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Andriuta D, Roussel M, Chene G, Fischer C, Mangin JF, Dubois B, Vellas B, Pasquier F, Tison F, Blanc F, Hanon O, Paquet C, Gabelle A, Ceccaldi M, Annweiler C, Krolak-Salmon P, David R, Rouch-Leroyer I, Benetos A, Moreaud O, Sellal F, Jalenques I, Vandel P, Bouteloup V, Godefroy O. The pattern of cortical thickness associated with executive dysfunction in MCI and SCC: The MEMENTO cohort. Rev Neurol (Paris) 2024:S0035-3787(24)00534-4. [PMID: 38866655 DOI: 10.1016/j.neurol.2024.02.394] [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: 01/18/2023] [Revised: 02/21/2024] [Accepted: 02/27/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND The association between the pattern of cortical thickness (CT) and executive dysfunction (ED) in mild cognitive impairment (MCI) and subjective cognitive complaints (SCC) is still poorly understood. We aimed to investigate the association between CT and ED in a large French cohort (MEMENTO) of 2323 participants with MCI or SCC. METHODS All participants with available CT and executive function data (verbal fluency and Trail Making Test [TMT]) were selected (n=1924). Linear regressions were performed to determine relationships between executive performance and the brain parenchymal fraction (BPF) and CT using FreeSurfer. RESULTS The global executive function score was related to the BPF (sß: 0.091, P<0.001) and CT in the right supramarginal (sß: 0.060, P=0.041) and right isthmus cingulate (sß: 0.062, P=0.011) regions. Literal verbal fluency was related to the BPF (sß: 0.125, P<0.001) and CT in the left parsorbitalis region (sß: 0.045, P=0.045). Semantic verbal fluency was related to the BPF (sß: 0.101, P<0.001) and CT in the right supramarginal region (sß: 0.061, P=0.042). The time difference between the TMT parts B and A was related to the BPF (sß: 0.048, P=0.045) and CT in the right precuneus (sß: 0.073, P=0.019) and right isthmus cingulate region (sß: 0.054, P=0.032). CONCLUSIONS In a large clinically based cohort of participants presenting with either MCI or SCC (a potential early stage of Alzheimer's disease [AD]), ED was related to the BPF and CT in the left pars orbitalis, right precuneus, right supramarginal, and right isthmus cingulate regions. This pattern of lesions adds knowledge to the conventional anatomy of ED and could contribute to the early diagnosis of AD.
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Affiliation(s)
- D Andriuta
- Department of Neurology and Functional Neuroscience and Pathology Laboratory, Jules-Verne University of Picardy, Amiens University Hospital, CHU de Amiens-Picardie, 80054 Amiens, France.
| | - M Roussel
- Department of Neurology and Functional Neuroscience and Pathology Laboratory, Jules-Verne University of Picardy, Amiens University Hospital, CHU de Amiens-Picardie, 80054 Amiens, France
| | - G Chene
- School of Public Health, Inserm U1219, institut de santé publique, d'épidémiologie et de développement, université de Bordeaux, CHU de Bordeaux, Bordeaux, France
| | - C Fischer
- University Hospital, Sorbonne Universities, Pierre-et-Marie-Curie University, 75006 Paris, France; Institut du cerveau et la moelle (ICM), hôpital Pitié-Salpêtrière, Paris, France
| | - J-F Mangin
- University Hospital, Sorbonne Universities, Pierre-et-Marie-Curie University, 75006 Paris, France; Institut du cerveau et la moelle (ICM), hôpital Pitié-Salpêtrière, Paris, France
| | - B Dubois
- University Hospital, Sorbonne Universities, Pierre-et-Marie-Curie University, 75006 Paris, France; Department of Neurology, Institute of Memory and Alzheimer's Disease (IM2A), Brain and Spine Institute (ICM) UMR S 1127, AP-HP Pitié-Salpêtrière, Paris, France
| | - B Vellas
- Memory Resource and Research Centre of Toulouse, CHU de Toulouse, hôpital La Grave-Casselardit, Toulouse, France
| | - F Pasquier
- Memory Resource and Research Centre of Lille, hôpital Roger-Salengro, CHRU de Lille, 59000 Lille, France
| | - F Tison
- Institute for Neurodegenerative diseases, CMRR, University and University Hospital of Bordeaux, Bordeaux, France
| | - F Blanc
- Department of Neurology, CHU de Strasbourg, Strasbourg, France
| | - O Hanon
- Memory Resource and Research Centre of Paris Broca, hôpital Broca, AP-HP, 75013 Paris, France; Université Paris Descartes, Sorbonne-Paris-Cité, EA 4468, Paris, France
| | - C Paquet
- Cognitive Neurology Centre, groupe hospitalier Saint-Louis-Lariboisière-Fernand-Widal, université de Paris, Paris, France
| | - A Gabelle
- Memory Resource and Research Centre of Montpellier, Hôpital Gui-de-Chauliac, CHU de Montpellier, 34000 Montpellier, France
| | - M Ceccaldi
- Memory Resource and Research Centre of Marseille, hôpital La Timone, CHU de Marseille, 13000 Marseille, France
| | - C Annweiler
- Department of Geriatric Medicine and Memory Clinic, Research Center on Autonomy and Longevity, University Hospital, Angers, France; UPRES EA 4638, University of Angers, Angers, France; Department of Medical Biophysics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - P Krolak-Salmon
- Memory Resource and Research Centre of Lyon, hospices civils de Lyon, hôpital des Charpennes, 69000 Lyon, France
| | - R David
- Memory Resource and Research Centre of Nice, CHU de Nice, Nice, France; Institut Claude-Pompidou, EA 7276 CoBTeK "Cognition Behaviour Technology", 06100 Nice, France
| | - I Rouch-Leroyer
- Memory Resource and Research Centre of Saint-Étienne, hôpital Nord, CHU de Saint-Étienne, 42000 Saint-Étienne, France
| | - A Benetos
- Memory Resource and Research Centre of Nancy, CHU de Nancy, 54000 Nancy, France
| | - O Moreaud
- Memory Resource and Research Centre of Grenoble, hôpital de la Tronche, CHU de Grenoble Alpes, 38000 Grenoble, France
| | - F Sellal
- Memory Resource and Research Centre of Strasbourg/Colmar, hôpitaux civils de Colmar, 68000 Colmar, France; Inserm U-1118, Strasbourg University, 67000 Strasbourg, France
| | - I Jalenques
- Memory Resource and Research Centre of Clermont-Ferrand, Clermont-Auvergne University, CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - P Vandel
- Memory Resource and Research Centre of Besançon, hôpital Jean-Minjoz, hôpital Saint-Jacques, CHU de Besançon, 25000 Besançon, France
| | - V Bouteloup
- School of Public Health, Inserm U1219, institut de santé publique, d'épidémiologie et de développement, université de Bordeaux, CHU de Bordeaux, Bordeaux, France
| | - O Godefroy
- Department of Neurology and Functional Neuroscience and Pathology Laboratory, Jules-Verne University of Picardy, Amiens University Hospital, CHU de Amiens-Picardie, 80054 Amiens, France
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2
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Coenen M, de Kort FA, Weaver NA, Kuijf HJ, Aben HP, Bae HJ, Bordet R, Chen CP, Dewenter A, Doeven T, Dondaine T, Duering M, Fang R, van der Giessen RS, Kim J, Kim BJ, de Kort PL, Koudstaal PJ, Lee M, Lim JS, Lopes R, van Oostenbrugge RJ, Staals J, Yu KH, Biessels GJ, Biesbroek JM. Strategic white matter hyperintensity locations associated with post-stroke cognitive impairment: A multicenter study in 1568 stroke patients. Int J Stroke 2024:17474930241252530. [PMID: 38651756 DOI: 10.1177/17474930241252530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
BACKGROUND Post-stroke cognitive impairment (PSCI) occurs in up to 50% of stroke survivors. Presence of pre-existing vascular brain injury, in particular the extent of white matter hyperintensities (WMH), is associated with worse cognitive outcome after stroke, but the role of WMH location in this association is unclear. AIMS We determined if WMH in strategic white matter tracts explain cognitive performance after stroke. METHODS Individual patient data from nine ischemic stroke cohorts with magnetic resonance imaging (MRI) were harmonized through the Meta VCI Map consortium. The association between WMH volumes in strategic tracts and domain-specific cognitive functioning (attention and executive functioning, information processing speed, language and verbal memory) was assessed using linear mixed models and lasso regression. We used a hypothesis-driven design, primarily addressing four white matter tracts known to be strategic in memory clinic patients: the left and right anterior thalamic radiation, forceps major, and left inferior fronto-occipital fasciculus. RESULTS The total study sample consisted of 1568 patients (39.9% female, mean age = 67.3 years). Total WMH volume was strongly related to cognitive performance on all four cognitive domains. WMH volume in the left anterior thalamic radiation was significantly associated with cognitive performance on attention and executive functioning and information processing speed and WMH volume in the forceps major with information processing speed. The multivariable lasso regression showed that these associations were independent of age, sex, education, and total infarct volume and had larger coefficients than total WMH volume. CONCLUSION These results show tract-specific relations between WMH volume and cognitive performance after ischemic stroke, independent of total WMH volume. This implies that the concept of strategic lesions in PSCI extends beyond acute infarcts and also involves pre-existing WMH. DATA ACCESS STATEMENT The Meta VCI Map consortium is dedicated to data sharing, following our guidelines.
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Affiliation(s)
- Mirthe Coenen
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Floor As de Kort
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Nick A Weaver
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Hugo J Kuijf
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Hugo P Aben
- Department of Neurology, Elisabeth Tweesteden Hospital, Tilburg, The Netherlands
| | - Hee-Joon Bae
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Régis Bordet
- Lille Neuroscience & Cognition (LilNCog)-U1172, Université Lille, Inserm, CHU Lille, Lille, France
| | - Christopher Plh Chen
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Memory, Ageing and Cognition Center, National University Health System, Singapore
| | - Anna Dewenter
- Institute for Stroke and Dementia Research (ISD), LMU University Hospital, LMU Munich, Munich, Germany
| | - Thomas Doeven
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Thibaut Dondaine
- Lille Neuroscience & Cognition (LilNCog)-U1172, Université Lille, Inserm, CHU Lille, Lille, France
| | - Marco Duering
- Institute for Stroke and Dementia Research (ISD), LMU University Hospital, LMU Munich, Munich, Germany
- Medical Image Analysis Center (MIAC), Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Rong Fang
- Institute for Stroke and Dementia Research (ISD), LMU University Hospital, LMU Munich, Munich, Germany
| | | | - Jonguk Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
- Department of Neurology, School of Medicine, Inha University, Incheon, Republic of Korea
| | - Beom Joon Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Paul Lm de Kort
- Department of Neurology, Elisabeth Tweesteden Hospital, Tilburg, The Netherlands
| | - Peter J Koudstaal
- Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Minwoo Lee
- Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Jae-Sung Lim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Renaud Lopes
- Lille Neuroscience & Cognition (LilNCog)-U1172, Université Lille, Inserm, CHU Lille, Lille, France
| | | | - Julie Staals
- Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Kyung-Ho Yu
- Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Geert Jan Biessels
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J Matthijs Biesbroek
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Neurology, Diakonessenhuis Hospital, Utrecht, The Netherlands
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Khalilian M, Roussel M, Godefroy O, Aarabi A. Predicting functional impairments with lesion-derived disconnectome mapping: Validation in stroke patients with motor deficits. Eur J Neurosci 2024; 59:3074-3092. [PMID: 38578844 DOI: 10.1111/ejn.16334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 02/24/2024] [Accepted: 03/07/2024] [Indexed: 04/07/2024]
Abstract
Focal structural damage to white matter tracts can result in functional deficits in stroke patients. Traditional voxel-based lesion-symptom mapping is commonly used to localize brain structures linked to neurological deficits. Emerging evidence suggests that the impact of structural focal damage may extend beyond immediate lesion sites. In this study, we present a disconnectome mapping approach based on support vector regression (SVR) to identify brain structures and white matter pathways associated with functional deficits in stroke patients. For clinical validation, we utilized imaging data from 340 stroke patients exhibiting motor deficits. A disconnectome map was initially derived from lesions for each patient. Bootstrap sampling was then employed to balance the sample size between a minority group of patients exhibiting right or left motor deficits and those without deficits. Subsequently, SVR analysis was used to identify voxels associated with motor deficits (p < .005). Our disconnectome-based analysis significantly outperformed alternative lesion-symptom approaches in identifying major white matter pathways within the corticospinal tracts associated with upper-lower limb motor deficits. Bootstrapping significantly increased the sensitivity (80%-87%) for identifying patients with motor deficits, with a minimum lesion size of 32 and 235 mm3 for the right and left motor deficit, respectively. Overall, the lesion-based methods achieved lower sensitivities compared with those based on disconnection maps. The primary contribution of our approach lies in introducing a bootstrapped disconnectome-based mapping approach to identify lesion-derived white matter disconnections associated with functional deficits, particularly efficient in handling imbalanced data.
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Affiliation(s)
- Maedeh Khalilian
- Laboratory of Functional Neuroscience and Pathologies (UR UPJV 4559), University Research Center (CURS), University of Picardy Jules Verne, Amiens, France
| | - Martine Roussel
- Laboratory of Functional Neuroscience and Pathologies (UR UPJV 4559), University Research Center (CURS), University of Picardy Jules Verne, Amiens, France
| | - Olivier Godefroy
- Laboratory of Functional Neuroscience and Pathologies (UR UPJV 4559), University Research Center (CURS), University of Picardy Jules Verne, Amiens, France
- Faculty of Medicine, University of Picardy Jules Verne, Amiens, France
- Neurology Department, Amiens University Hospital, Amiens, France
| | - Ardalan Aarabi
- Laboratory of Functional Neuroscience and Pathologies (UR UPJV 4559), University Research Center (CURS), University of Picardy Jules Verne, Amiens, France
- Faculty of Medicine, University of Picardy Jules Verne, Amiens, France
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4
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Gustafson D, Kalaria R, O'Brien J, van den Brink H, Hilal S, Marseglia A, ter Telgte A, Skoog I. VasCog 2023: 20 years of research on vascular behavioural and cognitive disorders. CEREBRAL CIRCULATION - COGNITION AND BEHAVIOR 2024; 6:100224. [PMID: 38868624 PMCID: PMC11167242 DOI: 10.1016/j.cccb.2024.100224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 05/03/2024] [Indexed: 06/14/2024]
Abstract
This Commentary describes the 20th Anniversary of VasCog 2023, held in Gothenburg, Sweden.
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Affiliation(s)
- D.R. Gustafson
- Department of Neurology, State University of New York Downstate Health Sciences University, MSC 1213, 450 Clarkson Avenue, Brooklyn, NY 11203, USA
| | - R. Kalaria
- Translational and Clinical Research Institute, Newcastle University, United Kingdom
| | - J. O'Brien
- Department of Psychiatry, University of Cambridge School of Clinical Medicine, United Kingdom
| | - H. van den Brink
- J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - S. Hilal
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - A. Marseglia
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - A. ter Telgte
- VASCage – Center on Clinical Stroke Research, Innsbruck, Austria
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - I. Skoog
- Center for Ageing and Health, Institute for Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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5
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Zhai W, Zhao M, Wei C, Zhang G, Qi Y, Zhao A, Sun L. Biomarker profiling to determine clinical impact of microRNAs in cognitive disorders. Sci Rep 2024; 14:8270. [PMID: 38594359 PMCID: PMC11004146 DOI: 10.1038/s41598-024-58882-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 04/04/2024] [Indexed: 04/11/2024] Open
Abstract
Alzheimer's disease (AD) and post-stroke cognitive impairment (PSCI) are the leading causes of progressive dementia related to neurodegenerative and cerebrovascular injuries in elderly populations. Despite decades of research, patients with these conditions still lack minimally invasive, low-cost, and effective diagnostic and treatment methods. MicroRNAs (miRNAs) play a vital role in AD and PSCI pathology. As they are easily obtained from patients, miRNAs are promising candidates for the diagnosis and treatment of these two disorders. In this study, we performed complete sequencing analysis of miRNAs from 24 participants, split evenly into the PSCI, post-stroke non-cognitive impairment (PSNCI), AD, and normal control (NC) groups. To screen for differentially expressed miRNAs (DE-miRNAs) in patients, we predicted their target genes using bioinformatics analysis. Our analyses identified miRNAs that can distinguish between the investigated disorders; several of them were novel and never previously reported. Their target genes play key roles in multiple signaling pathways that have potential to be modified as a clinical treatment. In conclusion, our study demonstrates the potential of miRNAs and their key target genes in disease management. Further in-depth investigations with larger sample sizes will contribute to the development of precise treatments for AD and PSCI.
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Affiliation(s)
- Weijie Zhai
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Jilin University, Xinmin Street 1#, Changchun, 130021, China
- Department of Neurology, Cognitive Center, The First Hospital of Jilin University, Jilin University, Changchun, China
| | - Meng Zhao
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Jilin University, Xinmin Street 1#, Changchun, 130021, China
- Department of Neurology, Cognitive Center, The First Hospital of Jilin University, Jilin University, Changchun, China
| | - Chunxiao Wei
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Jilin University, Xinmin Street 1#, Changchun, 130021, China
- Department of Neurology, Cognitive Center, The First Hospital of Jilin University, Jilin University, Changchun, China
| | - Guimei Zhang
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Jilin University, Xinmin Street 1#, Changchun, 130021, China
- Department of Neurology, Cognitive Center, The First Hospital of Jilin University, Jilin University, Changchun, China
| | - Yiming Qi
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Jilin University, Xinmin Street 1#, Changchun, 130021, China
- Department of Neurology, Cognitive Center, The First Hospital of Jilin University, Jilin University, Changchun, China
| | - Anguo Zhao
- Department of Urology, Dushu Lake Hospital Affiliated to Soochow University, Medical Center of Soochow University, Suzhou Dushu Lake Hospital, Suzhou, 215000, China
| | - Li Sun
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Jilin University, Xinmin Street 1#, Changchun, 130021, China.
- Department of Neurology, Cognitive Center, The First Hospital of Jilin University, Jilin University, Changchun, China.
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Saks DG, Smith EE, Sachdev PS. National and international collaborations to advance research into vascular contributions to cognitive decline. CEREBRAL CIRCULATION - COGNITION AND BEHAVIOR 2023; 6:100195. [PMID: 38226362 PMCID: PMC10788430 DOI: 10.1016/j.cccb.2023.100195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 12/13/2023] [Accepted: 12/13/2023] [Indexed: 01/17/2024]
Abstract
Cerebrovascular disease is the second most common cause of cognitive disorders, usually referred to as vascular contributions to cognitive impairment and dementia (VCID) and makes some contribution to about 70 % of all dementias. Despite its importance, research into VCID has lagged as compared to cognitive impairment due to Alzheimer's disease. There is an increasing appreciation that closing this gap requires large national and international collaborations. This paper highlights 24 notable large-scale national and international efforts to advance research into VCID (MarkVCID, DiverseVCID, DISCOVERY, COMPASS-ND, HBC, RHU SHIVA, UK DRI Vascular Theme, STROKOG, Meta VCI Map, ISGC, ENIGMA-Stroke Recovery, CHARGE, SVDs@target, BRIDGET, CADASIL Consortium, CADREA, AusCADASIL, DPUK, DPAU, STRIVE, HARNESS, FINESSE, VICCCS, VCD-CRE Delphi). These collaborations aim to investigate the effects on cognition from cerebrovascular disease or impaired cerebral blood flow, the mechanisms of action, means of prevention and avenues for treatment. Consensus groups have been developed to harmonise global approaches to VCID, standardise terminology and inform management and treatment, and data sharing is becoming the norm. VCID research is increasingly a global collaborative enterprise which bodes well for rapid advances in this field.
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Affiliation(s)
- Danit G Saks
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Eric E Smith
- Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Perminder S Sachdev
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Neuropsychiatric Institute, Prince of Wales Hospital, Sydney, New South Wales, Australia
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7
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Luzum G, Gunnes M, Lydersen S, Saltvedt I, Tan X, Thingstad P, Thrane G, Askim T. Physical Activity Behavior and Its Association With Global Cognitive Function Three Months After Stroke: The Nor-COAST Study†. Phys Ther 2023; 103:pzad092. [PMID: 37440440 PMCID: PMC10733132 DOI: 10.1093/ptj/pzad092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 03/15/2023] [Accepted: 05/22/2023] [Indexed: 07/15/2023]
Abstract
OBJECTIVE The purposes of this study were to determine the association between physical activity (PA) behavior and global cognitive function 3 months after stroke and to explore the role of physical capacity as a mediating factor. METHODS Participants with stroke were successively recruited at 5 different hospitals in Norway. PA was measured using accelerometers, with a follow-up period of 7 consecutive days, and global cognitive function was assessed using the Montreal Cognitive Assessment (MoCA). The general pattern of PA and the percentage of participants adhering to World Health Organization PA recommendations (at least 150 minutes of moderate-intensity aerobic PA per week) were investigated using descriptive statistics. Multiple regression and mediator analyses were used to examine the relationship between PA behavior and MoCA scores; physical capacity, measured with the Short Physical Performance Battery, served as the mediating variable. RESULTS A total of 193 women (42.6%) and 260 men (57.4%) with a median age of 73.7 years (25th and 75th percentiles = 65.8 and 80.4, respectively) and a median MoCA score of 25 points (25th and 75th percentiles = 22 and 27, respectively) were included. Mean total time spent walking at moderate intensity was 251.7 (SD = 164.6) min/wk (mean bout length = 20.9 [SD = 7.3] seconds), which indicated 69.3% adherence to World Health Organization guidelines. With each point decrease in the MoCA score, there was an expected 8.6% increase in the odds of nonadherence to PA recommendations. Physical capacity was identified as an important mediating factor, explaining the strength of the association between cognition and PA behavior. CONCLUSIONS In contrast to previous research, in the present study, most participants adhered to the updated global PA guidelines. However, people who had survived stroke and had reduced cognitive function were at higher risk of inactivity, an association mediated by physical capacity. IMPACT A better understanding of the association between cognition and PA behavior after stroke might help for developing more targeted early-onset interventions.
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Affiliation(s)
- Geske Luzum
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
| | - Mari Gunnes
- Department of Health Research, SINTEF, Trondheim, Norway
| | - Stian Lydersen
- Department of Mental Health, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
| | - Ingvild Saltvedt
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
- Department of Geriatric Medicine, St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway
| | - Xiangchun Tan
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
| | - Pernille Thingstad
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
- Department of Health and Welfare Services, City of Trondheim, Trondheim, Norway
| | - Gyrd Thrane
- Department of Health and Care Science, Faculty of Health, The Arctic University of Norway, Tromsø, Norway
| | - Torunn Askim
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
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8
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Vestergaard SB, Dahm CC, Gottrup H, Valentin JB, Johnsen SP, Andersen G, Mortensen JK. Intravenous thrombolysis for acute ischemic stroke is associated with lower risk of post-stroke dementia: A nationwide cohort study. Eur Stroke J 2023; 8:947-955. [PMID: 37665134 PMCID: PMC10683737 DOI: 10.1177/23969873231197530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 08/09/2023] [Indexed: 09/05/2023] Open
Abstract
INTRODUCTION Dementia after stroke is common and is a great concern for patients and their caregivers. The objective was to investigate if intravenous thrombolysis (IVT) for acute ischemic stroke (AIS) was associated with lower risk of dementia after stroke. PATIENTS AND METHODS When IVT was introduced in Denmark, not all eligible patients were treated due to restricted access. We conducted a nationwide register-based cohort study of all patients with AIS in Denmark from 2004 to 2011. IVT-treated patients were propensity score-matched with comparable non-treated patients. Cox proportional hazards regression was used to estimate the hazard ratio (HR) for all-cause and vascular dementia 2, 5, and 10 years after stroke. RESULTS Of the 5919 patients eligible for the study, 2305 IVT-treated patients were propensity score-matched with 2305 non-treated patients. Mean (SD) age was 66.6 (13.3) and 61.2% were male. Rate of all-cause dementia was lower for the IVT-treated 2 years (8.4/1000 person years (PY) vs 13.6/1000 PY, HR 0.63 (0.40-0.99)) and 5 years after stroke (7.3/1000 PY vs 11.4/1000 PY, HR 0.65 (0.46-0.91)). 10 years after stroke, the rates of all-cause dementia remained in favor of IVT (8.0/1000 PY vs 9.8/1000 PY, HR 0.83 (0.64-1.07)). IVT-treated had lower rates of vascular dementia 2 years (2.4/1000 PY vs 7.4/1000 PY, HR 0.33 (0.15-0.71)), 5 years (2.3/1000 PY vs 6.2/1000 PY, HR 0.38 (0.23-0.65)), and 10 years after stroke (3.0/1000 PY vs 5.4/1000 PY, HR 0.56 (0.38-0.81)). CONCLUSION IVT treatment was associated with lower long-term risk of both vascular and all-cause dementia after AIS.
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Affiliation(s)
- Sigrid Breinholt Vestergaard
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Hanne Gottrup
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Jan Brink Valentin
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University & Aalborg University Hospital, Aalborg, Denmark
| | - Søren Paaske Johnsen
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University & Aalborg University Hospital, Aalborg, Denmark
| | - Grethe Andersen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Janne Kærgård Mortensen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
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9
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Chen Y, Lan M. A Hierarchical Multi-Dimensional Cognitive Training Program for Preventive Cognitive Decline in Acute Ischemic Stroke Patients: Study Protocol for a Randomized Controlled Trial. J Alzheimers Dis Rep 2023; 7:1267-1275. [PMID: 38143779 PMCID: PMC10741896 DOI: 10.3233/adr-230097] [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: 08/03/2023] [Accepted: 10/26/2023] [Indexed: 12/26/2023] Open
Abstract
Background One of the most popular ways to address cognitive decline is cognitive training. The fact that cognitive deterioration is permanent is one of the main issues. This issue might be resolved by preventive cognitive training when it is acute. As a result, this study aims to design and assess how well stroke patients respond to hierarchical, multi-dimensional preventative cognitive training. Objective To describe the study design of this center implementation trial. Methods Participants in the study will be recruited from a hospital in China and randomly assigned to the intervention group or the usual care group. Interventions will include four-week hierarchical multi-dimensional preventive cognitive training through a WeChat program. for Primary outcome measures will be the Montreal Cognitive Assessment, Mini-Mental State Examination, and Post-Stroke Cognitive Impairment (PSCI) Incidence. The secondary outcome measure will include the Hamilton Depression Scale, Hamilton Anxiety Scale, Modified Barthel Index, and National Institutes of Health Neurological Deficit Score. Outcomes will be measured at baseline, 12 weeks, and 24 weeks from the baseline. Results We expect that the hierarchical multi-dimensional preventive cognitive training program will be easy to implement, and the cognitive function, cognitive psychology, ability of daily living will vary in each setting. Conclusions The results will provide evidence highlighting differences in a new strategy of cognitive training through the WeChat program, which allows the home-based practice, puts forward an advanced idea of preventive cognitive training in the acute stage, and has the highest effectiveness of reducing cognitive impairment, and Alzheimer's disease.
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Affiliation(s)
- Yuanyuan Chen
- Nursing Department, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Meijuan Lan
- Nursing Department, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
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10
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Wu H, Zhang Q, Xu P, Chen J, Duan L, Xu F, Zhang F. Nattokinase Promotes Post-stroke Neurogenesis and Cognition Recovery via Increasing Circulating Irisin. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2023. [PMID: 37466380 DOI: 10.1021/acs.jafc.2c08718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
The therapeutic potential of treatments for post-stroke cognitive impairment (PSCI) is severely limited by the autonomic regeneration capacity of the adult brain. Nattokinase (NK), a serine protease from the traditional food natto, has many beneficial effects on the cardiovascular system by modulating the blood system. While the role of blood factors in neurogenesis and cognition is well-established, it remains unclear whether NK can serve as an anti-PSCI agent through these factors. Our study demonstrates that NK protects against acute ischemic stroke and impressively promotes neurogenesis in rat models by increasing peripheral blood irisin, leading to improved cognitive functions. Our findings demonstrate NK to be a promising candidate for treating PSCI, and we also highlight irisin as a novel target of NK, suggesting its potential role in the peripheral blood-to-brain axis.
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Affiliation(s)
- Hao Wu
- Wuya College of Innovation, Shenyang Pharmaceutical University, Shenyang, Liaoning 110016, People's Republic of China
| | - Qian Zhang
- Wuya College of Innovation, Shenyang Pharmaceutical University, Shenyang, Liaoning 110016, People's Republic of China
| | - Pu Xu
- Department of Pharmacology, Shenyang Pharmaceutical University, Shenyang, Liaoning 110016, People's Republic of China
| | - Jiepeng Chen
- Sungen Biotech Company, Limited, Shantou, Guangdong 515000, People's Republic of China
| | - Lili Duan
- Sungen Biotech Company, Limited, Shantou, Guangdong 515000, People's Republic of China
| | - Feng Xu
- Wuya College of Innovation, Shenyang Pharmaceutical University, Shenyang, Liaoning 110016, People's Republic of China
| | - Fengjiao Zhang
- Wuya College of Innovation, Shenyang Pharmaceutical University, Shenyang, Liaoning 110016, People's Republic of China
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11
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Dávila G, Torres-Prioris MJ, López-Barroso D, Berthier ML. Turning the Spotlight to Cholinergic Pharmacotherapy of the Human Language System. CNS Drugs 2023; 37:599-637. [PMID: 37341896 PMCID: PMC10374790 DOI: 10.1007/s40263-023-01017-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/24/2023] [Indexed: 06/22/2023]
Abstract
Even though language is essential in human communication, research on pharmacological therapies for language deficits in highly prevalent neurodegenerative and vascular brain diseases has received little attention. Emerging scientific evidence suggests that disruption of the cholinergic system may play an essential role in language deficits associated with Alzheimer's disease and vascular cognitive impairment, including post-stroke aphasia. Therefore, current models of cognitive processing are beginning to appraise the implications of the brain modulator acetylcholine in human language functions. Future work should be directed further to analyze the interplay between the cholinergic system and language, focusing on identifying brain regions receiving cholinergic innervation susceptible to modulation with pharmacotherapy to improve affected language domains. The evaluation of language deficits in pharmacological cholinergic trials for Alzheimer's disease and vascular cognitive impairment has thus far been limited to coarse-grained methods. More precise, fine-grained language testing is needed to refine patient selection for pharmacotherapy to detect subtle deficits in the initial phases of cognitive decline. Additionally, noninvasive biomarkers can help identify cholinergic depletion. However, despite the investigation of cholinergic treatment for language deficits in Alzheimer's disease and vascular cognitive impairment, data on its effectiveness are insufficient and controversial. In the case of post-stroke aphasia, cholinergic agents are showing promise, particularly when combined with speech-language therapy to promote trained-dependent neural plasticity. Future research should explore the potential benefits of cholinergic pharmacotherapy in language deficits and investigate optimal strategies for combining these agents with other therapeutic approaches.
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Affiliation(s)
- Guadalupe Dávila
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias, University of Malaga, Marqués de Beccaria 3, 29010, Malaga, Spain
- Instituto de Investigación Biomédica de Malaga-IBIMA, Malaga, Spain
- Department of Psychobiology and Methodology of Behavioral Sciences, Faculty of Psychology and Speech Therapy, University of Malaga, Malaga, Spain
- Language Neuroscience Research Laboratory, Faculty of Psychology and Speech Therapy, University of Malaga, Malaga, Spain
| | - María José Torres-Prioris
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias, University of Malaga, Marqués de Beccaria 3, 29010, Malaga, Spain
- Instituto de Investigación Biomédica de Malaga-IBIMA, Malaga, Spain
- Department of Psychobiology and Methodology of Behavioral Sciences, Faculty of Psychology and Speech Therapy, University of Malaga, Malaga, Spain
- Language Neuroscience Research Laboratory, Faculty of Psychology and Speech Therapy, University of Malaga, Malaga, Spain
| | - Diana López-Barroso
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias, University of Malaga, Marqués de Beccaria 3, 29010, Malaga, Spain
- Instituto de Investigación Biomédica de Malaga-IBIMA, Malaga, Spain
- Department of Psychobiology and Methodology of Behavioral Sciences, Faculty of Psychology and Speech Therapy, University of Malaga, Malaga, Spain
- Language Neuroscience Research Laboratory, Faculty of Psychology and Speech Therapy, University of Malaga, Malaga, Spain
| | - Marcelo L Berthier
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias, University of Malaga, Marqués de Beccaria 3, 29010, Malaga, Spain.
- Instituto de Investigación Biomédica de Malaga-IBIMA, Malaga, Spain.
- Language Neuroscience Research Laboratory, Faculty of Psychology and Speech Therapy, University of Malaga, Malaga, Spain.
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12
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Godefroy O, Aarabi A, Dorchies F, Barbay M, Andriuta D, Diouf M, Thiebaut de Schotten M, Kassir R, Tasseel-Ponche S, Roussel M. Functional architecture of executive processes: Evidence from verbal fluency and lesion mapping in stroke patients. Cortex 2023; 164:129-143. [PMID: 37207410 DOI: 10.1016/j.cortex.2023.03.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 03/03/2023] [Accepted: 03/19/2023] [Indexed: 05/21/2023]
Abstract
The functional organization and related anatomy of executive functions are still largely unknown and were examined in the present study using a verbal fluency task. The objective of this study was to determine the cognitive architecture of a fluency task and related voxelwise anatomy in the GRECogVASC cohort and fMRI based meta-analytical data. First, we proposed a model of verbal fluency in which two control processes, lexico-semantic strategic search process and attention process, interact with semantic and lexico-phonological output processes. This model was assessed by testing 404 patients and 775 controls for semantic and letter fluency, naming, and processing speed (Trail Making test part A). Regression (R2 = .276 and .3, P = .0001, both) and structural equation modeling (CFI: .88, RMSEA: .2, SRMR: .1) analyses supported this model. Second, voxelwise lesion-symptom mapping and disconnectome analyses demonstrated fluency to be associated with left lesions of the pars opercularis, lenticular nucleus, insula, temporopolar region, and a large number of tracts. In addition, a single dissociation showed specific association of letter fluency with the pars triangularis of F3. Disconnectome mapping showed the additional role of disconnection of left frontal gyri and thalamus. By contrast, these analyses did not identify voxels specifically associated with lexico-phonological search processes. Third, meta-analytic fMRI data (based on 72 studies) strikingly matched all structures identified by the lesion approach. These results support our modeling of the functional architecture of verbal fluency based on two control processes (strategic search and attention) operating on semantic and lexico-phonologic output processes. Multivariate analysis supports the prominent role of the temporopolar area (BA 38) in semantic fluency and the F3 triangularis area (BA 45) in letter fluency. Finally, the lack of voxels specifically dedicated to strategic search processes could be due to a distributed organization of executive functions warranting further studies.
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Affiliation(s)
- Olivier Godefroy
- Laboratory of Functional Neurosciences (UR UPJV 4559), Jules Verne University of Picardie, Amiens, France; Departments of Neurology, Amiens University Hospital, France.
| | - Ardalan Aarabi
- Laboratory of Functional Neurosciences (UR UPJV 4559), Jules Verne University of Picardie, Amiens, France
| | - Flore Dorchies
- Laboratory of Functional Neurosciences (UR UPJV 4559), Jules Verne University of Picardie, Amiens, France
| | - Mélanie Barbay
- Laboratory of Functional Neurosciences (UR UPJV 4559), Jules Verne University of Picardie, Amiens, France; Departments of Neurology, Amiens University Hospital, France
| | - Daniela Andriuta
- Laboratory of Functional Neurosciences (UR UPJV 4559), Jules Verne University of Picardie, Amiens, France; Departments of Neurology, Amiens University Hospital, France
| | - Momar Diouf
- Departments of Biostatistics, Amiens University Hospital, France
| | - Michel Thiebaut de Schotten
- Groupe d'Imagerie Neurofonctionnelle, Institut des Maladies Neurodégénératives-UMR 5293, CNRS, CEA, University of Bordeaux, Bordeaux, France; Brain Connectivity and Behaviour Laboratory, Sorbonne Universities, Paris, France
| | - Rania Kassir
- Laboratory of Functional Neurosciences (UR UPJV 4559), Jules Verne University of Picardie, Amiens, France; Laboratoire de Recherche en Neurosciences (LAREN), Université Saint-Joseph, Beyrouth, Lebanon
| | - Sophie Tasseel-Ponche
- Laboratory of Functional Neurosciences (UR UPJV 4559), Jules Verne University of Picardie, Amiens, France; Departments of Physical Medicine and Rehabilitation, Amiens University Hospital, France
| | - Martine Roussel
- Laboratory of Functional Neurosciences (UR UPJV 4559), Jules Verne University of Picardie, Amiens, France; Departments of Neurology, Amiens University Hospital, France
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13
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Tasseel-Ponche S, Roussel M, Toba MN, Sader T, Barbier V, Delafontaine A, Meynier J, Picard C, Constans JM, Schnitzler A, Godefroy O, Yelnik AP. Dual-task versus single-task gait rehabilitation after stroke: the protocol of the cognitive-motor synergy multicenter, randomized, controlled superiority trial (SYNCOMOT). Trials 2023; 24:172. [PMID: 36890548 PMCID: PMC9994785 DOI: 10.1186/s13063-023-07138-x] [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: 07/07/2022] [Accepted: 02/07/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Gait disorders and cognitive impairments are prime causes of disability and institutionalization after stroke. We hypothesized that relative to single-task gait rehabilitation (ST GR), cognitive-motor dual-task (DT) GR initiated at the subacute stage would be associated with greater improvements in ST and DT gait, balance, and cognitive performance, personal autonomy, disability, and quality of life in the short, medium and long terms after stroke. METHODS This multicenter (n=12), two-arm, parallel-group, randomized (1:1), controlled clinical study is a superiority trial. With p<0.05, a power of 80%, and an expected loss to follow-up rate of 10%, the inclusion of 300 patients will be required to evidence a 0.1-m.s-1 gain in gait speed. Trial will include adult patients (18-90 years) in the subacute phase (0 to 6 months after a hemispheric stroke) and who are able to walk for 10 m (with or without a technical aid). Registered physiotherapists will deliver a standardized GR program (30 min three times a week, for 4 weeks). The GR program will comprise various DTs (phasic, executive function, praxis, memory, and spatial cognition tasks during gait) in the DT (experimental) group and gait exercises only in the ST (control) group. The primary outcome measure is gait speed 6 months after inclusion. The secondary outcomes are post-stroke impairments (National Institutes of Health Stroke Scale and the motor part of the Fugl-Meyer Assessment of the lower extremity), gait speed (10-m walking test), mobility and dynamic balance (timed up-and-go test), ST and DT cognitive function (the French adaptation of the harmonization standards neuropsychological battery, and eight cognitive-motor DTs), personal autonomy (functional independence measure), restrictions in participation (structured interview and the modified Rankin score), and health-related quality of life (on a visual analog scale). These variables will be assessed immediately after the end of the protocol (probing the short-term effect), 1 month thereafter (the medium-term effect), and 5 months thereafter (the long-term effect). DISCUSSION The main study limitation is the open design. The trial will focus on a new GR program applicable at various stages after stroke and during neurological disease. TRIAL REGISTRATION NCT03009773 . Registered on January 4, 2017.
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Affiliation(s)
- Sophie Tasseel-Ponche
- Department of Physical Medicine and Rehabilitation, Amiens University Hospital, Amiens, France. .,Laboratory of Functional Neurosciences, UR UPJV 4559, Jules Verne University of Picardie, Amiens, France.
| | - Martine Roussel
- Laboratory of Functional Neurosciences, UR UPJV 4559, Jules Verne University of Picardie, Amiens, France.,Department of Neurology, Amiens University Hospital, Amiens, France
| | - Monica N Toba
- Laboratory of Functional Neurosciences, UR UPJV 4559, Jules Verne University of Picardie, Amiens, France
| | - Thibaud Sader
- Department of Physical Medicine and Rehabilitation, Amiens University Hospital, Amiens, France
| | - Vincent Barbier
- Department of Physical Medicine and Rehabilitation, Amiens University Hospital, Amiens, France
| | - Arnaud Delafontaine
- Department of Physical Medicine and Rehabilitation, Amiens University Hospital, Amiens, France
| | - Jonathan Meynier
- Clinical Research and Innovation Directorate, Amiens University Hospital, Amiens, France
| | - Carl Picard
- Clinical Research and Innovation Directorate, Amiens University Hospital, Amiens, France
| | | | - Alexis Schnitzler
- PRM Department, Hôpital Lariboisière-F.Widal AP-HP, Paris, France.,INSERM U1153 - CRESS EpiAgeing, Paris University, Hôtel-Dieu, Paris, France
| | - Olivier Godefroy
- Laboratory of Functional Neurosciences, UR UPJV 4559, Jules Verne University of Picardie, Amiens, France.,Department of Neurology, Amiens University Hospital, Amiens, France
| | - Alain Pierre Yelnik
- PRM Department, Hôpital Lariboisière-F.Widal AP-HP, Paris, France.,UMR 9010, Paris University, Centre Borelli, Paris, France
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14
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Liu H, Reynolds GP, Wei X. The Influence of Agricultural Work and Plasma Uric Acid on Hospital Admission for Alzheimer's Disease. J Alzheimers Dis 2023; 92:1283-1287. [PMID: 36872782 DOI: 10.3233/jad-221226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
BACKGROUND Exposure to environmental neurotoxins associated with agricultural work, such as pesticides, may be a risk factor for neurodegenerative disorders such as Alzheimer's (AD) and Parkinson's (PD) diseases. There is strong evidence that such exposure is associated with the development of PD; for AD the current evidence is equivocal. Several mechanisms are proposed to mediate this environmental toxicity, one of which is oxidative stress. Uric acid (UA) is an endogenous antioxidant, low levels of which are also implicated in neurodegenerative disease. OBJECTIVE This study aimed to determine whether agricultural work was a risk factor for AD in a population in which its association with PD was established, and whether UA was also associated with AD in this cohort. METHODS Hospital records of subjects meeting criteria for AD (n = 128) or vascular dementia (VaD) (n = 178) after hospital admission for symptoms of dementia were studied. History of agricultural work and plasma UA were recorded and their relationship to diagnosis determined. RESULTS In contrast to previous findings in this population in which agricultural work was strongly associated with PD, a history of agricultural work was not over-represented in hospital admission for AD versus VaD. AD was associated with a reduced level of circulating UA compared with VaD. CONCLUSION Agricultural work as a likely proxy for exposure to pesticides appears not to be a risk factor for AD to the extent found in PD, perhaps reflecting their differences in neuronal pathology. Nevertheless, findings with UA suggests that oxidative stress may be an important factor in AD pathogenesis.
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Affiliation(s)
- Hanxiang Liu
- Department of Neurology, Puer People's Hospital, Puer, Yunnan, China
| | - Gavin P Reynolds
- Biomolecular Sciences Research Centre, Sheffield Hallam University, Sheffield, UK
| | - Xianwen Wei
- Department of Neurology, Puer People's Hospital, Puer, Yunnan, China
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15
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Aubignat M, Roussel M, Aarabi A, Lamy C, Andriuta D, Tasseel-Ponche S, Makki M, Godefroy O, Roussel M, Barbay M, Canaple S, Lamy C, Leclercq C, Arnoux A, Despretz-Wannepain S, Despretz P, Berrissoul H, Picard C, Diouf M, Loas G, Deramond H, Taillia H, Ardisson AE, Nédélec-Ciceri C, Bonnin C, Thomas-Anterion C, Vincent-Grangette F, Varvat J, Quaglino V, Beaunieux H, Moroni C, Martens-Chazelles A, Batier-Monperrus S, Monteleone C, Costantino V, Theunssens E. Poststroke apathy: Major role of cognitive, depressive and neurological disorders over imaging determinants. Cortex 2023; 160:55-66. [PMID: 36745966 DOI: 10.1016/j.cortex.2022.12.012] [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: 05/30/2022] [Revised: 10/11/2022] [Accepted: 12/01/2022] [Indexed: 01/19/2023]
Abstract
Apathy occurs in approximately one third of people after stroke. Despite its frequency and functional consequences, the determinants of apathy have only been partially defined. The major difficulty lies in disentangling the reduction in activity due to apathy itself from those secondary to comorbidities, such as depression, sensorimotor deficits, and cognitive impairment. Here, we aimed to examine the prevalence of apathy, identify confounding sources of hypoactivity, and define its neuroimaging determinants using multivariate voxel lesion symptom-mapping (mVLSM) analyses. We assessed apathy in a subgroup (n = 325, mean age: 63.8 ± 10.5 years, 91.1% ischemic stroke) of the GRECogVASC cohort using the validated Behavioral Dysexecutive Syndrome Inventory, interpreted using GREFEX criteria, as well as confounding factors (depression, anxiety, severity of the neurological deficit, and gait disorders). mVLSM analysis was used to define neuroimaging determinants and was repeated after controlling for confounding factors. Apathy was present for 120 patients (36.9%, 95% CI: 31.7-42.2). Stepwise linear regression identified three factors associated with apathy: depressive symptoms (R2 = .3, p = .0001), cognitive impairment (R2 = .015, p = .02), and neurological deficit (R2 = .110, p = .0001). Accordingly, only 9 (7.5%) patients had apathy without a confounding factor, i.e., isolated apathy. In conventional VLSM analysis, apathy was associated with a large number of subcortical lesions that were no longer considered after controlling for confounding factors. Strategic site analysis identified five regions associated with isolated apathy: the F3 orbitalis pars, left amygdala, left thalamus, left pallidum, and mesencephalon. mVLSM analysis identified four strategic sites associated with apathy: the right corticospinal tract (R2 = .11; p = .0001), left frontostriatal tract (R2 = .11; p = .0001), left thalamus (R2 = .04; p = .0001), and left amygdala (R2 = .01; p = .013). These regions remained significant after controlling for confounding factors but explained a lower amount of variance. These findings indicate that poststroke apathy is more strongly associated with depression, neurological deficit, and cognitive impairment than with stroke lesions locations, at least using VLSM analysis.
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Affiliation(s)
- Mickael Aubignat
- Department of Neurology, Amiens University Hospital, Amiens, France
| | - Martine Roussel
- Department of Neurology, Amiens University Hospital, Amiens, France; Laboratory of Functional Neurosciences (UR UPJV 4559), Jules Verne University of Picardie, Amiens, France
| | - Ardalan Aarabi
- Laboratory of Functional Neurosciences (UR UPJV 4559), Jules Verne University of Picardie, Amiens, France
| | - Chantal Lamy
- Department of Neurology, Amiens University Hospital, Amiens, France; Laboratory of Functional Neurosciences (UR UPJV 4559), Jules Verne University of Picardie, Amiens, France
| | - Daniela Andriuta
- Department of Neurology, Amiens University Hospital, Amiens, France; Laboratory of Functional Neurosciences (UR UPJV 4559), Jules Verne University of Picardie, Amiens, France
| | - Sophie Tasseel-Ponche
- Laboratory of Functional Neurosciences (UR UPJV 4559), Jules Verne University of Picardie, Amiens, France; Departments of Rehabilitation, Amiens University Hospital, Amiens, France
| | - Malek Makki
- Laboratory of Functional Neurosciences (UR UPJV 4559), Jules Verne University of Picardie, Amiens, France
| | - Olivier Godefroy
- Department of Neurology, Amiens University Hospital, Amiens, France; Laboratory of Functional Neurosciences (UR UPJV 4559), Jules Verne University of Picardie, Amiens, France.
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16
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Geng J, Gao F, Ramirez J, Honjo K, Holmes MF, Adamo S, Ozzoude M, Szilagyi GM, Scott CJM, Stebbins GT, Nyenhuis DL, Goubran M, Black SE. Secondary thalamic atrophy related to brain infarction may contribute to post-stroke cognitive impairment. J Stroke Cerebrovasc Dis 2023; 32:106895. [PMID: 36495644 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106895] [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: 07/27/2022] [Revised: 10/24/2022] [Accepted: 11/10/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND PURPOSE The thalamus is a key brain hub that is globally connected to many cortical regions. Previous work highlights thalamic contributions to multiple cognitive functions, but few studies have measured thalamic volume changes or cognitive correlates. This study investigates associations between thalamic volumes and post-stroke cognitive function. METHODS Participants with non-thalamic brain infarcts (3-42 months) underwent MRI and cognitive testing. Focal infarcts and thalami were traced manually. In cases with bilateral infarcts, the side of the primary infarct volume defined the hemisphere involved. Brain parcellation and volumetrics were extracted using a standardized and previously validated neuroimaging pipeline. Age and gender-matched healthy controls provided normal comparative thalamic volumes. Thalamic atrophy was considered when the volume exceeded 2 standard deviations greater than the controls. RESULTS Thalamic volumes ipsilateral to the infarct in stroke patients (n=55) were smaller than left (4.4 ± 1.4 vs. 5.4 ± 0.5 cc, p < 0.001) and right (4.4 ± 1.4 vs. 5.5 ± 0.6 cc, p < 0.001) thalamic volumes in the controls. After controlling for head-size and global brain atrophy, infarct volume independently correlated with ipsilateral thalamic volume (β= -0.069, p=0.024). Left thalamic atrophy correlated significantly with poorer cognitive performance (β = 4.177, p = 0.008), after controlling for demographics and infarct volumes. CONCLUSIONS Our results suggest that the remote effect of infarction on ipsilateral thalamic volume is associated with global post-stroke cognitive impairment.
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Affiliation(s)
- Jieli Geng
- Department of Neurology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Fuqiang Gao
- LC Campbell Cognitive Neurology, Dr. Sandra Black Centre for Brain Resilience & Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto, Ontario, Canada
| | - Joel Ramirez
- LC Campbell Cognitive Neurology, Dr. Sandra Black Centre for Brain Resilience & Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto, Ontario, Canada; Heart and Stroke Foundation Canadian Partnership for Stroke Recovery (Sunnybrook site), Toronto, Ontario, Canada
| | - Kie Honjo
- LC Campbell Cognitive Neurology, Dr. Sandra Black Centre for Brain Resilience & Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto, Ontario, Canada; Heart and Stroke Foundation Canadian Partnership for Stroke Recovery (Sunnybrook site), Toronto, Ontario, Canada
| | - Melissa F Holmes
- LC Campbell Cognitive Neurology, Dr. Sandra Black Centre for Brain Resilience & Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto, Ontario, Canada
| | - Sabrina Adamo
- LC Campbell Cognitive Neurology, Dr. Sandra Black Centre for Brain Resilience & Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto, Ontario, Canada
| | - Miracle Ozzoude
- LC Campbell Cognitive Neurology, Dr. Sandra Black Centre for Brain Resilience & Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto, Ontario, Canada
| | - Gregory M Szilagyi
- LC Campbell Cognitive Neurology, Dr. Sandra Black Centre for Brain Resilience & Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto, Ontario, Canada
| | - Christopher J M Scott
- LC Campbell Cognitive Neurology, Dr. Sandra Black Centre for Brain Resilience & Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto, Ontario, Canada
| | - Glen T Stebbins
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - David L Nyenhuis
- Hauenstein Neuroscience Center, Saint Mary's Health Care, Grand Rapids, MI, USA; LCC International University
| | - Maged Goubran
- LC Campbell Cognitive Neurology, Dr. Sandra Black Centre for Brain Resilience & Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto, Ontario, Canada; Heart and Stroke Foundation Canadian Partnership for Stroke Recovery (Sunnybrook site), Toronto, Ontario, Canada; Department of Medical Biophysics, University of Toronto, Ontario, Canada
| | - Sandra E Black
- LC Campbell Cognitive Neurology, Dr. Sandra Black Centre for Brain Resilience & Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto, Ontario, Canada; Heart and Stroke Foundation Canadian Partnership for Stroke Recovery (Sunnybrook site), Toronto, Ontario, Canada; Department of Medicine (Neurology), Sunnybrook Health Sciences Centre and University of Toronto, Ontario, Canada.
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17
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Emelin AY, Lobzin VY. Criteria for diagnosis and classification of vascular cognitive impairment. NEUROLOGY, NEUROPSYCHIATRY, PSYCHOSOMATICS 2022. [DOI: 10.14412/2074-2711-2022-6-131-138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- A. Y. Emelin
- Department of Nervous System Diseases, S.M. Kirov Military Medical Academy, Ministry of Defense of Russia
| | - V. Y. Lobzin
- Department of Nervous System Diseases, S.M. Kirov Military Medical Academy, Ministry of Defense of Russia; I.I. Mechnikov North-Western State Medical University, Ministry of Health of Russia; Children's Scientific and Clinical Center for Infectious Diseases of the Federal Medical and Biological Agency of Russia
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18
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Ouin E, Roussel M, Aarabi A, Arnoux A, Tasseel-Ponche S, Andriuta D, Thiebaut de Schotten M, Toba MN, Makki M, Godefroy O. Poststroke action slowing: Motor and attentional impairments and their imaging determinants. Evidence from lesion-symptom mapping, disconnection and fMRI activation studies. Neuropsychologia 2022; 177:108401. [PMID: 36415018 DOI: 10.1016/j.neuropsychologia.2022.108401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 10/11/2022] [Accepted: 10/24/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND OBJECTIVES Although action slowing is the main cognitive impairment in stroke survivors, its mechanisms and determinants are still poorly understood. The objectives of the present study were to determine the mechanisms of post-stroke action slowing (using validated, highly specific simple reaction time (SRT) and tapping tests) and identify its imaging determinants (using multivariate lesion-symptom mapping (mLSM)). METHODS Action speed in the GRECogVASC cohort was assessed using finger tapping and SRT tests performed with both hands and analyzed using previously validated indices. Imaging determinants were identified using validated mLSM analyses and disconnection analysis and compared to those of an fMRI activation meta-analytic database. RESULTS Both the tapping time and SRT were 10.7% slower for the 394 patients (p = 0.0001) than for the 786 controls, without a group × test interaction (p = 0.2). The intra-individual distribution curve was characterized by a rightward shift with an unaltered attentional peak. The mLSM analyses showed tapping to be associated with lesions in the frontostriatal tract (p = 0.0007). The SRT was associated with lesions in the frontostriatal tract (p = 0.04) and the orbital part of F3 (p = 0.0001). The SRT-tapping index was associated with lesions in the orbital part of F3 (p = 0.0001). All lesions were located in the right hemisphere only and were responsible for the disconnection of several structures involved in motor preparation, initiation, and speed. A comparison with fMRI activation meta-analytic data highlighted mostly the same regions, including the orbital part of F3, the ventral and dorsal parts of F1, and the premotor and cingulate regions in the right hemisphere. DISCUSSION Our results confirm the marked impairment of action speed in stroke and show that the primary mechanism is motor slowing and that it is related to lesions in the right frontostriatal tract. A deficit in sustained alertness accounted for action slowing in the subgroup with lesions in the right orbital part of F3. Our SRT and mLSM results were in accordance with the fMRI activation data. Thus, stroke induces slowing in the broad network associated with SRT tasks by disrupting the frontostriatal tract and, to a lesser extent, other sites involved in attention.
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Affiliation(s)
- Elisa Ouin
- Departments of Neurology, Amiens University Hospital, France
| | - Martine Roussel
- Departments of Neurology, Amiens University Hospital, France; Departments of Laboratory of Functional Neurosciences, (EA 4559), Jules Verne University of Picardie, Amiens, France
| | - Ardalan Aarabi
- Departments of Laboratory of Functional Neurosciences, (EA 4559), Jules Verne University of Picardie, Amiens, France
| | - Audrey Arnoux
- Departments of Neurology, Amiens University Hospital, France
| | - Sophie Tasseel-Ponche
- Departments of Laboratory of Functional Neurosciences, (EA 4559), Jules Verne University of Picardie, Amiens, France; Departments of Rehabilitation, Amiens University Hospital, France
| | - Daniela Andriuta
- Departments of Neurology, Amiens University Hospital, France; Departments of Laboratory of Functional Neurosciences, (EA 4559), Jules Verne University of Picardie, Amiens, France
| | - Michel Thiebaut de Schotten
- Brain Connectivity and Behaviour Laboratory, Sorbonne Universities, Paris, France; Groupe D'Imagerie Neurofonctionnelle, Institut des Maladies Neurodégénératives- UMR 5293, CNRS, CEA University of Bordeaux, Bordeaux, France
| | - Monica N Toba
- Departments of Laboratory of Functional Neurosciences, (EA 4559), Jules Verne University of Picardie, Amiens, France
| | - Malek Makki
- Departments of Laboratory of Functional Neurosciences, (EA 4559), Jules Verne University of Picardie, Amiens, France
| | - Olivier Godefroy
- Departments of Neurology, Amiens University Hospital, France; Departments of Laboratory of Functional Neurosciences, (EA 4559), Jules Verne University of Picardie, Amiens, France.
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19
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Tasseel-Ponche S, Delafontaine A, Godefroy O, Yelnik AP, Doutrellot PL, Duchossoy C, Hyra M, Sader T, Diouf M. Walking speed at the acute and subacute stroke stage: A descriptive meta-analysis. Front Neurol 2022; 13:989622. [PMID: 36226075 PMCID: PMC9549366 DOI: 10.3389/fneur.2022.989622] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 09/05/2022] [Indexed: 11/30/2022] Open
Abstract
Gait disorders are one of the leading patient complaints at the sub-acute stroke stage (SSS) and a main determinant of disability. Walking speed (WS) is a major vital and functional index, and the Ten-Meter Walk Test is considered the gold standard after stroke. Based on a systematic review of the literature, studies published between January 2000 and November 2021 were selected when WS was reported (ten-meter walk test for short distance and/or 6-min walking distance for long distance) within 6 months following a first ischemic and/or hemorrhagic stroke (SSS) in adults prior to receiving specific walking rehabilitation. Following PRISMA guidelines, a meta-analysis was conducted on two kinds of WS: the principal criterion focused on short-distance WS (ten-meter walking test) and the secondary criteria focused on long-distance WS (6-min test) and meta-regressions to study the association of WS with balance, cognitive disorders and autonomy. Nine studies comprising a total of 939 data on post-stroke patients were selected. The weighted average age was 61 years [95% IC [55-67] and males represented 62% ± 2.7 of patients [57-67]. Average short-distance WS was 0.36 ± 0.06 m.s−1 [95% CI (0.23–0.49)]. Average long-distance WS was 0.46 ± 0.1 m.s−1 [95% CI (0.26–0.66)]. The funnel plot revealed asymmetry of publication bias and high heterogeneity of the nine studies (I2 index 98.7% and Q-test p < 0.0001). Meta-regressions of secondary endpoints could not be performed due to a lack of study data. At the SSS, WS would be lower than data in general population published in literature, but above all, lower than the WS required for safe daily autonomy and community ambulation after stroke. WS must be a priority objective of stroke rehabilitation to increase walking function but also for survival, autonomy, social participation and health-related quality of life.
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Affiliation(s)
- Sophie Tasseel-Ponche
- Department of Physical Medicine and Rehabilitation, Amiens University Hospital, Amiens, France
- Laboratory of Functional Neurosciences (EA 4559), Amiens University Hospital, Amiens, France
- *Correspondence: Sophie Tasseel-Ponche
| | - Arnaud Delafontaine
- Department of Physical Medicine and Rehabilitation, Amiens University Hospital, Amiens, France
- CIAMS, Paris-Saclay University, Orsay, France
- CIAMS, Orléans University, Orléans, France
| | - Olivier Godefroy
- Laboratory of Functional Neurosciences (EA 4559), Amiens University Hospital, Amiens, France
- Department of Neurology, Amiens University Hospital, Amiens, France
| | - Alain P. Yelnik
- Physical Medicine and Rehabilitation Department, Hôpital Lariboisière-F. Widal AP-HP, Paris, France
- INSERM U1153 - CRESS EpiAgeing, Paris University, Hôtel-Dieu, Paris, France
| | - Pierre-Louis Doutrellot
- Department of Physical Medicine and Rehabilitation, Amiens University Hospital, Amiens, France
| | - Charline Duchossoy
- Department of Physical Medicine and Rehabilitation, Amiens University Hospital, Amiens, France
| | - Marie Hyra
- Department of Physical Medicine and Rehabilitation, Amiens University Hospital, Amiens, France
| | - Thibaud Sader
- Department of Physical Medicine and Rehabilitation, Amiens University Hospital, Amiens, France
| | - Momar Diouf
- Department of Biostatistics, Amiens University Hospital, Amiens, France
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20
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Andriuta D, Si-Ahmed C, Roussel M, Constans JM, Makki M, Aarabi A, Basille D, Andrejak C, Godefroy O. Clinical and Imaging Determinants of Neurocognitive Disorders in Post-Acute COVID-19 Patients with Cognitive Complaints. J Alzheimers Dis 2022; 87:1239-1250. [DOI: 10.3233/jad-215506] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background: Neurocognitive disorders (NCDs) are a part of the post-acute coronavirus disease (COVID-19) syndrome. No study has specifically evaluated NCDs in post-acute COVID-19 patients with cognitive complaints or their MRI determinants. Objective: To characterize NCDs in post-acute COVID-19 patients with cognitive complaints. The secondary objectives were to assess their clinical and MRI determinants. Methods: We included 46 patients with a post-acute COVID-19 cognitive complaint referred to the Amiens University Hospital Memory Center. They underwent a neuropsychological assessment and 36 had cerebral MRI. The G3 overall summary score was the sum of the mean z scores for the executive function, language, and action speed domains. Neuropsychological profiles were compared in a general linear model. Clinical determinants were analyzed by stepwise linear regression. White matter hyperintensities (WMH) masks were analyzed using parcel-based WMH symptom mapping to identify the locations of WMHs associated with cognitive performance. Results: Repeated ANOVA showed a group effect (p = 0.0001) due to overall lower performance for patients and a domain effect (p = 0.0001) due to a lower (p = 0.007) action speed score. The G3 overall summary score was significantly associated with solely the requirement for oxygen (R2 = 0.319, p = 0.031). WHMs were associated with the G3 overall summary score in the following structures, all right-sided (p < 0.01): superior frontal region, postcentral region, cingulum, cortico-spinal tract, inferior longitudinal fasciculus, internal capsule, and posterior segment of the arcuate fasciculus. Conclusion: Post-acute COVID-19 patients with cognitive complaints had NCD, with prominent action slowing, significantly associated with the acute phase oxygen requirement and a right-sided WMH structure pattern.
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Affiliation(s)
- Daniela Andriuta
- Department of Neurology, Amiens University Medical Center, Amiens, France
- Laboratoire de Neurosciences Fonctionnelles et Pathologies (UR UPJV 4559), Jules Verne University of Picardy, Amiens, France
| | - Cherifa Si-Ahmed
- Department of Neurology, Amiens University Medical Center, Amiens, France
| | - Martine Roussel
- Department of Neurology, Amiens University Medical Center, Amiens, France
- Laboratoire de Neurosciences Fonctionnelles et Pathologies (UR UPJV 4559), Jules Verne University of Picardy, Amiens, France
| | - Jean-Marc Constans
- Department of Radiology, Amiens University Medical Center, Amiens, France
| | - Malek Makki
- Laboratoire de Neurosciences Fonctionnelles et Pathologies (UR UPJV 4559), Jules Verne University of Picardy, Amiens, France
| | - Ardalan Aarabi
- Laboratoire de Neurosciences Fonctionnelles et Pathologies (UR UPJV 4559), Jules Verne University of Picardy, Amiens, France
| | - Damien Basille
- Department of Pneumology, Amiens University Medical Center and UR 4294 AGIR, JulesVerne University of Picardy, Amiens, France
| | - Claire Andrejak
- Department of Pneumology, Amiens University Medical Center and UR 4294 AGIR, JulesVerne University of Picardy, Amiens, France
| | - Olivier Godefroy
- Department of Neurology, Amiens University Medical Center, Amiens, France
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21
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Tasseel-Ponche S, Barbay M, Roussel M, Lamrani A, Sader T, Arnoux-Courselle A, Canaple S, Lamy C, Leclercq C, Aarabi A, Schnitzler A, Yelnik AP, Godefroy O. Determinants of Disability at 6 Months After Stroke: the GRECogVASC Study. Eur J Neurol 2022; 29:1972-1982. [PMID: 35276029 DOI: 10.1111/ene.15319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/04/2022] [Accepted: 03/05/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND The present study aimed at determining the contributions of background disorders responsible for participation restriction as indexed by a structured interview for the modified Rankin scale (mRS-SI). METHODS A subset of 256 patients was assessed at 6 months after stroke using the National Institutes of Health Stroke Scale (NIHSS), gait score, comprehensive cognitive battery (yielding a global cognitive Z-score), behavioral dysexecutive disorders (DDs), anxiety and depressive symptoms, epilepsy, and headache. Following bivariate analyses, determinants of participation restriction were selected using ordinal regression analysis with partial odds. RESULTS Poststroke participation restriction (mRS-SI >1) was observed in 59% of the patients. In bivariate analyses mRS-SI was associated with prestroke mRS-SI, 6-month NIHSS score, gait score, global cognitive Z-score, behavioral DDs, and presence of anxiety and depression (p=0.0001, all) (epilepsy: p=0.3; headache: p=0.7). After logistic regression analysis, the NIHSS score was associated with increasing mRS-SI grades (p=0.00001). Prestroke mRS-SI (p=0.00001), behavioral DDs (p=0.0008) and global cognitive Z-score (p=0.01) were associated with both mRS-SI>1 and mRS-SI>2. In addition, the gait score was associated with mRS-SI >2 (p=0.00001). This model classified 85% of mRS-SI correctly (p=0.001). Structural equation modeling showed the contributions of gait limitation (standardized coefficient (SC): 0.68, p=0.01), prestroke mRS-SI (SC: 0.41, p=0.01), severity of neurological impairment (SC: 0.16, p=0.01), global cognitive Z-score (SC: -0.14, p=0.05), and behavioral DDs (SC: 0.13, p=0.01). CONCLUSION These results provide a statistical model of weights of determinants responsible for poststroke participation restriction and highlight a new independent determinant: behavioral DDs.
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Affiliation(s)
- Sophie Tasseel-Ponche
- Department of Physical Medicine and Rehabilitation, Amiens University Hospital, Amiens, France.,Laboratory of Functional Neurosciences, UR UPJV 4559, Jules Verne University of Picardie, Amiens, France
| | - Mélanie Barbay
- Laboratory of Functional Neurosciences, UR UPJV 4559, Jules Verne University of Picardie, Amiens, France.,Department of Neurology, Amiens University Hospital, Amiens, France
| | - Martine Roussel
- Laboratory of Functional Neurosciences, UR UPJV 4559, Jules Verne University of Picardie, Amiens, France.,Department of Neurology, Amiens University Hospital, Amiens, France
| | - Adnane Lamrani
- Biostatistics, Amiens University Hospital, Amiens, France
| | - Thibaud Sader
- Department of Physical Medicine and Rehabilitation, Amiens University Hospital, Amiens, France
| | - Audrey Arnoux-Courselle
- Laboratory of Functional Neurosciences, UR UPJV 4559, Jules Verne University of Picardie, Amiens, France.,Department of Neurology, Amiens University Hospital, Amiens, France
| | - Sandrine Canaple
- Laboratory of Functional Neurosciences, UR UPJV 4559, Jules Verne University of Picardie, Amiens, France.,Department of Neurology, Amiens University Hospital, Amiens, France
| | - Chantal Lamy
- Laboratory of Functional Neurosciences, UR UPJV 4559, Jules Verne University of Picardie, Amiens, France.,Department of Neurology, Amiens University Hospital, Amiens, France
| | - Claire Leclercq
- Laboratory of Functional Neurosciences, UR UPJV 4559, Jules Verne University of Picardie, Amiens, France.,Department of Neurology, Amiens University Hospital, Amiens, France
| | - Ardalan Aarabi
- Department of Neurology, Amiens University Hospital, Amiens, France
| | - Alexis Schnitzler
- PRM Department, Hôpital Lariboisière-F.Widal AP-HP, Paris, France.,INSERM U1153 - CRESS EpiAgeing, Paris University, Hôtel-Dieu, Paris, France
| | - Alain Pierre Yelnik
- PRM Department, Hôpital Lariboisière-F.Widal AP-HP, Paris, France.,UMR 9010, Paris University, Centre Borelli, Paris, France
| | - Olivier Godefroy
- Laboratory of Functional Neurosciences, UR UPJV 4559, Jules Verne University of Picardie, Amiens, France.,Department of Neurology, Amiens University Hospital, Amiens, France
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22
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Rimmele DL, Thomalla G. [Long-term consequences of stroke]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2022; 65:498-502. [PMID: 35258642 DOI: 10.1007/s00103-022-03505-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 02/07/2022] [Indexed: 11/24/2022]
Abstract
The treatment of stroke has significantly improved over the past two decades, resulting in reduced mortality and morbidity in high-income countries. However, strokes remain the third leading cause of mortality and disability worldwide. In addition to acute care and the prevention of risk factors, treatment of the various persisting disabilities that impact the daily activities and quality of life of patients also remain important. Motor and language deficits affect everyday life most obviously. Other deficits may involve complex movements, sensory, and cognitive functions. Patients also often suffer from anxiety, fatigue, and depression.Established ergotherapeutic, physiotherapeutic, and logopedic programs exist for motor and language deficits for in-patient treatment as well as in the ambulatory setting. The diagnosis and treatment of cognitive impairments and behavioral disorders, however, are largely confined to the early rehabilitation phase. Despite indications of a long-term impairment of quality of life due to cognitive deficits and behavioral disorders, previous study results speak against drug-based antidepressant therapy in in-patient rehabilitation. Individual patient-reported outcomes, supported by screening for cognitive deficits and consideration of individual risk factors and coping strategies, could further improve the treatment of stroke and its long-term burden.
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Affiliation(s)
- David Leander Rimmele
- Klinik und Poliklinik für Neurologie, Universitätsklinik Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
| | - Götz Thomalla
- Klinik und Poliklinik für Neurologie, Universitätsklinik Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland.
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23
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Zhang SH, Wang YL, Zhang CX, Zhang CP, Xiao P, Li QF, Liang WR, Pan XH, Zhou MC. Effect of Interactive Dynamic Scalp Acupuncture on Post-Stroke Cognitive Function, Depression, and Anxiety: A Multicenter, Randomized, Controlled Trial. Chin J Integr Med 2021; 28:106-115. [PMID: 34874523 DOI: 10.1007/s11655-021-3338-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To compare the clinical effects of interactive dynamic scalp acupuncture (IDSA), simple combination therapy (SCT), and traditional scalp acupuncture (TSA) on cognitive function, depression and anxiety in patients with post-stroke cognitive impairment. METHODS A total of 660 patients with post-stroke cognitive impairment who were admitted to 3 hospitals in Shenzhen City between May 2017 and May 2020 were recruited and randomly assigned to the IDSA (218 cases), SCT (222 cases) and TSA groups (220 cases) according to a random number table. All the patients received conventional drug therapy for cerebral stroke and exercise rehabilitation training. Scalp acupuncture and computer-based cognitive training (CBCT) were performed simultaneously in the IDSA group, but separately in the morning and in the afternoon in the SCT group. The patients in the TSA group underwent scalp acupuncture only. The course of treatment was 8 weeks. Before treatment (M0), 1 (M1) and 2 months (M2) after treatment, as well as follow-up at 1 (M3) and 2 months (M4), the cognitive function of patients was assessed using the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment Scale (MoCA) Scales; depression, anxiety, sleep quality, and self-care ability of patients were assessed using Hamilton Depression Rating Scale (HAMD), Hamilton Anxiety Rating Scale (HAMA), Pittsburgh Sleep Quality Index (PSQI), and Modified Barthel Index (MBI), respectively. During this trial, all adverse events (AEs) were accurately recorded. RESULTS There were no significant differences in the MMSE, MoCA, HAMD, HAMA, PSQI, and MBI scores among the 3 groups at M0 (all P>0.05). In the IDSA group, the MMSE, MoCA and MBI scores from M2 to M4 were significantly higher than those in the SCT and TSA groups, while the HAMD, HAMA and PSQI scores were significantly reduced (all P<0.01). The changes of all above scores (M2-M0, M4-M0) were significantly superior to those in the SCT and TSA groups (all P<0.01, except M4-M0 of HAMD). At M2, the severity of MMSE, HAMD, HAMA, PSQI and MBI in the IDSA group was significantly lower than that in the SCT and TSA groups (all P<0.01). There was no serious AE during this trial. CONCLUSIONS IDSA can not only significantly improve cognitive function, but also reduce depression, anxiety, which finally improves the patient's self-care ability. The effect of IDSA was significantly better than SCT and TSA. (Trial registration No. ChiCTR1900027206).
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Affiliation(s)
- Shao-Hua Zhang
- Department of Rehabilitation Medicine, Dapeng New District Nan'ao People's Hospital, Shenzhen, Guangdong Province, 518121, China
| | - Yu-Long Wang
- Department of Rehabilitation Medicine, Shenzhen Second People's Hospital, Shenzhen, Guangdong Province, 518037, China.
| | - Chun-Xia Zhang
- Department of Rehabilitation Medicine, Dapeng New District Nan'ao People's Hospital, Shenzhen, Guangdong Province, 518121, China
| | - Chun-Ping Zhang
- Department of Rehabilitation Medicine, Shenzhen Hospital of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong Province, 518034, China
| | - Peng Xiao
- Department of Rehabilitation Medicine, Dapeng New District Nan'ao People's Hospital, Shenzhen, Guangdong Province, 518121, China
| | - Qian-Feng Li
- Department of Rehabilitation Medicine, Dapeng New District Nan'ao People's Hospital, Shenzhen, Guangdong Province, 518121, China
| | - Wei-Rong Liang
- Department of Rehabilitation Medicine, Dapeng New District Nan'ao People's Hospital, Shenzhen, Guangdong Province, 518121, China
| | - Xiao-Hua Pan
- Department of Rehabilitation Medicine, Dapeng New District Nan'ao People's Hospital, Shenzhen, Guangdong Province, 518121, China
| | - Ming-Chao Zhou
- Department of Rehabilitation Medicine, Shenzhen Second People's Hospital, Shenzhen, Guangdong Province, 518037, China
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24
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Kumral E, Bayam FE, Arslan H, Orman M. Associations Between Neuroanatomic Patterns of Cerebral Infarctions and Vascular Dementia. J Neuropsychiatry Clin Neurosci 2021; 33:49-56. [PMID: 32718274 DOI: 10.1176/appi.neuropsych.19120356] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE A history of multiple cerebral infarctions is generally regarded as an important risk factor for vascular dementia. The authors examined the risk of vascular dementia in patients with multiple acute ischemic lesions. METHODS The authors conducted a hospital-based prospective study of 11,200 patients with first-time stroke who underwent 1.5 or 3-T MRI and a global cognitive assessment. Univariate and multivariate logistic regression analyses estimated the risk of dementia associated with multiple lesions versus a single lesion. RESULTS Having multiple lesions, compared with having a single lesion, was significantly associated with dementia in patients with stroke (odds ratio=5.83, 95% CI=5.08, 6.70; p<0.001). The apoliproprotein ε4 allele was more frequent in patients with multiple lesions than in those with a single lesion (odds ratio=1.70, 95% CI=1.39, 2.07; p<0.001). Severe leukoaraiosis (odds ratio=15.77, 95% CI=8.38, 29.68; p<0.001) and microbleedings (odds ratio=1.31, 95% CI=1.06, 1.63; p<0.01) were strong confounders for dementia in the multivariate analysis. Multiple logistic regression analysis showed that multiple lesions in one hemisphere versus a single lesion (odds ratio=2.14, 95% CI=1.83, 2.51; p<0.001), involvement of strategic regions (odds ratio=4.73, 95% CI=4.07, 5.49; p<0.001), and stroke lesion volume (odds ratio=1.31, 95% CI=1.03, 1.66; p=0.03) were significantly associated with dementia. There was a preponderance of lesions on the left side in patients with dementia (odds ratio=2.56, 95% CI=2.11, 3.11; p<0.001). CONCLUSIONS Multiple spontaneous anterior or posterior circulation lesions after stroke increase a patient's risk of developing dementia. Recognition of multiple ischemic lesions after stroke may allow targeted rapid therapeutic interventions to prevent subsequent cognitive deterioration.
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Affiliation(s)
- Emre Kumral
- Department of Neurology (Kumral, Ece Bayam, Arslan) and Department of Neuropsychology (Arslan), Ege University Medical School Hospital, Izmir, Turkey; and Department of Administration and Statistics, Ege University, Izmir, Turkey (Orman)
| | - Fatma Ece Bayam
- Department of Neurology (Kumral, Ece Bayam, Arslan) and Department of Neuropsychology (Arslan), Ege University Medical School Hospital, Izmir, Turkey; and Department of Administration and Statistics, Ege University, Izmir, Turkey (Orman)
| | - Hasan Arslan
- Department of Neurology (Kumral, Ece Bayam, Arslan) and Department of Neuropsychology (Arslan), Ege University Medical School Hospital, Izmir, Turkey; and Department of Administration and Statistics, Ege University, Izmir, Turkey (Orman)
| | - Mehmet Orman
- Department of Neurology (Kumral, Ece Bayam, Arslan) and Department of Neuropsychology (Arslan), Ege University Medical School Hospital, Izmir, Turkey; and Department of Administration and Statistics, Ege University, Izmir, Turkey (Orman)
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25
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Zhong HH, Qu JF, Xiao WM, Chen YK, Liu YL, Wu ZQ, Qiu DH, Liang WC. Severity of Lesions Involving the Cortical Cholinergic Pathways May Be Associated With Cognitive Impairment in Subacute Ischemic Stroke. Front Neurol 2021; 12:606897. [PMID: 34168604 PMCID: PMC8217623 DOI: 10.3389/fneur.2021.606897] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 05/04/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: Impairment of cortical cholinergic pathways (CCP) is an important risk factor for chronic vascular cognitive impairment. However, this phenomenon has rarely been studied in post-stroke cognitive impairment (PSCI). We investigated the relationship between PSCI and CCP lesions assessed by structural magnetic resonance imaging (MRI). Patients and methods: We prospectively enrolled 103 patients within 7 days of ischemic stroke onset. CCP was measured by the cholinergic pathways hyperintensities scale (CHIPS), which semiquantitatively grades MR lesions strategically located on the CCP identified in human brains. We also measured other MRI parameters, including the location and volumes of acute infarcts, cerebral microbleeds, medial temporal lobe atrophy, and white matter lesions. Neuropsychological assessments were performed using the 60-min modified vascular dementia battery (VDB) at 3 months after the index stroke, and PSCI was defined according to VDB as well as ADL. Results: Of all 103 patients, 69 men (67.0%) and 34 women (33.0%) with a mean age of 57.22 ± 12.95 years, 55 patients (53.4%) were judged to have PSCI at 3 months, including 43 (41.7%) patients with PSCI-no dementia and 12 (11.7%) patients with poststroke dementia. According to the VBD assessment, the most commonly impaired cognitive domain was visuomotor speed (27.2%) followed by verbal memory (25.2%). Univariate analysis showed that patients with PSCI were older; had higher informant questionnaire on cognitive decline in the elderly (IQCODE) scores; had more frequent previous stroke history and atrial fibrillation; and had higher CHIPS scores, more severe white matter lesions, and medial temporal lobe atrophy. PSCI patients also had higher depression scores at 3 months. In the multivariate regression analysis, age, IQCODE score, CHIPS score, and Hamilton depression rating scale score were independent predictors of PSCI. Ordinal regression analysis for risk factors of poor functional outcomes revealed that IQCODE scores and cognitive function status were related to mRS score at 3 months after stroke. Conclusion: In patients with early subacute ischemic stroke, the severity of lesions involving the CCP may be associated with cognitive impairment at 3 months. Clinical Trial Registration: Chinese Clinical Trial Registry, identifier: ChiCTR1800014982.
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Affiliation(s)
- Huo-Hua Zhong
- Department of Neurology, Dongguan People's Hospital, Dongguan, China
| | - Jian-Feng Qu
- Department of Neurology, Dongguan People's Hospital, Dongguan, China
| | - Wei-Min Xiao
- Department of Neurology, Dongguan People's Hospital, Dongguan, China
| | - Yang-Kun Chen
- Department of Neurology, Dongguan People's Hospital, Dongguan, China
| | - Yong-Lin Liu
- Department of Neurology, Dongguan People's Hospital, Dongguan, China
| | - Zhi-Qiang Wu
- Department of Neurology, Dongguan People's Hospital, Dongguan, China
| | - Dong-Hai Qiu
- Department of Neurology, Dongguan People's Hospital, Dongguan, China
| | - Wen-Cong Liang
- Graduate School, Guangdong Medical University, Dongguan, China
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26
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Weaver NA, Kuijf HJ, Aben HP, Abrigo J, Bae HJ, Barbay M, Best JG, Bordet R, Chappell FM, Chen CPLH, Dondaine T, van der Giessen RS, Godefroy O, Gyanwali B, Hamilton OKL, Hilal S, Huenges Wajer IMC, Kang Y, Kappelle LJ, Kim BJ, Köhler S, de Kort PLM, Koudstaal PJ, Kuchcinski G, Lam BYK, Lee BC, Lee KJ, Lim JS, Lopes R, Makin SDJ, Mendyk AM, Mok VCT, Oh MS, van Oostenbrugge RJ, Roussel M, Shi L, Staals J, Del C Valdés-Hernández M, Venketasubramanian N, Verhey FRJ, Wardlaw JM, Werring DJ, Xin X, Yu KH, van Zandvoort MJE, Zhao L, Biesbroek JM, Biessels GJ. Strategic infarct locations for post-stroke cognitive impairment: a pooled analysis of individual patient data from 12 acute ischaemic stroke cohorts. Lancet Neurol 2021; 20:448-459. [PMID: 33901427 DOI: 10.1016/s1474-4422(21)00060-0] [Citation(s) in RCA: 105] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 01/24/2021] [Accepted: 02/12/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Post-stroke cognitive impairment (PSCI) occurs in approximately half of people in the first year after stroke. Infarct location is a potential determinant of PSCI, but a comprehensive map of strategic infarct locations predictive of PSCI is unavailable. We aimed to identify infarct locations most strongly predictive of PSCI after acute ischaemic stroke and use this information to develop a prediction model. METHODS In this large-scale multicohort lesion-symptom mapping study, we pooled and harmonised individual patient data from 12 cohorts through the Meta-analyses on Strategic Lesion Locations for Vascular Cognitive Impairment using Lesion-Symptom Mapping (Meta VCI Map) consortium. The identified cohorts (as of Jan 1, 2019) comprised patients with acute symptomatic infarcts on CT or MRI (with available infarct segmentations) and a cognitive assessment up to 15 months after acute ischaemic stroke onset. PSCI was defined as performance lower than the fifth percentile of local normative data, on at least one cognitive domain on a multidomain neuropsychological assessment or on the Montreal Cognitive Assessment. Voxel-based lesion-symptom mapping (VLSM) was used to calculate voxel-wise odds ratios (ORs) for PSCI that were mapped onto a three-dimensional brain template to visualise PSCI risk per location. For the prediction model of PSCI risk, a location impact score on a 5-point scale was derived from the VLSM results on the basis of the mean voxel-wise coefficient (ln[OR]) within each patient's infarct. We did combined internal-external validation by leave-one-cohort-out cross-validation for all 12 cohorts using logistic regression. Predictive performance of a univariable model with only the location impact score was compared with a multivariable model with addition of other clinical PSCI predictors (age, sex, education, time interval between stroke onset and cognitive assessment, history of stroke, and total infarct volume). Testing of visual ratings was done by three clinicians, and accuracy, inter-rater reliability, and intra-rater reliability were assessed with Cohen's weighted kappa. FINDINGS In our sample of 2950 patients (mean age 66·8 years [SD 11·6]; 1157 [39·2%] women), 1286 (43·6%) had PSCI. We achieved high lesion coverage of the brain in our analyses (86·9%). Infarcts in the left frontotemporal lobes, left thalamus, and right parietal lobe were strongly associated with PSCI (after false discovery rate correction, q<0·01; voxel-wise ORs >20). On cross-validation, the location impact score showed good correspondence, based on visual assessment of goodness of fit, between predicted and observed risk of PSCI across cohorts after adjusting for cohort-specific PSCI occurrence. Cross-validations showed that the location impact score by itself had similar performance to the combined model with other PSCI predictors, while allowing for easy visual assessment. Therefore the univariable model with only the location impact score was selected as the final model. Correspondence between visual ratings and actual location impact score (Cohen's weighted kappa: range 0·88-0·92), inter-rater agreement (0·85-0·87), and intra-rater agreement (for a single rater, 0·95) were all high. INTERPRETATION To the best of our knowledge, this study provides the first comprehensive map of strategic infarct locations associated with risk of PSCI. A location impact score was derived from this map that robustly predicted PSCI across cohorts. Furthermore, we developed a quick and reliable visual rating scale that might in the future be applied by clinicians to identify individual patients at risk of PSCI. FUNDING The Netherlands Organisation for Health Research and Development.
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Affiliation(s)
- Nick A Weaver
- Department of Neurology and Neurosurgery, University Medical Centre (UMC) Utrecht Brain Center, Utrecht, Netherlands
| | - Hugo J Kuijf
- Image Sciences Institute, UMC Utrecht, Utrecht, Netherlands
| | - Hugo P Aben
- Department of Neurology, Elisabeth Tweesteden Hospital, Tilburg, Netherlands
| | - Jill Abrigo
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Hee-Joon Bae
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Mélanie Barbay
- Department of Neurology, Amiens University Hospital, Laboratory of Functional Neurosciences, Jules Verne Picardy University, Amiens, France
| | - Jonathan G Best
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, University College London Queen Square Institute of Neurology, London, UK
| | - Régis Bordet
- Université Lille, Inserm, CHU Lille, U1172-LilNCog-Lille Neuroscience and Cognition, Lille, France
| | - Francesca M Chappell
- Neuroimaging Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; UK Dementia Research Institute at the University of Edinburgh, Edinburgh, UK
| | - Christopher P L H Chen
- Department of Pharmacology, National University of Singapore, Singapore; Memory, Aging and Cognition Center, National University Health System, Singapore
| | - Thibaut Dondaine
- Université Lille, Inserm, CHU Lille, U1172-LilNCog-Lille Neuroscience and Cognition, Lille, France
| | | | - Olivier Godefroy
- Department of Neurology, Amiens University Hospital, Laboratory of Functional Neurosciences, Jules Verne Picardy University, Amiens, France
| | - Bibek Gyanwali
- Department of Pharmacology, National University of Singapore, Singapore; Memory, Aging and Cognition Center, National University Health System, Singapore
| | - Olivia K L Hamilton
- Neuroimaging Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; UK Dementia Research Institute at the University of Edinburgh, Edinburgh, UK
| | - Saima Hilal
- Department of Pharmacology, National University of Singapore, Singapore; Memory, Aging and Cognition Center, National University Health System, Singapore; Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Irene M C Huenges Wajer
- Department of Neurology and Neurosurgery, University Medical Centre (UMC) Utrecht Brain Center, Utrecht, Netherlands; Experimental Psychology, Helmholtz Institute, Utrecht University, Netherlands
| | - Yeonwook Kang
- Department of Psychology, Hallym University, Chuncheon, South Korea
| | - L Jaap Kappelle
- Department of Neurology and Neurosurgery, University Medical Centre (UMC) Utrecht Brain Center, Utrecht, Netherlands
| | - Beom Joon Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Sebastian Köhler
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Paul L M de Kort
- Department of Neurology, Elisabeth Tweesteden Hospital, Tilburg, Netherlands
| | - Peter J Koudstaal
- Department of Neurology, Erasmus Medical Center, Rotterdam, Netherlands
| | - Gregory Kuchcinski
- Université Lille, Inserm, CHU Lille, U1172-LilNCog-Lille Neuroscience and Cognition, Lille, France
| | - Bonnie Y K Lam
- Division of Neurology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Therese Pei Fong Chow Research Centre for Prevention of Dementia, Margaret Kam Ling Cheung Research Centre for Management of Parkinsonism, Gerald Choa Neuroscience Centre, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Byung-Chul Lee
- Department of Neurology, Hallym University Sacred Hospital, Hallym Neurological Institute, Hallym University College of Medicine, Anyang, South Korea
| | - Keon-Joo Lee
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Jae-Sung Lim
- Department of Neurology, Asan Medical Center, Seoul, South Korea
| | - Renaud Lopes
- Université Lille, Inserm, CHU Lille, U1172-LilNCog-Lille Neuroscience and Cognition, Lille, France
| | - Stephen D J Makin
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Anne-Marie Mendyk
- Université Lille, Inserm, CHU Lille, U1172-LilNCog-Lille Neuroscience and Cognition, Lille, France
| | - Vincent C T Mok
- Division of Neurology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Therese Pei Fong Chow Research Centre for Prevention of Dementia, Margaret Kam Ling Cheung Research Centre for Management of Parkinsonism, Gerald Choa Neuroscience Centre, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Mi Sun Oh
- Department of Neurology, Hallym University Sacred Hospital, Hallym Neurological Institute, Hallym University College of Medicine, Anyang, South Korea
| | | | - Martine Roussel
- Department of Neurology, Amiens University Hospital, Laboratory of Functional Neurosciences, Jules Verne Picardy University, Amiens, France
| | - Lin Shi
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; BrainNow Research Institute, Shenzhen, China
| | - Julie Staals
- Department of Neurology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Maria Del C Valdés-Hernández
- Neuroimaging Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; UK Dementia Research Institute at the University of Edinburgh, Edinburgh, UK
| | | | - Frans R J Verhey
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Joanna M Wardlaw
- Neuroimaging Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; UK Dementia Research Institute at the University of Edinburgh, Edinburgh, UK
| | - David J Werring
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, University College London Queen Square Institute of Neurology, London, UK
| | - Xu Xin
- Department of Pharmacology, National University of Singapore, Singapore; Memory, Aging and Cognition Center, National University Health System, Singapore
| | - Kyung-Ho Yu
- Department of Neurology, Hallym University Sacred Hospital, Hallym Neurological Institute, Hallym University College of Medicine, Anyang, South Korea
| | - Martine J E van Zandvoort
- Department of Neurology and Neurosurgery, University Medical Centre (UMC) Utrecht Brain Center, Utrecht, Netherlands; Experimental Psychology, Helmholtz Institute, Utrecht University, Netherlands
| | - Lei Zhao
- BrainNow Research Institute, Shenzhen, China
| | - J Matthijs Biesbroek
- Department of Neurology and Neurosurgery, University Medical Centre (UMC) Utrecht Brain Center, Utrecht, Netherlands
| | - Geert Jan Biessels
- Department of Neurology and Neurosurgery, University Medical Centre (UMC) Utrecht Brain Center, Utrecht, Netherlands.
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27
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Zhao Q, Wang X, Wang T, Dmytriw AA, Zhang X, Yang K, Luo J, Bai X, Jiang N, Yang B, Ma Y, Jiao L, Xie Y. Cognitive rehabilitation interventions after stroke: protocol for a systematic review and meta-analysis of randomized controlled trials. Syst Rev 2021; 10:66. [PMID: 33663590 PMCID: PMC7931553 DOI: 10.1186/s13643-021-01607-7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 02/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Stroke is the second leading cause of death worldwide, and 53.4% of stroke survivors suffer from post-stroke cognitive impairment. Post-stroke cognitive impairment can increase hospitalization rate and cost of care and decrease the quality of life of stroke patients. To date, multiple cognitive rehabilitation interventions have been tested in stroke populations with post-stroke cognitive impairment. However, the most efficacious intervention has not been established. This systematic review aims to compare the efficacy of cognitive rehabilitation interventions for patients with post-stroke cognitive impairment. METHODS We will search MEDLINE, EMBASE, CENTRAL, PsycINFO, CINAHL, PubMed, and clinical trial registries to identify eligible randomized clinical trials with no restrictions in the date of publication and language. Studies conducted with patients aged 18 or over, with the presence of cognitive impairment after being diagnosed with stroke will be included. Studies will be restricted to randomized controlled trials comparing a cognitive rehabilitation intervention with another intervention. The primary outcome is any clinical changes in the general or specific cognitive domain (e.g., executive function, attention, memory, or perception). The secondary outcomes that will be collected include adverse effects (e.g., stroke, disability, or mortality) and quality of life. Two independent reviewers will assess articles to identify trials eligible for inclusion. Data extraction and risk of bias assessment of the included studies will also be done independently. Any discrepancies will be solved by discussion, or a third reviewer will be consulted if necessary. A meta-analysis will be carried out if appropriate. DISCUSSION This systematic review for patients with post-stroke cognitive impairment will assess the efficacy of cognitive rehabilitation interventions. And our results will help clinical decision-making and support the development of clinical practice guidelines. TRIAL REGISTRATION Systematic review registration: PROSPERO CRD42020173988.
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Affiliation(s)
- Qing Zhao
- Department of Neurology, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Beijing, 100053, China.,Department of Clinical Medicine, Peking Union Medical College, No. 5 Dongdan Three Street, Beijing, China
| | - Xue Wang
- Medical Library, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Beijing, China
| | - Tao Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Beijing, China.,China International Neuroscience Institute (China-INI), No. 45 Changchun Street, Beijing, China
| | - Adam A Dmytriw
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA, USA
| | - Xiao Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Beijing, China.,China International Neuroscience Institute (China-INI), No. 45 Changchun Street, Beijing, China
| | - Kun Yang
- Department of Evidence-Based Medicine, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Beijing, China
| | - Jichang Luo
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Beijing, China.,China International Neuroscience Institute (China-INI), No. 45 Changchun Street, Beijing, China
| | - Xuesong Bai
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Beijing, China.,China International Neuroscience Institute (China-INI), No. 45 Changchun Street, Beijing, China
| | - Nan Jiang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Beijing, China.,China International Neuroscience Institute (China-INI), No. 45 Changchun Street, Beijing, China
| | - Bin Yang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Beijing, China.,China International Neuroscience Institute (China-INI), No. 45 Changchun Street, Beijing, China
| | - Yan Ma
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Beijing, China.,China International Neuroscience Institute (China-INI), No. 45 Changchun Street, Beijing, China
| | - Liqun Jiao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Beijing, China.,China International Neuroscience Institute (China-INI), No. 45 Changchun Street, Beijing, China.,Department of Interventional Neuroradiology, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Beijing, China
| | - Yunyan Xie
- Department of Neurology, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Beijing, 100053, China.
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28
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Verdelho A, Wardlaw J, Pavlovic A, Pantoni L, Godefroy O, Duering M, Charidimou A, Chabriat H, Biessels GJ. Cognitive impairment in patients with cerebrovascular disease: A white paper from the links between stroke ESO Dementia Committee. Eur Stroke J 2021; 6:5-17. [PMID: 33817330 PMCID: PMC7995319 DOI: 10.1177/23969873211000258] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 02/04/2021] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Many daily-life clinical decisions in patients with cerebrovascular disease and cognitive impairment are complex. Evidence-based information sustaining these decisions is frequently lacking. The aim of this paper is to propose a practical clinical approach to cognitive impairments in patients with known cerebrovascular disease. METHODS The document was produced by the Dementia Committee of the European Stroke Organisation (ESO), based on evidence from the literature where available and on the clinical experience of the Committee members. This paper was endorsed by the ESO. FINDINGS Many patients with stroke or other cerebrovascular disease have cognitive impairment, but this is often not recognized. With improvement in acute stroke care, and with the ageing of populations, it is expected that more stroke survivors and more patients with cerebrovascular disease will need adequate management of cognitive impairment of vascular etiology. This document was conceived for the use of strokologists and for those clinicians involved in cerebrovascular disease, with specific and practical hints concerning diagnostic tools, cognitive impairment management and decision on some therapeutic options.Discussion and conclusions: It is essential to consider a possible cognitive deterioration in every patient who experiences a stroke. Neuropsychological evaluation should be adapted to the clinical status. Brain imaging is the most informative biomarker concerning prognosis. Treatment should always include adequate secondary prevention.
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Affiliation(s)
- Ana Verdelho
- Department of Neurosciences and Mental Health, CHLN-Hospital de Santa Maria, Instituto de Medicina Molecular – IMM e Instituto de Saúde Ambiental –ISAMB, Faculdade de Medicina, University of Lisbon, Lisbon, Portugal
| | - Joanna Wardlaw
- Centre for Clinical Brain Sciences, UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Aleksandra Pavlovic
- Faculty for Special Education and Rehabilitation, University of Belgrade, Belgrade, Serbia
| | - Leonardo Pantoni
- Stroke and Dementia Lab, "Luigi Sacco" Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Olivier Godefroy
- Department of Neurology, Amiens University Hospital, Laboratory of Functional Neurosciences1,6 (UR UPJV 4559), Jules Verne Picardy University, Amiens, France
| | - Marco Duering
- Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Germany
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Andreas Charidimou
- Hemorrhagic Stroke Research Program, J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Neurology, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Hugues Chabriat
- Department of Neurology, FHU NeuroVasc, Hôpital Lariboisiere, University of Paris, Paris, France
| | - Geert Jan Biessels
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, the Netherlands
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29
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Drozdowska BA, McGill K, McKay M, Bartlam R, Langhorne P, Quinn TJ. Prognostic rules for predicting cognitive syndromes following stroke: A systematic review. Eur Stroke J 2021; 6:18-27. [PMID: 33817331 PMCID: PMC7995322 DOI: 10.1177/2396987321997045] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 01/29/2021] [Indexed: 11/15/2022] Open
Abstract
Purpose Stroke survivors are at high risk of developing cognitive syndromes, such as delirium and dementia. Accurate prediction of future cognitive outcomes may aid timely diagnosis, intervention planning, and stratification in clinical trials. We aimed to identify, describe and appraise existing multivariable prognostic rules for prediction of post-stroke cognitive status. Method We systematically searched four electronic databases from inception to November 2019 for publications describing a method to estimate individual probability of developing a cognitive syndrome following stroke. We extracted data from selected studies using a pre-specified proforma and applied the Prediction model Risk Of Bias Assessment Tool (PROBAST) for critical appraisal. Findings Of 17,390 titles, we included 10 studies (3143 participants), presenting the development of 11 prognostic rules – 7 for post-stroke cognitive impairment and 4 for delirium. Most commonly incorporated predictors were: demographics, imaging findings, stroke type and symptom severity. Among studies assessing predictive discrimination, the area under the receiver operating characteristic (AUROC) in apparent validation ranged from 0.80 to 0.91. The overall risk of bias for each study was high. Only one prognostic rule had been externally validated. Discussion/conclusion: Research into the prognosis of cognitive outcomes following stroke is an expanding field, still at its early stages. Recommending use of specific prognostic rules is limited by the high risk of bias in all identified studies, and lack of supporting evidence from external validation. To ensure the quality of future research, investigators should adhere to current, endorsed best practice guidelines for conduct of prediction model studies.
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Affiliation(s)
- Bogna A Drozdowska
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK
| | - Kris McGill
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK
| | - Michael McKay
- School of Medicine, Dentistry & Nursing, University of Glasgow, UK
| | - Roisin Bartlam
- Glasgow Royal Infirmary, National Health Service Greater Glasgow and Clyde, UK
| | - Peter Langhorne
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK
| | - Terence J Quinn
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK
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30
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O'Dell MW, Jaywant A, Frantz M, Patel R, Kwong E, Wen K, Taub M, Campo M, Toglia J. Changes in the Activity Measure for Post-Acute Care Domains in Persons With Stroke During the First Year After Discharge From Inpatient Rehabilitation. Arch Phys Med Rehabil 2021; 102:645-655. [PMID: 33440132 DOI: 10.1016/j.apmr.2020.11.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 11/18/2020] [Accepted: 11/25/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To describe functional changes after inpatient stroke rehabilitation using the Activity Measure for Post-Acute Care (AM-PAC), an assessment measure sensitive to change and with a low risk of ceiling effect. DESIGN Retrospective, longitudinal cohort study. SETTING Inpatient rehabilitation unit of an urban academic medical center. PARTICIPANTS Among 433 patients with stroke admitted from 2012-2016, a total of 269 (62%) were included in our database and 89 of 269 patients (33.1%) discharged from inpatient stroke rehabilitation had complete data. Patients with and without complete data were very similar. The group had a mean age of 68.0±14.2 years, National Institutes of Health Stroke Score of 8.0±8.0, and rehabilitation length of stay of 14.7±7.4 days, with 84% having an ischemic stroke and 22.5% having a recurrent stroke. INTERVENTION None. MAIN OUTCOME MEASURES Changes in function across the first year after discharge (DC) were measured in a variety of ways. Continuous mean scores for the basic mobility (BM), daily activity (DA), and applied cognitive domains of the AM-PAC were calculated at and compared between inpatient DC and 6 (6M) and 12 months (12M) post DC. Categorical changes among individuals were classified as "improved," "unchanged," or "declined" between the 3 time points based on the minimal detectable change, (estimated) minimal clinically important difference, and a change ≥1 AM-PAC functional stage (FS). RESULTS For the continuous analyses, the Friedman test was significant for all domains (P≤.002), with Wilcoxon signed-rank test significant for all domains from DC to 6M (all P<.001) but with no change in BM and DA between 6M and 12M (P>.60) and a decline in applied cognition (P=.002). Despite group improvements from DC to 6M, for categorical changes at an individual level 10%-20% declined and 50%-70% were unchanged. Despite insignificant group differences from 6M-12M, 15%-25% improved and 20%-30% declined in the BM and DA domains. CONCLUSIONS Despite group gains from DC to 6M and an apparent "plateau" after 6M post stroke, there was substantial heterogeneity at an individual level. Our results underscore the need to consider individual-level outcomes when evaluating progress or outcomes in stroke rehabilitation.
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Affiliation(s)
- Michael W O'Dell
- Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, New York; Department of Rehabilitation Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York.
| | - Abhishek Jaywant
- Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, New York; Department of Psychiatry, Weill Cornell Medicine, New York, New York
| | - Megan Frantz
- Kaiser Foundation Rehabilitation Center, Vallejo, California
| | - Ruchi Patel
- Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, New York; Department of Rehabilitation Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
| | - Erica Kwong
- Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, New York
| | - Karen Wen
- Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, New York
| | - Michael Taub
- Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, New York
| | - Marc Campo
- Department of Allied Health and Natural Sciences, Mercy College, Dobbs Ferry, New York
| | - Joan Toglia
- Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, New York; Department of Allied Health and Natural Sciences, Mercy College, Dobbs Ferry, New York
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31
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Aam S, Einstad MS, Munthe-Kaas R, Lydersen S, Ihle-Hansen H, Knapskog AB, Ellekjær H, Seljeseth Y, Saltvedt I. Post-stroke Cognitive Impairment-Impact of Follow-Up Time and Stroke Subtype on Severity and Cognitive Profile: The Nor-COAST Study. Front Neurol 2020; 11:699. [PMID: 32765406 PMCID: PMC7379332 DOI: 10.3389/fneur.2020.00699] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 06/09/2020] [Indexed: 12/29/2022] Open
Abstract
Background: Post-stroke cognitive impairment (PSCI) is common, but evidence of cognitive symptom profiles, course over time, and pathogenesis is scarce. We investigated the significance of time and etiologic stroke subtype for the probability of PSCI, severity, and cognitive profile. Methods: Stroke survivors (n = 617) underwent cognitive assessments of attention, executive function, memory, language, perceptual-motor function, and the Montreal Cognitive Assessment (MoCA) after 3 and/or 18 months. PSCI was classified according to DSM-5 criteria. Stroke severity was assessed with the National Institutes of Health Stroke Scale (NIHSS). Stroke subtype was categorized as intracerebral hemorrhage (ICH), large artery disease (LAD), cardioembolic stroke (CE), small vessel disease (SVD), or un-/other determined strokes (UD). Mixed-effects logistic or linear regression was applied with PSCI, MoCA, and z-scores of the cognitive domains as dependent variables. Independent variables were time as well as stroke subtype, time, and interaction between these. The analyses were adjusted for age, education, and sex. The effects of time and stroke subtype were analyzed by likelihood ratio tests (LR). Results: Mean age was 72 years (SD 12), 42% were females, and mean NIHSS score at admittance was 3.8 (SD 4.8). Probability (95% CI) for PSCI after 3 and 18 months was 0.59 (0.51–0.66) and 0.51 (0.52–0.60), respectively and remained constant over time. Global measures and most cognitive domains were assessed as impaired for the entire stroke population and for most stroke subtypes. Executive function and language improved for the entire stroke population (LR) = 9.05, p = 0.003, and LR = 10.38, p = 0.001, respectively). After dividing the sample according to stroke subtypes, language improved for ICH patients (LR = 18.02, p = 0.003). No significant differences were found in the severity of impairment between stroke subtypes except for attention, which was impaired for LAD and CE in contrast to no impairment for SVD (LR = 56.58, p < 0.001). Conclusions: In this study including mainly minor strokes, PSCI is common for all subtypes, both early and long-term after stroke, while executive function and language improve over time. The findings might contribute to personalizing follow-up and offer new insights into underlying mechanisms. Further research is needed on underlying mechanisms, PSCI prevention and treatment, and relevance for rehabilitation.
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Affiliation(s)
- Stina Aam
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU-Norwegian University of Science and Technology, Trondheim, Norway.,Department of Geriatric Medicine, Clinic of Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Marte Stine Einstad
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
| | - Ragnhild Munthe-Kaas
- Department of Medicine, Vestre Viken Hospital Trust, Bærum Hospital, Drammen, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Stian Lydersen
- Department of Mental Health, Faculty of Medicine and Health Science, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
| | - Hege Ihle-Hansen
- Department of Medicine, Vestre Viken Hospital Trust, Bærum Hospital, Drammen, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | | | - Hanne Ellekjær
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU-Norwegian University of Science and Technology, Trondheim, Norway.,Stroke Unit, Department of Internal Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Yngve Seljeseth
- Medical Department, Ålesund Hospital, Møre and Romsdal Health Trust, Ålesund, Norway
| | - Ingvild Saltvedt
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU-Norwegian University of Science and Technology, Trondheim, Norway.,Department of Geriatric Medicine, Clinic of Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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Sensitivity of the Montreal Cognitive Assessment in screening for cognitive impairment in patients with newly diagnosed high-grade glioma. J Neurooncol 2020; 148:335-342. [PMID: 32415644 DOI: 10.1007/s11060-020-03524-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 05/02/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Cognitive impairment is frequent in patients with high-grade glioma and requires cognitive follow-up. Cognitive screening tools such as the Montreal Cognitive Assessment (MoCA) have been used to assess cognition in these patients. Here we assessed the sensitivity of the MoCA in screening for cognitive impairment in a cohort of 156 patients with newly-diagnosed high-grade glioma, after surgery and before radiochemotherapy. METHODS We assessed cognitive performance with the MoCA and a neuropsychological battery. Cognitive scores were analyzed in terms of a previously validated framework designed to control false positives and data for 1003 control participants from the GRECOGVASC study. After comparison of performance on the tests, we used stepwise logistic regression to produce a cognitive summary score from the neuropsychological battery. Then we analyzed sensitivity and specificity of the MoCA with receiver operator characteristic (ROC) curve analysis. RESULTS Both raw and adjusted MoCA scores showed only moderate sensitivity. The area under the ROC curve was 0.759 (95% CI 0.703-0.815) for the raw score and 0.788 (95% CI 0.734-0.842) for the adjusted score. Optimal discrimination was obtained with a raw score ≤ 25 (sensitivity: 0.526; specificity: 0.832; positive predictive value: 0.2; negative predictive value: 0.96) and an adjusted score - 0.603 (sensitivity: 0.716; specificity: 0.768; positive predictive value: 0.24; negative predictive value: 0.96). CONCLUSION The moderate sensitivity of MoCA indicates that it is not a suitable screening tool for detecting cognitive impairment in patients with newly-diagnosed high-grade glioma.
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Gong L, Gu Y, Yu Q, Wang H, Zhu X, Dong Q, Xu R, Zhao Y, Liu X. Prognostic Factors for Cognitive Recovery Beyond Early Poststroke Cognitive Impairment (PSCI): A Prospective Cohort Study of Spontaneous Intracerebral Hemorrhage. Front Neurol 2020; 11:278. [PMID: 32411073 PMCID: PMC7198781 DOI: 10.3389/fneur.2020.00278] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 03/25/2020] [Indexed: 12/16/2022] Open
Abstract
Background: Poststroke cognitive impairment (PSCI) has been increasingly recognized in patients, but some stroke survivors appear to show cognitive improvement beyond the acute stage. The risk factors associated with cognitive recovery after spontaneous intracerebral hemorrhage (ICH) onset have not yet been sufficiently investigated in prospective studies. Objective: We aimed to identify the trajectory of post-ICH cognitive impairment and the association of potential prognostic factors with follow-up cognitive recovery beyond early PSCI. Methods: In this stroke center-based cohort study, 141 consecutive dementia-free patients with spontaneous ICH were included and underwent Montreal Cognitive Assessment (MoCA) evaluation for cognitive function at baseline (within 2 weeks of ICH onset) and the shortened MoCA (short-MoCA) at a 6-month follow-up. To explore the prognostic factors associated with trajectory of cognition after an ICH onset, we adjusted for demographic and vascular risk factors, using multivariate logistic regression analysis. Results: Of the 141 ICH patients, approximately three quarters (106/141) were diagnosed with early PSCI (MoCA score <26) within 2 weeks of ICH onset. The multiple logistic regression indicated independent positive associations between risk of early PSCI and dominant-hemisphere hemorrhage [odd's ratio (OR): 8.845 (3.347–23.371); P < 0.001], mean corpuscular volume (MCV) [OR: 1.079 (1.002–1.162); P = 0.043], admission systolic blood pressure (sBP) [OR: 1.021 (1.005–1.038); P = 0.012]. Furthermore, 36% (33/90) of ICH survivors who had early PSCI exhibited cognitive recovery at the 6-month follow-up. After examining potential predictors through multiple linear regression based on stepwise, there were independent negative associations between cognitive recovery and dominant hemisphere hemorrhage [OR: 6.955 (1.604–30.162); P < 0.01], lobar ICH [OR: 8.363 (1.479–47.290); P = 0.016], years of education ≤ 9 [OR: 5.145 (1.254–21.105); P = 0.023], and MCV [OR: 1.660 (1.171–2.354); P = 0.004]. Baseline cognitive performance in the domains of visuospatial/executive function, attention, orientation, and language showed positive correlations with cognitive improvement (P < 0.05). Conclusion: In this cohort study of dementia-free survivors of ICH, our results show that one in three early PSCI survivors exhibit cognitive recovery, in relation to dominant-hemisphere hematoma, lobar ICH, educational history, and MCV levels. Future clinical trials including ICH survivors with cognitive dysfunction should assess these factors.
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Affiliation(s)
- Li Gong
- Department of Neurology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Yongzhe Gu
- Department of Neurology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Qiuyue Yu
- Department of Neurology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Haichao Wang
- Department of Neurology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Xiaoping Zhu
- School of Nursing, Second Military Medical University, Shanghai, China.,Department of Nursing, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Qiong Dong
- Department of Neurology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Rong Xu
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Yanxin Zhao
- Department of Neurology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Xueyuan Liu
- Department of Neurology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
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Hagberg G, Fure B, Thommessen B, Ihle-Hansen H, Øksengård AR, Nygård S, Pendlebury ST, Beyer MK, Wyller TB, Ihle-Hansen H. Predictors for Favorable Cognitive Outcome Post-Stroke: A-Seven-Year Follow-Up Study. Dement Geriatr Cogn Disord 2020; 48:45-55. [PMID: 31461703 DOI: 10.1159/000501850] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 07/01/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND PURPOSE Knowledge of the burden and development of post-stroke cognitive impairments (CIs) in the long-term after the first event is limited. We aimed to assess the prevalence of mild CI (MCI) and dementia 7 years after first-ever stroke or transient ischemic attack (TIA), to subclassify the impairments, and to identify predictors for a favorable cognitive outcome. MATERIALS AND METHODS During 2007 and 2008, 208 patients with first-ever stroke or TIA without preexisting CI were included. After 1 and 7 years, survivors were invited to a follow-up. Transitions of cognitive status from 1 to 7 years were recorded based on the 3 categories dementia, MCI, or none. Etiologic subclassification was based on clinical cognitive profile, magnetic resonance imaging (MRI) findings, and biomarkers at both time points. Favorable outcome was defined as normal cognitive function or MCI after 7 years with exclusion of those who had progression from normal to MCI. RESULTS Eighty patients died during follow-up, 12 patients refused further participation. After 7 years, 109 completed follow-up of whom 40 (37%) were diagnosed with MCI and 24 (22%) with dementia. Of the 64 patients diagnosed with CI, 9 were subclassified with degenerative cognitive disease, 13 with vascular disease, and 42 had mixed cognitive disease. In all, 65 patients (60%) had a favorable outcome. In multivariable logistic regression analysis, lower age and lower medial temporal lobe atrophy (MTLA) grade on MRI at 12 months were independently associated with a favorable outcome, adjusted OR (95% CI), 0.94 (0.86-0.92), and 0.55 (0.35-0.85), respectively. CONCLUSIONS Sixty percent of stroke survivors have a favorable cognitive outcome. Lower age and lower MTLA grade on MRI were associated with favorable outcome.
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Affiliation(s)
- Guri Hagberg
- Department of Internal Medicine, Bærum Hospital, Vestre Viken Hospital Trust, Oslo, Norway, .,Institute of Clinical Medicine, University of Oslo, Oslo, Norway,
| | - Brynjar Fure
- Department of Internal Medicine, Karlstad Central Hospital and Institute of Public Health, University of Tromsoe, Tromsoe, Norway
| | - Bente Thommessen
- Department of Neurology, Akershus University Hospital, Akershus, Norway
| | - Håkon Ihle-Hansen
- Department of Internal Medicine, Bærum Hospital, Vestre Viken Hospital Trust, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Anne-Rita Øksengård
- Department of Internal Medicine, Bærum Hospital, Vestre Viken Hospital Trust, Oslo, Norway
| | - Ståle Nygård
- Bioinformatics Core Facility, Institute for Cancer Research, Oslo University Hospital and Department of Informatics, University of Oslo, Oslo, Norway
| | - Sarah T Pendlebury
- Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, NIHR Oxford Biomedical Research Centre, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
| | - Mona K Beyer
- Department of Radiology and Nuclear Medicine and Institute of Clinical Medicine, University of Oslo, Oslo University Hospital, Oslo, Norway
| | - Torgeir Bruun Wyller
- Department of Geriatric Medicine, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Hege Ihle-Hansen
- Department of Internal Medicine, Bærum Hospital, Vestre Viken Hospital Trust, Oslo, Norway.,Department of Geriatric Medicine, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Munthe-Kaas R, Aam S, Ihle-Hansen H, Lydersen S, Knapskog AB, Wyller TB, Fure B, Thingstad P, Askim T, Beyer MK, Næss H, Seljeseth YM, Ellekjær H, Pendlebury ST, Saltvedt I. Impact of different methods defining post-stroke neurocognitive disorder: The Nor-COAST study. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2020; 6:e12000. [PMID: 32211505 PMCID: PMC7085256 DOI: 10.1002/trc2.12000] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 01/23/2020] [Accepted: 01/29/2020] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Post-stroke neurocognitive disorder (NCD) is common; prevalence varies between studies, partially related to lack of consensus on how to identify cases. The aim was to compare the prevalence of post-stroke NCD using only cognitive assessment (model A), DSM-5 criteria (model B), and the Global Deterioration Scale (model C) and to determine agreement among the three models. METHODS In the Norwegian Cognitive Impairment After Stroke study, 599 patients were assessed 3 months after suffering a stroke. RESULTS The prevalence of mild NCD varied from 174 (29%) in model B to 83 (14%) in model C; prevalence of major NCD varied from 249 (42%) in model A to 68 (11%) in model C. Cohen's kappa and Cohen's quadratic weighted kappa showed fair to very good agreement among models; the poorest agreement was found for identification of mild NCD. DISCUSSION The findings indicate a need for international harmonization to classify post-stroke NCD.
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Affiliation(s)
- Ragnhild Munthe-Kaas
- Department of Medicine Vestre Viken Hospital Trust Bærum Hospital Drammen Norway
- Institute of Clinical Medicine University of Oslo Norway
| | - Stina Aam
- Department of Neuromedicine and Movement Science Faculty of Medicine and Health Science NTNU-Norwegian University of Science and Technology Trondheim Norway
- Department of Geriatric Medicine St. Olavs hospital Trondheim University Hospital Trondheim Norway
| | - Hege Ihle-Hansen
- Department of Medicine Vestre Viken Hospital Trust Bærum Hospital Drammen Norway
- Institute of Clinical Medicine University of Oslo Norway
- Department of Geriatric Medicine Oslo University Hospital Oslo Norway
| | - Stian Lydersen
- Department of Mental Health Faculty of Medicine and Health Science NTNU-Norwegian University of Science and Technology Trondheim Norway
| | | | - Torgeir Bruun Wyller
- Institute of Clinical Medicine University of Oslo Norway
- Department of Geriatric Medicine Oslo University Hospital Oslo Norway
| | - Brynjar Fure
- Department of Internal Medicine and Department of Neurology Central Hospital Karlstad Sweden and School of Medical Sciences Örebro University Sweden
| | - Pernille Thingstad
- Department of Neuromedicine and Movement Science Faculty of Medicine and Health Science NTNU-Norwegian University of Science and Technology Trondheim Norway
| | - Torunn Askim
- Department of Neuromedicine and Movement Science Faculty of Medicine and Health Science NTNU-Norwegian University of Science and Technology Trondheim Norway
| | - Mona K Beyer
- Institute of Clinical Medicine University of Oslo Norway
- Department of Radiology and Nuclear Medicine Oslo University Hospital Oslo Norway
| | - Halvor Næss
- Department of Neurology Haukeland University Hospital Bergen Norway
- Centre for Age-Related Medicine Stavanger University Hospital Stavanger Norway
- Institute of Clinical Medicine University of Bergen Bergen Norway
| | - Yngve M Seljeseth
- Medical Department Ålesund Hospital Møre and Romsdal Health Trust Ålesund Norway
| | - Hanne Ellekjær
- Department of Neuromedicine and Movement Science Faculty of Medicine and Health Science NTNU-Norwegian University of Science and Technology Trondheim Norway
- Stroke Unit Department of Internal Medicine St. Olavs hospital Trondheim University Hospital Trondheim Norway
| | - Sarah T Pendlebury
- Centre for Prevention of Stroke and Dementia Nuffield Department of Clinical Neurosciences University of Oxford Oxford UK
- Departments of Acute Internal Medicine and Gerontology John Radcliffe Hospital Oxford UK
| | - Ingvild Saltvedt
- Department of Neuromedicine and Movement Science Faculty of Medicine and Health Science NTNU-Norwegian University of Science and Technology Trondheim Norway
- Department of Geriatric Medicine St. Olavs hospital Trondheim University Hospital Trondheim Norway
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Liu H, Reynolds GP, Wei X. Uric Acid and High-Density Lipoprotein Cholesterol Are Differently Associated with Alzheimer’s Disease and Vascular Dementia. J Alzheimers Dis 2020; 73:1125-1131. [PMID: 31884488 DOI: 10.3233/jad-191111] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Hanxiang Liu
- Department of Neurology, Puer People’s Hospital, Puer, Yunnan, China
- Biomolecular Sciences Research Centre, Sheffield Hallam University, Sheffield, UK
| | - Gavin P. Reynolds
- Biomolecular Sciences Research Centre, Sheffield Hallam University, Sheffield, UK
| | - Xianwen Wei
- Department of Neurology, Puer People’s Hospital, Puer, Yunnan, China
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37
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Moulignier A, Costagliola D. Metabolic Syndrome and Cardiovascular Disease Impacts on the Pathophysiology and Phenotype of HIV-Associated Neurocognitive Disorders. Curr Top Behav Neurosci 2020; 50:367-399. [PMID: 31989463 DOI: 10.1007/7854_2019_123] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Evidence from epidemiological studies on the general population suggests that midlife cardiovascular disease (CVD) and/or metabolic syndrome (MetS) are associated with an increased risk of cognitive impairment and dementia later in life. In the modern combined antiretroviral therapy (cART) era, as in the general population, CVD and MetS were strongly and independently associated with poorer cognitive performances of sustained immunovirologically controlled persons living with human immunodeficiency viruses (PLHIVs). Those findings suggest that CV/metabolic comorbidities could be implicated in the pathogenesis of HIV-associated neurocognitive disorders (HAND) and might be more important than factors related to HIV infection or its treatment, markers of immunocompetence, or virus replication. The association between CVD/MetS and cognition decline is driven by still not well-understood mechanisms, but risk might well be the consequence of increased brain inflammation and vascular changes, notably cerebral small-vessel disease. In this review, we highlight the correspondences observed between the findings concerning CVD and MetS in the general population and virus-suppressed cART-treated PLHIVs to evaluate the real brain-aging processes. Indeed, incomplete HIV control mainly reflects HIV-induced brain damage described during the first decades of the pandemic. Given the growing support that CVD and MetS are associated with HAND, it is crucial to improve early detection and assure appropriate management of these conditions.
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Affiliation(s)
- Antoine Moulignier
- Department of Neurology, Memory Clinic, Fondation Adolphe de Rothschild, Paris, France.
| | - Dominique Costagliola
- INSERM, Sorbonne Université, Institut Pierre-Louis d'Epidémiologie et de Santé Publique (IPLESP), Paris, France.
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38
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Bogolepova AN. [Possibilities of neurotrophic therapy in early recovery after stroke]. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 119:84-89. [PMID: 31825367 DOI: 10.17116/jnevro201911908284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The high prevalence and disability of patients with ischemic stroke make the further development of the rehabilitation system relevant. The implementation of neuroplasticity mechanisms is largely provided by neurotrophic factors. One of the most well-known neurotrophic drugs is cerebrolysin, the efficacy of which in patients with stroke has been confirmed in many clinical studies. A recent meta-analysis included 9 randomized, double-blind, placebo-controlled clinical studies of using cerebrolysin in 1879 patients with hemispheric ischemic stroke, where it was administered at a dose of 30-50 ml for at least 1 week (10-21 days) and therapy was started during 72 hours after stroke. Cerebrolysin has been shown to give patients a 60% chance of better outcomes after a stroke, improves early recovery and increases the likelihood of better recovery.
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Affiliation(s)
- A N Bogolepova
- Pirogov Russian National Research Medical University, Moscow, Russia
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Rohde D, Gaynor E, Large M, Mellon L, Bennett K, Williams DJ, Brewer L, Hall P, Callaly E, Dolan E, Hickey A. Cognitive impairment and medication adherence post-stroke: A five-year follow-up of the ASPIRE-S cohort. PLoS One 2019; 14:e0223997. [PMID: 31622438 PMCID: PMC6797135 DOI: 10.1371/journal.pone.0223997] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Accepted: 10/02/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Control of vascular risk factors is essential for secondary stroke prevention. However, adherence to secondary prevention medications is often suboptimal, and may be affected by cognitive impairment. Few studies to date have examined associations between cognitive impairment and medication adherence post-stroke, and none have considered whether adherence to secondary prevention medications might affect subsequent cognitive function. The aim of this study was to explore prospective associations between cognitive impairment and medication non-adherence post-stroke. METHODS A five-year follow-up of 108 stroke survivors from the Action on Secondary Prevention Interventions and Rehabilitation in Stroke (ASPIRE-S) prospective observational cohort study. Cognitive function was assessed using the Montreal Cognitive Assessment at 6 months, and a neuropsychological test battery at 5 years. Adherence to antihypertensive, antithrombotic and lipid-lowering medications was assessed using prescription refill data. RESULTS The prevalence of cognitive impairment at five years was 35.6%. The prevalence of non-adherence ranged from 15.1% for lipid-lowering agents to 30.2% for antithrombotics. There were no statistically significant associations between medication non-adherence in the first year post-stroke and cognitive impairment at 5 years, nor between cognitive impairment at 6 months and non-adherence at 5 years. Stroke survivors with cognitive impairment were significantly more likely to report receiving help with taking medications [OR (95% CI): 4.84 (1.17, 20.07)]. CONCLUSIONS This is the first study to explore the potential impact of non-adherence to secondary prevention medications on cognitive impairment in stroke survivors. Findings highlight the role of family members and caregivers in assisting stroke survivors with medication administration, particularly in the context of deficits in cognitive function. Involving family members and caregivers may be a legitimate and cost-effective strategy to improve medication adherence in stroke survivors.
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Affiliation(s)
- Daniela Rohde
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
- * E-mail:
| | - Eva Gaynor
- Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Margaret Large
- Clinical Research Centre, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - Lisa Mellon
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Kathleen Bennett
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - David J. Williams
- Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland and Beaumont Hospital, Dublin, Ireland
| | - Linda Brewer
- Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland and Beaumont Hospital, Dublin, Ireland
| | - Patricia Hall
- Clinical Research Centre, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - Elizabeth Callaly
- Geriatric Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Eamon Dolan
- Geriatric Medicine, Connolly Hospital, Dublin, Ireland
| | - Anne Hickey
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
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40
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Puy L, Barbay M, Roussel M, Canaple S, Lamy C, Arnoux A, Leclercq C, Mas JL, Tasseel-Ponche S, Constans JM, Godefroy O. Neuroimaging Determinants of Poststroke Cognitive Performance. Stroke 2019; 49:2666-2673. [PMID: 30355190 DOI: 10.1161/strokeaha.118.021981] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- We aimed to define the neuroimaging determinants of poststroke cognitive performance and their relative contributions among a spectrum of magnetic resonance imaging markers, including lesion burden and strategic locations. Methods- We prospectively included patients with stroke from the GRECogVASC study (Groupe de Réflexion pour l'Évaluation Cognitive Vasculaire) who underwent 3-T magnetic resonance imaging and a comprehensive standardized battery of neuropsychological tests 6 months after the index event. An optimized global cognitive score and neuroimaging markers, including stroke characteristics, cerebral atrophy markers, and small vessel diseases markers, were assessed. Location of strategic strokes was determined using a specifically designed method taking into account stroke size and cerebral atrophy. A stepwise multivariable linear regression model was used to identify magnetic resonance imaging determinants of cognitive performance. Results- Data were available for 356 patients (mean age: 63.67±10.6 years; 326 [91.6%] of the patients had experienced an ischemic stroke). Six months poststroke, 50.8% of patients presented with a neurocognitive disorder. Strategic strokes (right corticospinal tract, left antero-middle thalamus, left arcuate fasciculus, left middle frontal gyrus, and left postero-inferior cerebellum; R2=0.225; P=0.0001), medial temporal lobe atrophy ( R2=0.077; P=0.0001), total brain tissue volume ( R2=0.028; P=0.004), and stroke volume ( R2=0.013; P=0.005) were independent determinants of cognitive performance. Strategic strokes accounted for the largest proportion of the variance in the cognitive score (22.5%). The white matter hyperintensity burden, brain microbleeds, and dilated perivascular spaces were not independent determinants. Conclusions- Optimized global cognitive score and combined approach of both quantitative measures related to structure loss and qualitative measures related to the presence of strategic lesion are required to improve the determination of structure-function relationship of cognitive performance after stroke.
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Affiliation(s)
- Laurent Puy
- From the Department of Neurology and Laboratory of Functional Neurosciences (L.P., M.B., M.R., S.C., C.L., A.A., C.L., O.G.), Amiens University Medical Center, France
| | - Mélanie Barbay
- From the Department of Neurology and Laboratory of Functional Neurosciences (L.P., M.B., M.R., S.C., C.L., A.A., C.L., O.G.), Amiens University Medical Center, France
| | - Martine Roussel
- From the Department of Neurology and Laboratory of Functional Neurosciences (L.P., M.B., M.R., S.C., C.L., A.A., C.L., O.G.), Amiens University Medical Center, France
| | - Sandrine Canaple
- From the Department of Neurology and Laboratory of Functional Neurosciences (L.P., M.B., M.R., S.C., C.L., A.A., C.L., O.G.), Amiens University Medical Center, France
| | - Chantal Lamy
- From the Department of Neurology and Laboratory of Functional Neurosciences (L.P., M.B., M.R., S.C., C.L., A.A., C.L., O.G.), Amiens University Medical Center, France
| | - Audrey Arnoux
- From the Department of Neurology and Laboratory of Functional Neurosciences (L.P., M.B., M.R., S.C., C.L., A.A., C.L., O.G.), Amiens University Medical Center, France
| | - Claire Leclercq
- From the Department of Neurology and Laboratory of Functional Neurosciences (L.P., M.B., M.R., S.C., C.L., A.A., C.L., O.G.), Amiens University Medical Center, France
| | - Jean-Louis Mas
- Department of Neurology, Sainte-Anne Hospital, INSERM 894, DHU NeuroVasc Sorbonne Paris-Cité, Paris Descartes University, France (J.-L.M.)
| | - Sophie Tasseel-Ponche
- PRM Department, CHU Amiens-Picardie, UPJV CURS LNFP EA 4559 (S.T.-P.), Amiens University Medical Center, France
| | - Jean-Marc Constans
- Department of Neuroimaging (J.-M.C.), Amiens University Medical Center, France
| | - Olivier Godefroy
- From the Department of Neurology and Laboratory of Functional Neurosciences (L.P., M.B., M.R., S.C., C.L., A.A., C.L., O.G.), Amiens University Medical Center, France
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Demeyere N, Sun S, Milosevich E, Vancleef K. Post-stroke cognition with the Oxford Cognitive Screen vs Montreal Cognitive Assessment: a multi-site randomized controlled study (OCS-CARE). ACTA ACUST UNITED AC 2019. [DOI: 10.12688/amrcopenres.12882.1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background: Cognitive impairment is common following stroke. The Oxford Cognitive Screen (OCS) was designed to assess focal post-stroke cognitive deficits in five domains. Here, we investigated whether results generated by the OCS vs the domain-general Montreal Cognitive Assessment (MoCA) at baseline impacted patient outcomes at 6 months follow-up. Methods: Patients <2 months post-stroke were randomized to receive either the OCS and corresponding information leaflet or standard care with the MoCA at baseline. After 6 months, patients received both the OCS and MoCA. The primary registered outcome measures were the Stroke Impact Scale (SIS) and change in stroke severity (National Institutes of Health Stroke Scale; NIHSS) at 6 months. The secondary outcome was change in cognitive performance from baseline to 6-month follow-up. The relationship between scores from the two cognitive screens at follow-up was also explored. Results: A total of 821 patients from 37 different hospital or rehabilitation sites (England, UK) were recruited to the OCS-CARE study, with 467 completing 6-month follow-up. Patient outcomes defined by overall SIS scores and changes in NIHSS did not differ between the OCS or MoCA groups. There were high accordance rates between the OCS and MoCA at 6 months, with severity of cognitive impairment reflected in both screening tools. Cognitive performance in both groups over the 6-month follow-up declined in 22% of patients. A larger proportion of OCS group patients demonstrated improvements in cognitive scores (49% vs 40% in MoCA). Conclusions: The type of cognitive screening test did not impact broad stroke outcome measures, and the two screening tools showed a high overall accordance. The results suggest that more of the domain-specific deficits in OCS recover subacutely, providing a more granular picture of cognitive recovery as well as decline. Registration: ISRCTN50857950; registered on 27/03/2014.
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Rationale and Design for the Remote Ischemic Preconditioning for Carotid Endarterectomy Trial. Ann Vasc Surg 2019; 60:246-253. [PMID: 31200043 DOI: 10.1016/j.avsg.2019.03.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 02/18/2019] [Accepted: 03/11/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND While the perioperative stroke rate after carotid endarterectomy (CEA) is low, "silent" microinfarctions identified by magnetic resonance imaging (MRI) are common and have been correlated with postoperative neurocognitive decline. Our study will investigate the role of remote ischemic preconditioning (RIPC) as a potential neuroprotective mechanism. RIPC is a well-tolerated stimulus that, through neuronal and humoral pathways, generates a systemic environment of greater resistance to subsequent ischemic insults. We hypothesized that patients undergoing RIPC before CEA will have improved postoperative neurocognitive scores compared with those of patients undergoing standard care. METHODS Patients undergoing CEA will be randomized 1:1 to RIPC or standard clinical care. Those randomized to RIPC will undergo a standard protocol of 4 cycles of RIPC. Each RIPC cycle will involve 5 min of forearm ischemia with 5 min of reperfusion. Forearm ischemia will be induced by a blood pressure cuff inflated to 200 mm Hg or at least 15 mm Hg higher than the systolic pressure if it is >185 mm Hg. This will occur after anesthesia induction and during incision/dissection but before manipulation or clamping of the carotid; thus, patients will be blinded to their assignment. Before carotid endarterectomy, all patients will undergo baseline neurocognitive testing in the form of a Montreal Cognitive Assessment (MoCA) and National Institutes of Health (NIH) Toolbox. MoCA testing only will be conducted on postoperative day 1 in the hospital. The full neurocognitive testing battery will again be conducted at 1-month follow-up in the office. Changes from baseline will be compared between arms at the follow-up time points. Assuming no drop-ins or dropouts and a 10% loss to follow-up, we would need a sample size of 43 patients for 80% power per treatment arm. The primary endpoint, change in MoCA scores, will be analyzed using a random effects model, and secondary outcomes will be analyzed using either linear or logistic regression where appropriate. CONCLUSIONS RIPC, if shown to be effective in protecting patients from neurocognitive decline after CEA, represents a safe, inexpensive, and easily implementable method of neuroprotection.
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Barbay M, Diouf M, Roussel M, Godefroy O. Systematic Review and Meta-Analysis of Prevalence in Post-Stroke Neurocognitive Disorders in Hospital-Based Studies. Dement Geriatr Cogn Disord 2019; 46:322-334. [PMID: 30504699 DOI: 10.1159/000492920] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 08/14/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Post-stroke neurocognitive disorders (post-stroke NCD) have been reported with a very variable prevalence. METHODS Based on a systematic literature search, hospital-based studies published between January 1990 and September 2015 were selected when they reported the prevalence of total, mild, and major post-stroke NCD diagnosed by using specified criteria. Factors affecting prevalence were assessed using meta-regression analysis. RESULTS Among the 7,440 references evaluated, 16 hospital-based studies were selected, corresponding to a total of 3,087 patients. The overall prevalence of total post-stroke NCD was 53.4% (95% CI: 46.9-59.8): 36.4% for mild post-stroke NCD (95% CI: 29-43.8) and 16.5% (95% CI: 12.1-20.8) for major post-stroke NCD. The overall prevalence was mainly influenced by the threshold score used for categorization (p = 0.0001) and, in the subgroup of studies using a conservative threshold (i.e., ≤7th percentile), by the recurrent stroke rate (p = 0.0005). The prevalence of major post-stroke NCD was mainly influenced by age (p = 0.003). CONCLUSION More than half of stroke survivors experience post-stroke NCD, corresponding to mild post-stroke NCD in two-thirds of cases and major post-stroke NCD in one-third of cases. Harmonization of stroke assessment and cognitive score thresholds is urgently needed to allow more accurate estimation of post-stroke NCD prevalence, especially mild post-stroke NCD.
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Affiliation(s)
- Mélanie Barbay
- Department of Neurology and Laboratory of Functional Neurosciences (EA 4559), Amiens University Hospital, Amiens, France,
| | - Momar Diouf
- Department of Biostatistics, Amiens University Hospital, Amiens, France
| | - Martine Roussel
- Department of Neurology and Laboratory of Functional Neurosciences (EA 4559), Amiens University Hospital, Amiens, France
| | - Olivier Godefroy
- Department of Neurology and Laboratory of Functional Neurosciences (EA 4559), Amiens University Hospital, Amiens, France
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Is VLSM a valid tool for determining the functional anatomy of the brain? Usefulness of additional Bayesian network analysis. Neuropsychologia 2018; 121:69-78. [DOI: 10.1016/j.neuropsychologia.2018.10.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 08/16/2018] [Accepted: 10/01/2018] [Indexed: 12/21/2022]
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Godefroy O, Yaïche H, Taillia H, Bompaire F, Nédélec-Ciceri C, Bonnin C, Varvat J, Vincent-Grangette F, Diouf M, Mas JL, Canaple S, Lamy C, Arnoux A, Leclercq C, Tasseel-Ponche S, Roussel M, Barbay M. Who should undergo a comprehensive cognitive assessment after a stroke? A cognitive risk score. Neurology 2018; 91:e1979-e1987. [PMID: 30333160 DOI: 10.1212/wnl.0000000000006544] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 08/13/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To validate the ability of a specifically developed cognitive risk score to identify patients at risk of poststroke neurocognitive disorders (NCDs) who are eligible for a comprehensive cognitive assessment. METHODS After assessing 404 patients (infarct 91.3%) in the Groupe de Réflexion pour l'Evaluation Cognitive VASCulaire (GRECogVASC) cross-sectional study with the National Institute of Neurological Disorders and Stroke-Canadian Stroke Network battery 6 months after stroke, we used multivariable logistic regression and bootstrap analyses to determine factors associated with NCDs. Independent, internally validated factors were included in a cognitive risk score. RESULTS Cognitive impairment was present in 170 of the 320 patients with a Rankin Scale score ≥1. The backward logistic regression selected 4 factors (≥73% of the permutations): NIH Stroke Scale score on admission ≥7 (odds ratio [OR] 2.73, 95% confidence interval [CI] 1.29-4.3, p = 0.005), multiple strokes (OR 3.78, 95% CI 1.6-8, p = 0.002), adjusted Mini-Mental State Examination (MMSEadj) score ≤27 (OR 6.69, 95% CI 3.9-11.6, p = 0.0001), and Fazekas score ≥2 (OR 2.34, 95% CI 1.3-4.2, p = 0.004). The cognitive risk score computed with these 4 factors provided good calibration, discrimination (overoptimism-corrected C = 0.793), and goodness of fit (Hosmer-Lemeshow test p = 0.99). A combination of Rankin Scale score ≥1, cognitive risk score ≥1, and MMSEadj score ≥21 selected 230 (56.9%) of the 404 patients for a comprehensive assessment. This procedure yielded good sensitivity (96.5%) and moderate specificity (43%; positive predictive value 0.66, negative predictive value 0.91) and was more accurate (p ≤ 0.03 for all) than the sole use of screening tests (MMSE or Montréal Cognitive Assessment). CONCLUSION The GRECogVASC cognitive risk score comprises 4 easily documented factors; this procedure helps to identify patients at risk of poststroke NCDs who must therefore undergo a comprehensive assessment. CLINICALTRIALSGOV IDENTIFIER NCT01339195.
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Affiliation(s)
- Olivier Godefroy
- From the Department of Neurology (O.G., H.Y., S.C., C.L., A.A., C.L., M.R., M.B.), Amiens University Hospital; Laboratory of Functional Neurosciences (O.G., H.Y., J.S.C., C.L., A.A., C.L., M.R., M.B.) (EA 4559), Department of Biostatistics (M.D.), and Department of Rehabilitation (S.T.-P.), Jules Verne University of Picardie, Amiens; Department of Neurology (H.T., F.B.), Val-de-Grâce Hospital, Paris; Department of Neurology (C.N.-C. C.B.), La Rochelle Hospital; Department of Neurology (J.V., F.V.-G.), Saint-Étienne University Hospital; and Department of Neurology (J.-L.M.), Saint Anne Hospital, Paris, France.
| | - Hugo Yaïche
- From the Department of Neurology (O.G., H.Y., S.C., C.L., A.A., C.L., M.R., M.B.), Amiens University Hospital; Laboratory of Functional Neurosciences (O.G., H.Y., J.S.C., C.L., A.A., C.L., M.R., M.B.) (EA 4559), Department of Biostatistics (M.D.), and Department of Rehabilitation (S.T.-P.), Jules Verne University of Picardie, Amiens; Department of Neurology (H.T., F.B.), Val-de-Grâce Hospital, Paris; Department of Neurology (C.N.-C. C.B.), La Rochelle Hospital; Department of Neurology (J.V., F.V.-G.), Saint-Étienne University Hospital; and Department of Neurology (J.-L.M.), Saint Anne Hospital, Paris, France
| | - Hervé Taillia
- From the Department of Neurology (O.G., H.Y., S.C., C.L., A.A., C.L., M.R., M.B.), Amiens University Hospital; Laboratory of Functional Neurosciences (O.G., H.Y., J.S.C., C.L., A.A., C.L., M.R., M.B.) (EA 4559), Department of Biostatistics (M.D.), and Department of Rehabilitation (S.T.-P.), Jules Verne University of Picardie, Amiens; Department of Neurology (H.T., F.B.), Val-de-Grâce Hospital, Paris; Department of Neurology (C.N.-C. C.B.), La Rochelle Hospital; Department of Neurology (J.V., F.V.-G.), Saint-Étienne University Hospital; and Department of Neurology (J.-L.M.), Saint Anne Hospital, Paris, France
| | - Flavie Bompaire
- From the Department of Neurology (O.G., H.Y., S.C., C.L., A.A., C.L., M.R., M.B.), Amiens University Hospital; Laboratory of Functional Neurosciences (O.G., H.Y., J.S.C., C.L., A.A., C.L., M.R., M.B.) (EA 4559), Department of Biostatistics (M.D.), and Department of Rehabilitation (S.T.-P.), Jules Verne University of Picardie, Amiens; Department of Neurology (H.T., F.B.), Val-de-Grâce Hospital, Paris; Department of Neurology (C.N.-C. C.B.), La Rochelle Hospital; Department of Neurology (J.V., F.V.-G.), Saint-Étienne University Hospital; and Department of Neurology (J.-L.M.), Saint Anne Hospital, Paris, France
| | - Claudine Nédélec-Ciceri
- From the Department of Neurology (O.G., H.Y., S.C., C.L., A.A., C.L., M.R., M.B.), Amiens University Hospital; Laboratory of Functional Neurosciences (O.G., H.Y., J.S.C., C.L., A.A., C.L., M.R., M.B.) (EA 4559), Department of Biostatistics (M.D.), and Department of Rehabilitation (S.T.-P.), Jules Verne University of Picardie, Amiens; Department of Neurology (H.T., F.B.), Val-de-Grâce Hospital, Paris; Department of Neurology (C.N.-C. C.B.), La Rochelle Hospital; Department of Neurology (J.V., F.V.-G.), Saint-Étienne University Hospital; and Department of Neurology (J.-L.M.), Saint Anne Hospital, Paris, France
| | - Camille Bonnin
- From the Department of Neurology (O.G., H.Y., S.C., C.L., A.A., C.L., M.R., M.B.), Amiens University Hospital; Laboratory of Functional Neurosciences (O.G., H.Y., J.S.C., C.L., A.A., C.L., M.R., M.B.) (EA 4559), Department of Biostatistics (M.D.), and Department of Rehabilitation (S.T.-P.), Jules Verne University of Picardie, Amiens; Department of Neurology (H.T., F.B.), Val-de-Grâce Hospital, Paris; Department of Neurology (C.N.-C. C.B.), La Rochelle Hospital; Department of Neurology (J.V., F.V.-G.), Saint-Étienne University Hospital; and Department of Neurology (J.-L.M.), Saint Anne Hospital, Paris, France
| | - Jérôme Varvat
- From the Department of Neurology (O.G., H.Y., S.C., C.L., A.A., C.L., M.R., M.B.), Amiens University Hospital; Laboratory of Functional Neurosciences (O.G., H.Y., J.S.C., C.L., A.A., C.L., M.R., M.B.) (EA 4559), Department of Biostatistics (M.D.), and Department of Rehabilitation (S.T.-P.), Jules Verne University of Picardie, Amiens; Department of Neurology (H.T., F.B.), Val-de-Grâce Hospital, Paris; Department of Neurology (C.N.-C. C.B.), La Rochelle Hospital; Department of Neurology (J.V., F.V.-G.), Saint-Étienne University Hospital; and Department of Neurology (J.-L.M.), Saint Anne Hospital, Paris, France
| | - Françoise Vincent-Grangette
- From the Department of Neurology (O.G., H.Y., S.C., C.L., A.A., C.L., M.R., M.B.), Amiens University Hospital; Laboratory of Functional Neurosciences (O.G., H.Y., J.S.C., C.L., A.A., C.L., M.R., M.B.) (EA 4559), Department of Biostatistics (M.D.), and Department of Rehabilitation (S.T.-P.), Jules Verne University of Picardie, Amiens; Department of Neurology (H.T., F.B.), Val-de-Grâce Hospital, Paris; Department of Neurology (C.N.-C. C.B.), La Rochelle Hospital; Department of Neurology (J.V., F.V.-G.), Saint-Étienne University Hospital; and Department of Neurology (J.-L.M.), Saint Anne Hospital, Paris, France
| | - Momar Diouf
- From the Department of Neurology (O.G., H.Y., S.C., C.L., A.A., C.L., M.R., M.B.), Amiens University Hospital; Laboratory of Functional Neurosciences (O.G., H.Y., J.S.C., C.L., A.A., C.L., M.R., M.B.) (EA 4559), Department of Biostatistics (M.D.), and Department of Rehabilitation (S.T.-P.), Jules Verne University of Picardie, Amiens; Department of Neurology (H.T., F.B.), Val-de-Grâce Hospital, Paris; Department of Neurology (C.N.-C. C.B.), La Rochelle Hospital; Department of Neurology (J.V., F.V.-G.), Saint-Étienne University Hospital; and Department of Neurology (J.-L.M.), Saint Anne Hospital, Paris, France
| | - Jean-Louis Mas
- From the Department of Neurology (O.G., H.Y., S.C., C.L., A.A., C.L., M.R., M.B.), Amiens University Hospital; Laboratory of Functional Neurosciences (O.G., H.Y., J.S.C., C.L., A.A., C.L., M.R., M.B.) (EA 4559), Department of Biostatistics (M.D.), and Department of Rehabilitation (S.T.-P.), Jules Verne University of Picardie, Amiens; Department of Neurology (H.T., F.B.), Val-de-Grâce Hospital, Paris; Department of Neurology (C.N.-C. C.B.), La Rochelle Hospital; Department of Neurology (J.V., F.V.-G.), Saint-Étienne University Hospital; and Department of Neurology (J.-L.M.), Saint Anne Hospital, Paris, France
| | - Sandrine Canaple
- From the Department of Neurology (O.G., H.Y., S.C., C.L., A.A., C.L., M.R., M.B.), Amiens University Hospital; Laboratory of Functional Neurosciences (O.G., H.Y., J.S.C., C.L., A.A., C.L., M.R., M.B.) (EA 4559), Department of Biostatistics (M.D.), and Department of Rehabilitation (S.T.-P.), Jules Verne University of Picardie, Amiens; Department of Neurology (H.T., F.B.), Val-de-Grâce Hospital, Paris; Department of Neurology (C.N.-C. C.B.), La Rochelle Hospital; Department of Neurology (J.V., F.V.-G.), Saint-Étienne University Hospital; and Department of Neurology (J.-L.M.), Saint Anne Hospital, Paris, France
| | - Chantal Lamy
- From the Department of Neurology (O.G., H.Y., S.C., C.L., A.A., C.L., M.R., M.B.), Amiens University Hospital; Laboratory of Functional Neurosciences (O.G., H.Y., J.S.C., C.L., A.A., C.L., M.R., M.B.) (EA 4559), Department of Biostatistics (M.D.), and Department of Rehabilitation (S.T.-P.), Jules Verne University of Picardie, Amiens; Department of Neurology (H.T., F.B.), Val-de-Grâce Hospital, Paris; Department of Neurology (C.N.-C. C.B.), La Rochelle Hospital; Department of Neurology (J.V., F.V.-G.), Saint-Étienne University Hospital; and Department of Neurology (J.-L.M.), Saint Anne Hospital, Paris, France
| | - Audrey Arnoux
- From the Department of Neurology (O.G., H.Y., S.C., C.L., A.A., C.L., M.R., M.B.), Amiens University Hospital; Laboratory of Functional Neurosciences (O.G., H.Y., J.S.C., C.L., A.A., C.L., M.R., M.B.) (EA 4559), Department of Biostatistics (M.D.), and Department of Rehabilitation (S.T.-P.), Jules Verne University of Picardie, Amiens; Department of Neurology (H.T., F.B.), Val-de-Grâce Hospital, Paris; Department of Neurology (C.N.-C. C.B.), La Rochelle Hospital; Department of Neurology (J.V., F.V.-G.), Saint-Étienne University Hospital; and Department of Neurology (J.-L.M.), Saint Anne Hospital, Paris, France
| | - Claire Leclercq
- From the Department of Neurology (O.G., H.Y., S.C., C.L., A.A., C.L., M.R., M.B.), Amiens University Hospital; Laboratory of Functional Neurosciences (O.G., H.Y., J.S.C., C.L., A.A., C.L., M.R., M.B.) (EA 4559), Department of Biostatistics (M.D.), and Department of Rehabilitation (S.T.-P.), Jules Verne University of Picardie, Amiens; Department of Neurology (H.T., F.B.), Val-de-Grâce Hospital, Paris; Department of Neurology (C.N.-C. C.B.), La Rochelle Hospital; Department of Neurology (J.V., F.V.-G.), Saint-Étienne University Hospital; and Department of Neurology (J.-L.M.), Saint Anne Hospital, Paris, France
| | - Sophie Tasseel-Ponche
- From the Department of Neurology (O.G., H.Y., S.C., C.L., A.A., C.L., M.R., M.B.), Amiens University Hospital; Laboratory of Functional Neurosciences (O.G., H.Y., J.S.C., C.L., A.A., C.L., M.R., M.B.) (EA 4559), Department of Biostatistics (M.D.), and Department of Rehabilitation (S.T.-P.), Jules Verne University of Picardie, Amiens; Department of Neurology (H.T., F.B.), Val-de-Grâce Hospital, Paris; Department of Neurology (C.N.-C. C.B.), La Rochelle Hospital; Department of Neurology (J.V., F.V.-G.), Saint-Étienne University Hospital; and Department of Neurology (J.-L.M.), Saint Anne Hospital, Paris, France
| | - Martine Roussel
- From the Department of Neurology (O.G., H.Y., S.C., C.L., A.A., C.L., M.R., M.B.), Amiens University Hospital; Laboratory of Functional Neurosciences (O.G., H.Y., J.S.C., C.L., A.A., C.L., M.R., M.B.) (EA 4559), Department of Biostatistics (M.D.), and Department of Rehabilitation (S.T.-P.), Jules Verne University of Picardie, Amiens; Department of Neurology (H.T., F.B.), Val-de-Grâce Hospital, Paris; Department of Neurology (C.N.-C. C.B.), La Rochelle Hospital; Department of Neurology (J.V., F.V.-G.), Saint-Étienne University Hospital; and Department of Neurology (J.-L.M.), Saint Anne Hospital, Paris, France
| | - Mélanie Barbay
- From the Department of Neurology (O.G., H.Y., S.C., C.L., A.A., C.L., M.R., M.B.), Amiens University Hospital; Laboratory of Functional Neurosciences (O.G., H.Y., J.S.C., C.L., A.A., C.L., M.R., M.B.) (EA 4559), Department of Biostatistics (M.D.), and Department of Rehabilitation (S.T.-P.), Jules Verne University of Picardie, Amiens; Department of Neurology (H.T., F.B.), Val-de-Grâce Hospital, Paris; Department of Neurology (C.N.-C. C.B.), La Rochelle Hospital; Department of Neurology (J.V., F.V.-G.), Saint-Étienne University Hospital; and Department of Neurology (J.-L.M.), Saint Anne Hospital, Paris, France
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