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Ong LK, Zhao Z, Kluge M, Walker FR, Nilsson M. Chronic stress exposure following photothrombotic stroke is associated with increased levels of Amyloid beta accumulation and altered oligomerisation at sites of thalamic secondary neurodegeneration in mice. J Cereb Blood Flow Metab 2017; 37:1338-1348. [PMID: 27342322 PMCID: PMC5453455 DOI: 10.1177/0271678x16654920] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Exposure to severe stress following stroke is recognised to complicate the recovery process. We have identified that stress can exacerbate the severity of post-stroke secondary neurodegeneration in the thalamus. In this study, we investigated whether exposure to stress could influence the accumulation of the neurotoxic protein Amyloid-β. Using an experimental model of focal cortical ischemia in adult mice combined with exposure to chronic restraint stress, we examined changes within the contra- and ipsilateral thalamus at six weeks post-stroke using Western blotting and immunohistochemical approaches. Western blotting analysis indicated that stroke was associated with a significant enhancement of the 25 and 50 kDa oligomers within the ipsilateral hemisphere and the 20 kDa oligomer within the contralateral hemisphere. Stroked animals exposed to stress exhibited an additional increase in multiple forms of Amyloid-beta oligomers. Immunohistochemistry analysis confirmed that stroke was associated with a significant accumulation of Amyloid-beta within the thalami of both hemispheres, an effect that was exacerbated in stroke animals exposed to stress. Given that Amyloid-beta oligomers, most notably the 30-40 and 50 kDa oligomers, are recognised to correlate with accelerated cognitive decline, our results suggest that monitoring stress levels in patients recovering from stroke may merit consideration in the future.
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Affiliation(s)
- Lin Kooi Ong
- 1 School of Biomedical Sciences and Pharmacy and the Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Callaghan, NSW, Australia.,2 Hunter Medical Research Institute, Newcastle, NSW, Australia.,3 NHMRC Centre of Research Excellence Stroke Rehabilitation and Brain Recovery, Heidelberg, VIC, Australia
| | - Zidan Zhao
- 1 School of Biomedical Sciences and Pharmacy and the Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Callaghan, NSW, Australia.,2 Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Murielle Kluge
- 1 School of Biomedical Sciences and Pharmacy and the Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Callaghan, NSW, Australia.,2 Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Frederick R Walker
- 1 School of Biomedical Sciences and Pharmacy and the Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Callaghan, NSW, Australia.,2 Hunter Medical Research Institute, Newcastle, NSW, Australia.,3 NHMRC Centre of Research Excellence Stroke Rehabilitation and Brain Recovery, Heidelberg, VIC, Australia
| | - Michael Nilsson
- 1 School of Biomedical Sciences and Pharmacy and the Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Callaghan, NSW, Australia.,2 Hunter Medical Research Institute, Newcastle, NSW, Australia.,3 NHMRC Centre of Research Excellence Stroke Rehabilitation and Brain Recovery, Heidelberg, VIC, Australia
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Jones KA, Zouikr I, Patience M, Clarkson AN, Isgaard J, Johnson SJ, Spratt N, Nilsson M, Walker FR. Chronic stress exacerbates neuronal loss associated with secondary neurodegeneration and suppresses microglial-like cells following focal motor cortex ischemia in the mouse. Brain Behav Immun 2015; 48:57-67. [PMID: 25749481 DOI: 10.1016/j.bbi.2015.02.014] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 02/06/2015] [Accepted: 02/16/2015] [Indexed: 12/26/2022] Open
Abstract
Post-stroke patients describe suffering from persistent and unremitting levels of distress. Using an experimental model of focal cortical ischemia in adult male C57BL/6 mice, we examined whether exposure to chronic stress could modify the development of secondary thalamic neurodegeneration (STND), which is commonly reported to be associated with impaired functional recovery. We were particularly focused on the modulatory role of microglia-like cells, as several clinical studies have linked microglial activation to the development of STND. One month following the induction of cortical ischemia we identified that numbers of microglial-like cells, as well as putative markers of microglial structural reorganization (Iba-1), complement processing (CD11b), phagocytosis (CD68), and antigen presentation (MHC-II) were all significantly elevated in response to occlusion. We further identified that these changes co-occurred with a decrease in the numbers of mature neurons within the thalamus. Occluded animals that were also exposed to chronic stress exhibited significantly lower levels of Iba-1 positive cells and a reduced expression of Iba-1 and CD11b compared to the 'occlusion-alone' group. Interestingly, the dampened expression of microglial/monocyte markers observed in stressed animals was associated with significant additional loss of neurons. These findings indicate that the process of STND can be negatively modified, potentially in a microglial dependent manner, by exposure to chronic stress.
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Affiliation(s)
- Kimberley A Jones
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, NSW, Australia; Centre for Translational Neuroscience and Mental Health Research, Australia; Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Ihssane Zouikr
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, NSW, Australia; Centre for Translational Neuroscience and Mental Health Research, Australia; Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Madeleine Patience
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, NSW, Australia; Centre for Translational Neuroscience and Mental Health Research, Australia; Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Andrew N Clarkson
- Department of Anatomy and the Brain Health Research Center, Dunedin 9054, New Zealand; Centre for Translational Physiology, University of Otago Wellington, Dunedin 9054, New Zealand; Department of Psychology, University of Otago, Dunedin 9054, New Zealand
| | - Jörgen Isgaard
- University of Newcastle, Australia; Laboratory of Experimental Endocrinology, Department of Internal Medicine, Sahlgrenska Academy at the University of Gothenburg, SE-413 45 Gothenburg, Sweden
| | - Sarah J Johnson
- School of Electrical Engineering and Computer Science, University of Newcastle, Callaghan, NSW, Australia
| | - Neil Spratt
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, NSW, Australia; Centre for Translational Neuroscience and Mental Health Research, Australia; Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Michael Nilsson
- University of Newcastle, Australia; Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Frederick R Walker
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, NSW, Australia; Centre for Translational Neuroscience and Mental Health Research, Australia; Hunter Medical Research Institute, Newcastle, NSW, Australia.
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Taule T, Strand LI, Skouen JS, Råheim M. Striving for a life worth living: stroke survivors' experiences of home rehabilitation. Scand J Caring Sci 2015; 29:651-61. [PMID: 25648326 DOI: 10.1111/scs.12193] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 10/10/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND For mild-to-moderate stroke survivors, early supported discharge from hospital, followed by home rehabilitation is preferred over conventional care. How this mode of service contributes to recovery from stroke survivors' perspective needs further investigation. AIM The aim of this study was to explore mild-to-moderate stroke survivors' experiences with home rehabilitation after early supported discharge from hospital. METHODS A qualitative interpretive interview design was used in the context of a randomised controlled trial. A purposive sample of eight participants (45-80 years) was followed by an ambulant team, and a specific healthcare team provided home rehabilitation. Data were analysed using interpretive description, systematic text condensation and coping theory. FINDINGS A crucial determinant for the participants' hopes for a life worth living was the mutual confidence expressed in encounters with healthcare professionals and the participants' ability to make sense of their now-altered body. The professional caretakers' communication qualities and their ability to attend to individual needs were important. Help in processing the emotional reactions caused by a changed body and in socialising was requested by participants. Professional caretakers providing home rehabilitation should strive for a more flexible- and individually tailored service and should seek increased cooperation among stakeholders. CONCLUSION The focus on therapeutic communicative qualities, bodily changes, emotional processes, social concerns and long-term follow-up should be increased in order to achieve a more beneficial experience for stroke survivors.
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Affiliation(s)
- Tina Taule
- Department of Occupational Therapy, Haukeland University Hospital (HUH), Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Liv Inger Strand
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Department of Physiotherapy, HUH, Bergen, Norway
| | - Jan Sture Skouen
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Department of Physical Medicine and Rehabilitation, HUH, Bergen, Norway
| | - Målfrid Råheim
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Walker FR, Jones KA, Patience MJ, Zhao Z, Nilsson M. Stress as necessary component of realistic recovery in animal models of experimental stroke. J Cereb Blood Flow Metab 2014; 34:208-14. [PMID: 24326386 PMCID: PMC3915218 DOI: 10.1038/jcbfm.2013.211] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 10/25/2013] [Accepted: 10/31/2013] [Indexed: 11/09/2022]
Abstract
Over the last decade there has been a considerable effort directed toward reformulating the standard approach taken to preclinically model stroke and stroke recovery. The principal objective of this undertaking has been to improve the success with which preclinical findings can be translated. Although several advancements have already been introduced, one potentially critical feature that appears to have been overlooked is psychological stress. Stroke is well recognized to produce high levels of stress in patients, and ongoing exposure to stress is recognized to deleteriously interfere with recovery. The presence of high levels of stress (distress) in stroke patients is also relevant because nearly all clinically deployed neurorestorative interventions occur against this background. Somewhat perplexingly, however, we could find no preclinical stroke studies concerned with investigating the efficacy of putative neurorestorative compounds that did so in the presence of stress. The following article will make the case that failure to recognize or compensate for the effects of ongoing stress in standard preclinical experimental models of recovery is likely to result in overestimation of the effectiveness of pharmacological or behavioral neurorestorative interventions.
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Affiliation(s)
- Frederick R Walker
- 1] School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, New South Wales, Australia [2] Centre for Translational Neuroscience, Mental Health Research, University of Newcastle, Callaghan, New South Wales, Australia [3] Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, New South Wales, Australia
| | - Kimberley A Jones
- 1] School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, New South Wales, Australia [2] Centre for Translational Neuroscience, Mental Health Research, University of Newcastle, Callaghan, New South Wales, Australia [3] Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, New South Wales, Australia
| | - Madeleine J Patience
- 1] School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, New South Wales, Australia [2] Centre for Translational Neuroscience, Mental Health Research, University of Newcastle, Callaghan, New South Wales, Australia [3] Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, New South Wales, Australia
| | - Zidan Zhao
- 1] School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, New South Wales, Australia [2] Centre for Translational Neuroscience, Mental Health Research, University of Newcastle, Callaghan, New South Wales, Australia [3] Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, New South Wales, Australia
| | - Michael Nilsson
- 1] Centre for Translational Neuroscience, Mental Health Research, University of Newcastle, Callaghan, New South Wales, Australia [2] Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, New South Wales, Australia
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Brunborg B, Ytrehus S. Sense of well-being 10 years after stroke. J Clin Nurs 2013; 23:1055-63. [PMID: 24004444 DOI: 10.1111/jocn.12324] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2013] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To describe factors that promote subjective well-being in a long-time perspective of 10 years after stroke. BACKGROUND The research literature describes circumstances that are difficult to deal with after a stroke, but there is relatively little knowledge of factors that contribute to well-being in a longer-time perspective than two years after the incident. This study focuses on such conditions in a 10-year perspective. DESIGN Qualitative study METHODS Qualitative in-depth interviews were carried out with nine stroke survivors. The interviews addressed their description of factors accounting for adaptation and subjective well-being after the stroke. Kvale and Brinkmann's (2008, Interview. Sage Publications, Inc., København) guidelines for qualitative research informed the analysis. RESULTS Six major themes emerged from these analyses: (1) personal characteristics as the cause of positive adaptation to the new situation, (2) new meaningful activities, (3) new health habits, (4) social networks and family, (5) economical resources and (6) public help. Only a few of the survivors had received any home-based nursing care or health assistance, but they were nevertheless mainly satisfied with their rehabilitation outcome. Self-care, health literacy, stamina, a positive way of thinking and attention from family and friends seemed to be of immense importance for adaptation and well-being. CONCLUSION Personal characteristics and synergy with significant others seem to be the most important factors for having a good and long life after a stroke. RELEVANCE TO CLINICAL PRACTICE The results of this study will contribute to rehabilitation planning and to understanding, assisting and supporting stroke survivors in restoring a good life despite disabilities after the stroke.
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Affiliation(s)
- Birgit Brunborg
- Institute of Nursing and Health, Diakonhjemmet University College, Oslo, Norway
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