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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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Du R, Zhou Y, You C, Liu K, King DA, Liang ZS, Ranson JM, Llewellyn DJ, Huang J, Zhang Z. Attention-deficit/hyperactivity disorder and ischemic stroke: A Mendelian randomization study. Int J Stroke 2023; 18:346-353. [PMID: 35670701 DOI: 10.1177/17474930221108272] [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] [Indexed: 11/17/2022]
Abstract
BACKGROUND Observational studies have found an association between attention-deficit/hyperactivity disorder (ADHD) and ischemic stroke. AIMS The purpose of this study was to investigate whether genetic liability to ADHD has a causal effect on ischemic stroke and its subtypes. METHODS In this two-sample Mendelian randomization (MR) study, genetic variants (nine single-nucleotide polymorphisms; P < 5 × 10-8) using as instrumental variables for the analysis was obtained from a genome-wide association study of ADHD with 19,099 cases and 34,194 controls. The outcome datasets for stroke and its subtypes were obtained from the MEGASTROKE consortium, with 40,585 cases and 406,111 controls. MR inverse variance-weighted method was conducted to investigate the effect of genetic liability to ADHD on ischemic stroke and its subtypes. Sensitivity analyses (median-based methods, MR-Egger, MR-robust adjusted profile scores, MR-pleiotropy residual sum and outlier) were also utilized to assess horizontal pleiotropy and remove outliers. Multivariable MR (MVMR) analyses were conducted to explore potential mediators. RESULTS Genetically determined ADHD (per 1 SD) was significantly associated with a higher risk of any ischemic stroke (AIS) (odds ratio (OR) = 1.15, 95% confidence interval (CI) = 1.05-1.25, P = 0.002) and large-artery atherosclerotic stroke (LAS) (OR = 1.40, 95% CI = 1.10-1.76, P = 0.005). The significant association was also found in sensitivity analyses and MVMR analyses. CONCLUSIONS Genetic liability to ADHD was significantly associated with an increased risk of AIS, especially LAS. The association between ADHD and LAS was independent of age of smoking initiation but mediated by coronary artery disease.
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Affiliation(s)
- Runming Du
- Department of Global Health, Peking University School of Public Health, Beijing, China
| | - Yi Zhou
- Department of Global Health, Peking University School of Public Health, Beijing, China
| | - Chong You
- Department of Biostatistics, Peking University School of Public Health, Beijing, China
| | - Kevin Liu
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Daniel A King
- Northwell Health Cancer Institute and Feinstein Institute of Research, Lake Success, NY, USA
| | - Zhi-Sheng Liang
- Department of Global Health, Peking University School of Public Health, Beijing, China
| | - Janice M Ranson
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - David J Llewellyn
- College of Medicine and Health, University of Exeter, Exeter, UK.,Alan Turing Institute, London, UK
| | - Jie Huang
- School of Public Health and Emergency Management, Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Zhenyu Zhang
- Department of Global Health, Peking University School of Public Health, Beijing, China.,Institute for Global Health and Development, Peking University, Beijing, China
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Lau SCL, Connor LT, Baum CM. Subjective and objective assessments are associated for physical function but not cognitive function in community-dwelling stroke survivors. Disabil Rehabil 2022; 44:8349-8356. [PMID: 34904503 DOI: 10.1080/09638288.2021.2012845] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE To investigate the relation between subjectively and objectively assessed cognitive and physical functioning among community-dwelling stroke survivors, and to examine the association of stroke severity with subjectively and objectively assessed cognitive and physical impairments. MATERIALS AND METHODS Secondary data analysis was conducted with 127 community-dwelling stroke survivors. For cognitive functioning, objective measures included the NIH Toolbox Cognition Battery and the Executive Function Performance Test; subjective measures included the Quality of Life in Neurological Disorders Applied Cognition. Objective and subjective physical functioning was measured by the NIH Toolbox 2-Minute Walk Test and the Patient-Reported Outcomes Measurement Information System Physical Function, respectively. RESULTS A positive correlation was observed between subjective and objective physical functioning, whereas the correlation between subjective and objective cognitive functioning was nonsignificant. Stroke severity was associated with objective cognitive impairment and objective and subjective physical impairment, but not subjective cognitive impairment. CONCLUSIONS The lack of association between objective and subjective cognitive functioning challenges the conventional assumption that perceived functioning reflects actual performance. We recommend using both objective and subjective measures to accurately identify cognitive and physical impairment following stroke.Implications for RehabilitationSubjective cognitive functioning is not associated with objective cognitive functioning, suggesting that solely relying on stroke patients' reports is inadequate and may inaccurately estimate patients' actual deficits.Both objective and subjective measures should be used to accurately identify cognitive and physical impairment following stroke.Practitioners should be cognizant of stroke patients' behavioral signs associated with underlying cognitive problems that warrant further evaluation.
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Affiliation(s)
- Stephen C L Lau
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - Lisa Tabor Connor
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA.,Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Carolyn M Baum
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA.,Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA.,Brown School of Social Work, Washington University in St. Louis, St. Louis, MO, USA
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4
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Synchronized Cyclograms to Assess Inter-Limb Symmetry during Gait in Post-Stroke Patients. Symmetry (Basel) 2022. [DOI: 10.3390/sym14081560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
The aim of this study was to assess the inter-limb symmetry during gait in post-stroke patients using the synchronized cyclograms technique. In total, 41 individuals with stroke (21 left and 20 right hemiplegic patients; age: 57.9 ± 12.8 years; time stroke event 4.6 ± 1.8 years) and 48 age-, sex-, and height-matched individuals (control group: CG; age: 54.4 ± 12.5 years) were assessed via 3D gait analysis. Raw kinematic data were processed to compute spatio-temporal parameters (speed, stride length, cadence, stance, swing, and double support phases duration) and angle–angle diagrams (synchronized cyclograms), which were characterized in terms of area, orientation, and trend symmetry indices. The results reveal that all spatio-temporal parameters are characterized by abnormal values, with reduced speed, stride length, cadence, and swing phase duration and increased stance and double support phases duration. With respect to inter-limb symmetry, higher values were found in post-stroke individuals for all the considered parameters as patients generally exhibited a cyclogram characterized by larger areas, higher orientation, and trend symmetry parameters with respect to CG. The described alterations of gait asymmetry are important from a clinical point of view as the achievement of symmetry in gait represents a crucial objective in the rehabilitation of hemiplegic people.
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Pusil S, Torres-Simon L, Chino B, López ME, Canuet L, Bilbao Á, Maestú F, Paúl N. Resting-State Beta-Band Recovery Network Related to Cognitive Improvement After Stroke. Front Neurol 2022; 13:838170. [PMID: 35280290 PMCID: PMC8914082 DOI: 10.3389/fneur.2022.838170] [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: 12/17/2021] [Accepted: 02/03/2022] [Indexed: 11/29/2022] Open
Abstract
Background Stroke is the second leading cause of death worldwide and it causes important long-term cognitive and physical deficits that hamper patients' daily activity. Neuropsychological rehabilitation (NR) has increasingly become more important to recover from cognitive disability and to improve the functionality and quality of life of these patients. Since in most stroke cases, restoration of functional connectivity (FC) precedes or accompanies cognitive and behavioral recovery, understanding the electrophysiological signatures underlying stroke recovery mechanisms is a crucial scientific and clinical goal. Methods For this purpose, a longitudinal study was carried out with a sample of 10 stroke patients, who underwent two neuropsychological assessments and two resting-state magnetoencephalographic (MEG) recordings, before and after undergoing a NR program. Moreover, to understand the degree of cognitive and neurophysiological impairment after stroke and the mechanisms of recovery after cognitive rehabilitation, stroke patients were compared to 10 healthy controls matched for age, sex, and educational level. Findings After intra and inter group comparisons, we found the following results: (1) Within the stroke group who received cognitive rehabilitation, almost all cognitive domains improved relatively or totally; (2) They exhibit a pattern of widespread increased in FC within the beta band that was related to the recovery process (there were no significant differences between patients who underwent rehabilitation and controls); (3) These FC recovery changes were related with the enhanced of cognitive performance. Furthermore, we explored the capacity of the neuropsychological scores before rehabilitation, to predict the FC changes in the brain network. Significant correlations were found in global indexes from the WAIS-III: Performance IQ (PIQ) and Perceptual Organization index (POI) (i.e., Picture Completion, Matrix Reasoning, and Block Design).
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Affiliation(s)
- Sandra Pusil
- Department of Experimental Psychology, Universidad Complutense de Madrid, Madrid, Spain
| | - Lucía Torres-Simon
- Department of Experimental Psychology, Universidad Complutense de Madrid, Madrid, Spain
| | - Brenda Chino
- Institute of Neuroscience, Autonomous University of Barcelona, Barcelona, Spain
| | - María Eugenia López
- Department of Experimental Psychology, Universidad Complutense de Madrid, Madrid, Spain
| | - Leonides Canuet
- Department of Experimental Psychology, Universidad Complutense de Madrid, Madrid, Spain
| | - Álvaro Bilbao
- National Centre for Brain Injury Treatment, Centro de Referencia Estatal de Atención Al Daño Cerebral (CEADAC), Madrid, Spain
| | - Fernando Maestú
- Department of Experimental Psychology, Universidad Complutense de Madrid, Madrid, Spain
| | - Nuria Paúl
- Department of Experimental Psychology, Universidad Complutense de Madrid, Madrid, Spain
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Aamodt EB, Schellhorn T, Stage E, Sanjay AB, Logan PE, Svaldi DO, Apostolova LG, Saltvedt I, Beyer MK. Predicting the Emergence of Major Neurocognitive Disorder Within Three Months After a Stroke. Front Aging Neurosci 2021; 13:705889. [PMID: 34489676 PMCID: PMC8418065 DOI: 10.3389/fnagi.2021.705889] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 07/26/2021] [Indexed: 01/20/2023] Open
Abstract
Background: Neurocognitive disorder (NCD) is common after stroke, with major NCD appearing in about 10% of survivors of a first-ever stroke. We aimed to classify clinical- and imaging factors related to rapid development of major NCD 3 months after a stroke, so as to examine the optimal composition of factors for predicting rapid development of the disorder. We hypothesized that the prediction would mainly be driven by neurodegenerative as opposed to vascular brain changes. Methods: Stroke survivors from five Norwegian hospitals were included from the "Norwegian COgnitive Impairment After STroke" (Nor-COAST) study. A support vector machine (SVM) classifier was trained to distinguish between patients who developed major NCD 3 months after the stroke and those who did not. Potential predictor factors were based on previous literature and included both vascular and neurodegenerative factors from clinical and structural magnetic resonance imaging findings. Cortical thickness was obtained via FreeSurfer segmentations, and volumes of white matter hyperintensities (WMH) and stroke lesions were semi-automatically gathered using FSL BIANCA and ITK-SNAP, respectively. The predictive value of the classifier was measured, compared between classifier models and cross-validated. Results: Findings from 227 stroke survivors [age = 71.7 (11.3), males = (56.4%), stroke severity NIHSS = 3.8 (4.8)] were included. The best predictive accuracy (AUC = 0.876) was achieved by an SVM classifier with 19 features. The model with the fewest number of features that achieved statistically comparable accuracy (AUC = 0.850) was the 8-feature model. These features ranked by their weighting were; stroke lesion volume, WMH volume, left occipital and temporal cortical thickness, right cingulate cortical thickness, stroke severity (NIHSS), antiplatelet medication intake, and education. Conclusion: The rapid (<3 months) development of major NCD after stroke is possible to predict with an 87.6% accuracy and seems dependent on both neurodegenerative and vascular factors, as well as aspects of the stroke itself. In contrast to previous literature, we also found that vascular changes are more important than neurodegenerative ones. Although possible to predict with relatively high accuracy, our findings indicate that the development of rapid onset post-stroke NCD may be more complex than earlier suggested.
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Affiliation(s)
- Eva Birgitte Aamodt
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Till Schellhorn
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Edwin Stage
- Department of Neurology, School of Medicine, Indiana University, Indianapolis, IN, United States
| | - Apoorva Bharthur Sanjay
- Department of Neurology, School of Medicine, Indiana University, Indianapolis, IN, United States
| | - Paige E Logan
- Department of Neurology, School of Medicine, Indiana University, Indianapolis, IN, United States
| | - Diana Otero Svaldi
- Department of Neurology, School of Medicine, Indiana University, Indianapolis, IN, United States
| | - Liana G Apostolova
- Department of Neurology, School of Medicine, Indiana University, Indianapolis, IN, United States
| | - 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 Geriatrics, Clinic of Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Mona Kristiansen Beyer
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
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Ferreira Pereira NK, de Medeiros Cirne GN, de Oliveira Galvão FR, Costa ME, Dos Santos Lima Júnior W, Azevedo Cacho EW, N Chagas MH, de Oliveira Cacho R. Reliability of the Theory of Mind Task Battery (ToM TB) to assess social cognition in post-stroke patients. Top Stroke Rehabil 2021; 29:499-506. [PMID: 34334107 DOI: 10.1080/10749357.2021.1948155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Theory of mind is the ability to understand, and infer thoughts or mental states to others. This is a central domain of social cognition that can be impaired after brain injury, resulting in changes in social skills and implications for rehabilitation.The aim of this investigation was to analyze the reliability of the Theory of Mind Task Battery (ToM TB) in post-stroke patients.This is a cross-sectional prospective study with psychometric characteristics, involving 38 patients diagnosed with ischemic or hemorrhagic stroke assessed by three examiners using the ToM TB scale, translated and adapted to Brazilian Portuguese. Satisfactory levels of interexaminer agreement were found for almost all categories of the ToM TB: Kappa ranged from 0.036 to 1.00, total score (ICC) from 0.958 to 0.999 and a Cronbach's alpha of 0.658 was obtained with the complete instrument.The Brazilian version of the ToM TB in post-stroke patients is a reliable instrument that can be used to assess the theory of mind, prognosis and rehabilitation of post-stroke patients.
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Affiliation(s)
- Nayara Karina Ferreira Pereira
- Postgraduate Program in Rehabilitation Sciences, Federal University of Rio Grande Do Norte, Faculty of Health Sciences of Trairí, Santa Cruz, Rio Grande Do Norte, Brazil
| | - Gabriele Natane de Medeiros Cirne
- Postgraduate Program in Rehabilitation Sciences, Federal University of Rio Grande Do Norte, Faculty of Health Sciences of Trairí, Santa Cruz, Rio Grande Do Norte, Brazil
| | - Fábio Ricardo de Oliveira Galvão
- Postgraduate Program in Rehabilitation Sciences, Federal University of Rio Grande Do Norte, Faculty of Health Sciences of Trairí, Santa Cruz, Rio Grande Do Norte, Brazil
| | - Maria Eloiza Costa
- Physiotherapist, Federal University of Rio Grande Do Norte, Faculty of Health Sciences of Trairí, Santa Cruz, Rio Grande Do Norte, Brazil
| | - Wellington Dos Santos Lima Júnior
- Postgraduate Program in Rehabilitation Sciences, Federal University of Rio Grande Do Norte, Faculty of Health Sciences of Trairí, Santa Cruz, Rio Grande Do Norte, Brazil
| | - Enio Walker Azevedo Cacho
- Postgraduate Program in Rehabilitation Sciences, Federal University of Rio Grande Do Norte, Faculty of Health Sciences of Trairí, Santa Cruz, Rio Grande Do Norte, Brazil
| | - Marcos Hortes N Chagas
- Department of Gerontology, Federal University of São Carlos, São Carlos, Brazil.,Bairral Institute of Psychiatry, Itapira, Brazil
| | - Roberta de Oliveira Cacho
- Postgraduate Program in Rehabilitation Sciences, Federal University of Rio Grande Do Norte, Faculty of Health Sciences of Trairí, Santa Cruz, Rio Grande Do Norte, Brazil
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8
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Belova AN, Bogdanov EI, Voznyuk IA, Zhdanov VA, Kamchatnov PR, Kurushina OV, Maslova NN. [Therapy of moderate cognitive impairment in the early recovery period of ischemic stroke]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:33-39. [PMID: 34184475 DOI: 10.17116/jnevro202112105133] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To assess the efficacy and safety of prospecta in the treatment of moderate cognitive impairment in the early recovery period of ischemic stroke. MATERIAL AND METHODS The study included 275 patients (mean age 64.0±8.1 years) with a history of single ischemic stroke from 3 to 6 months, with moderate cognitive impairment, and moderate activity in everyday life, who were randomized in two groups. During the screening phase, the severity of cognitive impairment was assessed with the Mini-Mental State Examination and Montreal Cognitive Assessment scales; the level of activity in everyday life was evaluated with the Barthel Scale; and quality of life was assessed with the Stroke Specific Quality of Life Scale. Patients took 2 tablets of prospecta or placebo 2 times a day for 24 weeks. The follow-up period was 4 weeks. The primary endpoint of the study was the proportion of patients with improvement in cognitive function (+1 or more on the MoCA test) after 24 weeks of treatment. The occurrence and type of adverse events (AEs), their severity, relationship to the drug, outcome, changes in vital signs, and the proportion of patients with clinically significant abnormality in laboratory tests were analyzed to assess the safety. RESULTS A clinically significant improvement in cognitive function was obtained in 91.9% of patients in the prospecta group vs 82.,1% in the placebo group, (p=0.02). There were 57 AEs in 37 (27.4%) Prospecta group patients and 53 AEs in 39 (27.9%) Placebo group participants (p=1.00). No AEs were certainly associated with taking the medication. No clinically significant changes in vital signs or abnormal laboratory results were detected during the study. CONCLUSION Prospecta is an effective and safe treatment option for patients with moderate cognitive impairment in the early recovery period of ischemic stroke.
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Affiliation(s)
- A N Belova
- Privolzhsky Research Medical University, Nizhniy Novgorod, Russia
| | | | - I A Voznyuk
- Dzhanelidze St. Petersburg Research Institute of Emergency Medicine, St. Petersburg, Russia
| | - V A Zhdanov
- Pavlov Ryazan State Medical University, Ryazan, Russia
| | - P R Kamchatnov
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - O V Kurushina
- Volgograd State Medical University, Volgograd, Russia
| | - N N Maslova
- Smolensk State Medical University, Smolensk, Russia
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9
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de Souza MDFD, Cardoso MGDF, Vieira ÉLM, Rocha NP, Vieira THFE, Pessoa AE, Pedroso VSP, Rachid MA, de Souza LC, Teixeira AL, Mourão AM, de Miranda AS. Clinical correlates of social cognition after an ischemic stroke: preliminary findings. Dement Neuropsychol 2021; 15:223-229. [PMID: 34345364 PMCID: PMC8283877 DOI: 10.1590/1980-57642021dn15-020010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 12/29/2020] [Indexed: 11/22/2022] Open
Abstract
The co-occurrence of post-stroke behavioral disorders and cognitive impairment has been extensively investigated. However, studies usually do not include social cognition among the assessed cognitive domains. Objective To investigate the potential association between facial emotion recognition, a measure of social cognition, and behavioral and cognitive symptoms in the subacute phase of ischemic stroke. Methods Patients admitted to a Stroke Unit with ischemic stroke were followed up to 60 days. At this time point, they were evaluated with the following tools: Mini-Mental State Examination (MMSE); Frontal Assessment Battery (FAB); Visual Memory Test of the Brief Cognitive Battery (VMT); Phonemic Verbal Fluency (F-A-S Test); Digit Span; Facial Emotion Recognition Test (FERT) and Hospital Anxiety and Depression Scale (HADS). A control group composed of 21 healthy individuals also underwent the same evaluation. Results Eighteen patients with ischemic stroke were enrolled in this study. They had similar age, sex and schooling years compared to controls. Depression symptoms and episodic memory deficits were significantly more frequent in patients compared to controls. The recognition of sadness expression positively correlated with the levels of anxiety and depression, while and the recognition of fear expression negatively correlated with depression in the stroke group. Conclusions After an ischemic stroke, patients exhibit impairment in social cognition skills, specifically facial emotion recognition, in association with behavioral symptoms.
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Affiliation(s)
- Maria de Fátima Dias de Souza
- Laboratório Interdisciplinar de Investigação Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais - Belo Horizonte, MG, Brazil
| | - Maíra Glória de Freitas Cardoso
- Laboratório Interdisciplinar de Investigação Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais - Belo Horizonte, MG, Brazil
| | - Érica Leandro Marciano Vieira
- Laboratório Interdisciplinar de Investigação Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais - Belo Horizonte, MG, Brazil
| | - Natália Pessoa Rocha
- The Mitchell Center for Alzheimer's Disease and Related Brain Disorders, Department of Neurology, McGovern Medical School, The University of Texas Health Science Center at Houston - Houston, TX, USA
| | - Talita Hélen Ferreira E Vieira
- Departamento de Morfologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais - Belo Horizonte, MG, Brazil.,Departamento de Fisioterapia, Faculdade Sete Lagoas - Sete Lagoas, MG, Brazil
| | | | - Vinicius Sousa Pietra Pedroso
- Laboratório Interdisciplinar de Investigação Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais - Belo Horizonte, MG, Brazil
| | - Milene Alvarenga Rachid
- Departamento de Patologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais - Belo Horizonte, MG, Brazil
| | - Leonardo Cruz de Souza
- Laboratório Interdisciplinar de Investigação Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais - Belo Horizonte, MG, Brazil
| | - Antônio Lúcio Teixeira
- Santa Casa BH Ensino e Pesquisa - Belo Horizonte, MG, Brazil.,Neuropsychiatry Program, Department of Psychiatry & Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston - Houston, TX, USA
| | - Aline Mansueto Mourão
- Departamento de Fonoaudiologia, Faculdade de Medicina, Universidade Federal de Minas Gerais - Belo Horizonte, MG, Brazil
| | - Aline Silva de Miranda
- Laboratório Interdisciplinar de Investigação Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais - Belo Horizonte, MG, Brazil.,Departamento de Morfologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais - Belo Horizonte, MG, Brazil
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10
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Polding LC, Tate WJ, Mlynash M, Marks MP, Heit JJ, Christensen S, Kemp S, Albers GW, Lansberg MG. Quality of Life in Physical, Social, and Cognitive Domains Improves With Endovascular Therapy in the DEFUSE 3 Trial. Stroke 2021; 52:1185-1191. [PMID: 33596675 DOI: 10.1161/strokeaha.120.031490] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The DEFUSE 3 (Endovascular Therapy Following Imaging Evaluation for Ischemic Stroke 3) randomized clinical trial demonstrated the efficacy of endovascular therapy in treating ischemic stroke 6 to 16 hours after onset, resulting in better functional outcomes than standard medical therapy alone. The objective of this secondary analysis is to analyze the effect of late-window endovascular treatment of ischemic stroke on quality of life (QoL) outcomes. METHODS Patients (n=182) who presented between 6 and 16 hours after they were last known to be well with acute anterior circulation ischemic stroke were randomized to endovascular thrombectomy plus standard medical therapy or standard medical therapy alone and followed-up through 90 days poststroke. QoL at day 90 was assessed with the QoL in Neurological Disorders measurement tool. RESULTS Of the 146 subjects alive at day 90, 136 (95%) filled out QoL in Neurological Disorders short forms. Patients treated with endovascular therapy had better QoL scores in each domain: mobility, social participation, cognitive function, and depression (P<0.01 for all). Variables other than endovascular therapy that were independently associated with better QoL included lower baseline National Institutes of Health Stroke Scale, younger age, and male sex. The degree to which the modified Rankin Scale captures differences in QoL between patients varied by domain; the modified Rankin Scale score accounted for a high proportion of the variability in mobility (Rs2=0.82), a moderate proportion in social participation (Rs2=0.62), and a low proportion in cognition (Rs2=0.31) and depression (Rs2=0.19). CONCLUSIONS Patients treated with endovascular therapy 6 to 16 hours after stroke have better QoL than patients treated with medical therapy alone, including better mobility, more social participation, superior cognition, and less depression. The modified Rankin Scale fails to capture patients' outcomes in cognition and depression, which should therefore be assessed with dedicated QoL tools. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02586415.
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Affiliation(s)
| | - William J Tate
- Stanford University School of Medicine, CA (L.C.P., W.J.T.)
| | - Michael Mlynash
- Stanford Stroke Center, Palo Alto, CA (M.M., S.C., S.K., G.W.A., M.G.L.)
| | - Michael P Marks
- Department of Radiology, Stanford University School of Medicine, Palo Alto, CA (M.P.M., J.J.H.)
| | - Jeremy J Heit
- Department of Radiology, Stanford University School of Medicine, Palo Alto, CA (M.P.M., J.J.H.)
| | - Soren Christensen
- Stanford Stroke Center, Palo Alto, CA (M.M., S.C., S.K., G.W.A., M.G.L.)
| | | | - Gregory W Albers
- Stanford Stroke Center, Palo Alto, CA (M.M., S.C., S.K., G.W.A., M.G.L.)
| | - Maarten G Lansberg
- Stanford Stroke Center, Palo Alto, CA (M.M., S.C., S.K., G.W.A., M.G.L.)
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11
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Sørensen SL, Pedersen SKS, Pallesen H. Social psychological mechanisms and processes in a novel, health professional-led, self-management intervention for older stroke individuals: a synthesis and phenomenological study. BMC Health Serv Res 2019; 19:320. [PMID: 31113442 PMCID: PMC6530065 DOI: 10.1186/s12913-019-4150-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 05/08/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A good portion of stroke patients in Western countries are over 65 of age. Because of sequelae, they often lead more isolated lives after the stroke. In terms of social reintegration, this group of patients is especially vulnerable. Reintegration into the community post-stroke greatly depends on support from family. However, the stroke individual's closest relatives are at risk of becoming overburdened. The objectives are to describe the social psychological mechanisms and processes involved in a novel self-management intervention, and to evaluate their feasibility and acceptability from the stroke individuals', the informal caregivers' and the mentors' perspectives, before implementation into a randomised controlled trial. METHODS Qualitative interviews were conducted and analysed using a phenomenological approach. Informants comprised four stroke individuals, three informal caregivers and two mentors. The UK Medical Research Council Framework for developing and evaluating complex interventions was used in the evaluation design of the intervention. RESULTS Six social psychological mechanisms were revealed as the mentors' focus areas in their interaction with stroke individuals and informal caregivers: a) Tailored approach - by individual preferences, b) Dialogue-based communication, c) Development of a good relationship, d) Transfer of activities to everyday and social contexts, e) Involvement of relatives and social networks, and f) Supporting tools - to optimise actions and communication. Furthermore, interaction processes between the stroke individual and the informal caregiver and the mentors occurred, and generated processes of change and learning in the stroke individual and the informal caregiver. The mechanisms and processes described were perceived as feasible and acceptable to the informants - with the exception of the technological supporting tool. CONCLUSION The social psychological mechanisms and processes involved in the intervention indicated a positive association to self-management behaviour from the informants' perspectives. The informants evaluated them to be relevant and meaningful in the novel self-management intervention. TRIAL REGISTRATION ClinicalTrials.gov NCT03183960. Reg. June 15, 2017.
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Affiliation(s)
- Susanne Lillelund Sørensen
- Hammel Neurorehabilitation Centre and University Research Clinic, RM, University of Aarhus, Voldbyvej 15, 8450, Hammel, Aarhus, Denmark.
| | - Sedsel Kristine Stage Pedersen
- Hammel Neurorehabilitation Centre and University Research Clinic, RM, University of Aarhus, Voldbyvej 15, 8450, Hammel, Aarhus, Denmark
| | - Hanne Pallesen
- Hammel Neurorehabilitation Centre and University Research Clinic, RM, University of Aarhus, Voldbyvej 15, 8450, Hammel, Aarhus, Denmark
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12
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Rodrigues JDC, Becker N, Beckenkamp CL, Miná CS, de Salles JF, Bandeira DR. Psychometric properties of cognitive screening for patients with cerebrovascular diseases A systematic review. Dement Neuropsychol 2019; 13:31-43. [PMID: 31073378 PMCID: PMC6497015 DOI: 10.1590/1980-57642018dn13-010004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Screening instruments are ideal for acute clinical settings because they are easy to apply, fast, inexpensive and sensitive for specific samples. However, there is a need to verify the psychometric properties of screening in stroke patients. Objective This study investigated the psychometric properties (methodological procedures) of cognitive screening for patients with cerebrovascular diseases. Methods A systematic review of papers published on PsycINFO, Web of Knowledge, PubMed and Science Direct (2005 to 2016) was performed. Results A total of 55 articles remained after applying exclusion criteria. The samples ranged from 20 to 657 patients. Most articles evaluated elderly individuals with four to 13 years of education who had experienced ischemic or hemorrhagic stroke. There was a tendency to find evidence of validity for criteria and to analyze the sensitivity/specificity of the instruments. Although the studies frequently used the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) to seek evidence of validity and reliability, the use of these instruments among stroke patients has been criticized due to their psychometric properties and the neuropsychological functions evaluated. Conclusion Although there is no gold standard screen for assessing adults post-stroke, instruments devised specifically for this population have shown promise. This review helps both researchers and clinicians to select the most appropriate screen for identifying cognitive impairment in adults post-stroke.
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Affiliation(s)
| | - Natália Becker
- Psicóloga, Mestre e Doutoranda em Psicologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | | | - Camila Schorr Miná
- Psicóloga, Mestranda em Neurociências, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Jerusa Fumagalli de Salles
- Professora Associada do Instituto de Psicologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Denise Ruschel Bandeira
- Professora Titular do Instituto de Psicologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
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13
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Unibaso-Markaida I, Iraurgi I, Ortiz-Marqués N, Amayra I, Martínez-Rodríguez S. Effect of the Wii Sports Resort on the improvement in attention, processing speed and working memory in moderate stroke. J Neuroeng Rehabil 2019; 16:32. [PMID: 30819204 PMCID: PMC6394083 DOI: 10.1186/s12984-019-0500-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 02/17/2019] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Stroke is the most common neurological disease in the world. After the stroke, some people suffer a cognitive disability. Commercial videogames have been used after stroke for physical rehabilitation; however, their use in cognitive rehabilitation has hardly been studied. The objectives of this study were to analyze attention, processing speed, and working memory in patients with moderate stroke after an intervention with Wii Sports Resort and compared these results with a control group. METHODS A pre-post design study was conducted with 30 moderate stroke patients aged 65 ± 15. The study lasted eight weeks. 15 participated in the intervention group and 15 belong to the control group. They were assessed in attention and processing speed (TMT-A and B) and working memory (Digit Span of WAIS-III). Parametric and effect size tests were used to analyze the improvement of those outcomes and compared both groups. RESULTS At the baseline, there was no difference between TMT-A and B. A difference was found in the scalar score of TMT-B, as well as in Digit Backward Span and Total Digit Task. In TMT-A and B, the intervention group had better scores than the control group. The intervention group in the Digit Forward Span and the Total Digit obtained a moderate effect size and the control group also obtained a moderate effect size in Total Digit. In the Digit scalar scores, the control group achieved better results than the intervention group. CONCLUSIONS The results on attention, processing speed and working memory improved in both groups. However, according to the effect sizes, the intervention group achieved better results than the control group. In addition, the attention and processing speed improved more than the working memory after the intervention. Although more studies are needed in this area, the results are encouraging for cognitive rehabilitation after stroke.
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Affiliation(s)
- Iratxe Unibaso-Markaida
- Faculty of Psychology at University of Deusto (Office DARC 1 BIS), 24 Avda. Universidades, 48007 Bilbao, Basque Country Spain
| | - Ioseba Iraurgi
- Faculty of Psychology at University of Deusto (Office DARC 1 BIS), 24 Avda. Universidades, 48007 Bilbao, Basque Country Spain
| | - Nuria Ortiz-Marqués
- Faculty of Psychology at University of Deusto (Office DARC 1 BIS), 24 Avda. Universidades, 48007 Bilbao, Basque Country Spain
| | - Imanol Amayra
- Faculty of Psychology at University of Deusto (Office DARC 1 BIS), 24 Avda. Universidades, 48007 Bilbao, Basque Country Spain
| | - Silvia Martínez-Rodríguez
- Faculty of Psychology at University of Deusto (Office DARC 1 BIS), 24 Avda. Universidades, 48007 Bilbao, Basque Country Spain
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