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Ji W, Wang C, Chen H, Liang Y, Wang S. Predicting post-stroke cognitive impairment using machine learning: A prospective cohort study. J Stroke Cerebrovasc Dis 2023; 32:107354. [PMID: 37716104 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107354] [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: 06/30/2023] [Revised: 08/27/2023] [Accepted: 09/11/2023] [Indexed: 09/18/2023] Open
Abstract
BACKGROUND Post-stroke cognitive impairment (PSCI) is a serious complication of stroke that warrants prompt detection and management. Consequently, the development of a diagnostic prediction model holds clinical significance. OBJECTIVE Machine learning algorithms were employed to identify crucial variables and forecast PSCI occurrence within 3-6 months following acute ischemic stroke (AIS). METHODS A prospective study was conducted on a developed cohort (331 patients) utilizing data from the Affiliated Zhongda Hospital of Southeast University between January 2022 and August 2022, as well as an external validation cohort (66 patients) from December 2022 to January 2023. The optimal model was determined by integrating nine machine learning classification models, and personalized risk assessment was facilitated by a Shapley Additive exPlanations (SHAP) interpretation. RESULTS Age, education, baseline National Institutes of Health Scale (NIHSS), Cerebral white matter degeneration (CWMD), Homocysteine (Hcy), and C-reactive protein (CRP) were identified as predictors of PSCI occurrence. Gaussian Naïve Bayes (GNB) model was determined to be the optimal model, surpassing other classifier models in the validation set (area under the curve [AUC]: 0.925, 95 % confidence interval [CI]: 0.861 - 0.988) and achieving the lowest Brier score. The GNB model performed well in the test sets (AUC: 0.919, accuracy: 0.864, sensitivity: 0.818, and specificity: 0.932). CONCLUSIONS The present study involved the development of a GNB model and its elucidation through employment of the SHAP method. These findings provide compelling evidence for preventing PSCI, which could serve as a guide for high-risk patients to undertake appropriate preventive measures.
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Affiliation(s)
- Wencan Ji
- Nanjing Medical University, Nanjing, China; Jiangsu Research Center for Primary Health Development and General Practice Education, Jiangsu, China; Department of General Practice, Zhongda Hospital, Southeast University, Nanjing, China
| | - Canjun Wang
- Center of Clinical Laboratory Medicine, Zhongda Hospital, Southeast University, Nanjing, China
| | - Hanqing Chen
- Department of General Practice, Zhongda Hospital, Southeast University, Nanjing, China
| | - Yan Liang
- Department of General Practice, Zhongda Hospital, Southeast University, Nanjing, China
| | - Shaohua Wang
- Nanjing Medical University, Nanjing, China; Department of Endocrinology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China.
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Tsapanou A, Gacheru M, Lee S, Mourtzi N, Gazes Y, Habeck C, Belsky DW, Stern Y. Association of Cognitive Polygenic Index and Cognitive Performance with Age in Cognitively Healthy Adults. Genes (Basel) 2023; 14:1814. [PMID: 37761954 PMCID: PMC10531331 DOI: 10.3390/genes14091814] [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: 08/01/2023] [Revised: 09/08/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023] Open
Abstract
Genome-wide association studies have discovered common genetic variants associated with cognitive performance. Polygenic scores that summarize these discoveries explain up to 10% of the variance in cognitive test performance in samples of adults. However, the role these genetics play in cognitive aging is not well understood. We analyzed data from 168 cognitively healthy participants aged 23-77 years old, with data on genetics, neuropsychological assessment, and brain-imaging measurements from two large ongoing studies, the Reference Abilities Neural Networks, and the Cognitive Reserve study. We tested whether a polygenic index previously related to cognition (Cog PGI) would moderate the relationship between age and measurements of the cognitive domains extracted from a neuropsychological evaluation: fluid reasoning, memory, vocabulary, and speed of processing. We further explored the relationship of Cog PGI and age on cognition using Johnson-Neyman intervals for two-way interactions. Sex, education, and brain measures of cortical thickness, total gray matter volume, and white matter hyperintensity were considered covariates. The analysis controlled for population structure-ancestry. There was a significant interaction effect of Cog PGI on the association between age and the domains of memory (Standardized coefficient = -0.158, p-value = 0.022), fluid reasoning (Standardized coefficient = -0.146, p-value = 0.020), and vocabulary (Standardized coefficient = -0.191, p-value = 0.001). Higher PGI strengthened the negative relationship between age and the domains of memory and fluid reasoning while PGI weakened the positive relationship between age and vocabulary. Based on the Johnson-Neyman intervals, Cog PGI was significantly associated with domains of memory, reasoning, and vocabulary for younger adults. There is a significant moderation effect of genetic predisposition for cognition for the association between age and cognitive performance. Genetics discovered in genome-wide association studies of cognitive performance show a stronger association in young and midlife older adults.
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Affiliation(s)
- Angeliki Tsapanou
- Department of Neurology, Columbia University Irving Medical Center, New York, NY 10032, USA; (A.T.); (C.H.)
| | - Margaret Gacheru
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY 10032, USA;
| | - Seonjoo Lee
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Niki Mourtzi
- Department of Neurology, National and Kapodistrian University of Athens, 10679 Athens, Greece
| | - Yunglin Gazes
- Department of Neurology, Columbia University Irving Medical Center, New York, NY 10032, USA; (A.T.); (C.H.)
| | - Christian Habeck
- Department of Neurology, Columbia University Irving Medical Center, New York, NY 10032, USA; (A.T.); (C.H.)
| | - Daniel W. Belsky
- Department of Epidemiology and Butler Columbia Aging Center, Columbia University Mailman School of Public Health, New York, NY 10032, USA
| | - Yaakov Stern
- Department of Neurology, Columbia University Irving Medical Center, New York, NY 10032, USA; (A.T.); (C.H.)
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3
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Analysis of medical service utilization for post-stroke sequelae in Korea between 2016 and 2018: a cross-sectional study. Sci Rep 2022; 12:20501. [PMID: 36443359 PMCID: PMC9705313 DOI: 10.1038/s41598-022-24710-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 11/18/2022] [Indexed: 11/29/2022] Open
Abstract
In this retrospective cross-sectional observational study, the medical service utilization of post-stroke sequelae patients was examined using a national patient sample. The Korean Health Insurance Review and Assessment Service-National Patients Sample database was used to investigate the medical service utilization of 19,562 patients, diagnosed with post-stroke sequelae of cerebrovascular disease (I69) in Korea between January 2016 and December 2018. We compared the demographic characteristics, diagnosis code subtypes, frequency of healthcare utilization, medical costs, and comorbidities of standard care (SC) and Korean medicine (KM) users. Overall, patients aged ≥ 65 years accounted for the highest percentage, and utilization of medical services increased among patients aged ≥ 45 years. Outpatient care was higher among SC (79.23%) and KM (99.38%) users. Sequelae of cerebral infarction accounted for the highest percentage of diagnosis subtypes. Physical therapy and rehabilitation therapy were most frequent in SC, whereas injection/procedure and acupuncture were most frequent in KM. Cerebrovascular circulation/dementia drugs were prescribed most frequently in SC. Circulatory, digestive, endocrine, and metabolic disorders were the most common comorbidities in SC, whereas musculoskeletal and connective tissue disorders were most common in KM. Overall, SC and KM users showed differences in the number of medical service claims, cost of care, and comorbidities. Our findings provide basic research data for clinicians, researchers, and policy makers.
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4
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She R, Yan Z, Hao Y, Zhang Z, Du Y, Liang Y, Vetrano DL, Dekker J, Bai B, Lau JTF, Qiu C. Comorbidity in patients with first-ever ischemic stroke: Disease patterns and their associations with cognitive and physical function. Front Aging Neurosci 2022; 14:887032. [PMID: 36158561 PMCID: PMC9500284 DOI: 10.3389/fnagi.2022.887032] [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: 03/01/2022] [Accepted: 08/22/2022] [Indexed: 11/13/2022] Open
Abstract
The present study examined the prevalence and pattern of comorbidity among Chinese patients with first-ever acute ischemic stroke, and assessed the associations of specific comorbidity patterns with physical and cognitive functioning after stroke occurrence. A hospital-based cross-sectional study was conducted among 2,151 patients with first-ever ischemic stroke (age ≥40 years; 64.2% men) who were admitted to two university hospitals in Shandong, China between 2016 and 2017. Data on demographics, lifestyles, chronic health conditions, and use of medications were collected through in-person interviews, clinical examinations, and laboratory tests. Physical functioning was assessed by the Barthel index (BI) and the modified Rankin Scale (mRS) while cognitive functioning was assessed by the Montreal Cognitive Assessment test. The results showed that comorbidity was present in 90.9% of the stroke patients (women vs. men: 95.2 vs. 88.7%, P < 0.001). Exploratory factor analysis identified three patterns of comorbidity, i.e., patterns of degenerative-cardiopulmonary, heart-gastrointestinal-psychiatric, and metabolic-kidney diseases. The number of comorbidities was significantly associated with a higher likelihood of moderate-to-severe physical dependence [odds ratio (95% CI) = 1.15 (1.06–1.25) for BI and 1.12 (1.04–1.21) for mRS, all P < 0.01] and cognitive impairment [odds ratio (95% CI) = 1.11 (1.02–1.20), P = 0.017], after adjusting for multiple covariates. Almost all the three comorbidity patterns were associated with increased likelihoods of physical dependence (range for odds ratios: 1.26–1.33) and cognitive impairment (range for odds ratios: 1.25–1.34). No significant association was found between degenerative-cardiopulmonary pattern and mRS. These findings suggest that comorbidity is associated with poor physical and cognitive functioning during the acute phase of ischemic stroke. Routine assessments of comorbidity and cognitive and physical function among patients with acute ischemic stroke should be considered in stroke research and clinical practice.
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Affiliation(s)
- Rui She
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Zhongrui Yan
- Department of Neurology, Jining No. 1 People’s Hospital, Jining, Shandong, China
| | - Yanlei Hao
- Department of Neurology, The Affiliated Hospital of Jining Medical University, Jining, Shandong, China
| | - Zuoji Zhang
- Department of Neurology, Jining Medical University, Jining, Shandong, China
| | - Yifeng Du
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China
| | - Yajun Liang
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Davide L. Vetrano
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Centro Medicina dell’Invecchiamento, Fondazione Policlinico “A. Gemelli” IRCCS and Catholic University of Rome, Rome, Italy
| | - Joost Dekker
- Department of Psychiatry and Department of Rehabilitation Medicine, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Bo Bai
- Department of Neurology, Jining Medical University, Jining, Shandong, China
| | - Joseph T. F. Lau
- Zhejiang Provincial Clinical Research Center for Mental Disorders, The Affiliated Wenzhou Kangning Hospital, Wenzhou Medical University, Wenzhou, China
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
- *Correspondence: Joseph T. F. Lau,
| | - Chengxuan Qiu
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Chengxuan Qiu,
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Dong Y, Ding M, Cui M, Fang M, Gong L, Xu Z, Zhang Y, Wang X, Xu X, Liu X, Li G, Zhao Y, Dong Q. Development and validation of a clinical model (DREAM-LDL) for post-stroke cognitive impairment at 6 months. Aging (Albany NY) 2021; 13:21628-21641. [PMID: 34506303 PMCID: PMC8457606 DOI: 10.18632/aging.203507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 08/17/2021] [Indexed: 01/31/2023]
Abstract
Introduction: This multicenter, retrospective study assessed the prevalence of post-stroke cognitive impairment (PSCI) 6 months after acute ischemic stroke (AIS) and its risk factors to build a bedside early predictive model for PSCI using the Montreal Cognitive Assessment (MoCA). Methods: Records of consecutive patients with AIS treated at 4 stroke centers in Shanghai had MoCA assessments within 2 weeks after AIS onset and 6 months later were reviewed. Prevalence of PSCI (MoCA<22) was calculated and risk factors were identified by multivariate logistic regression analysis. The modeling and validation and identified risk factors were included in a predictive model using multivariate regression. Results: There were 383 patients included and prevalence of PSCI 6 months after AIS was 34.2%, significantly lower than prevalence of patients with acute cognitive impairment (49.6%). Aging, less education, higher glucose level and severe stroke were PSCI risk factors, while level of low-density lipoprotein cholesterol (LDL-C) had a paradox effect on the risk of PSCI. 40.0% of the patients with cognitive impairment at acute phase reverted to normal, and patients with LDL-C 1.8-2.5 mmol/L were more likely to revert. The predictive model we built, DREAM-LDL (Diabetes [fasting blood glucose level], Rating [NIHSS], level of Education, Age, baseline MoCA and LDL-C level), had an AUROC of 0.93 for predicting PSCI at 6 months. Conclusion: PSCI was common among AIS patients 6 months after AIS. We provided a practical tool to predict PSCI based on MoCA and risk factors present during acute phase of AIS.
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Affiliation(s)
- Yi Dong
- Department of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, China
| | - Mengyuan Ding
- Department of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, China
| | - Mei Cui
- Department of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, China
| | - Min Fang
- Department of Neurology, The Tenth People's Hospital Affiliated to Tongji University, Shanghai, China
| | - Li Gong
- Department of Neurology, The Tenth People's Hospital Affiliated to Tongji University, Shanghai, China
| | - Zhuojun Xu
- Department of Neurology, The East Hospital Affiliated to Tongji University, Shanghai, China
| | - Yue Zhang
- Department of Neurology, The East Hospital Affiliated to Tongji University, Shanghai, China
| | - Xiuzhe Wang
- Department of Neurology, The Six People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, China
| | - Xiaofeng Xu
- Department of Neurology, The Six People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, China
| | - Xueyuan Liu
- Department of Neurology, The Tenth People's Hospital Affiliated to Tongji University, Shanghai, China
| | - Gang Li
- Department of Neurology, The East Hospital Affiliated to Tongji University, Shanghai, China
| | - Yuwu Zhao
- Department of Neurology, The Six People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, China
| | - Qiang Dong
- Department of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, China
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Chun YJ, Lee BY, Lee YH. Association between Accreditation and In-Hospital Mortality in Patients with Major Cardiovascular Diseases in South Korean Hospitals: Pre-Post Accreditation Comparison. ACTA ACUST UNITED AC 2020; 56:medicina56090436. [PMID: 32872208 PMCID: PMC7558878 DOI: 10.3390/medicina56090436] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/25/2020] [Accepted: 08/27/2020] [Indexed: 11/16/2022]
Abstract
The direct impact of hospital accreditation on patients' clinical outcomes is unclear. The purpose of this study was to evaluate whether mortality within 30 days of hospitalization for acute myocardial infarction (AMI), ischemic stroke (IS), and hemorrhagic stroke (HS) differed before and after hospital accreditation. This study targeted patients who had been hospitalized for the three diseases at the general hospitals newly accredited by the government in 2014. Thirty-day mortality rates of three years before and after accreditation were compared. Mortality within 30 days of hospitalization for the three diseases was lower after accreditation than before (7.34% vs. 6.15% for AMI; 4.64% vs. 3.80% for IS; and 18.52% vs. 15.81% for HS). In addition, hospitals that meet the criteria of the patient care process domain have a statistically lower mortality rate than hospitals that do not. In the newly accredited Korean general hospital, it was confirmed that in-hospital mortality rates of major cardiovascular diseases were lower than before the accreditation.
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Affiliation(s)
- You Jin Chun
- Korea Institute for Healthcare Accreditation, Seoul 07238, Korea;
| | - Bo Yeon Lee
- Health Insurance Review and Assessment Service, Wonju 26465, Korea;
| | - Yo Han Lee
- Graduate School of Public Health, Ajou University, Suwon 16499, Korea
- Correspondence:
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7
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Pontone GM, Dissanayaka N, Apostolova L, Brown RG, Dobkin R, Dujardin K, Friedman JH, Leentjens AFG, Lenze EJ, Marsh L, Mari L, Monchi O, Richard IH, Schrag A, Strafella AP, Vernaleo B, Weintraub D, Mari Z. Report from a multidisciplinary meeting on anxiety as a non-motor manifestation of Parkinson's disease. NPJ Parkinsons Dis 2019; 5:30. [PMID: 31840044 PMCID: PMC6906437 DOI: 10.1038/s41531-019-0102-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 10/17/2019] [Indexed: 12/14/2022] Open
Abstract
Anxiety is a severe problem for at least one-third of people living with Parkinson's disease (PD). Anxiety appears to have a greater adverse impact on quality of life than motor impairment. Despite its high prevalence and impact on daily life, anxiety is often undiagnosed and untreated. To better address anxiety in PD, future research must improve knowledge about the mechanism of anxiety in PD and address the lack of empirical evidence from clinical trials. In response to these challenges, the Parkinson's Foundation sponsored an expert meeting on anxiety on June 13th and 14th 2018. This paper summarizes the findings from that meeting informed by a review of the existing literature and discussions among patients, caregivers, and an international, clinician-scientist, expert panel working group. The goal is to provide recommendations to improve our understanding and treatment of anxiety in PD.
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Affiliation(s)
- Gregory M. Pontone
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD USA
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Nadeeka Dissanayaka
- The University of Queensland Centre for Clinical Research, Faculty of Medicine, Brisbane, Australia
- School of Psychology, The University of Queensland, Brisbane, Australia
- Department of Neurology, Royal Brisbane & Woman’s Hospital, Brisbane, Australia
| | - Liana Apostolova
- Department of Neurology, Indiana University School of Medicine, Indianapolis, IN USA
| | - Richard G. Brown
- Department of Psychology, Institute of Psychiatry Psychology and Neuroscience, King’s College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Roseanne Dobkin
- Department of Psychiatry, Rutgers University, Robert Wood Johnson Medical School, Piscataway, NJ USA
| | - Kathy Dujardin
- Department of Neurology and Movement Disorders, Lille University Medical Center, Lille, France
| | - Joseph H. Friedman
- Movement Disorders Program, Butler Hospital; Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI USA
| | - Albert F. G. Leentjens
- Department of Psychiatry, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Eric J. Lenze
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO USA
| | - Laura Marsh
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX USA
- Department of Psychiatry, Baylor College of Medicine, Houston, TX USA
| | - Lynda Mari
- Person Holistic Innovation, Las Vegas, NV USA
| | - Oury Monchi
- Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - Irene H. Richard
- Department of Neurology, University of Rochester Medical Center, Rochester, NY USA
| | - Anette Schrag
- Department of Clinical and Movement Neurosciences, University College London, London, UK
| | - Antonio P. Strafella
- E.J. Safra Parkinson Disease Program, Toronto Western Hospital & Krembil Research Institute, UHN; Research Imaging Centre, Campbell Family Mental Health Research Institute, CAMH; University of Toronto, Ontario, Canada
| | | | - Daniel Weintraub
- Departments of Psychiatry and Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA USA
- Parkinson’s Disease Research, Education and Clinical Center, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA USA
| | - Zoltan Mari
- Cleveland Clinic Lou Ruvo Center for Brain Health, Movement Disorders Program, Las Vegas, NV USA
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Association Between Spasticity and Functional Impairments During the First Year After Stroke in Korea: The KOSCO Study. Am J Phys Med Rehabil 2019; 97:557-564. [PMID: 29509548 DOI: 10.1097/phm.0000000000000916] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of the study was to investigate the correlation between spasticity severity and functional outcomes during the first year after stroke. DESIGN The Korean Stroke Cohort for Functioning and Rehabilitation is a large, multicenter, prospective cohort study of all patients with acute first-ever stroke admitted to participating hospitals in nine Korean areas. To investigate the correlation between spasticity severity and functional status measured by using the Institutes of Health Stroke Scale (NIHSS), Modified Barthel Index (MBI), Functional Independence Measurement (FIM), Fugl-Meyer Assessment (FMA), Functional Ambulatory Category (FAC), modified Rankin scale (mRS), and American Speech-Language Hearing Association National Outcome Measurement System Swallowing Scale (ASHA-NOMS), data were analyzed at 3, 6, and 12 mos after the occurrence of stroke. RESULTS A total of 7359 stroke patients, 3056 were finally included. Prevalence rates of spasticity in patients after stroke were 6.8% at 3 mos, 6.9% at 6 mos, and 7.6% at 12 mos. The scores of mRS and NIHSS were higher and those of K-MBI, FIM, FMA, and ASHA-NOMS were lower in more severe spastic patients, indicating poorer functional outcomes (P < 0.05). CONCLUSIONS This study demonstrated the coexistence of spasticity and poor functional outcome during the first year after first-ever stroke patients.
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9
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Banerjee G, Chan E, Ambler G, Wilson D, Cipolotti L, Shakeshaft C, Cohen H, Yousry T, Lip GYH, Muir KW, Brown MM, Jäger HR, Werring DJ. Effect of small-vessel disease on cognitive trajectory after atrial fibrillation-related ischaemic stroke or TIA. J Neurol 2019; 266:1250-1259. [PMID: 30847646 PMCID: PMC6469837 DOI: 10.1007/s00415-019-09256-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 02/16/2019] [Accepted: 02/19/2019] [Indexed: 01/12/2023]
Abstract
Post-stroke dementia is common but has heterogenous mechanisms that are not fully understood, particularly in patients with atrial fibrillation (AF)-related ischaemic stroke or TIA. We investigated the relationship between MRI small-vessel disease markers (including a composite cerebral amyloid angiopathy, CAA, score) and cognitive trajectory over 12 months. We included patients from the CROMIS-2 AF study without pre-existing cognitive impairment and with Montreal Cognitive Assessment (MoCA) data. Cognitive impairment was defined as MoCA < 26. We defined “reverters” as patients with an “acute” MoCA (immediately after the index event) score < 26, who then improved by ≥ 2 points at 12 months. In our cohort (n = 114), 12-month MoCA improved overall relative to acute performance (mean difference 1.69 points, 95% CI 1.03–2.36, p < 0.00001). 12-month cognitive impairment was associated with increasing CAA score (per-point increase, adjusted OR 4.09, 95% CI 1.36–12.33, p = 0.012). Of those with abnormal acute MoCA score (n = 66), 59.1% (n = 39) were “reverters”. Non-reversion was associated with centrum semi-ovale perivascular spaces (per-grade increase, unadjusted OR 1.83, 95% CI 1.06–3.15, p = 0.03), cerebral microbleeds (unadjusted OR 10.86, 95% CI 1.22–96.34, p = 0.03), and (negatively) with multiple ischaemic lesions at baseline (unadjusted OR 0.11, 95% CI 0.02–0.90, p = 0.04), as well as composite small-vessel disease (per-point increase, unadjusted OR 2.91, 95% CI 1.23–6.88, p = 0.015) and CAA (per-point increase, unadjusted OR 6.71, 95% CI 2.10–21.50, p = 0.001) scores. In AF-related acute ischaemic stroke or TIA, cerebral small-vessel disease is associated both with cognitive performance at 12 months and failure to improve over this period.
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Affiliation(s)
- Gargi Banerjee
- Department of Brain Repair and Rehabilitation, Stroke Research Centre, UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, Russell Square House, 10-12 Russell Square, London, WC1B 5EH, UK
| | - Edgar Chan
- Department of Neuropsychology, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Gareth Ambler
- Department of Statistical Science, University College London, Gower Street, London, UK
| | - Duncan Wilson
- Department of Brain Repair and Rehabilitation, Stroke Research Centre, UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, Russell Square House, 10-12 Russell Square, London, WC1B 5EH, UK.,New Zealand Brain Research Institute, Christchurch, New Zealand
| | - Lisa Cipolotti
- Department of Neuropsychology, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Clare Shakeshaft
- Department of Brain Repair and Rehabilitation, Stroke Research Centre, UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, Russell Square House, 10-12 Russell Square, London, WC1B 5EH, UK
| | - Hannah Cohen
- Haemostasis Research Unit, Department of Haematology, University College London, 51 Chenies Mews, London, UK
| | - Tarek Yousry
- Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, Queen Square, London, UK
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK.,Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Keith W Muir
- Institute of Neuroscience and Psychology, University of Glasgow, Queen Elizabeth University Hospital, Glasgow, UK
| | - Martin M Brown
- Department of Brain Repair and Rehabilitation, Stroke Research Centre, UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, Russell Square House, 10-12 Russell Square, London, WC1B 5EH, UK
| | - Hans Rolf Jäger
- Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, Queen Square, London, UK
| | - David J Werring
- Department of Brain Repair and Rehabilitation, Stroke Research Centre, UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, Russell Square House, 10-12 Russell Square, London, WC1B 5EH, UK.
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10
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Ihle A, Gouveia ÉR, Gouveia BR, Kliegel M. The Cognitive Telephone Screening Instrument (COGTEL): A Brief, Reliable, and Valid Tool for Capturing Interindividual Differences in Cognitive Functioning in Epidemiological and Aging Studies. Dement Geriatr Cogn Dis Extra 2017; 7:339-345. [PMID: 29118786 PMCID: PMC5662972 DOI: 10.1159/000479680] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 07/20/2017] [Indexed: 11/19/2022] Open
Abstract
Aims The present study set out to evaluate the psychometric properties of the Cognitive Telephone Screening Instrument (COGTEL) in 2 different samples of older adults. Methods We assessed COGTEL in 116 older adults, with retest after 7 days to evaluate the test-retest reliability. Moreover, we assessed COGTEL in 868 older adults to evaluate convergent validity to the Mini-Mental State Examination (MMSE). Results Test-retest reliability of the COGTEL total score was good at 0.85 (p < 0.001). Latent variable analyses revealed that COGTEL and MMSE correlated by 0.93 (p < 0.001), indicating convergent validity of the COGTEL. Conclusion The present analyses suggest COGTEL as a brief, reliable, and valid instrument for capturing interindividual differences in cognitive functioning in epidemiological and aging studies, with the advantage of covering more cognitive domains than traditional screening tools such as the MMSE, as well as differentiating between individual performance levels, in healthy older adults.
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Affiliation(s)
- Andreas Ihle
- Department of Psychology, University of Geneva, Geneva, Switzerland.,Center for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, Geneva, Switzerland
| | - Élvio R Gouveia
- Center for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, Geneva, Switzerland.,Department of Physical Education and Sport, University of Madeira, Funchal, Portugal.,Madeira Interactive Technologies Institute, Funchal, Portugal
| | - Bruna R Gouveia
- Center for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, Geneva, Switzerland.,Madeira Interactive Technologies Institute, Funchal, Portugal.,Saint Joseph of Cluny Higher School of Nursing, Funchal, Portugal
| | - Matthias Kliegel
- Department of Psychology, University of Geneva, Geneva, Switzerland.,Center for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, Geneva, Switzerland
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