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Hervella P, Sampedro-Viana A, Fernández-Rodicio S, Rodríguez-Yáñez M, López-Dequidt I, Pumar JM, Mosqueira AJ, Bazarra-Barreiros M, Abengoza-Bello MT, Ortega-Espina S, Ouro A, Pérez-Mato M, Campos F, Sobrino T, Castillo J, Alonso-Alonso ML, Iglesias-Rey R. Precision Medicine for Blood Glutamate Grabbing in Ischemic Stroke. Int J Mol Sci 2024; 25:6554. [PMID: 38928260 PMCID: PMC11204254 DOI: 10.3390/ijms25126554] [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: 05/13/2024] [Revised: 06/01/2024] [Accepted: 06/09/2024] [Indexed: 06/28/2024] Open
Abstract
Glutamate grabbers, such as glutamate oxaloacetate transaminase (GOT), have been proposed to prevent excitotoxicity secondary to high glutamate levels in stroke patients. However, the efficacy of blood glutamate grabbing by GOT could be dependent on the extent and severity of the disruption of the blood-brain barrier (BBB). Our purpose was to analyze the relationship between GOT and glutamate concentration with the patient's functional status differentially according to BBB serum markers (soluble tumor necrosis factor-like weak inducer of apoptosis (sTWEAK) and leukoaraiosis based on neuroimaging). This retrospective observational study includes 906 ischemic stroke patients. We studied the presence of leukoaraiosis and the serum levels of glutamate, GOT, and sTWEAK in blood samples. Functional outcome was assessed using the modified Rankin Scale (mRS) at 3 months. A significant negative correlation between GOT and glutamate levels at admission was shown in those patients with sTWEAK levels > 2900 pg/mL (Pearson's correlation coefficient: -0.249; p < 0.0001). This correlation was also observed in patients with and without leukoaraiosis (Pearson's correlation coefficients: -0.299; p < 0.001 vs. -0.116; p = 0.024). The logistic regression model confirmed the association of higher levels of GOT with lower odds of poor outcome at 3 months when sTWEAK levels were >2900 pg/mL (OR: 0.41; CI 95%: 0.28-0.68; p < 0.0001) or with leukoaraiosis (OR: 0.75; CI 95%: 0.69-0.82; p < 0.0001). GOT levels are associated with glutamate levels and functional outcomes at 3 months, but only in those patients with leukoaraiosis and elevated sTWEAK levels. Consequently, therapies targeting glutamate grabbing might be more effective in patients with BBB dysfunction.
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Grants
- SAF2017-84267-R, PDC2021-121455-I00 Spanish Ministry of Science and Innovation
- IN607A2022-03, IN607A2022/07 Xunta de Galicia
- PI17/01103, PI22/00938, PI21/01256/, DTS23/00103, RD16/0019/0001, RD21/0006/0003, CB22/05/00067, CPII17/00027, CPII19/00020, CP22/00061, FI22/00200 Instituto de Salud Carlos III
- EAPA_791/2018_ NEUROATLANTIC, 0624_2IQBIONEURO_6_E INTERREG
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Affiliation(s)
- Pablo Hervella
- Neuroimaging and Biotechnology Laboratory (NOBEL), Clinical Neurosciences Research Laboratory (LINC), Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain; (P.H.); (A.S.-V.); (S.F.-R.); (J.M.P.); (A.J.M.); (M.B.-B.); (M.T.A.-B.); (S.O.-E.); (J.C.)
| | - Ana Sampedro-Viana
- Neuroimaging and Biotechnology Laboratory (NOBEL), Clinical Neurosciences Research Laboratory (LINC), Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain; (P.H.); (A.S.-V.); (S.F.-R.); (J.M.P.); (A.J.M.); (M.B.-B.); (M.T.A.-B.); (S.O.-E.); (J.C.)
| | - Sabela Fernández-Rodicio
- Neuroimaging and Biotechnology Laboratory (NOBEL), Clinical Neurosciences Research Laboratory (LINC), Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain; (P.H.); (A.S.-V.); (S.F.-R.); (J.M.P.); (A.J.M.); (M.B.-B.); (M.T.A.-B.); (S.O.-E.); (J.C.)
| | - Manuel Rodríguez-Yáñez
- Stroke Unit, Department of Neurology, Hospital Clínico Universitario, 15706 Santiago de Compostela, Spain;
| | - Iria López-Dequidt
- Department of Neurology, Hospital Clínico Universitario de Ferrol, 15405 Ferrol, Spain;
| | - José M. Pumar
- Neuroimaging and Biotechnology Laboratory (NOBEL), Clinical Neurosciences Research Laboratory (LINC), Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain; (P.H.); (A.S.-V.); (S.F.-R.); (J.M.P.); (A.J.M.); (M.B.-B.); (M.T.A.-B.); (S.O.-E.); (J.C.)
- Department of Neuroradiology, Hospital Clínico Universitario, Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain
| | - Antonio J. Mosqueira
- Neuroimaging and Biotechnology Laboratory (NOBEL), Clinical Neurosciences Research Laboratory (LINC), Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain; (P.H.); (A.S.-V.); (S.F.-R.); (J.M.P.); (A.J.M.); (M.B.-B.); (M.T.A.-B.); (S.O.-E.); (J.C.)
- Department of Neuroradiology, Hospital Clínico Universitario, Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain
| | - Marcos Bazarra-Barreiros
- Neuroimaging and Biotechnology Laboratory (NOBEL), Clinical Neurosciences Research Laboratory (LINC), Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain; (P.H.); (A.S.-V.); (S.F.-R.); (J.M.P.); (A.J.M.); (M.B.-B.); (M.T.A.-B.); (S.O.-E.); (J.C.)
| | - María Teresa Abengoza-Bello
- Neuroimaging and Biotechnology Laboratory (NOBEL), Clinical Neurosciences Research Laboratory (LINC), Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain; (P.H.); (A.S.-V.); (S.F.-R.); (J.M.P.); (A.J.M.); (M.B.-B.); (M.T.A.-B.); (S.O.-E.); (J.C.)
| | - Sara Ortega-Espina
- Neuroimaging and Biotechnology Laboratory (NOBEL), Clinical Neurosciences Research Laboratory (LINC), Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain; (P.H.); (A.S.-V.); (S.F.-R.); (J.M.P.); (A.J.M.); (M.B.-B.); (M.T.A.-B.); (S.O.-E.); (J.C.)
| | - Alberto Ouro
- NeuroAging Group (NEURAL), Clinical Neurosciences Research Laboratory (LINC), Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain; (A.O.); (T.S.)
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - María Pérez-Mato
- Translational Stroke Laboratory (TREAT), Clinical Neurosciences Research Laboratory (LINC), Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain; (M.P.-M.); (F.C.)
| | - Francisco Campos
- Translational Stroke Laboratory (TREAT), Clinical Neurosciences Research Laboratory (LINC), Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain; (M.P.-M.); (F.C.)
| | - Tomás Sobrino
- NeuroAging Group (NEURAL), Clinical Neurosciences Research Laboratory (LINC), Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain; (A.O.); (T.S.)
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - José Castillo
- Neuroimaging and Biotechnology Laboratory (NOBEL), Clinical Neurosciences Research Laboratory (LINC), Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain; (P.H.); (A.S.-V.); (S.F.-R.); (J.M.P.); (A.J.M.); (M.B.-B.); (M.T.A.-B.); (S.O.-E.); (J.C.)
| | - Maria Luz Alonso-Alonso
- Neuroimaging and Biotechnology Laboratory (NOBEL), Clinical Neurosciences Research Laboratory (LINC), Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain; (P.H.); (A.S.-V.); (S.F.-R.); (J.M.P.); (A.J.M.); (M.B.-B.); (M.T.A.-B.); (S.O.-E.); (J.C.)
| | - Ramón Iglesias-Rey
- Neuroimaging and Biotechnology Laboratory (NOBEL), Clinical Neurosciences Research Laboratory (LINC), Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain; (P.H.); (A.S.-V.); (S.F.-R.); (J.M.P.); (A.J.M.); (M.B.-B.); (M.T.A.-B.); (S.O.-E.); (J.C.)
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Schmidt J, Düvel JA, Elkenkamp S, Greiner W. Comparing the EQ-5D-5L and stroke impact scale 2.0 in stroke patients: an analysis of measurement properties. Health Qual Life Outcomes 2024; 22:45. [PMID: 38835023 DOI: 10.1186/s12955-024-02252-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 04/20/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND Stroke has evolved to become a chronic disease and a major public health challenge. To adequately capture the full disease burden of stroke patients, the assessment of health-related quality of life (HRQoL) and thus the performance of respective measures is increasingly relevant. The aim of this analysis was to compare the measurement properties of two self-report instruments, the EQ-5D-5L and the Stroke Impact Scale 2.0. METHODS The data used for the analysis was derived from a quasi-experimental case management study for mildly to moderately affected incident stroke and transient ischemic attack (TIA) patients aged ≥ 18 in Germany. Data was collected patient-individually at 3, 6 and 12 months after initial stroke. The EQ-5D-5L and SIS 2.0 were compared in terms of feasibility, ceiling and floor effects, responsiveness and known-groups validity (Kruskal-Wallis H and Wilcoxon rank-sum test). RESULTS A response for all three follow-ups is available for n = 855 patients. The feasibility of the EQ-5D-5L is determined as good (completion rate: 96.4-96.6%, ≥ one item missing: 3.2 - 3.3%), whereas the SIS 2.0 is moderately feasible (overall completion rate: 44.9-46.1%, ≥ one item missing in domains: 4.7 - 28.7%). The SIS 2.0 shows substantial ceiling effects in comparable domains (physical function: 10.4 - 13%, others: 3.5-31.3%) which are mainly larger than ceiling effects in the EQ-5D-5L index (17.1-21.5%). In terms of responsiveness, the EQ-5D-5L shows small to moderate change while the SIS 2.0 presents with moderate to large responsiveness. The EQ-5D-5L index, mobility, usual activities and Visual Analogue Scale show known-groups validity (p < 0.05). Content-related domains of the SIS 2.0 show known-groups validity as well (p < 0.05). However, it is compromised in the emotion domain in both measures (p > 0.05). CONCLUSIONS The EQ-5D-5L seems to be slightly more suitable for this cohort. Nonetheless, the results of both measures indicate limited suitability for TIA patients. Large-scale studies concerning responsiveness and known-groups validity are encouraged. TRIAL REGISTRATION The study was registered in the German Clinical Trials Register, retrospective registration on 21.09.2022. REGISTRATION ID DRKS00030297.
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Affiliation(s)
- Juliana Schmidt
- Department of Health Economics and Health Care Management, School of Public Health, Bielefeld University, Bielefeld, Germany.
| | - Juliane Andrea Düvel
- Department of Health Economics and Health Care Management, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Svenja Elkenkamp
- Department of Health Economics and Health Care Management, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Wolfgang Greiner
- Department of Health Economics and Health Care Management, School of Public Health, Bielefeld University, Bielefeld, Germany
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Hervella P, Sampedro-Viana A, Rodríguez-Yáñez M, López-Dequidt I, Pumar JM, Mosqueira AJ, Fernández-Rodicio S, Bazarra-Barreiros M, Serena J, Silva-Blas Y, Gubern-Merida C, Rey-Aldana D, Cinza S, Campos F, Sobrino T, Castillo J, Alonso-Alonso ML, Iglesias-Rey R. Systemic biomarker associated with poor outcome after futile reperfusion. Eur J Clin Invest 2024; 54:e14181. [PMID: 38361320 DOI: 10.1111/eci.14181] [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: 09/12/2023] [Revised: 02/06/2024] [Accepted: 02/06/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Successful recanalization does not lead to complete tissue reperfusion in a considerable percentage of ischemic stroke patients. This study aimed to identify biomarkers associated with futile recanalization. Leukoaraiosis predicts poor outcomes of this phenomenon. Soluble tumour necrosis factor-like weak inducer of apoptosis (sTWEAK), which is associated with leukoaraiosis degrees, could be a potential biomarker. METHODS This study includes two cohorts of ischemic stroke patients in a multicentre retrospective observational study. Effective reperfusion, defined as a reduction of ≥8 points in the National Institutes of Health Stroke Scale (NIHSS) within the first 24 h, was used as a clinical marker of effective reperfusion. RESULTS In the first cohort study, female sex, age, and high NIHSS at admission (44.7% vs. 81.1%, 71.3 ± 13.7 vs. 81.1 ± 6.7; 16 [13, 21] vs. 23 [17, 28] respectively; p < .0001) were confirmed as predictors of futile recanalization. ROC curve analysis showed that leukocyte levels (sensitivity of 99%, specificity of 55%) and sTWEAK level (sensitivity of 92%, specificity of 88%) can discriminate between poor and good outcomes. Both biomarkers simultaneously are higher associated with outcome after effective reperfusion (OR: 2.17; CI 95% 1.63-4.19; p < .0001) than individually (leukocytes OR: 1.38; CI 95% 1.00-1.64, p = .042; sTWEAK OR: 1.00; C I95% 1.00-1.01, p = .019). These results were validated using a second cohort, where leukocytes and sTWEAK showed a sensitivity of 100% and specificity of 66.7% and 75% respectively. CONCLUSIONS Leukocyte and sTWEAK could be biomarkers of reperfusion failure and subsequent poor outcomes. Further studies will be necessary to explore its role in reperfusion processes.
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Affiliation(s)
- Pablo Hervella
- Neuroimaging and Biotechnology Laboratory (NOBEL), Clinical Neurosciences Research Laboratory (LINC), Health Research Institute of Santiago de Compostela (IDIS), A Coruña, Spain
| | - Ana Sampedro-Viana
- Neuroimaging and Biotechnology Laboratory (NOBEL), Clinical Neurosciences Research Laboratory (LINC), Health Research Institute of Santiago de Compostela (IDIS), A Coruña, Spain
| | | | - Iria López-Dequidt
- Stroke Unit, Department of Neurology, Hospital Clínico Universitario, A Coruña, Spain
| | - José M Pumar
- Neuroimaging and Biotechnology Laboratory (NOBEL), Clinical Neurosciences Research Laboratory (LINC), Health Research Institute of Santiago de Compostela (IDIS), A Coruña, Spain
- Department of Neuroradiology, Hospital Clínico Universitario, Health Research Institute of Santiago de Compostela (IDIS), A Coruña, Spain
| | - Antonio J Mosqueira
- Neuroimaging and Biotechnology Laboratory (NOBEL), Clinical Neurosciences Research Laboratory (LINC), Health Research Institute of Santiago de Compostela (IDIS), A Coruña, Spain
- Department of Neuroradiology, Hospital Clínico Universitario, Health Research Institute of Santiago de Compostela (IDIS), A Coruña, Spain
| | - Sabela Fernández-Rodicio
- Neuroimaging and Biotechnology Laboratory (NOBEL), Clinical Neurosciences Research Laboratory (LINC), Health Research Institute of Santiago de Compostela (IDIS), A Coruña, Spain
| | - Marcos Bazarra-Barreiros
- Neuroimaging and Biotechnology Laboratory (NOBEL), Clinical Neurosciences Research Laboratory (LINC), Health Research Institute of Santiago de Compostela (IDIS), A Coruña, Spain
| | - Joaquín Serena
- Cerebrovascular Pathology Research Group, Stroke Unit, Department of Neurology, Hospital Universitari Dr. Josep Trueta de Girona, Girona Biomedical Research Institute (IDIBGI), Girona, Spain
| | - Yolanda Silva-Blas
- Cerebrovascular Pathology Research Group, Stroke Unit, Department of Neurology, Hospital Universitari Dr. Josep Trueta de Girona, Girona Biomedical Research Institute (IDIBGI), Girona, Spain
| | - Carme Gubern-Merida
- Cerebrovascular Pathology Research Group, Girona Biomedical Research Institute (IDIBGI), Parc Hospitalari Martí I Julià, Salt, Spain
| | - Daniel Rey-Aldana
- Centro de Salud de A Estrada, Area Sanitaria de Santiago de Compostela, A Estrada, Spain
| | - Sergio Cinza
- Centro de Saúde O Milladoiro, Santiago de Compostela, Spain
| | - Francisco Campos
- Translational Stroke Laboratory (TREAT), Clinical Neurosciences Research Laboratory (LINC), Health Research Institute of Santiago de Compostela (IDIS), A Coruña, Spain
| | - Tomás Sobrino
- NeuroAging Laboratory Group (NEURAL), Clinical Neurosciences Research Laboratory (LINC), Health Research Institute of Santiago de Compostela (IDIS), A Coruña, Spain
| | - José Castillo
- Neuroimaging and Biotechnology Laboratory (NOBEL), Clinical Neurosciences Research Laboratory (LINC), Health Research Institute of Santiago de Compostela (IDIS), A Coruña, Spain
| | - Maria Luz Alonso-Alonso
- Neuroimaging and Biotechnology Laboratory (NOBEL), Clinical Neurosciences Research Laboratory (LINC), Health Research Institute of Santiago de Compostela (IDIS), A Coruña, Spain
| | - Ramón Iglesias-Rey
- Neuroimaging and Biotechnology Laboratory (NOBEL), Clinical Neurosciences Research Laboratory (LINC), Health Research Institute of Santiago de Compostela (IDIS), A Coruña, Spain
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Braga MAF, Faria-Fortini I, Soares CLDA, Rodrigues NAG, Sant Anna RV, Faria CDCDM. Acute clinical outcomes predict both generic and specific health-related quality of life six and 12 months after stroke: A one-year prospective study developed in a middle-income country. J Stroke Cerebrovasc Dis 2024; 33:107777. [PMID: 38795794 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107777] [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: 10/20/2023] [Revised: 01/30/2024] [Accepted: 05/16/2024] [Indexed: 05/28/2024] Open
Abstract
OBJECTIVE To identify acute predictors of generic and specific health-related quality of life (HRQoL) six and 12 months after stroke in individuals from a middle-income country. MATERIAL AND METHODS This was a prospective study. The dependent outcomes assessed during six and 12 months after stroke included both generic and specific HRQoL (Short Form Health Survey-36 [SF-36] and stroke-specific quality of life [SSQOL]). The predictors were age, sex, education level, length of hospital stay, current living arrangement, stroke severity, functional independence, and motor impairment. RESULTS 122 (59.9±14 years) and 103 (59.8±14.71 years) individuals were evaluated six and 12 months after stroke, respectively. Functional independence and sex were significant acute predictors of both generic and specific HRQoL. Functional independence was the strongest predictor (0.149≤R2≤0.262; 20.01≤F≤43.96, p<0.001), except for generic HRQoL at 12 months, where sex was the strongest predictor (R2=0.14; F=17.97, p<0.001). CONCLUSION Generic and specific HRQoL in chronic individuals six and 12 months after stroke, from a middle-income country, can be predicted based on functional independence, the strongest predictor, assessed in the acute phase, except for generic HRQoL at 12 months. Functional independence can be modified by rehabilitation strategies and thus should be considered for HRQoL prognoses at chronic phase.
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Affiliation(s)
- Marcela Aline Fernandes Braga
- Graduate Program in Rehabilitation Sciences of the Universidade Federal de Minas Gerais, (UFMG), Belo Horizonte, (MG), Brazil
| | - Iza Faria-Fortini
- Department of Occupational Therapy, Universidade Federal de Minas Gerais, (UFMG), Belo Horizonte, (MG), Brazil; Graduate Program in Occupation Studies of the Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, (MG), Brazil
| | - Carolina Luísa de Almeida Soares
- Graduate Program in Rehabilitation Sciences of the Universidade Federal de Minas Gerais, (UFMG), Belo Horizonte, (MG), Brazil; Physiotherapy graduation in Universidade Federal de Minas Gerais, (UFMG), Belo Horizonte, (MG), Brazil
| | | | - Romeu Vale Sant Anna
- Neurologist, coordinator of the stroke unit at the public hospital Risoleta Tolentino Neves, Belo Horizonte, (MG), Brazil
| | - Christina Danielli Coelho de Morais Faria
- Graduate Program in Rehabilitation Sciences of the Universidade Federal de Minas Gerais, (UFMG), Belo Horizonte, (MG), Brazil; Department of Physical Therapy, Universidade Federal de Minas Gerais, (UFMG), Belo Horizonte, (MG), Brazil.
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5
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Suñer-Soler R, Maldonado E, Rodrigo-Gil J, Font-Mayolas S, Gras ME, Terceño M, Silva Y, Serena J, Grau-Martín A. Sex-Related Differences in Post-Stroke Anxiety, Depression and Quality of Life in a Cohort of Smokers. Brain Sci 2024; 14:521. [PMID: 38928522 PMCID: PMC11201541 DOI: 10.3390/brainsci14060521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 05/10/2024] [Accepted: 05/16/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND We aimed to study anxiety, depression and quality of life in smokers after stroke by sex. METHODS A longitudinal prospective study with a 24-month follow-up of acute stroke patients who were previously active smokers. Anxiety and depression were evaluated with the Hospital Anxiety and Depression scale, and quality of life was evaluated with the EQ-5D questionnaire. RESULTS One hundred and eighty patients participated (79.4% men); their mean age was 57.6 years. Anxiety was most prevalent at 3 months (18.9% in men and 40.5% in women) and depression at 12 months (17.9% in men and 27% in women). The worst perceived health occurred at 24 months (EQ-VAS 67.5 in men and 65.1 in women), which was associated with depression (p < 0.001) and Rankin Scale was worse in men (p < 0.001) and depression in women (p < 0.001). Continued tobacco use was associated with worse perceived health at 3 months in men (p = 0.034) and at 12 months in both sexes. Predictor variables of worse perceived health at 24 months remaining at 3 and 12 months were tobacco use in men and neurological damage in women. CONCLUSION Differences by sex are observed in the prevalence of anxiety and depression and associated factors and in the predictive factors of perceived health.
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Affiliation(s)
- Rosa Suñer-Soler
- Research Group Health and Health Care, Nursing Department, University of Girona, 17003 Girona, Spain
| | | | - Joana Rodrigo-Gil
- Department of Neurology, Dr. Josep Trueta University Hospital, 17007 Girona, Spain; (J.R.-G.); (M.T.); (Y.S.); (J.S.)
| | - Silvia Font-Mayolas
- Quality of Life Research Institute, University of Girona, 17003 Girona, Spain; (S.F.-M.); (M.E.G.)
| | - Maria Eugenia Gras
- Quality of Life Research Institute, University of Girona, 17003 Girona, Spain; (S.F.-M.); (M.E.G.)
| | - Mikel Terceño
- Department of Neurology, Dr. Josep Trueta University Hospital, 17007 Girona, Spain; (J.R.-G.); (M.T.); (Y.S.); (J.S.)
| | - Yolanda Silva
- Department of Neurology, Dr. Josep Trueta University Hospital, 17007 Girona, Spain; (J.R.-G.); (M.T.); (Y.S.); (J.S.)
| | - Joaquín Serena
- Department of Neurology, Dr. Josep Trueta University Hospital, 17007 Girona, Spain; (J.R.-G.); (M.T.); (Y.S.); (J.S.)
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Protzmann J, Jung F, Jakobsson L, Fredriksson L. Analysis of ischemic stroke-mediated effects on blood-brain barrier properties along the arteriovenous axis assessed by intravital two-photon imaging. Fluids Barriers CNS 2024; 21:35. [PMID: 38622710 PMCID: PMC11017501 DOI: 10.1186/s12987-024-00537-5] [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: 11/08/2023] [Accepted: 04/03/2024] [Indexed: 04/17/2024] Open
Abstract
Early breach of the blood-brain barrier (BBB) and consequently extravasation of blood-borne substances into the brain parenchyma is a common hallmark of ischemic stroke. Although BBB breakdown is associated with an increased risk of cerebral hemorrhage and poor clinical prognosis, the cause and mechanism of this process are largely unknown. The aim of this study was to establish an imaging and analysis protocol which enables investigation of the dynamics of BBB breach in relation to hemodynamic properties along the arteriovenous axis. Using longitudinal intravital two-photon imaging following photothrombotic induction of ischemic stroke through a cranial window, we were able to study the response of the cerebral vasculature to ischemia, from the early critical hours to the days/weeks after the infarct. We demonstrate that disruption of the BBB and hemodynamic parameters, including perturbed blood flow, can be studied at single-vessel resolution in the three-dimensional space as early as 30 min after vessel occlusion. Further, we show that this protocol permits longitudinal studies on the response of individual blood vessels to ischemia over time, thus enabling detection of (maladaptive) vascular remodeling such as intussusception, angiogenic sprouting and entanglement of vessel networks. Taken together, this in vivo two-photon imaging and analysis protocol will be useful in future studies investigating the molecular and cellular mechanisms, and the spatial contribution, of BBB breach to disease progression which might ultimately aid the development of new and more precise treatment strategies for ischemic stroke.
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Affiliation(s)
- Jil Protzmann
- Department of Medical Biochemistry and Biophysics, Division of Vascular Biology, Karolinska Institutet, Solnavägen 9, Stockholm, Sweden, 17165
| | - Felix Jung
- Department of Neuroscience , Karolinska Institutet, Solnavägen 9, Stockholm, Sweden, 17165
| | - Lars Jakobsson
- Department of Medical Biochemistry and Biophysics, Division of Vascular Biology, Karolinska Institutet, Solnavägen 9, Stockholm, Sweden, 17165
| | - Linda Fredriksson
- Department of Medical Biochemistry and Biophysics, Division of Vascular Biology, Karolinska Institutet, Solnavägen 9, Stockholm, Sweden, 17165.
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Song YY, Sun WJ, Wang C, Tian YM, Liu H, Jiang Y. Effects of multicomponent exercise on quality of life, depression and anxiety among stroke survivors: A systematic review and meta-analysis. J Clin Nurs 2023; 32:7677-7690. [PMID: 37727891 DOI: 10.1111/jocn.16853] [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: 04/17/2023] [Revised: 08/02/2023] [Accepted: 08/04/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Current guidelines stress the importance of exercise, especially multicomponent exercise to older adults with chronic conditions. AIM To critically synthesise evidence that evaluates the effects of multicomponent exercise on quality of life, depression and anxiety after stroke. DESIGN Systematic review and meta-analysis followed the PRISMA 2020 statement. METHODS A systematic search of PubMed, Embase, Web of Science, Cochrane Library, CINAHL and PsycINFO from inception to 12 June 2023 was performed. Risk of bias was assessed using the Revised Cochrane risk-of-bias tool for randomised trials (RoB 2). Meta-analyses were conducted using Review Manager 5.4 and narrative syntheses were adopted whenever meta-analysis was inappropriate. The overall certainty of the evidence was rated using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. RESULTS Of 15,351 records identified, nine were eligible and data were available for seven randomised controlled trials, three of which were identified as having a high risk of bias, one as low risk, and five as having some concerns. Subgroup pooled analyses indicated that multicomponent exercise engaged in longer exercise sessions (>60 min) was effective in improving quality of life immediately post-intervention and through 3-6 months post-intervention. However, multicomponent exercise did not significantly affect depression and anxiety. CONCLUSIONS Multicomponent exercise with longer duration of exercise sessions has promising effects on both short- to medium-term quality of life among stroke survivors. PATIENT OR PUBLIC CONTRIBUTION This does not apply to our work as it is a review paper. RELEVANCE TO CLINICAL PRACTICE Healthcare providers could consider encouraging the patients to participate in multicomponent exercise sessions for more than 60 min. It is important to note that stroke survivors should be supervised by trained personnel at the beginning of the training. REGISTRATION The protocol was registered on PROSPERO.
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Affiliation(s)
- Yuan-Yuan Song
- Department of Critical Care Medicine, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
- Evidence-based Nursing Center, West China Hospital, Sichuan University, Chengdu, China
| | - Wen-Jing Sun
- Department of Neurosurgery, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Cong Wang
- Evidence-based Nursing Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yong-Ming Tian
- Department of Critical Care Medicine, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Huan Liu
- Department of Critical Care Medicine, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Yan Jiang
- Evidence-based Nursing Center, West China Hospital, Sichuan University, Chengdu, China
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Mota DMS, Moraes ÍAP, Papa DCR, Fernani DCGL, Almeida CS, Tezza MHS, Dantas MTAP, Fernandes SMS, Ré AHN, Silva TD, Monteiro CBM. Bilateral Transfer of Performance between Real and Non-Immersive Virtual Environments in Post-Stroke Individuals: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3301. [PMID: 36834000 PMCID: PMC9963577 DOI: 10.3390/ijerph20043301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/07/2023] [Accepted: 02/10/2023] [Indexed: 06/18/2023]
Abstract
(1) Background: Post-stroke presents motor function deficits, and one interesting possibility for practicing skills is the concept of bilateral transfer. Additionally, there is evidence that the use of virtual reality is beneficial in improving upper limb function. We aimed to evaluate the transfer of motor performance of post-stroke and control groups in two different environments (real and virtual), as well as bilateral transfer, by changing the practice between paretic and non-paretic upper limbs. (2) Methods: We used a coincident timing task with a virtual (Kinect) or a real device (touch screen) in post-stroke and control groups; both groups practiced with bilateral transference. (3) Results: Were included 136 participants, 82 post-stroke and 54 controls. The control group presented better performance during most parts of the protocol; however, it was more evident when compared with the post-stroke paretic upper limb. We found bilateral transference mainly in Practice 2, with the paretic upper limb using the real interface method (touch screen), but only after Practice 1 with the virtual interface (Kinect), using the non-paretic upper limb. (4) Conclusions: The task with the greatest motor and cognitive demand (virtual-Kinect) provided transfer into the real interface, and bilateral transfer was observed in individuals post-stroke. However, this is more strongly observed when the virtual task was performed using the non-paretic upper limb first.
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Affiliation(s)
- Deise M. S. Mota
- Physical Activity Sciences, School of Arts, Science and Humanities, University of São Paulo (EACH-USP), São Paulo 03828-000, Brazil
| | - Íbis A. P. Moraes
- Rehabilitation Sciences, Faculty of Medicine, University of São Paulo (FMUSP), São Paulo 01246-903, Brazil
- Faculty of Medicine, University City of Sao Paulo (UNICID), São Paulo 03071-000, Brazil
| | - Denise C. R. Papa
- Medicine (Cardiology) at Escola Paulista de Medicina, Federal University of São Paulo (EPM/UNIFESP), São Paulo 04021-001, Brazil
| | - Deborah C. G. L. Fernani
- Department of Physiotherapy, Universidade do Oeste Paulista (UNOESTE), Presidente Prudente 19050-920, Brazil
| | - Caroline S. Almeida
- Department of Physiotherapy, University of Medical Sciences of Santa Casa of São Paulo, São Paulo 01224-001, Brazil
| | - Maria H. S. Tezza
- Physical Activity Sciences, School of Arts, Science and Humanities, University of São Paulo (EACH-USP), São Paulo 03828-000, Brazil
| | - Maria T. A. P. Dantas
- Department of Physiotherapy, Universidade do Oeste Paulista (UNOESTE), Presidente Prudente 19050-920, Brazil
| | - Susi M. S. Fernandes
- Department of Physiotherapy, Mackenzie Presbyterian University (UPM), São Paulo 01302-907, Brazil
| | - Alessandro H. N. Ré
- Physical Activity Sciences, School of Arts, Science and Humanities, University of São Paulo (EACH-USP), São Paulo 03828-000, Brazil
| | - Talita D. Silva
- Rehabilitation Sciences, Faculty of Medicine, University of São Paulo (FMUSP), São Paulo 01246-903, Brazil
- Faculty of Medicine, University City of Sao Paulo (UNICID), São Paulo 03071-000, Brazil
- Medicine (Cardiology) at Escola Paulista de Medicina, Federal University of São Paulo (EPM/UNIFESP), São Paulo 04021-001, Brazil
| | - Carlos B. M. Monteiro
- Physical Activity Sciences, School of Arts, Science and Humanities, University of São Paulo (EACH-USP), São Paulo 03828-000, Brazil
- Rehabilitation Sciences, Faculty of Medicine, University of São Paulo (FMUSP), São Paulo 01246-903, Brazil
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9
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Physical function, depressive symptoms, and quality of life with post-acute stroke care. Collegian 2023. [DOI: 10.1016/j.colegn.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
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10
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Predicting Independence 6 and 18 Months after Ischemic Stroke Considering Differences in 12 Countries: A Secondary Analysis of the IST-3 Trial. Stroke Res Treat 2021; 2021:5627868. [PMID: 34373778 PMCID: PMC8349276 DOI: 10.1155/2021/5627868] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 07/11/2021] [Indexed: 11/17/2022] Open
Abstract
Objectives This study is aimed at identifying the best clinical model to predict poststroke independence at 6 and 18 months, considering sociodemographic and clinical characteristics, and then identifying differences between countries. Methods Data was retrieved from the International Stroke Trial 3 study. Nine clinical variables (age, gender, severity, rt-PA, living alone, atrial fibrillation, history of transient ischemic attack/stroke, and abilities to lift arms and walk) were measured immediately after the stroke and considered to predict independence at 6 and 18 months poststroke. Independence was measured using the Oxford Handicap Scale. The adequacy, predictive capacity, and discriminative capacity of the models were checked. Countries were added to the final models. Results At 6 months poststroke, 35.8% (n = 1088) of participants were independent, and at 18 months, this proportion decreased to 29.9% (n = 747). Both 6 and 18 months poststroke predictive models obtained fair discriminatory capacities. Gender, living alone, and rt-PA only reached predictive significance at 18 months. Poststroke patients from Poland and Sweden showed greater chances to achieve independence at 6 months compared to the UK. Poland also achieved greater chances at 18 months. Italy had worse chances than the UK at both follow-ups. Discussion. Six and eight variables predicted poststroke independence at 6 and 18 months, respectively. Some variables only reached significance at 18 months, suggesting a late influence in stroke patients' rehabilitation. Differences found between countries in achieving independence may be related to healthcare system organization or cultural characteristics, a hypothesis that must be addressed in future studies. These results can allow the development of tailored interventions to improve the outcomes.
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Nababan T, Phillips TJ, Hankey GJ, Crockett MT, Chiu AHY, Singh TP, Blacker D, McAuliffe W. Mechanical thrombectomy is efficacious in patients with pre-stroke moderate disability. J Med Imaging Radiat Oncol 2021; 65:858-863. [PMID: 34137506 DOI: 10.1111/1754-9485.13260] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 05/25/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Patients with ischaemic stroke due to large vessel occlusion (LVO) can be treated successfully with mechanical thrombectomy (MT) and/or intravenous thrombolysis. In the landmark trials, MT was only performed for those with no functional disability prior to stroke (mRS 0-2). There are limited data available regarding clinical outcomes for patients with pre-stroke moderate disability (mRS ≥ 3). The aims of this study were to analyse the clinical outcomes and financial implications in regard to accommodation costs of performing MT in patients with pre-stroke mRS = 3. METHODS An observational cohort study was performed of 802 patients with anterior circulation LVO ischaemic stroke who underwent MT between October 2016 and January 2020 at three tertiary hospitals. Patient demographics, premorbid mRS, stroke and interventional data, 90-day mRS and accommodation situation were recorded. RESULTS Eighty-two patients with anterior circulation LVO ischaemic stroke were pre-stroke mRS 3. 38% had a good clinical outcome, as defined by mRS 3 at 90 days. Mortality rate was 38%. The majority of patients presented from home (83%) and greater than one third of those returned home during the 90 days post treatment. 81% of patients had no increase in accommodation cost at 90 days. CONCLUSION Patients with pre-stroke moderate disability may benefit from MT if they are appropriately selected. This may result in fewer patients requiring nursing home placement and less financial burden on the public health system, indicating significant savings are possible.
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Affiliation(s)
- Tara Nababan
- Neurological Interventional and Imaging Service of WA (NIISWA), Perth, Western Australia, Australia
| | - Timothy J Phillips
- Neurological Interventional and Imaging Service of WA (NIISWA), Perth, Western Australia, Australia
| | - Graeme J Hankey
- Department of Neurology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Matthew T Crockett
- Neurological Interventional and Imaging Service of WA (NIISWA), Perth, Western Australia, Australia
| | - Albert Ho Yuen Chiu
- Neurological Interventional and Imaging Service of WA (NIISWA), Perth, Western Australia, Australia
| | - Tejinder P Singh
- Neurological Interventional and Imaging Service of WA (NIISWA), Perth, Western Australia, Australia
| | - David Blacker
- Department of Neurology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - William McAuliffe
- Neurological Interventional and Imaging Service of WA (NIISWA), Perth, Western Australia, Australia
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12
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Zemed A, Nigussie Chala K, Azeze Eriku G, Yalew Aschalew A. Health-related quality of life and associated factors among patients with stroke at tertiary level hospitals in Ethiopia. PLoS One 2021; 16:e0248481. [PMID: 33735246 PMCID: PMC7971497 DOI: 10.1371/journal.pone.0248481] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 02/27/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Evidence on a patient-centered assessment of outcome among patients with stroke is limited in Ethiopia. Therefore, this study aimed to assess the level of health-related quality of life (HRQOL) and associated factors in Ethiopia's tertiary level hospitals. METHODS A cross-sectional study was conducted at three tertiary level hospitals (Felege Hiwot comprehensive specialized hospital, University of Gondar comprehensive specialized hospital, and Dessie referral hospital) from April 1 to May 31, 2019. A total of 180 patients with stroke were included, and a consecutive sampling method was employed to recruit the participants. RAND 36-Item Health Survey was used to measure the HRQOL. A generalized linear model with a gamma distribution and log-link function was used to investigate potential predictors, and variables with a P value of <0.05 were considered statistically significant. RESULTS Out of the participants, 50.56% were female. The average age and average duration of illness were 59.04 (12.71) and 1.5 (1.46) years, correspondingly. The physical health domain score was higher than the mental health domain score. Education (P = 0.041), social support (P = 0.050), disability (P <0.001), co-morbidity (P = 0.011), depression (P = 0.015) and income (<1000 ETB P = 0.002; 1000-4000 ETB P = 0.009) were associated with physical health domain. Whereas, ischemic stroke (P = 0.014), education (P = 0.020), disability (P <0.001), and depression (P <0.001) were associated with the mental health domain. CONCLUSION The HRQOL of the patients was low. Social support and lower disability status were associated with higher HRQOL, whereas disability and depression were associated with higher HRQOL. Therefore, attention should be given to strengthening social support; health professionals should focus on reducing disability/physical dependency and depression, as these are vital factors for improving HRQOL.
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Affiliation(s)
- Ashenafi Zemed
- Department of Physiotherapy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Kalkidan Nigussie Chala
- Department of Physiotherapy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Getachew Azeze Eriku
- Department of Physiotherapy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Andualem Yalew Aschalew
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- * E-mail:
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13
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Sadlonova M, Wasser K, Nagel J, Weber-Krüger M, Gröschel S, Uphaus T, Liman J, Hamann GF, Kermer P, Gröschel K, Herrmann-Lingen C, Wachter R. Health-related quality of life, anxiety and depression up to 12 months post-stroke: Influence of sex, age, stroke severity and atrial fibrillation - A longitudinal subanalysis of the Find-AF RANDOMISED trial. J Psychosom Res 2021; 142:110353. [PMID: 33421630 DOI: 10.1016/j.jpsychores.2020.110353] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 12/10/2020] [Accepted: 12/28/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND Stroke can negatively impact the health-related quality of life (HRQoL). Anxiety or depression after stroke have been associated with poorer HRQoL, higher mortality and greater dependence in activities of daily living. We aimed to analyze HRQoL, anxiety and depressive symptoms in patients with and without atrial fibrillation (AF) up to 12 months post-stroke. METHODS Find-AFRANDOMISED was a prospective, randomized multicenter study, which included 398 patients ≥60 years with acute cerebral ischemia. HRQoL data were collected using the 3-level EuroQol-5D (EQ-5D-3L) and Stroke Impact Scale (SIS-16). Anxiety and depressive symptoms were measured using the Hospital Anxiety and Depression Scale (HADS). The severity of stroke was measured using the modified Rankin Scale (mRS). RESULTS In this study (mean age 72.7 ± 7.5 years, 40.2% females), there was a significant improvement in HRQoL using EQ-5D-3L after 3 months (β = 0.37, p < .01), 6 months (β = 0.43, p < .01) and 12 months (β = 0.44, p < .01) post-stroke compared to baseline. HADS anxiety scores after 3 months (β = -0.22, p < .01) and 12 months (β = -0.28, p < .01) were significantly reduced. Older patients reported reduced HRQoL and more depressive symptoms. Females indicated lower HRQoL and more anxiety. mRS score at baseline was an independent predictor for HRQoL. There was a significant but small effect of AF on EQ-5D-3L and on HADS anxiety. CONCLUSIONS Patients showed significant improvement in HRQoL and reduced anxiety after 3 and 12 months after stroke. We could demonstrate that the severity of stroke as well as sex and age impact long-term post-stroke HRQoL. CLINICAL TRIAL REGISTRATION Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01855035.
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Affiliation(s)
- Monika Sadlonova
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Center, Göttingen, Germany; Department of Thoracic- und Cardiovascular Surgery, University of Göttingen Medical Center, Göttingen, Germany; DZHK (German Center for Cardiovascular Research), Partner site Göttingen, Germany.
| | - Katrin Wasser
- Department of Neurology, University of Göttingen Medical Center, Göttingen, Germany
| | - Jonas Nagel
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Center, Göttingen, Germany
| | - Mark Weber-Krüger
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany
| | - Sonja Gröschel
- Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Timo Uphaus
- Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Jan Liman
- Department of Neurology, University of Göttingen Medical Center, Göttingen, Germany
| | - Gerhard F Hamann
- Department of Neurology and Neurorehabilitation, Bezirkskrankenhaus Günzburg, Günzburg, Germany
| | - Pawel Kermer
- Department of Neurology, University of Göttingen Medical Center, Göttingen, Germany; Department of Neurology, Nordwest-Krankenhaus Sanderbusch, Sande, Germany
| | - Klaus Gröschel
- Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Christoph Herrmann-Lingen
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Center, Göttingen, Germany; DZHK (German Center for Cardiovascular Research), Partner site Göttingen, Germany
| | - Rolf Wachter
- DZHK (German Center for Cardiovascular Research), Partner site Göttingen, Germany; Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany; Department of Cardiology, University Hospital Leipzig, Leipzig, Germany
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Persistent depression is a predictor of quality of life in stroke survivors: results from a 5-year follow-up study of a Chinese cohort. Chin Med J (Engl) 2020; 132:2206-2212. [PMID: 31436596 PMCID: PMC6797138 DOI: 10.1097/cm9.0000000000000400] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Whether the time course of post-stroke depression (PSD) can be used to predict the quality of life (QoL) of patients with late-stage stroke remains unclear, this study investigated whether persistent depression at 1 year after stroke predicts QoL at 5 years following stroke. METHODS We analyzed the demographic and clinical data of patients with stroke in 56 hospitals across China that participated in the Prospective Cohort Study on the Incidence and Outcome of Patients with PSD in China Study. Follow-up assessments were performed at the following time points after stroke: in person, 2 weeks, 3 months, 6 months, and 1 year; by telephone, 5 years. National Institutes of Health Stroke Scale (NIHSS) score on admission, recurrence, disability, depression, QoL, and chronic complications were recorded. Depression was diagnosed using the Diagnostic and Statistical Manual of Mental Disorders. QoL was measured using short form-12 (SF-12). Multivariable ordinal logistic regression analysis was used to identify factors that independently affected the physical component summary (PCS) and mental component summary (MCS) scores of the SF-12. RESULTS Of the 801 patients evaluated in this study, 80 had persistent depression. The multivariable regression analysis of data obtained at 5 years showed that persistent depression at 1 year (odds ratio [OR]: 0.48; 95% confidence interval [CI]: 0.29-0.81) and disability at 5 years (OR: 0.34; 95% CI: 0.23-0.49) were associated with poor MCS scores at 5 years. Old age, a high NIHSS score on admission, disability at 5 years, and stroke recurrence within 5 years were associated with poor PCS scores at the 5-year follow-up. CONCLUSIONS Persistent depression at the 1-year follow-up could predict poor MCS scores at the 5-year follow-up. The development of interventional strategies targeting post-stroke patients with persistent depression is warranted.
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Kim SE, Lee H, Kim JY, Lee KJ, Kang J, Kim BJ, Han MK, Choi KH, Kim JT, Shin DI, Yeo MJ, Cha JK, Kim DH, Nah HW, Kim DE, Ryu WS, Park JM, Kang K, Kim JG, Lee SJ, Oh MS, Yu KH, Lee BC, Park HK, Hong KS, Cho YJ, Choi JC, Sohn SI, Hong JH, Park MS, Park TH, Park SS, Lee KB, Kwon JH, Kim WJ, Lee J, Lee JS, Lee J, Meretoja A, Gorelick PB, Bae HJ. Three-month modified Rankin Scale as a determinant of 5-year cumulative costs after ischemic stroke. Neurology 2020; 94:e978-e991. [DOI: 10.1212/wnl.0000000000009034] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 09/24/2019] [Indexed: 02/04/2023] Open
Abstract
ObjectiveStroke is a devastating and costly disease; however, there is a paucity of information on long-term costs and on how they differ according to 3-month modified Rankin scale (mRS) score, which is a primary outcome variable in acute stroke intervention trials.MethodsWe analyzed a prospective multicenter stroke registry (Clinical Research Collaboration for Stroke in Korea) database through linkage with claims data from the National Health Insurance Service with follow-up to December 2016. Healthcare expenditures were converted into daily cost individually, and annual and cumulative costs up to 5 years were estimated and compared according to the 3-month mRS score.ResultsBetween January 2011 and November 2013, 11,136 patients were enrolled in the study. The mean age was 68 years, and 58% were men. The median follow-up period was 3.9 years (range 0–5 years). Mean cumulative cost over 5 years was $117,576 (US dollars [USD]); the cost in the first year after stroke was the highest ($38,152 USD), which increased markedly from the cost a year before stroke ($8,718 USD). The mean 5-year cumulative costs differed significantly according to the 3-month mRS score (p < 0.001); the costs for a 3-month mRS score of 0 or 5 were $53,578 and $257,486 USD, respectively. Three-month mRS score was an independent determinant of long-term costs after stroke.ConclusionsWe show that 3-month mRS score plays an important role in the prediction of long-term costs after stroke. Such estimates relating to 3-month mRS categories may be valuable when undertaking health economic evaluations related to stroke care.
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