research suggestions; (2) in smaller groups people came to an agreement on what their top research questions were; and (3) the whole group agreed final research priorities. What did we find? Eleven people attended who were representatives for patients, GPs, stroke consultants, stroke nurses, psychologists, the Stroke Association (charity) and stroke researchers, The group agreed on eleven research questions which they felt were the most important to improve health and well-being for people who have had a mini-stroke.The eleven research questions encompass a range of categories, including: understanding the existing care patients receive (according to diagnosis and geographical location); exploring what optimal care post-TIA/minor stroke should comprise (identifying and treating impairments, information giving and support groups) and how that care should be delivered (clinical setting and follow-up pathway); impact on family members; and education/training for health care professionals. ABSTRACT Background Clinical management after transient ischaemic attack (TIA) and minor stroke focuses on stroke prevention. However, evidence demonstrates that many patients experience ongoing residual impairments. Residual impairments post-TIA and minor stroke may affect patients' quality of life and return to work or social activities. Research priorities of patients, health care professionals and key stakeholders relating to the long-term impact of TIA and minor stroke are unknown.Methods Our objective was to establish the top shared research priorities relating to the long-term impact of TIA and minor stroke through stakeholder-centred consensus. A one-day priority setting consensus meeting took place with representatives from different stakeholder groups in October 2016 (Birmingham, UK). Nominal group technique was used to establish research priorities. This involved three stages: (i) gathering research priorities from individual stakeholders; (ii) interim prioritisation in three subgroups; and (iii) final priority setting.Results The priority setting consensus meeting was attended by 11 stakeholders. The individual stakeholders identified 34 different research priorities. During the interim prioritisation exercise, the three subgroups generated 24 unique research priorities which were discussed as a whole group. Following the final consensus discussion, 11 shared research priorities were unanimously agreed.The 11 research questions encompass a range of categories, including: understanding the existing care patients receive (according to diagnosis and geographical location); exploring what optimal care post-TIA/minor stroke should comprise (identifying and treating impairments, information giving and support groups) and how that care should be delivered (clinical setting and follow-up pathway); impact on family members; and education/training for health care professionals.Conclusions Eleven different research priorities were established through stakeholder-centred consensus. These research questions could usefully inform the research agenda and policy decisions for TIA and minor stroke. Inclusion of stakeholders in setting research priorities is important to increase the relevance of research and reduce research waste.
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Affiliation(s)
- Grace M. Turner
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT England
- Centre for Patient Reported Outcomes Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT England
| | - Ruth Backman
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT England
| | - Christel McMullan
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT England
| | - Jonathan Mathers
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT England
| | - Tom Marshall
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT England
- Centre for Patient Reported Outcomes Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT England
| | - Melanie Calvert
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT England
- Centre for Patient Reported Outcomes Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT England
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Executive Function Declines in the First 6 Months After a Transient Ischemic Attack or Transient Neurological Attack. Stroke 2017; 48:3323-3328. [DOI: 10.1161/strokeaha.117.018298] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 09/30/2017] [Accepted: 10/04/2017] [Indexed: 11/16/2022]
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Pucite E, Krievina I, Miglane E, Erts R, Krievins D. Influence of Severe Carotid Stenosis on Cognition, Depressive Symptoms and Quality of Life. Clin Pract Epidemiol Ment Health 2017; 13:168-180. [PMID: 29238393 PMCID: PMC5712638 DOI: 10.2174/1745017901713010168] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 09/07/2017] [Accepted: 09/26/2017] [Indexed: 05/17/2023]
Abstract
BACKGROUND Carotid artery disease is not just a causal risk factor of ischemic stroke, but may predispose patients to depressive symptoms and low health related quality of life (HRQoL). OBJECTIVES The objectives of the present study were to assess the association between severe carotid artery stenosis (CAS) and cognitive impairment, frequency of depressive symptoms and status of HRQoL. METHODS Cross - sectional study involved 55 patients with severe CAS and 54 patients with lower extremity peripheral artery disease (PAD). Cognitive impairment was assessed using Montreal Cognitive Assessment Scale (MoCA), depressive symptoms - PHQ-9 scale. HRQoL was measured using Medical Outcome Survey Short Form version 2 (SF-36v2). RESULTS Median MoCA score 24 [23;26] was significantly lower in patients with severe CAS than in patients with PAD - 26 [25-28],(p=0.005; effect size r=0.3). There was no statistically significant difference of median PHQ-9 scores the in CAS group (median PHQ-9 score 4.0 [5]) and in the PAD group (median PHQ-9 score 5.5 [7]), (p=0.08, effect size r=0.18). Mean SF-36v2 scores were similar in CAS and PAD groups except for bodily pain (p=0.001, Cohen's d value = 0.77) and vitality (p=0.02, Cohen's d value = 0.49). CONCLUSION In summary, our findings indicate that severe CAS could play a role in cognitive decline. Further studies should be conducted using larger patient cohorts without ischemic brain lesions and with balanced vascular risk profiles to investigate impact of CAS on cognition. There was no association between severe CAS and depressive symptoms in the present study. As patients with severe CAS did not exhibit physical symptoms, HRQoL was better for those patients than for patients with lower extremity PAD.
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Affiliation(s)
- Elina Pucite
- Department of Neurology, Pauls Stradins Clinical University Hospital, , Latvia
- Department of Neurology and Neurosurgery, Riga Stradins University, Riga, Latvia
| | - Ildze Krievina
- Department of Neurology, Pauls Stradins Clinical University Hospital, , Latvia
| | - Evija Miglane
- Department of Neurology, Pauls Stradins Clinical University Hospital, , Latvia
- Department of Neurology and Neurosurgery, Riga Stradins University, Riga, Latvia
| | - Renars Erts
- Department of Physics, Riga Stradins University, , Latvia
| | - Dainis Krievins
- Vascular Surgery Centre, Pauls Stradins Clinical University Hospital, , Latvia
- Department of Surgery, University of Latvia, Faculty of Medicine, , Latvia
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Faux SG, Arora P, Shiner CT, Thompson-Butel AG, Klein LA. Rehabilitation and education are underutilized for mild stroke and TIA sufferers. Disabil Rehabil 2017; 40:1480-1484. [DOI: 10.1080/09638288.2017.1295473] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Steven G. Faux
- Department of Rehabilitation Medicine, St Vincent’s Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Pooja Arora
- Department of Rehabilitation Medicine, St Vincent’s Hospital, Sydney, New South Wales, Australia
| | - Christine T. Shiner
- Department of Rehabilitation Medicine, St Vincent’s Hospital, Sydney, New South Wales, Australia
| | | | - Linda A. Klein
- Sydney Medical School, University of Sydney, New South Wales, Australia
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Mijajlović MD, Pavlović A, Brainin M, Heiss WD, Quinn TJ, Ihle-Hansen HB, Hermann DM, Assayag EB, Richard E, Thiel A, Kliper E, Shin YI, Kim YH, Choi S, Jung S, Lee YB, Sinanović O, Levine DA, Schlesinger I, Mead G, Milošević V, Leys D, Hagberg G, Ursin MH, Teuschl Y, Prokopenko S, Mozheyko E, Bezdenezhnykh A, Matz K, Aleksić V, Muresanu D, Korczyn AD, Bornstein NM. Post-stroke dementia - a comprehensive review. BMC Med 2017; 15:11. [PMID: 28095900 PMCID: PMC5241961 DOI: 10.1186/s12916-017-0779-7] [Citation(s) in RCA: 377] [Impact Index Per Article: 53.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 01/03/2017] [Indexed: 12/11/2022] Open
Abstract
Post-stroke dementia (PSD) or post-stroke cognitive impairment (PSCI) may affect up to one third of stroke survivors. Various definitions of PSCI and PSD have been described. We propose PSD as a label for any dementia following stroke in temporal relation. Various tools are available to screen and assess cognition, with few PSD-specific instruments. Choice will depend on purpose of assessment, with differing instruments needed for brief screening (e.g., Montreal Cognitive Assessment) or diagnostic formulation (e.g., NINDS VCI battery). A comprehensive evaluation should include assessment of pre-stroke cognition (e.g., using Informant Questionnaire for Cognitive Decline in the Elderly), mood (e.g., using Hospital Anxiety and Depression Scale), and functional consequences of cognitive impairments (e.g., using modified Rankin Scale). A large number of biomarkers for PSD, including indicators for genetic polymorphisms, biomarkers in the cerebrospinal fluid and in the serum, inflammatory mediators, and peripheral microRNA profiles have been proposed. Currently, no specific biomarkers have been proven to robustly discriminate vulnerable patients ('at risk brains') from those with better prognosis or to discriminate Alzheimer's disease dementia from PSD. Further, neuroimaging is an important diagnostic tool in PSD. The role of computerized tomography is limited to demonstrating type and location of the underlying primary lesion and indicating atrophy and severe white matter changes. Magnetic resonance imaging is the key neuroimaging modality and has high sensitivity and specificity for detecting pathological changes, including small vessel disease. Advanced multi-modal imaging includes diffusion tensor imaging for fiber tracking, by which changes in networks can be detected. Quantitative imaging of cerebral blood flow and metabolism by positron emission tomography can differentiate between vascular dementia and degenerative dementia and show the interaction between vascular and metabolic changes. Additionally, inflammatory changes after ischemia in the brain can be detected, which may play a role together with amyloid deposition in the development of PSD. Prevention of PSD can be achieved by prevention of stroke. As treatment strategies to inhibit the development and mitigate the course of PSD, lowering of blood pressure, statins, neuroprotective drugs, and anti-inflammatory agents have all been studied without convincing evidence of efficacy. Lifestyle interventions, physical activity, and cognitive training have been recently tested, but large controlled trials are still missing.
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Affiliation(s)
- Milija D Mijajlović
- Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, Dr Subotica 6, 11000, Belgrade, Serbia.
| | - Aleksandra Pavlović
- Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, Dr Subotica 6, 11000, Belgrade, Serbia
| | - Michael Brainin
- Department of Clinical Neurosciences and Preventive Medicine, Danube University Krems, Krems, Austria
| | | | - Terence J Quinn
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Hege B Ihle-Hansen
- Department of internal medicine, Oslo University Hospital, Ullevål and Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, Bærum, Norway
| | - Dirk M Hermann
- Department of Neurology, University Hospital Essen, Essen, Germany
| | - Einor Ben Assayag
- Stroke Unit, Department of Neurology, Tel-Aviv Sorasky Medical Center, Tel-Aviv, Israel
- Shaare Zedek Medical Center, Jerusalem, Israel
| | - Edo Richard
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Alexander Thiel
- Department of Neurology and Neurosurgery, McGill University at SMBD Jewish General Hospital and Lady Davis Institute for Medical Research, Montreal, Québec, Canada
| | - Efrat Kliper
- Stroke Unit, Department of Neurology, Tel-Aviv Sorasky Medical Center, Tel-Aviv, Israel
- Shaare Zedek Medical Center, Jerusalem, Israel
| | - Yong-Il Shin
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Busan, Republic of Korea
| | - Yun-Hee Kim
- Department of Physical and Rehabilitation Medicine, Sungkyunkwan University School of Medicine, Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea
| | - SeongHye Choi
- Department of Neurology, Inha University School of Medicine, Incheon, South Korea
| | - San Jung
- Hallym University Medical Center, Kang Nam Sacred Heart Hospital, Seoul, South Korea
| | - Yeong-Bae Lee
- Department of Neurology, Gachon University Gil Medical Center, Incheon, South Korea
| | - Osman Sinanović
- Department of Neurology, University Clinical Center Tuzla, School of Medicine University of Tuzla, 75000, Tuzla, Bosnia and Herzegovina
| | - Deborah A Levine
- Department of Internal Medicine, University of Michigan and the VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Ilana Schlesinger
- Department of Neurology, Rambam Health Care Campus, Haifa, Israel
- Technion Faculty of Medicine, Haifa, Israel
| | - Gillian Mead
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Vuk Milošević
- Clinic of Neurology, Clinical Center Nis, Nis, Serbia
| | - Didier Leys
- U1171-Department of Neurology, University of Lille, Inserm, Faculty of Medicine, Lille University Hospital, Lille, France
| | - Guri Hagberg
- Department of internal medicine, Oslo University Hospital, Ullevål and Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, Bærum, Norway
| | - Marie Helene Ursin
- Department of internal medicine, Oslo University Hospital, Ullevål and Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, Bærum, Norway
| | - Yvonne Teuschl
- Department of Clinical Neurosciences and Preventive Medicine, Danube University Krems, Krems, Austria
| | - Semyon Prokopenko
- Department of Neurology and Medical Rehabilitation, Krasnoyarsk State Medical University named after Professor V.F. Voyno-Yasenetsky, Krasnoyarsk, Russia
| | - Elena Mozheyko
- Department of Neurology and Medical Rehabilitation, Krasnoyarsk State Medical University named after Professor V.F. Voyno-Yasenetsky, Krasnoyarsk, Russia
| | - Anna Bezdenezhnykh
- Department of Neurology and Medical Rehabilitation, Krasnoyarsk State Medical University named after Professor V.F. Voyno-Yasenetsky, Krasnoyarsk, Russia
| | - Karl Matz
- Department of Clinical Neurosciences and Preventive Medicine, Danube University Krems, Krems, Austria
| | - Vuk Aleksić
- Department of Neurosurgery, Clinical Hospital CenterZemun, Belgrade, Serbia
| | - DafinFior Muresanu
- Department of Clinical Neurosciences, "Iuliu Hatieganu" University of Medicine, Clij-Napoca, Romania
| | - Amos D Korczyn
- Department of Neurology, Tel Aviv University, Ramat Aviv, 69978, Israel
| | - Natan M Bornstein
- Stroke Unit, Department of Neurology, Tel-Aviv Sorasky Medical Center, Tel-Aviv, Israel
- Shaare Zedek Medical Center, Jerusalem, Israel
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